The effect of joint contraceptive decisions on the use of Injectables, Long-Acting and Permanent Methods (ILAPMs) among married female (15–49) contraceptive users in Zambia: a cross-sectional study

PubMed Central

2014-01-01

Background Zambia’s fertility rate and unmet need for family planning are still high. This is in spite of the progress reported from 1992 to 2007 of the increase in contraceptive prevalence rate from 15% to 41% and use of modern methods of family planning from 9% to 33%. However, partner disapproval of family planning has been cited by many women in many countries including Zambia. Given the effectiveness of long-acting and permanent methods of family planning (ILAPMs) in fertility regulation, this paper sought to examine the relationship between contraceptive decision-making and use of ILAPMs among married women in Zambia. Methods This paper uses data from the 2007 Zambia Demographic and Health Survey. The analysis is based on married women (15–49) who reported using a method of family planning at the time of the survey. Out of the 7,146 women interviewed, only 1,630 women were valid for this analysis. Cross-tabulations and binary logistic regressions with Chi-square were used to analyse associations and the predictors of use of ILAPMs of contraception, respectively. A confidence interval of .95 was used in determining relationships between independent and dependent variables. Results Two thirds of women made joint decisions regarding contraception and 29% of the women were using ILAPMs. Women who made joint contraceptive decisions are significantly more likely to use ILAPMs than women who did not involve their husband in contraceptive decisions. However, the most significant predictor is the wealth index. Women from rich households are more likely to use ILAPMs than women from medium rich and poor households. Results also show that women of North Western ethnicities and those from Region 3 had higher odds of using ILAPMs than Tonga women and women from Region 2, respectively. Conclusion Joint contraceptive decision-making between spouses is key to use of ILAPMs in Zambia. Our findings have also shown that the wealth index is actually the strongest factor

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

Current status of contraceptive use among rural married women in Anhui Province of China.

PubMed

Zhang, X-J; Wang, G-Y; Shen, Q; Yu, Y-L; Sun, Y-H; Yu, G-B; Zhao, D; Ye, D-Q

2009-11-01

This study aims to explore the current status of married women in regard of their use of contraceptive methods (permanent methods versus non-permanent methods) and to find out factors that affect the use of contraceptive methods in rural areas of Anhui Province of China. Survey. Anhui, China. A total of 53,652 married women aged 18-49 years. A multistage probability sampling method was used to identify a representative sample of 53,652 married women aged 18-49 years. All women were asked to provide detailed information by completing detailed questionnaires. Contraceptive prevalence and influence factors. The total birth control rate of the sample was 95.2%. Samples choosing the permanent and nonpermanent contraceptive methods have taken up 46.7 and 48.5% respectively. Female sterilisation was the first choice with a usage rate of 43.6%, followed by intrauterine device (IUD), which was used by 41.1% of samples. Single-variable analysis showed that the choice of contraceptive methods was associated with age, education level, parity, frequency of sex intercourses in a month, contraceptive knowledge, RTI symptom and the gender of the last child of rural married women. A significant increase in contraceptive use of rural married women in Anhui Province of China. Female sterilisation and IUD still play the dominant role. Effective family planning methods should be advocated through adequate counselling on the correct use and proper management, with consideration of the background of custom and belief.

Two low-dose levonorgestrel intrauterine contraceptive systems: a randomized controlled trial.

PubMed

Nelson, Anita; Apter, Dan; Hauck, Brian; Schmelter, Thomas; Rybowski, Sarah; Rosen, Kimberly; Gemzell-Danielsson, Kristina

2013-12-01

To evaluate the efficacy and safety of two low-dose levonorgestrel intrauterine contraceptive systems. Nulliparous and parous women aged 18-35 years with regular menstrual cycles (21-35 days) requesting contraception were randomized to 3 years of treatment with one of two levonorgestrel intrauterine contraceptive systems: 13.5 mg total content or 19.5 mg total content. The primary outcome was the pregnancy rate, calculated as the Pearl Index. Overall, 1,432 and 1,452 women in the 13.5 mg intrauterine contraceptive system and 19.5 mg intrauterine contraceptive system groups, respectively, had a placement attempted and were included in the full analysis set to evaluate efficacy and safety. Mean (standard deviation) age was 27.1 (4.8) years; 39.2% were nulliparous. Over the 3-year study period, 0.33 pregnancies per 100 women-years (95% confidence interval [CI] 0.16-0.60) were observed with the 13.5 mg intrauterine contraceptive system compared with 0.31 per 100 women-years (95% CI 0.15-0.57) with the 19.5 mg intrauterine contraceptive system. Kaplan-Meier estimates for that period were 0.009 and 0.010, respectively. At least partial expulsions occurred in 4.56% and 3.58% and discontinuation rates resulting from a reported adverse event occurred in 21.9% and 19.1%, respectively. Ten of the 20 pregnancies were ectopic. Serious adverse events included six cases of pelvic inflammatory disease and one partial uterine perforation. Both lower-dose levonorgestrel intrauterine contraceptive systems were highly effective for 3 years of use and generally well tolerated. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00528112. : I.

Private providers' knowledge, attitudes and misconceptions related to long-acting and permanent contraceptive methods: a case study in Bangladesh.

PubMed

Ugaz, Jorge; Banke, Kathryn; Rahaim, Stephen; Chowdhury, Wahiduzzaman; Williams, Julie

2016-11-01

In Bangladesh, use of long-acting and permanent methods of contraception (LAPMs) remains stagnant. Providers' limited knowledge and biases may be a factor. We assessed private providers' knowledge, misconceptions and general attitudes towards LAPM in two urban areas. The ultimate goal is to shape programs and interventions to overcome these obstacles and improve full method choice in Bangladesh. Trained data collectors interviewed a convenience sample of 235 female doctors (obstetricians-gynecologists and general practitioners) and 150 female nurses from 194 commercial (for-profit) health care facilities in Chittagong City Corporation and Dhaka district. Data were collected on the nature of the practice, training received, knowledge about modern contraceptives and attitudes towards LAPM [including intrauterine device (IUDs), implants, female and male sterilization]. All providers, and especially doctors, lacked adequate knowledge regarding side effects for all LAPMs, particularly female and male sterilization. Providers had misconceptions about the effectiveness and convenience of LAPMs compared to short-acting contraceptive methods. Implants and IUDs were generally perceived more negatively than other methods. The majority of providers believed that husbands favor short-acting methods rather than LAPMs and that women should not use a method that their husbands do not approve of. Our findings document knowledge and attitudinal barriers among private for-profit providers in urban areas affecting their provision of accurate information about LAPM choices. Practitioners should be offered the necessary tools to provide women full access to all modern methods, especially LAPMs, in order to contribute to decreasing unmet need and improving full method choice in Bangladesh. Copyright © 2016 Elsevier Inc. All rights reserved.

Unmet demand for highly effective postpartum contraception in Texas.

PubMed

Potter, Joseph E; Hopkins, Kristine; Aiken, Abigail R A; Hubert, Celia; Stevenson, Amanda J; White, Kari; Grossman, Daniel

2014-11-01

We aimed to assess women's contraceptive preferences and use in the first 6 months after delivery. The postpartum period represents a key opportunity for women to learn about and obtain effective contraception, especially since 50% of unintended pregnancies to parous women occur within 2 years of a previous birth. We conducted a prospective cohort study of 800 postpartum women recruited from three hospitals in Austin and El Paso, TX. Women aged 18-44 who wanted to delay childbearing for at least 24 months were eligible for the study and completed interviews following delivery and at 3 and 6 months postpartum. Participants were asked about the contraceptive method they were currently using and the method they would prefer to use at 6 months after delivery. At 6 months postpartum, 13% of women were using an intrauterine device or implant, and 17% were sterilized or had a partner who had had a vasectomy. Twenty-four percent were using hormonal methods, and 45% relied on less effective methods, mainly condoms and withdrawal. Yet 44% reported that they would prefer to be using sterilization, and 34% would prefer to be using long-acting reversible contraception (LARC). This study shows a considerable preference for LARC and permanent methods at 6 months postpartum. However, there is a marked discordance between women's method preference and actual use, indicating substantial unmet demand for highly effective methods of contraception. In two Texas cities, many more women preferred long-acting and permanent contraceptive methods (LAPM) than were able to access these methods at 6 months postpartum. Women's contraceptive needs could be better met by counseling about all methods, by reducing cost barriers and by making LAPM available at more sites. Copyright © 2014 Elsevier Inc. All rights reserved.

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.

Cost-effectiveness analysis of a low-dose contraceptive levonorgestrel intrauterine system in Sweden.

PubMed

Henry, Nathaniel; Hawes, Charlie; Lowin, Julia; Lekander, Ingrid; Filonenko, Anna; Kallner, Helena K

2015-08-01

To evaluate the cost-effectiveness of a novel intrauterine system, levonorgestrel intrauterine system 13.5 mg vs. oral contraception, in women at risk of unintended pregnancy. Cost-effectiveness model using efficacy and discontinuation data from published articles. Societal perspective including direct and indirect costs. Women at risk of unintended pregnancy using reversible contraception. An economic analysis was conducted by modeling the different health states of women using contraception over a 3-year period. Typical use efficacy rates from published articles were used to determine unintended pregnancy events. Discontinuation rates were used to account for method switching. Cost-effectiveness was evaluated in terms of the incremental cost per unintended pregnancy avoided. In addition, the incremental cost per quality-adjusted life-year was calculated. Levonorgestrel intrauterine system 13.5 mg generated costs savings of € 311,000 in a cohort of 1000 women aged 15-44 years. In addition, there were fewer unintended pregnancies (55 vs. 294) compared with women using oral contraception. Levonorgestrel intrauterine system 13.5 mg is a cost-effective method when compared with oral contraception. A shift in contraceptive use from oral contraception to long-acting reversible contraception methods could result in fewer unintended pregnancies, quality-adjusted life-year gains, as well as cost savings. © 2015 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).

Demand for long acting and permanent contraceptive methods and associated factors among married women of reproductive age group in Debre Markos Town, North West Ethiopia.

PubMed

Bulto, Gizachew Abdissa; Zewdie, Tatek Abate; Beyen, Teresa Kisi

2014-03-13

Ethiopia is the second most populous country in sub Saharan Africa with high total fertility rate, and high maternal and child mortality rates. In sub Saharan African countries, including Ethiopia, even though studies show that demand for contraception is high, the practice is low. Particularly, in Ethiopia, despite the fact that practices on long acting and permanent methods are believed to be low, there are limited evidences on the real magnitude of demand for the methods. To assess demand for long acting and permanent contraceptive methods and associated factors among married women of reproductive age group in Debre Markos town, Amhara Regional State, North West Ethiopia, A community based cross sectional study was conducted, from April 08-19, 2012. Systematic sampling technique was used to select 523 study participants. Pre tested structured Amharic version questionnaire was used to collect the data through interview. Both bivariate and multiple logistic regressions were used to identify associated factors. Among 519 respondents, 323 (62.2%) were using modern family planning (FP) methods in which 101 (19.5%) were using long acting and permanent contraceptive methods (LAPMs). Among all respondents, 171 (32.9%) had unmet need for LAPMs. The total demand for LAPMs was 272 (52.4%) of which 37.1% were satisfied and 62.9% unsatisfied demand. Being in the older age group (40-44 years) [AOR = 2.8; 95% CI:1.12, 9.55], having no desire for more child [AOR = 20.37; 95% CI:9.28, 44.72], desire to have a child after 2 years [AOR = 6.4; 95%CI:3.04,13.47], not ever heard of modern FP [AOR = 5.73; 95% CI:1.26, 25.91], not ever using of modern FP [AOR = 1.89; 95% CI:1.01, 3.55] and having no spousal discussion in the last six month [AOR = 1.642, 95% CI: 1.049, 2.57) were some of the factors significantly associated with demand for LAPMs. Demand and unmet need for LAPMs were high in the study area. Therefore raising awareness of the community

Poor Knowledge and Nonuse of Long-Acting/Permanent Methods of Contraceptives in Six Districts in Indonesia.

PubMed

Titaley, Christiana R; Ariawan, Iwan; Damayanti, Rita; Ismail, Amry; Saputri, A Y; Yelda, Fitra; Soeharno, Nugroho; Subarkah; Harlan, Sarah; Wahyuningrum, Yunita; Storey, Douglas

2017-11-01

This analysis aimed at examining the association between the level of knowledge about long-acting/permanent methods of contraceptives (LAPM) and nonuse of LAPM among currently married, nonpregnant, and fecund women aged 15 to 49 years intending to limit childbearing. Data were derived from a cross-sectional study in Tuban, Kediri, and Lumajang District (East Java Province) and Lombok Barat, Lombok Timur, and Sumbawa District (Nusa Tenggara Barat Province) in June 2012. Information was obtained from 4323 respondents. Using multivariate logistic regression, we found that women with moderate levels of LAPM knowledge were less likely to use LAPM than women with high levels of knowledge (adjusted odds ratio [aOR] = 2.01, 95% CI = 1.51-2.68). Women with low level of LAPM knowledge were less likely to use LAPM than women with high levels of knowledge (aOR = 4.25, 95% CI = 3.37-5.36). Efforts to strengthen counseling services and increased provider knowledge and counselling skills are important to improve women's knowledge about and use of LAPM.

Efficacy and safety of a transdermal contraceptive system.

PubMed

Smallwood, G H; Meador, M L; Lenihan, J P; Shangold, G A; Fisher, A C; Creasy, G W

2001-11-01

To evaluate the efficacy, cycle control, compliance, and safety of a transdermal contraceptive system that delivers norelgestromin 150 microg and ethinyl estradiol 20 microg daily. In this open-label, 73-center study, 1672 healthy, ovulatory, sexually active women received ORTHO EVRA/EVRA for six (n = 1171) or 13 cycles (n = 501). The treatment regimen for each cycle was three consecutive 7-day patches (21 days) followed by 1 patch-free week. The overall and method-failure probabilities of pregnancy through 13 cycles were 0.7% and 0.4%, respectively. The incidence of breakthrough bleeding was low throughout the study. Perfect compliance (21 consecutive days of dosing, followed by a 7-day drug-free interval; no patch could be worn for more than 7 days) was achieved in 90% of subject cycles; only 1.9% of patches detached completely. Adverse events were typical of hormonal contraception, and most were mild-to-moderate in severity and not treatment limiting. The most common adverse events resulting in discontinuation were application site reactions (1.9%), nausea (1.8%), emotional lability (1.5%), headache (1.1%), and breast discomfort (1.0%). The transdermal contraceptive patch provides effective contraception and cycle control, and is well tolerated. The weekly change schedule for the contraceptive patch is associated with excellent compliance and wearability characteristics.

Son Preference and Family Limitation in Pakistan: A Parity- and Contraceptive Method-Specific Analysis.

PubMed

Channon, Melanie Dawn

2017-09-01

Son preference exerts a strong influence over contraceptive and fertility decisions in many South Asian countries. In Pakistan, where fertility remains high and contraceptive use low, research on son preference has been limited. Data from Pakistan Demographic and Health Surveys conducted in 1990-1991, 2006-2007 and 2012-2013 were used to examine potential indicators and outcomes of son preference. Descriptive analyses looked at sex composition preferences of men and women, as well as the sex ratio at last birth. Multivariate logistic regression analyses examined parity progression by birth order, while multinomial logistic regression was used to identify associations between sex composition and use of permanent, temporary and traditional contraceptive methods. Parity progression and choice of contraceptive method are increasingly associated with the sex composition of children. Many respondents wanted at least two sons, though most also wanted at least one daughter. Analyses suggest that the prevalence of modern contraceptive use among parous women would have been 19% higher in 2012-2013 in the absence of son preference. Permanent method use was extremely low among women with no sons and increased significantly with number of sons. The association between number of sons and use of temporary methods was weaker, while son preference had little relationship with traditional method use. The association of son preference with parity progression and modern contraceptive use has become stronger in Pakistan. Continuation of the fertility transition may be difficult unless the degrees of differential stopping behavior and differential contraceptive use decline.

Permanency and the Foster Care System.

PubMed

Lockwood, Katie K; Friedman, Susan; Christian, Cindy W

2015-10-01

Each year over 20,000 youth age out of the child welfare system without reaching a permanent placement in a family. Certain children, such as those spending extended time in foster care, with a diagnosed disability, or adolescents, are at the highest risk for aging out. As young adults, this population is at and increased risk of incarceration; food, housing, and income insecurity; unemployment; educational deficits; receipt of public assistance; and mental health disorders. We reviewed the literature on foster care legislation, permanency, outcomes, and interventions. The outcomes of children who age out of the child welfare system are poor. Interventions to increase permanency include training programs for youth and foster parents, age extension for foster care and insurance coverage, an adoption tax credit, and specialized services and programs that support youth preparing for their transition to adulthood. Future ideas include expanding mentoring, educational support, mental health services, and post-permanency services to foster stability in foster care placements and encourage permanency planning. Children in the child welfare system are at a high risk for physical, mental, and emotional health problems that can lead to placement instability and create barriers to achieving permanency. Failure to reach the permanency of a family leads to poor outcomes, which have negative effects on the individual and society. Supporting youth in foster care throughout transitions may mediate the negative outcomes that have historically followed placement in out-of-home care. Copyright © 2015 Mosby, Inc. All rights reserved.

Contraceptive use at last intercourse among reproductive-aged women with disabilities: an analysis of population-based data from seven states.

PubMed

Haynes, Renee Monique; Boulet, Sheree L; Fox, Michael H; Carroll, Dianna D; Courtney-Long, Elizabeth; Warner, Lee

2018-06-01

To assess patterns of contraceptive use at last intercourse among women with physical or cognitive disabilities compared to women without disabilities. We analyzed responses to 12 reproductive health questions added by seven states to their 2013 Behavioral Risk Factor Surveillance System questionnaire. Using responses from female respondents 18-50 years of age, we performed multinomial regression to calculate estimates of contraceptive use among women at risk for unintended pregnancy by disability status and type, adjusted for age, race/ethnicity, marital status, education, health insurance status, and parity. Women with disabilities had similar rates of sexual activity as women without disabilities (90.0% vs. 90.6%, p=.76). Of 5995 reproductive-aged women at risk for unintended pregnancy, 1025 (17.1%) reported one or more disabilities. Contraceptive use at last intercourse was reported by 744 (70.1%) of women with disabilities compared with 3805 (74.3%) of those without disabilities (p=.22). Among women using contraception, women with disabilities used male or female permanent contraception more often than women without disabilities (333 [29.6%] versus 1337 [23.1%], p<.05). Moderately effective contraceptive (injection, oral contraceptive, patch, or ring) use occurred less frequently among women with cognitive (13.1%, n=89) or independent living (13.9%, n=40) disabilities compared to women without disabilities (22.2%, n=946, p<.05). The overall prevalence of sexual activity and contraceptive use was similar for women with and without physical or cognitive disabilities. Method use at last intercourse varied based on presence and type of disability, especially for use of permanent contraception. Although women with disabilities were sexually active and used contraception at similar rates as women without disabilities, contraception use varied by disability type, suggesting the importance of this factor in reproductive health decision-making among patients and

Is Household Wealth Associated With Use of Long-Acting Reversible and Permanent Methods of Contraception? A Multi-Country Analysis

PubMed Central

Ugaz, Jorge I; Chatterji, Minki; Gribble, James N; Banke, Kathryn

2016-01-01

Abstract As programs continue to expand access to family planning information, services, and products, it is critical that these efforts be undertaken with an equity lens, ensuring that regardless of socioeconomic status, all women and couples can use the method that meets their needs. This study explores the relationship between household wealth and the use of long-acting and permanent methods (LAPMs) versus short-acting methods of contraception among modern method users, using multivariate analyses based on Demographic Health Survey data from 30 developing countries conducted between 2006 and 2013. Overall, and controlling for relevant individual and household characteristics including age, number of living children, education, and urban/rural residence, we found that wealthier women were more likely than poorer women to use LAPMs instead of short-acting methods: 20 of the 30 countries showed a positive and statistically significant association between wealth and LAPM use. For 10 of those countries, however, LAPM use was significantly higher only for the top (1 or 2) wealthiest quintiles. Eight countries showed no broad pattern of association, while in 2 countries—Bangladesh and India—poorer women were more likely to use LAPMs than wealthier women. The positive association between wealth and LAPM use was found most consistently in the Latin American and the Caribbean countries in our sample. These findings can help program implementers respond better to women’s needs for modern contraception, especially in reaching women from lower- and middle-income households. PMID:27016543

Is Household Wealth Associated With Use of Long-Acting Reversible and Permanent Methods of Contraception? A Multi-Country Analysis.

PubMed

Ugaz, Jorge I; Chatterji, Minki; Gribble, James N; Banke, Kathryn

2016-03-01

As programs continue to expand access to family planning information, services, and products, it is critical that these efforts be undertaken with an equity lens, ensuring that regardless of socioeconomic status, all women and couples can use the method that meets their needs. This study explores the relationship between household wealth and the use of long-acting and permanent methods (LAPMs) versus short-acting methods of contraception among modern method users, using multivariate analyses based on Demographic Health Survey data from 30 developing countries conducted between 2006 and 2013. Overall, and controlling for relevant individual and household characteristics including age, number of living children, education, and urban/rural residence, we found that wealthier women were more likely than poorer women to use LAPMs instead of short-acting methods: 20 of the 30 countries showed a positive and statistically significant association between wealth and LAPM use. For 10 of those countries, however, LAPM use was significantly higher only for the top (1 or 2) wealthiest quintiles. Eight countries showed no broad pattern of association, while in 2 countries-Bangladesh and India-poorer women were more likely to use LAPMs than wealthier women. The positive association between wealth and LAPM use was found most consistently in the Latin American and the Caribbean countries in our sample. These findings can help program implementers respond better to women's needs for modern contraception, especially in reaching women from lower- and middle-income households. © Ugaz et al.

Contraceptive counseling and postpartum contraceptive use.

PubMed

Zapata, Lauren B; Murtaza, Sarah; Whiteman, Maura K; Jamieson, Denise J; Robbins, Cheryl L; Marchbanks, Polly A; D'Angelo, Denise V; Curtis, Kathryn M

2015-02-01

The objective of the study was to examine the associations between prenatal and postpartum contraceptive counseling and postpartum contraceptive use. The Pregnancy Risk Assessment Monitoring System 2004-2008 data were analyzed from Missouri, New York state, and New York City (n = 9536). We used multivariable logistic regression to assess the associations between prenatal and postpartum contraceptive counseling and postpartum contraceptive use, defined as any method and more effective methods (sterilization, intrauterine device, or hormonal methods). The majority of women received prenatal (78%) and postpartum (86%) contraceptive counseling; 72% received both. Compared with those who received no counseling, those counseled during 1 time period (adjusted odds ratio [AOR], 2.10; 95% confidence interval [CI], 1.65-2.67) and both time periods (AOR, 2.33; 95% CI, 1.87-2.89) had significantly increased odds of postpartum use of a more effective contraceptive method (32% vs 49% and 56%, respectively; P for trend < .0001). Results for counseling during both time periods differed by type of health insurance before pregnancy, with greater odds of postpartum use of a more effective method observed for women with no insurance (AOR, 3.51; 95% CI, 2.18-5.66) and Medicaid insurance (AOR, 3.74; 95% CI, 1.98-7.06) than for those with private insurance (AOR, 1.87; 95% CI, 1.44-2.43) before pregnancy. Findings were similar for postpartum use of any contraceptive method, except that no differences by insurance status were detected. The prevalence of postpartum contraceptive use, including the use of more effective methods, was highest when contraceptive counseling was provided during both prenatal and postpartum time periods. Women with Medicaid or no health insurance before pregnancy benefited the most. Published by Elsevier Inc.

Expanding contraceptive options for PMTCT clients: a mixed methods implementation study in Cape Town, South Africa

PubMed Central

2014-01-01

Background Clients of prevention of mother-to-child transmission (PMTCT) services in South Africa who use contraception following childbirth rely primarily on short-acting methods like condoms, pills, and injectables, even when they desire no future pregnancies. Evidence is needed on strategies for expanding contraceptive options for postpartum PMTCT clients to include long-acting and permanent methods. Methods We examined the process of expanding contraceptive options in five health centers in Cape Town providing services to HIV-positive women. Maternal/child health service providers received training and coaching to strengthen contraceptive counseling for postpartum women, including PMTCT clients. Training and supplies were introduced to strengthen intrauterine device (IUD) services, and referral mechanisms for female sterilization were reinforced. We conducted interviews with separate samples of postpartum PMTCT clients (265 pre-intervention and 266 post-intervention) to assess knowledge and behaviors regarding postpartum contraception. The process of implementing the intervention was evaluated through systematic documentation and interpretation using an intervention tracking tool. In-depth interviews with providers who participated in study-sponsored training were conducted to assess their attitudes toward and experiences with promoting voluntary contraceptive services to HIV-positive clients. Results Following the intervention, 6% of interviewed PMTCT clients had the desired knowledge about the IUD and 23% had the desired knowledge about female sterilization. At both pre- and post-intervention, 7% of clients were sterilized and IUD use was negligible; by comparison, 75% of clients used injectables. Intervention tracking and in-depth interviews with providers revealed intervention shortcomings and health system constraints explaining the failure to produce intended effects. Conclusions The intervention failed to improve PMTCT clients’ knowledge about the IUD

Access to Contraception in the Context of Zika: Health System Challenges and Responses

PubMed Central

Darney, Blair G.; Aiken, Abigail R.A.; Küng, Stephanie

2017-01-01

Women in areas of the Americas with endemic Aedes mosquito populations are at risk for exposure to Zika virus, which can cause fetal brain abnormalities and associated congenital microcephaly. Individual health care providers may encounter health systems barriers to providing evidence-based care. We focus on Mexico and the U.S. state of Texas to highlight the role of health system factors in contraceptive access in the context of Zika, and highlight efforts in Puerto Rico as an example of efforts to improve access to contraception. In Mexico, states with the highest unmet need for contraception are low-lying, coastal states. The government recently announced an investment to combat Zika, but made no mention of family planning initiatives to assist women in preventing pregnancy. In Texas, the Department of State Health Services (DSHS) has issued recommendations to help women and men avoid mosquito-bites; the issue of whether women should plan or avoid pregnancy is not addressed. Puerto Rico has the largest number of confirmed cases of Zika virus in the US states and territories. Recently, the CDC Foundation launched the Zika Contraception Access Network (Z-CAN), which provides contraceptives at no cost to participating clinics in Puerto Rico. The Zika virus highlights weaknesses in health systems that make it difficult for women to use contraception if they want to delay births. Women across the globe, with or without Zika, need access to contraception to prevent unintended pregnancy, and providers require functioning health systems that offer the support to ensure access is a reality. PMID:28277362

Patterns of contraceptive use among Mexican-origin women.

PubMed

White, Kari L; Potter, Joseph E

Mexican women in the United States (US) have higher rates of fertility compared to other ethnic groups and women in Mexico. Whether variation in women's access to family planning services or patterns of contraceptive use contributes to this higher fertility has received little attention. We explore Mexican women's contraceptive use, taking into account women's place in the reproductive life course. Using nationally representative samples from the US (National Survey of Family Growth) and Mexico (Encuesta National de la Dinámica Demográfica), we compared the parity-specific frequency of contraceptive use and fertility intentions for non-migrant women, foreign-born Mexicans in the US, US-born Mexicans, and whites. Mexican women in the US were less likely to use IUDs and more likely to use hormonal contraception than women in Mexico. Female sterilization was the most common method among higher parity women in both the US and Mexico, however, foreign-born Mexicans were less likely to be sterilized, and the least likely to use any permanent contraceptive method. Although foreign-born Mexicans were slightly less likely to report that they did not want more children, differences in method use remained after controlling for women's fertility intentions. At all parities, foreign-born Mexicans used less effective methods. These findings suggest that varying access to family planning services may contribute to variation in women's contraceptive use. Future studies are needed to clarify the extent to which disparities in fertility result from differences in contraceptive access.

Current and future role of voluntary surgical contraception in increasing access to and utilization of family planning services in Africa.

PubMed

Gaym, Asheber

2012-10-01

Voluntary surgical contraception is the most widely utilized method of contraception in the world. High effectiveness, low complication rates and reduced cost in the long term make them the ideal contraceptive choice to diverse group of clients including clients from low resource settings. To assess the current status of utilization and effectiveness of voluntary surgical contraception in Africa and suggest possible future roles in contraceptive method choice. A review of available literature on voluntary surgical contraception and synthesis of information under relevant headings. Despite very high total fertility rates in most countries of Africa, surgical contraceptives still contribute to a very small proportion ofcontraceptive method choice in the continent. Client profile and acceptability studies indicate a large unmet need for permanent contraception in the continent. Lack of information, misconceptions and weak health systems (particularly surgical care) are the major impediments to increasing availability of surgical contraception. Lack of knowledge and low levels of motivation among health care providers may also be significant barriers to access. Ihcreasing availability of information on the safety and effectiveness of these methods to both health care providers and the general population can increase demand and acceptability. Delegating service provision to appropriately trained non-physician providers at primary care settings can assist in increasing accessibility of these important family planning methods.

Contraceptive use by female physicians in the United States.

PubMed

Frank, E

1999-11-01

Little is known about female physicians' personal contraceptive use, and such usage could influence their prescribing patterns. We used data from the Women Physicians' Health Study, a large (n = 4501) national study, administered in 1993-1994, on characteristics of female physicians in the United States. These female physicians (ages 30-44 years) were more likely to use contraception than women in the general population (ages 15-44 years); this was true even when the physicians were compared with only other women of high socioeconomic status and when stratified by ethnicity, age, and number of children. Physicians were also more likely to use intrauterine devices, diaphragms, or condoms, and less likely to use female or male sterilization than were other women. Younger female physicians were especially unlikely to use permanent methods, particularly when compared with their age-matched counterparts in the general population. One fifth of contracepting physicians used more than one type of contraceptive; the most frequently used combination was spermicide with a barrier method. Female physicians contracept differently than do women in the general population, in ways consistent with delaying and reducing total fertility. Physicians' personal characteristics have been shown to influence their patient counseling practices, including their contraception-related attitudes and practices. Although female physicians' clinical advice might differ from their personal practices, as women physicians become more prevalent, their contraceptive choices could influence those of their patients.

Contraceptive Equity

PubMed Central

Temkin, Elizabeth

2007-01-01

The Equity in Prescription Insurance and Contraceptive Coverage Act, introduced in Congress in 1997 and still unpassed, seeks to redress health insurers’ failure to pay for birth control as they pay for other prescription drugs, most paradoxically Viagra. In 1936 the International Workers Order (IWO), a fraternal society, became the first insurer to include contraception in its benefits package. A forerunner in the movement for prepaid medical care, the IWO offered its members primary care and contraceptive services for annual flat fees. Founded at a time when the legal status of contraception was in flux, the IWO’s Birth Control Center was the only such clinic to operate on an insurance system. Recent state laws and judicial actions have revived the IWO’s groundbreaking view of contraception as a basic preventive service deserving of insurance coverage. PMID:17761562

Topology optimized permanent magnet systems

NASA Astrophysics Data System (ADS)

Bjørk, R.; Bahl, C. R. H.; Insinga, A. R.

2017-09-01

Topology optimization of permanent magnet systems consisting of permanent magnets, high permeability iron and air is presented. An implementation of topology optimization for magnetostatics is discussed and three examples are considered. The Halbach cylinder is topology optimized with iron and an increase of 15% in magnetic efficiency is shown. A topology optimized structure to concentrate a homogeneous field is shown to increase the magnitude of the field by 111%. Finally, a permanent magnet with alternating high and low field regions is topology optimized and a Λcool figure of merit of 0.472 is reached, which is an increase of 100% compared to a previous optimized design.

Contraceptive social marketing and community-based distribution systems in Colombia.

PubMed

Vernon, R; Ojeda, G; Townsend, M C

1988-01-01

Three operations research experiments were carried out in three provinces of Colombia to improve the cost-effectiveness of Profamilia's nonclinic-based programs. The experiments tested: (a) whether a contraceptive social marketing (CSM) strategy can replace a community-based distribution (CBD) program in a high contraceptive use area; (b) if wage incentives for salaried CBD instructors will increase contraceptive sales; and (c) whether a specially equipped information, education, and communication (IEC) team can replace a cadre of rural promoters to expand family planning coverage. All three strategies proved to be effective, but only the CSM system yielded a profit. Despite this, Profamilia discontinued its CSM program soon after the experiment was completed. Unexpected government controls regulating the price and sale of contraceptives in Colombia made the program unprofitable. As a result, family planning agencies are cautioned against replacing CBD programs with CSM. Instead, CBD programs might adopt a more commercial approach to become more efficient.

Initiation and continuation of long-acting reversible contraception in the United States military healthcare system.

PubMed

Chiles, Daniel P; Roberts, Timothy A; Klein, David A

2016-09-01

Long-acting reversible contraception is more effective for pregnancy prevention than shorter-acting contraceptive methods and has the potential to reduce healthcare disparities and costs. However, long-acting reversible contraception is underused in the United States. One population of interest is beneficiaries of the United States military healthcare system who have access to universal healthcare, including no-cost, no-copay contraception with unlimited method switching, and comprise a large, actual use cohort. Efforts to increase long-acting reversible contraception initiation and continuation in this population may improve health outcomes and mitigate the profound consequences of unintended or mistimed pregnancy on readiness and cost to the military. We aimed to determine long-acting reversible contraception initiation and continuation rates among the diverse population with universal healthcare who are enrolled in the US military healthcare system. This study is a retrospective cohort of >1.7 million women, aged 14-40 years, who were enrolled in the US military healthcare system, TRICARE Prime, between October 2009 and September 2014. Individuals were assessed for long-acting reversible contraception initiation and continuation with the use of medical billing records. Method continuation and factors that were associated with early method discontinuation were evaluated with the Kaplan-Meier estimator and Cox proportional hazard models. During the study dates, 188,533 women initiated long-acting reversible contraception. Of these, 74.6% women selected intrauterine contraceptives. Method initiation rates remained relatively stable (41.7-50.1/1000 women/year) for intrauterine methods, although the rate for subdermal implants increased from 6.1-23.0/1000 women/year. In analysis of women who selected intrauterine contraceptives, 61.2% continued their method at 36 months, and 48.8% continued at 60 months. Among women who selected the implant, 32.0% continued their

Contraceptive practices adopted by women attending an urban health centre.

PubMed

Prateek, S S; Saurabh, R S

2012-12-01

India was the first country in world to launch - The National Family Welfare Programme in 1951 but even today the couple protection rate (CPR) is still not achieved as desired. To determine extent of awareness regarding contraception among married women. To estimate proportion of couples using contraceptive methods, identify reasons for their adoption & non adoption and to assess unmet needs for contraception. A cross sectional descriptive study of four months duration was conducted among married women in reproductive age group (15 - 49 years) attending general out-patient department in Urban Health Centre (UHC) employing universal sampling method. Participants not willing to respond and pregnant women were excluded. Total of 180 women were selected as study participants. Every woman was interviewed face to face with pre-tested questionnaire after taking informed consent. The data was analyzed by SPSS version 16. 94 (52.2%) were in age group of 20 - 24 years. 52.4% of women were aware about contraceptive practices, of which only 32.2% of subjects were using contraceptive methods. Out of these subjects, 89.66% used temporary methods and 10.34% used permanent methods. Cu-T (41.37%) was most preferred method. 93 subjects (51.6%) had unmet need for contraception. Religion, education status and age at marriage were significantly associated with contraceptive usage. The results suggest a significant Knowledge - Application Gap with regards to contraceptives knowledge and their actual usage in study participants. Almost fifty percent of the subjects had unmet need for contraception. This shows the need for more intense awareness campaigns for promoting contraceptive usage.

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

Prohibiting consent: what are the costs of denying permanent contraception concurrent with abortion care?

PubMed

Krashin, Jamie W; Edelman, Alison B; Nichols, Mark D; Allen, Allison J; Caughey, Aaron B; Rodriguez, Maria I

2014-07-01

Oregon and federal laws prohibit giving informed consent for permanent contraception when presenting for an abortion. The primary objective of this study was to estimate the number of unintended pregnancies associated with this barrier to obtaining concurrent tubal occlusion and abortion, compared with the current policy, which limits women to obtaining interval tubal occlusion after abortion. The secondary objectives were to compare the financial costs, quality-adjusted life years, and the cost-effectiveness of these policies. We designed a decision-analytic model examining a theoretical population of women who requested tubal occlusion at time of abortion. Model inputs came from the literature. We examined the primary and secondary outcomes stratified by maternal age (>30 and <30 years). A Markov model incorporated the possibility of multiple pregnancies. Sensitivity analyses were performed on all variables and a Monte Carlo simulation was conducted. For every 1000 women age <30 years in Oregon who did not receive requested tubal occlusion at the time of abortion, over 5 years there would be 1274 additional unintended pregnancies and an additional $4,152,373 in direct medical costs. Allowing women to receive tubal occlusion at time of abortion was the dominant strategy. It resulted in both lower costs and greater quality-adjusted life years compared to allowing only interval tubal occlusion after abortion. Prohibiting tubal occlusion at time of abortion resulted in an increased incidence of unintended pregnancy and increased public costs. Copyright © 2014 Mosby, Inc. All rights reserved.

Regional trends in the use of short-acting and long-acting contraception accessed through the private and public sectors.

PubMed

Ugaz, Jorge I; Chatterji, Minki; Gribble, James N; Mitchell, Susan

2015-08-01

To examine trends in the source of modern contraception (public versus private sector); method choice (long-acting or permanent methods versus short-acting methods); and method and source combined. A retrospective analysis was conducted using data collected by national Demographic and Health Surveys and Reproductive Health Surveys during the period 1992-2012. The dataset included 18 low-income countries in Sub-Saharan Africa, 10 from Latin America and the Caribbean (LAC), and 8 from Asia. A substantial proportion-between 40% and 49%-of modern contraceptive users relied on the private sector in Asia and LAC in the last 20years, yet the proportion has been smaller in Sub-Saharan Africa, between 27% and 30%. Increased use of short-acting methods from both public and private sectors has driven the rise in contraceptive prevalence in Asia and LAC. Similarly, increased contraceptive prevalence in Sub-Saharan Africa reflected the increased use of short-acting methods obtained mainly through the public sector, with only limited use of long-acting or permanent methods through the private sector. The private sector has played a key role in the increase of modern CPR and the provision of modern contraceptives around the world, providing almost half of them in low-income countries. Yet, such increase was driven primarily by a more substantial role in the provision of short-acting methods than long acting and permanent methods. Crown Copyright © 2015. Published by Elsevier Ireland Ltd. All rights reserved.

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.

Expert System Application of Forward Chaining and Certainty Factors Method for The Decision of Contraception Tools

NASA Astrophysics Data System (ADS)

Prambudi, Dwi Arief; Widodo, Catur Edi; Widodo, Aris Puji

2018-02-01

The choice of contraceptive tools is not an easy thing because the risks or effects will give impact on the body that never using it previously. in the other side, there is no contraception always suit for everybody because the circumstances of each body is different, so the extensive knowledge must be needed to know the advantages and disadvantages of each contraceptive tools then adjusted to the user's body.The expert system for contraceptive tools uses Forward Chaining search method combined with Certainty Factors Method. These method value the patient's indication. The Expert system gives the output data which define the kind of tool uses of the patient. the results obtained will be able to help people to find indications that lead to appropriate contraceptive tools and advice or suggestions about these tools. The success rate of the contraceptive tools decision experienced by experienced by the user by using forward chaining combined with the CF computation method is also influenced by the number of indication criteria selected by the user. Based on testing that has been done, expert system contraception tools has accuracy level equal to 75%.

Contraception today.

PubMed

Benagiano, Giuseppe; Bastianelli, Carlo; Farris, Manuela

2006-12-01

device capable of delivering progesterone directly into the uterus was withdrawn, a new system releasing locally 20 microg evonorgestrel is today marketed in a majority of countries with excellent contraceptive and therapeutic performance. Finally, several subcutaneously implanted systems have been developed: contraceptive "rods," where the polymeric matrix is mixed with the steroid and "capsules" made of a hollow polymer tube filled with free steroid crystals. New advances have also been made in nonhormonal intrauterine contraception with the development of "frameless" devices. The HIV/AIDS pandemic forced policy makers to look for ways to protect young people from sexually transmitted diseases as well as from untimely pregnancies. This led to the development of the so-called dual protection method, involving the use of a physical barrier (condom) as well as that of a second, highly effective contraceptive method. More complex is the situation with antifertility vaccines, still at a preliminary stage of development and unlikely to be in widespread use for years to come. Last, but not least, work is in progress to provide effective emergency contraception after an unprotected intercourse. Very promising in this area is the use of selective progesterone receptor modulators (antiprogestins).

Contraceptive use in the Nordic countries.

PubMed

Lindh, Ingela; Skjeldestad, Finn E; Gemzell-Danielsson, Kristina; Heikinheimo, Oskari; Hognert, Helena; Milsom, Ian; Lidegaard, Øjvind

2017-01-01

The aim was to compare contraceptive use in the Nordic countries and to assess compliance with recommendations from the European Medicines Agency regarding the use of combined oral contraception containing low-dose estrogen and levonorgestrel, norethisterone or norgestimate. Data on hormonal contraceptive prescriptions and sales figures for copper intrauterine devices were obtained from national databases and manufacturers in Denmark, Finland, Iceland, Norway and Sweden in 2010-2013. Contraceptive use was highest in Denmark (42%) and Sweden (41%), followed by Finland (40%). Combined oral contraception was the most used method in all countries, with the highest use in Denmark (26%). The second most used method was the levonorgestrel-releasing intrauterine system, with the highest use in Finland (15%) and ≈10% in the other countries. Copper intrauterine devices (7%) and the progestin-only pill (7%) were most often used in Sweden. Combined oral contraception use decreased with increasing age and levonorgestrel-releasing intrauterine system and progestin-only pills use increased. The use of long-acting reversible methods of contraception (=levonorgestrel-releasing intrauterine system, copper intrauterine devices, and implants) increased with time and was highest in Sweden (20%) and Finland (18%). The highest use of European Medicines Agency recommended combined oral contraception was in Denmark, increasing from 13 to 50% between 2010 and 2013. In Finland, recommended combined oral contraception remained below 1%. Contraceptive use was highest in Denmark and Sweden, levonorgestrel-releasing intrauterine system use was highest in Finland and all long-acting methods were most common in Sweden. The use of combined oral contraception recommended by the European Medicines Agency was highest in Denmark. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

Women's Awareness of, Interest in, and Experiences with Long-acting Reversible and Permanent Contraception.

PubMed

Burns, Bridgit; Grindlay, Kate; Dennis, Amanda

2015-01-01

Long-acting reversible contraception (LARC) and sterilization are popular contraceptive methods. However, they have been associated with safety concerns and coercive practices. We aimed to understand women's opinions and experiences related to these methods, including whether the methods' fraught histories influence use or interest. Between May and July 2013, we conducted an online survey with a convenience sample of 520 women aged 14 to 45. We used quota sampling to ensure women of color were at least 60% of our sample. Descriptive statistics, χ(2) tests, and multivariable logistic regression were used to estimate participants' awareness of, interest in, and experiences with LARCs and sterilization. Overall, 30% of women reported current LARC use and 67% interest in future LARC use. Four percent reported sterilization use and 48% interest in future sterilization. In multivariate analyses, current LARC use was lower among Asian women versus White women (odds ratio [OR], 0.24), and interest in future use was higher among women aged 14 to 24 versus 35 to 45 (OR, 5.49). Interest in sterilization was higher among women aged 14 to 24 and 25 to 34 versus 35 to 45 (ORs, 3.29-3.66) and women with disabilities (OR, 1.64), and lower among Black compared with White women (OR, 0.41). Method misperceptions were evident, and concerns about contraceptive coercion were reported. Concerns about contraceptive coercion were not predominant reasons for noninterest in LARCs and sterilization, but were reported by some participants. Lower sterilization interest among Black women and higher sterilization interest among women with disabilities warrant further research. Efforts to address misperceptions about LARCs and sterilization, including their safety and efficacy, are needed. Copyright © 2015 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Contraception After Delivery Among Publicly Insured Women in Texas: Use Compared With Preference.

PubMed

Potter, Joseph E; Coleman-Minahan, Kate; White, Kari; Powers, Daniel A; Dillaway, Chloe; Stevenson, Amanda J; Hopkins, Kristine; Grossman, Daniel

2017-08-01

.18-3.51). Limited use of long-acting and permanent contraceptive methods after delivery is associated with indicators of health care provider and system-level barriers. Expansion of immediate postpartum LARC provision as well as contraceptive coverage for undocumented women could reduce the gap between preference and use.

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.

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.

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.

Divorced women's sexual and contraceptive issues.

PubMed

Leslie, N J

1988-01-01

This work attempts to answer the question: could divorce create a feeling of alienation in women which causes one to feel vulnerable and detached and thus making sexual decision-making and planning difficult? When a women is married her sexuality is taken for granted because she is expected to have children; however, after a divorce, she must face many of the conflicts she felt as a young single woman. Guilt, planning contraceptive use, and coming to terms with her sexual behavior all present themselves again. 1 factor that must be considered is that contraceptive use is always assumed to be the function of the married women. Very little research has gone into the contraceptive use habits of unmarried women. This is primarily due to the societal assumption that unmarried woman don't have sex. This work contains the clinical observation of the author in which 28% of 459 prenatal patients were interviewed specifically because they were divorced. The conclusion is that divorced women are being neglected by the health care profession and are in great need of contraceptive counseling. This work primarily discusses a study done to expand and examine the conclusions of the clinical research. The study consisted of 101 sexually active, legally divorced, single women between the ages of 18-44 and physiologically capable of becoming pregnant. 53 of these women had experienced post-divorce pregnancies. Each woman was interviewed and given 3 standard tests: the Rosenberg Self-Acceptance Scale, the Snyder's Self-Monitoring Scale and Beckham's Coping Strategies Scale. The conclusion of the author is that divorce and its associated psychological problems may temporarily or permanently affect one's thoughts, feelings, and life course. Sexual and contraceptive use decision-making are both directly both directly affected by these changes. Some divorced women may be experiencing inadequate self-esteem, identity, and self-awareness.

Forgettable contraception.

PubMed

Grimes, David A

2009-12-01

The term "forgettable contraception" has received less attention in family planning than has "long-acting reversible contraception." Defined here as a method requiring attention no more often than every 3 years, forgettable contraception includes sterilization (female or male), intrauterine devices, and implants. Five principal factors determine contraceptive effectiveness: efficacy, compliance, continuation, fecundity, and the timing of coitus. Of these, compliance and continuation dominate; the key determinants of contraceptive effectiveness are human, not pharmacological. Human nature undermines methods with high theoretical efficacy, such as oral contraceptives and injectable contraceptives. By obviating the need to think about contraception for long intervals, forgettable contraception can help overcome our human fallibility. As a result, all forgettable contraception methods provide first-tier effectiveness (contraceptives today with exclusively first-tier effectiveness is the one that can be started -- and then forgotten for years.

Changes in state prescription contraceptive mandates for insurers: the effect on women's contraceptive use.

PubMed

Atkins, Danielle N; Bradford, W David

2014-03-01

Access to effective contraceptives is critical to reducing levels of unintended childbearing in the United States. Since 1998, more than half the states have passed legislation requiring insurers that cover prescription drugs to cover prescription contraceptives approved by the Food and Drug Administration. An assessment of the impact of these laws on women's contraceptive use is needed to determine whether such policies are effective. Information was collected on state contraceptive coverage policies, and contraceptive use data among women at risk of unintended pregnancy were drawn from Behavioral Risk Factor Surveillance System surveys conducted between 1998 and 2010. Logit regression analysis was used to calculate the marginal effects of state contraceptive coverage laws on insured and uninsured women's use of prescription methods. Insured women who lived in a state with a contraceptive coverage law were 5% more likely than their counterparts in states without such laws to use an effective method (i.e., a prescription method, condoms or sterilization). Among women who used such methods, those in contraceptive coverage states were 5% more likely than women in other states to use any prescription method, and 4% more likely to use the pill. No associations were found between contraceptive mandates and method use by uninsured women. Among both users and nonusers, contraceptive coverage was associated with a 5% increase in pill use. Contraceptive coverage mandates appear to play a role in increasing the use of prescription contraceptives among insured women, and hence may help to reduce the numbers of unintended pregnancies. Copyright © 2014 by the Guttmacher Institute.

Emergency contraception: a survey of 1773 women.

PubMed

Bastianelli, Carlo; Rosato, Elena; Farris, Manuela; Benagiano, Giuseppe

2016-12-01

The aim of the study was to retrieve data on the characteristics and profile of women attending an emergency service (ES) to receive a prescription (mandatory until May 2015) for emergency contraception (EC). In a retrospective study the following data were collected for all women requesting EC between January 2014 and June 2015: demographic characteristics, time between unprotected sexual intercourse (USI) and arrival at the ES, time between the last menstrual period and the USI, and type of EC prescribed. In a prospective study starting January 2015, a questionnaire was administered requesting the following information: reasons for requiring EC, previous EC use, source of knowledge about EC, prior contraception and age at first intercourse. During the whole study period, 1773 women requested EC: their mean age was 26.0 years; 78.5% were Italian; 91.5% were unmarried; 55.2% were still studying and 51.9% had high school education; 61.2% reached the ES within 12 h of the USI; and 42.4% had a USI during days 9-16 of their menstrual cycle. Levonorgestrel was prescribed in 81.4% of women and ulipristal acetate in 17.7%. In the prospective part of the study (382 women), the majority (57.9%) requested EC for condom rupture; 49.5% reported previous use of EC; and 41.6% received information on the subject through friends. The vast majority (83.8%) reported prior use of contraception; in 25.4% the reason for not using it was the absence of a relationship. An exact profile of women requesting EC can help women in their choice of permanent contraception, and help clinicians in counselling women on appropriate contraception.

Contraceptive Practice in Sub-Saharan Africa

PubMed Central

Tsui, Amy O.; Brown, Win; Li, Qingfeng

2017-01-01

Forty eight of the African continent’s 54 sovereign states are located in the Sub-Saharan Africa (SSA) region, with the government of each defining and shaping its own health services and delivery systems. This paper reviews the trends and patterns of contraceptive practice in the region. Using survey data available from the Demographic and Health Surveys and Performance Monitoring and Accountability 2020, the study finds modern contraceptive practice to be on the rise overall but with much geographic variation. The contraceptive methods most frequently used are injectables and, more recently, implants. Higher levels of use are observed among unmarried sexually active than married females. Although use is rising, contraceptive discontinuation rates are also high. Recent program initiatives discussed include expanding long-acting contraceptive options, promoting and delivering contraceptive methods in the postpartum period, and relying on community health workers for contraceptive outreach and service delivery. SSA’s family planning situation remains challenged by weak health systems which must address competing priorities to manage disease prevention as well as primary health care. Increasing investments in family planning delivery in many SSA countries, however, augur for continued rapid uptake of modern contraception, possibly matching if not outpacing the record of other regions. PMID:29081552

Postabortion contraception a decade after legalization of abortion in Nepal.

PubMed

Rocca, Corinne H; Puri, Mahesh; Harper, Cynthia C; Blum, Maya; Dulal, Bishnu; Henderson, Jillian T

2014-08-01

To assess the contraceptive information received and methods chosen, received, and used among women having abortions one decade after legalization of abortion in Nepal. We examined postabortion contraception with questionnaires at baseline and six months among women obtaining legal abortions (n=838) at four facilities in 2011. Multivariate regression analysis was used to measure factors associated with method information, choice, receipt, and use. One-third of participants received no information on effective methods, and 56% left facilities without a method. The majority of women who chose to use injectables and pills were able to do so (88% and 75%, respectively). However, only 44% of women choosing long-acting reversible contraceptives and 5% choosing sterilization had initiated use of the method by six months. Levels of contraceptive use after medical abortion were on par with those after aspiration abortion. Nulliparous women were far less likely than parous women to receive information and use methods. Women living without husbands or partners were also less likely to receive information and supplies, or to use methods. Improvements in postabortion counseling and provision are needed. Ensuring that women choosing long-acting and permanent contraceptive methods are able to obtain either them or interim methods is essential. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Role of Insurance Coverage in Contraceptive Use After Abortion.

PubMed

Biggs, M Antonia; Taylor, Diana; Upadhyay, Ushma D

2017-12-01

To assess postaspiration abortion contraceptive use and the role of insurance coverage for abortion in a state that covers abortion and contraception for low-income women. This is a secondary analysis of a previously published prospective study to assess the safety of abortion provision. From 2007 through 2013, women seeking first-trimester aspiration abortion were recruited at 25 clinical facilities within four Planned Parenthood affiliates and Kaiser Permanente of Northern California. Patients' medical charts were reviewed to assess the contraceptive methods received on the day of the abortion. A 4-week follow-up survey assessed contraceptive use and contraceptive-related incidents. Primary outcomes included leaving with any method on the day of the abortion and use of any method at the 4-week assessment. Secondary outcomes included intrauterine device or implant use on the day of the procedure and at 4 weeks and switching to a less effective method at 4 weeks. A total of 19,673 women agreed to participate, and 13,904 (71%) completed the 4-week follow-up survey. Ninety-four percent (18,486/19,673) left their abortion visit with a contraceptive method: 21% (4,111/19,673) with an intrauterine device, implant, or permanent method. By the 4-week survey, 8% (1,135/13,904) switched from a high- or medium-efficacy method to a low-efficacy or no method; 0.4% (60/13,904) experienced a contraceptive incident. In adjusted regression analyses, women who paid for the abortion with Medicaid were significantly more likely to use any method (adjusted odds ratio [OR] 3.70, 95% CI 3.09-4.42) or an intrauterine device or implant (adjusted OR 2.14, 95% CI 1.92-2.38) on the day of the abortion than those who did not pay with insurance. Experiencing a contraceptive-related incident was associated with switching to a low-efficacy or no method by the 4-week survey (adjusted OR 3.98, 95% CI 2.20-7.22). Insurance coverage for abortion is associated with postabortion contraceptive

Design and simulation of permanent magnet synchronous motor control system

NASA Astrophysics Data System (ADS)

Li, Li; Liu, Yongqiu

2018-06-01

In recent years, with the development of power electronics, microelectronics, new motor control theory and rare earth permanent magnet materials, permanent magnet synchronous motors have been rapidly applied. Permanent magnet synchronous motors have the advantages of small size, low loss and high efficiency. Today, energy conservation and environmental protection are increasingly valued. It is very necessary to study them. Permanent magnet synchronous motor control system has a wide range of application prospects in the fields of electric vehicles, ships and other transportation. Using the simulation function of MATLAB/SIMULINK, a modular design structure was used to simulate the whole system model of speed loop adjustment, current PI modulation, SVPWM (Space Vector Pulse Width Module) wave generation and double closed loop. The results show that this control method has good robustness, and this method can improve the design efficiency and shorten the system design time. In this article, the analysis of the control principle of modern permanent magnet synchronous motor and the various processes of MATLAB simulation application will be analyzed in detail. The basic theory, basic method and application technology of the permanent magnet synchronous motor control system are systematically introduced.

Use of contraceptive methods and contraceptive recommendations among health care providers actively involved in contraceptive counseling -- results of an international survey in 10 countries.

PubMed

Gemzell-Danielsson, Kristina; Cho, SiHyun; Inki, Pirjo; Mansour, Diana; Reid, Robert; Bahamondes, Luis

2012-12-01

This study was conducted to determine the personal choices of contraceptive methods among an international sample of contraception health care professionals (HCPs) and to determine if these choices are concordant with their recommendations to women. In an anonymous online survey, 1001 HCPs actively involved in contraceptive counseling [obstetrician/gynecologists (OB/GYNs), general practitioners (GPs) and midwives (only in Sweden)] from 10 countries (Australia, Brazil, Canada, France, Germany, Korea, Mexico, Spain, Sweden and the United Kingdom) were asked about their personal use of contraceptive methods and their recommendations to women in two different clinical scenarios: for spacing between children (Group A) and after completion of the family (Group B). The largest HCP group was OB/GYNs (67.1%), followed by GPs (31.4%) and midwives (1.5%). A total of 42.7% of respondents were male, and 57.3% were female. The majority of respondents were aged 36-45 years (38.9%) or 46-55 years (42.8%), 79.7% had children, and 53.9% were currently using contraception (by themselves or by their partners). Among 540 contraceptive users, the three most common methods were the levonorgestrel-releasing intrauterine system (LNG-IUS; 29.3%), combined oral contraceptives (COCs; 20.0%) and condoms (17.0%). OB/GYNs were more likely to be using the LNG-IUS than GPs (p=.014). Gender did not seem to influence contraceptive preference. Reasons for these choices were largely influenced by family situation and high contraceptive efficacy (for the LNG-IUS) or side effects caused by other methods (for condoms). The top contraceptive recommendation was COCs for Group A and the LNG-IUS for Group B. HCPs currently using COCs and the LNG-IUS were more likely to recommend these methods than other contraceptive methods for Group A and Group B, respectively. The most popular contraceptive method in this sample of HCPs was the LNG-IUS. Choice of contraceptive method was driven by family situation, age

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

Contraceptive Provision in the VA Healthcare System to Women Who Report Military Sexual Trauma

PubMed Central

Mattocks, Kristin; Schwarz, Eleanor Bimla; Borrero, Sonya; Skanderson, Melissa; Zephyrin, Laurie; Brandt, Cynthia; Haskell, Sally

2014-01-01

Abstract Background: Women Veterans who suffered military sexual trauma (MST) may be at high risk for unintended pregnancy and benefit from contraceptive services. The objective of this study is to compare documented provision of contraceptives to women Veterans using the Department of Veterans Affairs (VA) health system who report or deny MST. Methods: This retrospective cohort study included women Veterans aged 18–45 years who served in Operation Enduring or Iraqi Freedom and had at least one visit to a VA medical center between 2002 and 2010. Data were obtained from VA administrative and clinical databases. Chi-squared tests and logistic regression were conducted to evaluate the association between MST, ascertained by routine clinical screening, and first documented receipt of hormonal or long-acting contraception. Results: Of 68,466 women Veterans, 13% reported, 59% denied and 28% had missing data for the MST screen. Among the entire study cohort, 30% of women had documented receipt of a contraceptive method. Women reporting MST were significantly more likely than those denying MST to receive a method of contraception (adjusted odds ratio [aOR] 1.12, 95% confidence interval [CI] 1.07–1.18) including an intrauterine device (odds ratio [OR] 1.29, 95% CI 1.17–1.41) or contraceptive injection (OR 1.17, 95% CI 1.05–1.29). Women who were younger, unmarried, seen at a women's health clinic, or who had more than one visit were more likely to receive contraception. Conclusions: A minority of women Veterans of reproductive age receive contraceptive services from the VA. Women Veterans who report MST, and particularly those who seek care at VA women's health clinics, are more likely to receive contraception. PMID:24787680

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…

Attitude toward, acceptance of and knowledge about female sterilization as a method of contraception.

PubMed

Erlenwein, J; Kundu, S; Schippert, C; Soergel, P; Hillemanns, P; Staboulidou, I

2015-02-01

Surgical sterilization via tubal ligation or the disconnection of the tubes is a method of permanent contraception. The aim of this study was to evaluate the attitude, acceptance and knowledge of women about female sterilization as a method of contraception in terms of the social and cultural backgrounds of those women. Prospective study based on an anonymous questionnaire that analyzed background knowledge, attitude, influence factors and motivation regarding sterilization, as well as the reasons for declining. The questionnaire also attempted to evaluate the effects on the self-esteem of the women, as well as the impact of religious dogma and the related beliefs. One thousand, eight hundred questionnaires were distributed, and 1247 women completed the questionnaire—a response rate of 69.3%. There were mainly positive attitudes toward sterilization as a contraceptive method. Cultural background, including religion and faith; the mother's experiences and point of view; knowledge; family planning and the actual life situation have an influence on the attitudes toward and acceptance of sterilization as a contraceptive method and on the final choice of a contraceptive method. Cultural background and present life situation have a great impact on the attitude toward and acceptance of sterilization as a method of contraception, thus influencing the final choice of a contraceptive method. Detailed counselling about this topic is essential and should be improved. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Contraceptive use and the role of contraceptive counseling in reproductive-aged women with cancer.

PubMed

Maslow, Bat-Sheva L; Morse, Christopher B; Schanne, Allison; Loren, Alison; Domchek, Susan M; Gracia, Clarisa R

2014-07-01

Few data on contraceptive choices in women with cancer exist. Contraception is challenging for women with cancer, particularly those with breast cancer, who are limited to nonhormonal methods. This study characterized contraceptive use during cancer treatment in a group of reproductive-aged women with a recent cancer diagnosis and assessed the impact of contraceptive counseling on the methods they selected. Cross-sectional, survey study of reproductive-aged women at a large tertiary care health system with a recent cancer diagnosis. A total of 107 women completed the survey. Eighty-two women reported 101 contraceptive choices. Twenty-seven percent (27/101) of all methods selected were Tier I/II, and 35% (35/101) were Tier III/IV. Only 4 used an intrauterine device (IUD). Among women reporting sexual activity after diagnosis, 19 (27%) of 71 reported using Tier I/II methods, 21 (30%) of 71 reported using Tier III/IV methods, 16 (23%) of 71 reported abstinence and 10 (14%) of 71 reported using no method. Factors significantly associated with Tier I/II use in the multivariable model included not having a college degree [odds ratio (OR) 0.21, 95% confidence interval (CI) 0.05-0.92, p=.038], intercourse during treatment (OR 5.92, 95% CI 1.48-23.66, p=.012) and non-breast cancer (OR 3.60, 95% CI 1.03-12.64, p=.046). Report of contraceptive counseling was positively associated with Tier I/II contraceptive use during cancer treatment (OR 6.92, 95% CI 1.14-42.11, p=.036). Reproductive-aged women diagnosed with cancer underutilized Tier I/II contraceptive agents, especially IUDs. Contraceptive counseling by physicians increases contraceptive use, particularly methods most effective at preventing pregnancy. The study uniquely described the contraceptive practices of over 100 women with cancer. The study sample commonly reported abstinence and use of contraceptive methods with high failure rates. Our data suggest that contraceptive counseling from a health care provider may

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

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

[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.

Patterns of Contraceptive Adoption, Continuation, and Switching after Delivery among Malawian Women.

PubMed

Kopp, Dawn M; Rosenberg, Nora E; Stuart, Gretchen S; Miller, William C; Hosseinipour, Mina C; Bonongwe, Phylos; Mwale, Mwawi; Tang, Jennifer H

2017-01-01

Women who report use of postpartum family planning may not continue their initial method or use it consistently. Understanding the patterns of method uptake, discontinuation, and switching among women after delivery is important to promote uptake and continuation of effective methods of contraception. This is a secondary analysis of 634 Malawian women enrolled into a prospective cohort study after delivery. They completed baseline surveys upon enrollment and follow-up telephone surveys 3, 6, and 12 months post-delivery. Women were included in this analysis if they had completed at least the 3- and 6-month post-delivery surveys. Descriptive statistics were used to assess contraceptive method mix and patterns of switching, whereas Pearson's χ2 tests were used for bivariable analyses to compare characteristics of women who continued and discontinued their initial post-delivery contraceptive method. Among the 479 women included in this analysis, the use of abstinence/traditional methods decreased and the use of long-acting and permanent methods (LAPM) increased over time. Almost half (47%) discontinued the contraceptive method reported at 3-months post-delivery; women using injectables or LAPM at 3-months post-delivery were significantly more likely to continue their method than those using non-modern methods (p<0.001). Of the 216 women who switched methods, 82% switched to a more or equally effective method. The change in contraceptive method mix and high rate of contraceptive switching in the first 12 months postpartum highlights a need to assist women in accessing effective contraceptives soon after delivery.

Patterns of Contraceptive Adoption, Continuation, and Switching after Delivery among Malawian Women

PubMed Central

Rosenberg, Nora E.; Stuart, Gretchen S.; Miller, William C.; Hosseinipour, Mina C.; Bonongwe, Phylos; Mwale, Mwawi; Tang, Jennifer H.

2017-01-01

Women who report use of postpartum family planning may not continue their initial method or use it consistently. Understanding the patterns of method uptake, discontinuation, and switching among women after delivery is important to promote uptake and continuation of effective methods of contraception. This is a secondary analysis of 634 Malawian women enrolled into a prospective cohort study after delivery. They completed baseline surveys upon enrollment and follow-up telephone surveys 3, 6, and 12 months post-delivery. Women were included in this analysis if they had completed at least the 3- and 6-month post-delivery surveys. Descriptive statistics were used to assess contraceptive method mix and patterns of switching, whereas Pearson’s χ2 tests were used for bivariable analyses to compare characteristics of women who continued and discontinued their initial post-delivery contraceptive method. Among the 479 women included in this analysis, the use of abstinence/traditional methods decreased and the use of long-acting and permanent methods (LAPM) increased over time. Almost half (47%) discontinued the contraceptive method reported at 3-months post-delivery; women using injectables or LAPM at 3-months post-delivery were significantly more likely to continue their method than those using non-modern methods (p<0.001). Of the 216 women who switched methods, 82% switched to a more or equally effective method. The change in contraceptive method mix and high rate of contraceptive switching in the first 12 months postpartum highlights a need to assist women in accessing effective contraceptives soon after delivery. PMID:28107404

The contraception needs of the perimenopausal woman.

PubMed

Hardman, Sarah M R; Gebbie, Ailsa E

2014-08-01

Perimenopausal women have low fertility but must still be advised to use contraception until natural sterility is reached if they are sexually active. Patterns of contraceptive use vary in different countries worldwide. Long-acting reversible contraceptive methods offer reliable contraception that may be an alternative to sterilisation. Hormonal methods confer significant non-contraceptive benefits, and each individual woman should weigh up the benefits and risks of a particular method. No method of contraception is contraindicated by age alone, although combined hormonal contraception and injectable progestogens are not recommended for women over the age of 50 years. The intrauterine system has particular advantages as a low-dose method of effective hormonal contraception, which also offers control of menstrual dysfunction and endometrial protection in women requiring oestrogen replacement. Condoms are recommended for personal protection against sexually transmitted infections in new relationships. Standard hormone replacement therapy is not a method of contraception. Copyright © 2014 Elsevier Ltd. All rights reserved.

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.

Suspect online sellers and contraceptive access.

PubMed

Liang, Bryan A; Mackey, Tim K; Lovett, Kimberly M

2012-11-01

Issues surrounding contraception access have been a national focus. During this debate, adolescent and adult women may seek these products online. Due to safety concerns, including potential counterfeit forms, we wished to assess whether online "no prescription" contraceptives were available. We assessed online availability of reversible, prescription contraceptive methods resulting in <10 undesired pregnancies/year, i.e., Depo-Provera shot; oral contraceptives; NuvaRing; Ortho Evra patch; Paragard and Mirena IUDs; and Implanon/Nexplanon implants. Using Google search "buy ITEM no prescription," we reviewed the first five result pages for "no prescription" vendors. Searches were conducted 1/3/2012-2/20/2012. All contraceptives were available as "no prescription" products. Furthermore, IUDs were advertised as "over-the-counter" and YouTube videos provided "how to" videos, including a cartoon version. We also found that illicit online pharmacy marketing is shifting from direct search engine access to social media (Facebook, Twitter, Slidehare, flickr). Online contraceptive sales represent patient safety risks and a parallel system of high-risk product access absent professional guidance. Providers should educate patients, while policy makers employ legal strategies to address these systemic risks. Copyright © 2012 Elsevier Inc. All rights reserved.

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.

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.

[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.

Ocular complications of oral contraceptives.

PubMed

Wood, J R

1977-01-01

The systemic side effects of oral contraceptives are mentioned, and the incidence and variety of ocular complications are discussed. Experimental studies on the ocular effects of oral contraceptives in laboratory animals have shown only increased permeability of the lens and possibly vascular dilatation. Numerous case reports, however, have been published which describe neuroophthalamic, vascular, retinal and macular, aqueous humor dynamic, cornea and contact lense, lens, color vision, and other miscellaneous effects. These reports are reviewed as are the 6 reported prospective studies. These prospective studies reveal only changes in kerotometry readings. Thus the large number of case reports may represent a low overall incidence or may be normal findings in the population as a whole or may be caused by other systemic factors. Until multicenter prospective studies provide definitive guidelines, the risk associated with oral contraceptive use must be kept in its proper perpsective and ocular histories should contain information on oral contraceptive use.

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

Pregnancy and contraception in systemic and cutaneous lupus erythematosus.

PubMed

Guettrot-Imbert, G; Morel, N; Le Guern, V; Plu-Bureau, G; Frances, C; Costedoat-Chalumeau, N

2016-10-01

A causal link has long been described between estrogen and systemic lupus erythematosus activity. Contraceptive and pregnancy management is now common for lupus patients, but pregnancy continues to be associated with higher maternal and fetal mortality/morbidity in systemic lupus erythematosus patients than among the general population. Potential complications include lupus flares, obstetric complications (fetal loss, in utero growth retardation, premature birth) and neonatal lupus syndrome. Association with antiphospholipid antibodies or antiphospholipid syndrome increases the risk of obstetric complications. Anti-SSA and/or anti-SSB antibodies put fetuses at risk for neonatal lupus. Improving the outcome of such pregnancies depends upon optimal systematic planning of pregnancy at a preconception counseling visit coupled with a multidisciplinary approach. Absence of lupus activity, use of appropriate medication during pregnancy based on the patient's medical history and risk factors, and regular monitoring constitute the best tools for achieving a favorable outcome in such high-risk pregnancies. The aim of this review is to provide an update on the management of contraception and pregnancy in systemic lupus erythematosus, cutaneous lupus and/or antiphospholipid syndrome in order to reduce the risk of complications and to ensure the best maternal and fetal prognosis. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

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

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.

Contraceptive Provision to Adolescent Females Prescribed Teratogenic Medications.

PubMed

Stancil, Stephani L; Miller, Melissa; Briggs, Holley; Lynch, Daryl; Goggin, Kathy; Kearns, Gregory

2016-01-01

Rates of adult women receiving contraceptive provision when simultaneously prescribed a known teratogen are alarmingly low. The prevalence of this behavior among pediatric providers and their adolescent patients is unknown. The objective of this study was to describe pediatric provider behaviors for prescribing teratogens concurrently with counseling, referral, and/or prescribing of contraception (collectively called contraceptive provision) in the adolescent population. A retrospective review was conducted examining visits in 2008-2012 by adolescents aged 14 to 25 years in which a known teratogen (US Food and Drug Administration pregnancy risk category D or X) was prescribed. The electronic medical records were queried for demographic information, evidence of contraceptive provision, and menstrual and sexual histories. The data were analyzed using standard statistical methods. Within 4172 clinic visits, 1694 females received 4506 prescriptions for teratogenic medications. The most commonly prescribed teratogens were topiramate, methotrexate, diazepam, isotretinoin, and enalapril. The subspecialties prescribing teratogens most frequently were neurology, hematology-oncology, and dermatology. Overall, contraceptive provision was documented in 28.6% of the visits. Whites versus nonwhites and older versus younger girls were more likely to receive contraceptive provision. The presence of a federal risk mitigation system for the teratogen also increased the likelihood of contraceptive provision. Our data demonstrate female adolescents prescribed teratogens receive inadequate contraception provision, which could increase their risk for negative pregnancy outcomes. Although the presence of a federal risk mitigation system appears to improve contraceptive provision, these systems are costly and, in some instances, difficult to implement. Efforts to improve provider practices are needed. Copyright © 2016 by the American Academy of Pediatrics.

Unmet Demand for Highly Effective Postpartum Contraception in Texas

PubMed Central

Potter, Joseph E.; Hopkins, Kristine; Aiken, Abigail R. A.; Lopez, Celia Hubert; Stevenson, Amanda J.; White, Kari; Grossman, Daniel

2014-01-01

Objectives We aimed to assess women's contraceptive preferences and use in the first 6 months after delivery. The postpartum period represents a key opportunity for women to learn about and obtain effective contraception, especially since 50% of unintended pregnancies to parous women occur within 2 years of a previous birth. Methods We conducted a prospective cohort study of 800 postpartum women recruited from three hospitals in Austin and El Paso, TX. Women aged 18–44 who wanted to delay childbearing for at least 24 months were eligible for the study and completed interviews following delivery and at 3 and 6 months postpartum. Participants were asked about the contraceptive method they were currently using and the method they would prefer to use at 6 months after delivery. Results At 6 months postpartum, 13% of women were using an IUD or implant, and 17% were sterilized or had a partner who had had a vasectomy. Twenty-four percent were using hormonal methods, and 45% relied on less effective methods, mainly condoms and withdrawal. Yet 44% reported that they would prefer to be using sterilization, and 34% would prefer to be using LARC. Conclusions This study shows a considerable preference for LARC and permanent methods at six months postpartum. However, there is a marked discordance between women's method preference and actual use, indicating substantial unmet demand for highly effective methods of contraception. PMID:25129329

The role of contraceptive attributes in women's contraceptive decision making.

PubMed

Madden, Tessa; Secura, Gina M; Nease, Robert F; Politi, Mary C; Peipert, Jeffrey F

2015-07-01

Contraceptive methods have differing attributes. Women's preferences for these attributes may influence contraceptive decision making. Our objective was to identify women's contraceptive preferences among women initiating a new contraceptive method. We conducted a cross-sectional, self-administered survey of women's contraceptive preferences at the time of enrollment into the Contraceptive CHOICE Project. Participants were asked to rank the importance of 15 contraceptive attributes on a 3-point scale (1 = not at all important, 2 = somewhat important, and 3 = very important) and then to rank the 3 attributes that were the most important when choosing a contraceptive method. The survey also contained questions about prior contraceptive experience and barriers to contraceptive use. Information about demographic and reproductive characteristics was collected through the CHOICE Project baseline survey. There were 2590 women who completed the survey. Our sample was racially and socioeconomically diverse. Method attributes with the highest importance score (mean score [SD]) were effectiveness (2.97 [0.18]), safety (2.96 [0.22]), affordability (2.61 [0.61]), whether the method is long lasting (2.58 [0.61]), and whether the method is "forgettable" (2.54 [0.66]). The attributes most likely to be ranked by respondents among the top 3 attributes included effectiveness (84.2%), safety (67.8%), and side effects of the method (44.6%). Multiple contraceptive attributes influence decision making and no single attribute drives most women's decisions. Tailoring communication and helping women make complex tradeoffs between attributes can better support their contraceptive decisions and may assist them in making value-consistent choices. This process could improve continuation and satisfaction. Copyright © 2015 Elsevier Inc. All rights reserved.

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.

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.

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 Embarrassment and Contraceptive Behavior among Young Single Women.

ERIC Educational Resources Information Center

Herold, Edward S.

1981-01-01

This paper determined factors predictive of contraceptive embarrassment, and the relationship of contraceptive embarrassment to contraceptive use among young unmarried females. The most important predictors found were parental attitude to premarital intercourse and sexual guilt. The embarrassment scale had significant correlations with…

Contraception for adolescents.

PubMed

Ott, Mary A; Sucato, Gina S

2014-10-01

A working knowledge of contraception will assist the pediatrician in both sexual health promotion as well as treatment of common adolescent gynecologic problems. Best practices in adolescent anticipatory guidance and screening include a sexual health history, screening for pregnancy and sexually transmitted infections, counseling, and if indicated, providing access to contraceptives. Pediatricians' long-term relationships with adolescents and families allow them to help promote healthy sexual decision-making, including abstinence and contraceptive use. Additionally, medical indications for contraception, such as acne, dysmenorrhea, and heavy menstrual bleeding, are frequently uncovered during adolescent visits. This technical report provides an evidence base for the accompanying policy statement and addresses key aspects of adolescent contraceptive use, including the following: (1) sexual history taking, confidentiality, and counseling; (2) adolescent data on the use and side effects of newer contraceptive methods; (3) new data on older contraceptive methods; and (4) evidence supporting the use of contraceptives in adolescent patients with complex medical conditions. Copyright © 2014 by the American Academy of Pediatrics.

Contraception Update: Sterilization.

PubMed

Antell, Karen; Deshmukh, Prium; Brown, Elizabeth J

2017-11-01

Female sterilization procedures include postpartum partial salpingectomy via cesarean or minilaparotomy incision, interval laparoscopic procedures, or hysteroscopic placement of microinserts. Rates of failure and serious complications are low and comparable among the various methods. A hysteroscopic procedure requires a 3-month confirmatory hysterosalpingogram before it is considered effective for contraception. Hysteroscopic sterilization has been shown to be associated with a higher reoperation rate than laparoscopic procedures. For male sterilization, vasectomy is a noninvasive and highly effective method. Vasectomy is an outpatient procedure performed under local anesthesia. The procedure requires confirmation of azoospermia with a semen analysis 8 to 16 weeks after the procedure. Patients who are considering sterilization should be counseled about all the available options and the permanent nature of such procedures. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

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…

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…

Combined oral contraceptives: health benefits beyond contraception.

PubMed

Caserta, D; Ralli, E; Matteucci, E; Bordi, G; Mallozzi, M; Moscarini, M

2014-09-01

It has been recognized for over 50 years that combined oral contraceptives (COCs) are also capable of offering health benefits beyond contraception through the treatment and prevention of several gynaecological and medical disorders. During the last years a constant attention was given to the adverse effects of COCs, whereas their non-contraceptive benefits were underestimated. To date, most women are still unaware of the therapeutic uses of hormonal contraceptives, while on the contrary there is an extensive and constantly increasing of these non-contraceptive health benefits. This review summarizes the conditions of special interest for physicians, including dysmenorrhoea, menorrhagia, hyperandrogenism (acne, hirsutism, polycystic ovary syndrome), functional ovarian cysts, endometriosis, premenstrual syndrome, myomas, pelvic inflammatory disease, bone mineral density, benign breast disease and endometrial/ovarian and colorectal cancer. The benefits of COCs in rheumatoid arthritis, multiple sclerosis, menstrual migraine and in perimenopause have also been treated for more comprehensive information. Using COCs specifically for non-contraceptive indications is still outside the product licence in the majority of cases. We strongly believe that these aspects are not of minor relevance and they deserve a special consideration by health providers and by the mass media, which have the main responsibility in the diffusion of scientific information. Thus, counseling and education are necessary to help women make well-informed health-care decisions and it is also crucial to increase awareness among general practitioners and gynaecologists.

ESTIMATING SYSTEMIC EXPOSURE TO ETHINYL ESTRADIOL FROM AN ORAL CONTRACEPTIVE

PubMed Central

WESTHOFF, Carolyn L.; PIKE, Malcolm C.; TANG, Rosalind; DINAPOLI, Marianne N.; SULL, Monica; CREMERS, Serge

2015-01-01

Objectives This study was conducted to compare single-dose pharmacokinetics of ethinyl estradiol in an oral contraceptive to steady-state values, and to assess whether any simpler measures could provide an adequate proxy of the ‘gold standard’ 24-hour steady-state area-under-the-curve. Identifying a simple, less expensive, measure of systemic ethinyl estradiol exposure would be useful for larger studies designed to assess the relationship between an individual’s ethinyl estradiol exposure and her side effects. Study Design We conducted a 13 samples over 24 hours pharmacokinetic analysis on day 1 and day 21 of the first cycle of a monophasic oral contraceptive containing 30 mcg ethinyl estradiol and 150 mcg levonorgestrel in 17 non-obese healthy white women. We also conducted an abbreviated single dose 9-sample pharmacokinetic analysis after a month washout. Ethinyl estradiol was measured by liquid chromatography-tandem mass spectrometry. We compared results of full 13-sample steady-state pharmacokinetic analysis with results calculated using fewer samples (9 or 5) and following the single doses. We calculated Pearson correlation coefficients to evaluate the relationships between these estimates of systemic ethinyl estradiol exposure. Results The area-under-the-curve, maximum (Cmax), and 24-hour (C24) values were similar following the two single oral contraceptive doses (area-under-the-curve, r = 0.92). The steady-state 13-sample 24-hour area-under-the-curve was highly correlated with the average 9-sample area-under-the-curve after the two single doses (r = 0.81, p = 0.0002). This correlation remained the same if the number of samples was reduced to 4, taken at time 1, 2.5, 4 and 24 hours. The C24 at steady-state was highly correlated with the 24-hour steady-state area-under-the-curve (r = 0.92, p < 0.0001). The average of the C24 values following the two single doses was also quite highly correlated with the steady-state area-under-the-curve (r = 0.72, p = 0

Estimating systemic exposure to ethinyl estradiol from an oral contraceptive.

PubMed

Westhoff, Carolyn L; Pike, Malcolm C; Tang, Rosalind; DiNapoli, Marianne N; Sull, Monica; Cremers, Serge

2015-05-01

This study was conducted to compare single-dose pharmacokinetics of ethinyl estradiol in an oral contraceptive with steady-state values and to assess whether any simpler measures could provide an adequate proxy of the "gold standard" 24-hour steady-state area under the curve (AUC) value. Identification of a simple, less expensive measure of systemic ethinyl estradiol exposure would be useful for larger studies that are designed to assess the relationship between an individual's ethinyl estradiol exposure and side-effects. We collected 13 samples over 24 hours for pharmacokinetic analysis on days 1 and 21 of the first cycle of a monophasic oral contraceptive that contained 30 μg ethinyl estradiol and 150 μg levonorgestrel in 17 nonobese healthy white women. We also conducted an abbreviated single-dose 9-sample pharmacokinetic analysis after a month washout. Ethinyl estradiol was measured by liquid chromatography-tandem mass spectrometry. We compared results of a full 13-sample steady-state pharmacokinetic analysis with results that had been calculated with the use of fewer samples (9 or 5) and after the single doses. We calculated Pearson correlation coefficients to evaluate the relationships between these estimates of systemic ethinyl estradiol exposure. The AUC, maximum, and 24-hour values were similar after the 2 single oral contraceptive doses (AUC; r=0.92). The steady-state 13-sample 24-hour AUC value was correlated highly with the average 9-sample AUC value after the 2 single doses (r=0.81; P=.0002). This correlation remained the same if the number of single-dose samples was reduced to 4, taken at time 1, 2.5, 4, and 24 hours. The 24-hour value at steady-state was correlated highly with the 24-hour steady-state AUC value (r=0.92; P<.0001). The average of the 24-hour values after the 2 single doses was also correlated quite highly with the steady-state AUC value (r=0.72; P=.0026). Limited blood sampling, including results from 2 single doses, gave highly

[Contraception during the perimenopause: indications, security, and non contraceptive benefits].

PubMed

Cantero Pérez, P; Klingemann, J; Yaron, M; Irion, N Fournet; Streuli, I

2015-10-28

Although patients' fertility is diminished in the period of perimenopause, they still need efficient contraception. Thorough knowledge of the physiological changes occuring during this period of transition is essential in order to provide optimal care. Until the age of 50, no contraceptive method is specifically considered unsuitable due to age alone. The choice of contraceptive needs to be adapted to the patient, assessing the individual risk factors and favouring the potential non-contraceptive advantages of the method selected. Long-term contraceptive methods (e.g., the copper intrauterine device (IUD), the Mirena IUD or a subcutaneous implant) offer an excellent solution on both levels.

Pregnancy rates in HIV-positive women using contraceptives and efavirenz-based or nevirapine-based antiretroviral therapy in Kenya: a retrospective cohort study.

PubMed

Patel, Rena C; Onono, Maricianah; Gandhi, Monica; Blat, Cinthia; Hagey, Jill; Shade, Starley B; Vittinghoff, Eric; Bukusi, Elizabeth A; Newmann, Sara J; Cohen, Craig R

2015-11-01

Concerns have been raised about efavirenz reducing the effectiveness of contraceptive implants. We aimed to establish whether pregnancy rates differ between HIV-positive women who use various contraceptive methods and either efavirenz-based or nevirapine-based antiretroviral therapy (ART) regimens. We did this retrospective cohort study of HIV-positive women aged 15-45 years enrolled in 19 HIV care facilities supported by Family AIDS Care and Education Services in western Kenya between Jan 1, 2011, and Dec 31, 2013. Our primary outcome was incident pregnancy diagnosed clinically. The primary exposure was a combination of contraceptive method and efavirenz-based or nevirapine-based ART regimen. We used Poisson models, adjusting for repeated measures, and demographic, behavioural, and clinical factors, to compare pregnancy rates among women receiving different contraceptive and ART combinations. 24,560 women contributed 37,635 years of follow-up with 3337 incident pregnancies. In women using implants, adjusted pregnancy incidence was 1.1 per 100 person-years (95% CI 0.72-1.5) for nevirapine-based ART users and 3.3 per 100 person-years (1.8-4.8) for efavirenz-based ART users (adjusted incidence rate ratio [IRR] 3.0, 95% CI 1.3-4.6). In women using depot medroxyprogesterone acetate, adjusted pregnancy incidence was 4.5 per 100 person-years (95% CI 3.7-5.2) for nevirapine-based ART users and 5.4 per 100 person-years (4.0-6.8) for efavirenz-based ART users (adjusted IRR 1.2, 95% CI 0.91-1.5). Women using other contraceptive methods, except for intrauterine devices and permanent methods, had 3.1-4.1 higher rates of pregnancy than did those using implants, with 1.6-2.8 higher rates in women using efavirenz-based ART. Although HIV-positive women using implants and efavirenz-based ART had a three-times higher risk of contraceptive failure than did those using nevirapine-based ART, these women still had lower contraceptive failure rates than did those receiving all other

Copper intrauterine device for emergency contraception: clinical practice among contraceptive providers.

PubMed

Harper, Cynthia C; Speidel, J Joseph; Drey, Eleanor A; Trussell, James; Blum, Maya; Darney, Philip D

2012-02-01

The copper intrauterine device (IUD) is the most effective emergency contraceptive available but is largely ignored in clinical practice. We examined clinicians' recommendations of the copper IUD for emergency contraception in a setting with few cost obstacles. We conducted a survey among clinicians (n=1,246; response rate 65%) in a California State family planning program, where U.S. Food and Drug Administration-approved contraceptives are available at no cost to low-income women. We used multivariable logistic regression to measure the association of intrauterine contraceptive training and evidence-based knowledge with having recommended the copper IUD for emergency contraception. The large majority of clinicians (85%) never recommended the copper IUD for emergency contraception, and most (93%) required two or more visits for an IUD insertion. Multivariable analyses showed insertion skills were associated with having recommended the copper IUD for emergency contraception, but the most significant factor was evidence-based knowledge of patient selection for IUD use. Clinicians who viewed a wide range of patients as IUD candidates were twice as likely to have recommended the copper IUD for emergency contraception. Although more than 93% of obstetrician-gynecologists were skilled in inserting the copper IUD, they were no more likely to have recommended it for emergency contraception than other physicians or advance practice clinicians. Recommendation of the copper IUD for emergency contraception is rare, despite its high efficacy and long-lasting contraceptive benefits. Recommendation would require clinic flow and scheduling adjustments to allow same-day IUD insertions. Patient-centered and high-quality care for emergency contraception should include a discussion of the most effective method. III.

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.

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

-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

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

-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

Recasting image of contraceptives.

PubMed

Rimon Jg; Kiragu, K

1993-03-01

Even though contraceptives are linked to sex which, along with sensuality and peer acceptance, is used to market consumer goods, contraceptives are promoted in a hygienic, clinical way. Glamorous images which divert from adverse health effects are used to sell unhealthy goods, e.g., alcohol and cigarettes, but technical and intimidating promotion techniques centering on risks are used to promote family planning (FP) products and services which actually save the lives of mothers and children and improve their health. Until recently, only the medical system provided FP products and services so consumers identified them with illness and a help-seeking behavior. The image of contraceptives must be remolded to gain people's attention. To avoid instilling mistrust of a method in consumers, even those who believe in birth spacing, it is important for images to be positive and to reflect accurate information. In Indonesia, the Dualima condom has been linked to responsible fatherhood thereby creating a positive image and removing the negative image of a condom being linked to illicit sex. In the US, condom adds show the user in control, especially in reference to AIDS. Prior to promotion of any contraceptive, complete, clear communication and marketing plans are needed to identify and to focus on consumers' perceived needs. A survey in Egypt shows that the most important attributes of a contraceptive are ease of use, healthiness, and effectiveness and that Egyptians considered IUDs to best fit these attributes. Images of contraceptive users often determine whether potential users do choose to use contraceptives. For example, in Cameroon and the Philippines, female users are considered to be smart, rich, educated, confident and in control of their lives. In the Philippines, male users are perceived to be loving, caring, and considerate husbands. The mass medias can improve providers' public image as was the case in Turkey and Egypt.

Permanency analysis on human electroencephalogram signals for pervasive Brain-Computer Interface systems.

PubMed

Sadeghi, Koosha; Junghyo Lee; Banerjee, Ayan; Sohankar, Javad; Gupta, Sandeep K S

2017-07-01

Brain-Computer Interface (BCI) systems use some permanent features of brain signals to recognize their corresponding cognitive states with high accuracy. However, these features are not perfectly permanent, and BCI system should be continuously trained over time, which is tedious and time consuming. Thus, analyzing the permanency of signal features is essential in determining how often to repeat training. In this paper, we monitor electroencephalogram (EEG) signals, and analyze their behavior through continuous and relatively long period of time. In our experiment, we record EEG signals corresponding to rest state (eyes open and closed) from one subject everyday, for three and a half months. The results show that signal features such as auto-regression coefficients remain permanent through time, while others such as power spectral density specifically in 5-7 Hz frequency band are not permanent. In addition, eyes open EEG data shows more permanency than eyes closed data.

Sexual and Contraceptive Behaviors among Adolescents Requesting Emergency Contraception.

PubMed

Cwiak, Carrie; Howard, Brandon; Hsieh, Jennifer; Ricciotti, Nancy; Sucato, Gina S

2016-12-01

Unintended pregnancy rates in the United States remain high among adolescents. Emergency contraception (EC) provides the only option for pregnancy prevention after unprotected sex. To better define the population of adolescents who request and use EC pills, we performed a post hoc analysis of an over-the-counter simulation study of EC pills. Teen reproductive health clinics in 5 cities. Adolescents between the ages of 13 and 17 years who requested EC. Single-tablet levonorgestrel 1.5 mg. We calculated the correlations between age and baseline sexual and contraceptive behaviors. χ 2 Tests were used to compare behaviors of first-time and repeat EC users. Overall, the most commonly reported contraceptive methods ever used were condoms, oral contraceptives, none, and withdrawal; the most common method ever used in each age group was no method for 13- to 14-year-olds and condom for 15-, 16-, and 17-year-olds. The percentage of participants who had never used contraception before requesting EC decreased with age (53% [20/28] of 13- to 14-year-olds vs 15% [10/65] of 17-year-olds). First-time EC users were more likely to report no previous contraceptive use compared with repeat EC users (42% [88/208] vs 10% [13/135]; P < .001). Regardless of age, the most commonly reported reason for requesting EC was nonuse of any contraceptive method (ie, "unprotected sex"). Adolescents who requested EC most commonly reported ever-use of contraceptive methods that rely on user adherence or no method at all, with younger adolescents more likely than older adolescents to have used no previous method. The provision of EC presents an opportunity to provide education and access to highly effective, long-term contraceptive methods. Copyright © 2016 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

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.

Emergency Contraception Website

MedlinePlus

Text Only Full media Version Get Emergency Contraception NOW INFO about Emergency Contraception Q&A about Emergency Contraception Español | Arabic Find a Morning After Pill Provider Near You This website is ...

'Stratified Contraception': Emergency Contraceptive Pills and Women's Differential Experiences in Contemporary India.

PubMed

Sheoran, Nayantara

2015-01-01

Available without prescriptions in India since 2005, emergency contraceptive pills (ECPs) and their advertisements have provided women with increased contraceptive options and a vocabulary to talk about their reproductive lives. I draw on long-term fieldwork with women in urban India about ECPs, demonstrating a new form of 'stratified contraception' enabled by these pills and their advertisements. I posit that there are within India spaces that replicate the luxuries and privileges of the global North. These material conditions, I suggest, are replicated when it comes to contraception as there are hubs of women consumers of contraception and contraceptive advertising that participate in an 'imagined cosmopolitanism' within the global South in close proximity to 'contraceptive ghettos.' Moving beyond simplistic binaries, I outline three major stratifications along which women experience this medical technology and outline the implications for women and their contraceptive choices when notions of northern privilege exist in the 'South.'

[Contraception and adolescence].

PubMed

Amate, P; Luton, D; Davitian, C

2013-06-01

The mean age of first sexual intercourse is still around 17 in France, but a lot of teenagers are concerned by contraception before, with approximately 25% of sexually active 15-year-old girls. The contraceptive method must take into consideration some typical features of this population, as sporadic and non-planned sexual activity, with several sexual partners in a short period of time. In 2004, the "Haute Autorité de santé" has recommended, as first-line method, combined oral contraceptive (COC) pills, in association with male condoms. Copper-containing intrauterine contraceptive devices (IUCD) and etonogestrel-containing subcutaneous implant have been suggested but not recommended. However, oral contraceptive pill, as a user-based method, carries an important typical-use failure rate, because remembering taking a daily pill, and dealing with stop periods, may be challenging. Some easier-to-use method should be kept in mind, as 28-day COC packs, transdermal contraceptive patches, and vaginal contraceptive rings. Moreover, American studies have shown that long-acting reversible contraceptives (LARC), i.e. IUCD and implant, have many advantages for teenagers: very effective, safe, invisible. They seem well-fitted for this population, with high satisfaction and continuation rates, as long as side effects are well explained. Thus, LARC methods should be proposed more widely to teenagers. Anyway, before prescribing a contraceptive method, it is important to determine the specific situation of every teenager, to let them choose the method that they consider as appropriate in their own case, and to think about the availability of the chosen method. It is necessary to explain how to handle mistakes or misses with user-based contraceptive methods, and emergency contraception can be anticipated and prescribed in advanced provision. The use of male condoms should be encouraged for adolescents, with another effective contraceptive method, in order to reduce the high risk

Update on emergency contraception.

PubMed

Fok, Wing Kay; Blumenthal, Paul D

2016-12-01

Emergency contraception provides a critical and time-sensitive opportunity for women to prevent undesired pregnancy after intercourse. Both access and available options for emergency contraception have changed over the last several years. Emergency contraceptive pills can be less effective in obese women. The maximum achieved serum concentration of levonorgestrel (LNG) is lower in obese women than women of normal BMI, and doubling the dose of LNG (3 mg) increases its concentration maximum, approximating the level in normal BMI women receiving one dose of LNG. Repeated use of both LNG and ulipristal acetate (UPA) is well tolerated. Hormonal contraception can be immediately started following LNG use, but should be delayed for 5 days after UPA use to avoid dampening the efficacy of UPA. The copper intrauterine device (IUD) is the only IUD approved for emergency contraception (and the most effective method of emergency contraception), but use of LNG IUD as emergency contraception is currently being investigated. Accurate knowledge about emergency contraception remains low both for patients and healthcare providers. Emergency contraception is an important yet underutilized tool available to women to prevent pregnancy. Current options including copper IUD and emergency contraceptive pills are safe and well tolerated. Significant gaps in knowledge of emergency contraception on both the provider and user level exist, as do barriers to expedient access of emergency contraception.

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/.

The Mayer Hashi Large-Scale Program to Increase Use of Long-Acting Reversible Contraceptives and Permanent Methods in Bangladesh: Explaining the Disappointing Results. An Outcome and Process Evaluation

PubMed Central

Rahman, Mizanur; Haider, M Moinuddin; Curtis, Sian L; Lance, Peter M

2016-01-01

ABSTRACT Background: Bangladesh has achieved a low total fertility rate of 2.3. Two-thirds of currently married women of reproductive age (CMWRA) want to limit fertility, and many women achieve their desired fertility before age 30. The incidence of unintended pregnancy and pregnancy termination is high, however. Long-acting reversible contraceptives (LARCs), consisting of the intrauterine device and implant, and permanent methods (PM), including female sterilization and vasectomy, offer several advantages in this situation, but only 8% of CMWRA or 13% of method users use these methods. Program: The Mayer Hashi (MH) program (2009–2013) aimed to improve access to and the quality of LARC/PM services in 21 of the 64 districts in Bangladesh. It was grounded in the SEED (supply–enabling environment–demand) Programming Model. Supply improvements addressed provider knowledge and skills, system strengthening, and logistics. Creating an enabling environment involved holding workshops with local and community leaders, including religious leaders, to encourage them to help promote demand for LARCs and PMs and overcome cultural barriers. Demand promotion encompassed training of providers in counseling, distribution of behavior change communication materials in the community and in facilities, and community mobilization. Methods: We selected 6 MH program districts and 3 nonprogram districts to evaluate the program. We used a before–after and intervention–comparison design to measure the changes in key contraceptive behavior outcomes, and we used a difference-in-differences (DID) specification with comparison to the nonprogram districts to capture the impact of the program. In addition to the outcome evaluation, we considered intermediate indicators that measured the processes through which the interventions were expected to affect the use of LARCs and PMs. Results: The use of LARCs/PMs among CMWRA increased between 2010 and 2013 in both program (from 5.3% to 7.5%) and

The Mayer Hashi Large-Scale Program to Increase Use of Long-Acting Reversible Contraceptives and Permanent Methods in Bangladesh: Explaining the Disappointing Results. An Outcome and Process Evaluation.

PubMed

Rahman, Mizanur; Haider, M Moinuddin; Curtis, Sian L; Lance, Peter M

2016-08-11

Bangladesh has achieved a low total fertility rate of 2.3. Two-thirds of currently married women of reproductive age (CMWRA) want to limit fertility, and many women achieve their desired fertility before age 30. The incidence of unintended pregnancy and pregnancy termination is high, however. Long-acting reversible contraceptives (LARCs), consisting of the intrauterine device and implant, and permanent methods (PM), including female sterilization and vasectomy, offer several advantages in this situation, but only 8% of CMWRA or 13% of method users use these methods. The Mayer Hashi (MH) program (2009-2013) aimed to improve access to and the quality of LARC/PM services in 21 of the 64 districts in Bangladesh. It was grounded in the SEED (supply-enabling environment-demand) Programming Model. Supply improvements addressed provider knowledge and skills, system strengthening, and logistics. Creating an enabling environment involved holding workshops with local and community leaders, including religious leaders, to encourage them to help promote demand for LARCs and PMs and overcome cultural barriers. Demand promotion encompassed training of providers in counseling, distribution of behavior change communication materials in the community and in facilities, and community mobilization. We selected 6 MH program districts and 3 nonprogram districts to evaluate the program. We used a before-after and intervention-comparison design to measure the changes in key contraceptive behavior outcomes, and we used a difference-in-differences (DID) specification with comparison to the nonprogram districts to capture the impact of the program. In addition to the outcome evaluation, we considered intermediate indicators that measured the processes through which the interventions were expected to affect the use of LARCs and PMs. The use of LARCs/PMs among CMWRA increased between 2010 and 2013 in both program (from 5.3% to 7.5%) and nonprogram (from 5.0% to 8.9%) districts, but the rate of

Contraception and hormonal management in the perimenopause.

PubMed

Long, Margaret E; Faubion, Stephanie S; MacLaughlin, Kathy L; Pruthi, Sandhya; Casey, Petra M

2015-01-01

This literature review focuses on contraception in perimenopausal women. As women age, their fecundity decreases but does not disappear until menopause. After age 40, 75% of pregnancies are unplanned and may result in profound physical and emotional impact. Clinical evaluation must be relied on to diagnose menopause, since hormonal levels fluctuate widely. Until menopause is confirmed, some potential for pregnancy remains; at age 45, women's sterility rate is 55%. Older gravidas experience higher rates of diabetes, hypertension, and death. Many safe and effective contraceptive options are available to perimenopausal women. In addition to preventing an unplanned and higher-risk pregnancy, perimenopausal contraception may improve abnormal uterine bleeding, hot flashes, and menstrual migraines. Long-acting reversible contraceptives, including the levonorgestrel intrauterine system (LNG-IUS), the etonogestrel subdermal implant (ESI), and the copper intrauterine device (Cu-IUD), provide high efficacy without estrogen. LNG-IUS markedly decreases menorrhagia commonly seen in perimenopause. Both ESI and LNG-IUS provide endometrial protection for women using estrogen for vasomotor symptoms. Women without cardiovascular risk factors can safely use combined hormonal contraception. The CDC's Medical Eligibility Criteria for Contraceptive Use informs choices for women with comorbidities. No medical contraindications exist for levonorgestrel emergency-contraceptive pills, though obesity does decrease efficacy. In contrast, the Cu-IUD provides reliable emergency and ongoing contraception regardless of body mass index (BMI).

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.

A retrospective cohort analysis comparing pregnancy rates among HIV-positive women using contraceptives and efavirenz- or nevirapine-based antiretroviral therapy in Kenya

PubMed Central

PATEL, Rena C.; ONONO, Maricianah; GANDHI, Monica; BLAT, Cinthia; HAGEY, Jill; SHADE, Starley B.; VITTINGHOFF, Eric; BUKUSI, Elizabeth A.; NEWMANN, Sara J.; COHEN, Craig R.

2015-01-01

SUMMARY Background Given recent concerns of efavirenz reducing the efficacy of contraceptive implants, we sought to determine if pregnancy rates differ among HIV-positive women using various contraceptive methods and efavirenz- or nevirapine-based antiretroviral therapy (ART) regimens. Methods We conducted a retrospective cohort analysis of HIV-positive women aged 15–45 years enrolled in HIV care facilities in western Kenya from January 2011 to December 2013. Pregnancy was diagnosed clinically and the primary exposure was a combination of contraceptive method and ART regimen. We used Poisson models, adjusting for repeated measures, as well as demographic, behavioral and clinical factors, to compare pregnancy rates among women on different contraceptive/ART combinations. Findings 24,560 women contributed 37,635 years of follow-up with 3,337 incident pregnancies. Among women using implants, adjusted pregnancy incidence for nevirapine- and efavirenz-based ART users were 1·1 (95% CI 0·72–1·5) and 3·3 (95% CI 1·8–4·8) per 100 women-years (w-y), respectively (adjusted incidence rate ratio (aIRR) 3·0, 95% CI 1·3–4·6). Among women using depomedroxyprogesterone acetate (DMPA), adjusted pregnancy incidence for nevirapine- and efavirenz-based ART users were 4·5 (95% CI 3·7–5·2) and 5·4 (95% CI 4·0–6·8) per 100 w-y, respectively (aIRR 1·2, 95% CI 0·91–1·5). Women using other contraceptive methods, except for intrauterine devices and permanent methods, experienced 3·1–4·1 higher rates of pregnancy than women using implants, with 1·6–2·8 higher rates specifically among women using efavirenz-based ART. Interpretation While HIV-positive women using implants on efavirenz-based ART faced three times higher risk of contraceptive failure than those on nevirapine-based ART, these women still experienced lower contraceptive failure rates than women on all other contraceptive methods, except for intrauterine devices and permanent methods

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

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.

Usage patterns and attitudes towards emergency contraception: the International Emergency Contraception Research Initiative.

PubMed

Krassovics, Miklós; Virágh, Gabriella

2016-08-01

The aim of the survey was to gain understanding of women's usage patterns and attitudes towards emergency contraception (i.e., the 'morning after pill') and to gain insight into the role and attitudes of pharmacists as providers of emergency contraception. As part of the International Emergency Contraception Research Initiative, approximately 6500 women (15-49 years) and nearly 500 pharmacists from 14 countries in Western, Central and Eastern Europe, and Central Asia completed questionnaires via web-based interrogation or computer-assisted/paper-assisted personal interviews. Common to almost all countries and cultures was that, while awareness of emergency contraception was high (≥84% of respondents, except in Kazakhstan), usage was generally low (4-18%). In Austria, the Czech Republic, Spain, and the UK, better underlying protection with hormonal contraceptives or male condoms would have meant less need for emergency contraception. In Bulgaria, Lithuania, Romania, and Russia, greater dependence on less reliable contraceptive methods such as calendar + withdrawal was associated with higher use of the emergency contraceptive pill (11-18%) but also with higher abortion rates (19-21%). Overt rejection of emergency contraception in the event of an accident was low, except in countries (e.g., Austria, Poland) where the misperception that it acts as an abortifacient was common. Except for Bulgaria, pharmacists elsewhere tended to have limited knowledge and moralistic attitudes towards emergency contraception. Improved educational efforts, probably country-specific, are required to increase the use of highly effective methods of regular contraception and overcome barriers to acceptance of emergency contraception as a suitable postcoital solution to avoid unwanted pregnancy or abortion.

Emergency contraception

MedlinePlus

Morning-after pill; Postcoital contraception; Birth control - emergency; Plan B; Family planning - emergency contraception ... pregnancy in the same way as regular birth control pills: By preventing or delaying the release of ...

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

Controversies in contraception for women with epilepsy

PubMed Central

Thomas, Sanjeev V.

2015-01-01

Contraception is an important choice that offers autonomy to women with regard to prevention of unintended pregnancies. There is wide variation in the contraceptive practices between continents, countries, and societies. The medical eligibility for contraception for sexually active women with epilepsy (WWE) is determined by the type of anti-epileptic drugs (AEDs) that they use. Enzyme inducing AEDs such as phenobarbitone, phenytoin, carbamazepine, and oxcarbazepine increase the metabolism of orally administered estrogen (and progesterone to a lesser extent). Estrogen can increase the metabolism of certain AEDs, such as lamotrigine, leading to cyclical variation in its blood level with resultant adverse effect profile or seizure dyscontrol. AEDs and sex hormones can increase the risk of osteoporosis and fracture in WWE. The potential interactions between AEDs and hormonal contraception need to be discussed with all women in reproductive age-group. The alternate options of oral contraception such as intrauterine copper device, intrauterine levonorgestrel release system, and supplementary protection with barriers need to be presented to them. World Health Organization has recommended to avoid combination contraceptive pills containing estrogen and progesteron in women who desire contraception and in breastfeeding mothers. Care providers need to consider the option of non-enzyme-inducing AEDs while initiating long-term treatment in adolescent and young WWE. PMID:26425002

Photovoltaic-wind hybrid system for permanent magnet DC motor

NASA Astrophysics Data System (ADS)

Nasir, M. N. M.; Lada, M. Y.; Baharom, M. F.; Jaafar, H. I.; Ramani, A. N.; Sulaima, M. F.

2015-05-01

Hybrid system of Photovoltaic (PV) - Wind turbine (WT) generation has more advantages and reliable compared to PV or wind turbine system alone. The aim of this paper is to model and design hybrid system of PV-WT supplying 100W permanent-magnet dc motor. To achieve the objective, both of PV and WT are connected to converter in order to get the same source of DC supply. Then both sources were combined and straightly connected to 100W permanent magnet dc motor. All the works in this paper is only applied in circuit simulator by using Matlab Simulink. The output produced from each converter is expected to be suit to the motor specification. The output produced from each renewable energy system is as expected to be high as it can support the motor if one of them is breakdown

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.

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.

The Effect of Contraceptive Knowledge Source upon Knowledge Accuracy and Contraceptive Behavior.

ERIC Educational Resources Information Center

Pope, A. J.; And Others

1985-01-01

The purpose of this investigation was to determine the relationship of the source of contraceptive knowledge to contraceptive knowledge accuracy and contraceptive behavior of college freshmen. Results and implications for health educators are discussed. (MT)

Contraceptive use and preferences of young married women in Kerala, India.

PubMed

Thulaseedharan, Jissa Vinoda

2018-01-01

As in other states of India, female sterilization is the most widely used contraceptive method in Kerala where women have higher levels of education compared to most other states in India. This paper describes the use and preferences of contraceptive methods among young married women in Trivandrum district, Kerala, India. A community-based cross-sectional survey was carried out among 203 young married women (18-28 years) during January-March 2015 using multistage cluster sampling method. Statistical analysis was mainly descriptive, and chi-squared test was used to test the statistical significance of the relationship between sociodemographic factors and contraceptive use. The average age at marriage for women was 21.3 years, and 23% of women had more than one child. Current use of any contraceptive methods was 58%. Female sterilization was preferred by 13% and it was significantly higher among women aged 25-28 years than in those aged 18-24 years (20% vs 2.6%, p <0.001). Female sterilization was significantly lower among women with higher levels of education than in women with an education level of plus two or below (5.8% vs 19%, p =0.006). Women were mostly in favor of female sterilization (91%), and a significantly lower proportion of highly educated women preferred female sterilization than women with an education of 12 years or below (85% vs 95.7%, p =0.008). A considerable number of females in the age group 25-28-years opting for sterilization and the unique preference for female sterilization when the family size is complete show the predominant reliance on female sterilization among young women. Higher education delays sterilization in young women due to delayed marriage and childbirth. Women empowerment, proper information and assuring availability and accessibility to different methods can gradually change the dominant preference for female-oriented permanent method of contraception.

Contraceptive counseling for adolescents.

PubMed

Potter, Julia; Santelli, John S

2015-11-01

The majority of adolescents become sexually active during their teenage years, making contraceptive counseling an important aspect of routine adolescent healthcare. However, many healthcare providers express discomfort when it comes to counseling adolescents about contraceptive options. This Special Report highlights the evidence supporting age-appropriate contraceptive counseling for adolescents and focuses on best practices for addressing adolescents' questions and concerns about contraceptive methods.

Transcervical Sterilization: A Comparison of Essure® Permanent Birth Control System and Adiana® Permanent Contraception System

PubMed Central

Palmer, Sophia N; Greenberg, James A

2009-01-01

Transcervical sterilization has moved female sterilization from a minimally invasive laparoscopic technique, which requires entry into the abdominal cavity, to a less invasive hysteroscopic procedure. Along with the decreased potential for complications, its ease of performance with minimal anesthesia has facilitated a move from the operating room to the office. This review compares the available data on transcervical sterilization procedures to better understand the strengths and weakness of each system. PMID:19609402

Adherence to hormonal contraception among women veterans: differences by race/ethnicity and contraceptive supply.

PubMed

Borrero, Sonya; Zhao, Xinhua; Mor, Maria K; Schwarz, Eleanor B; Good, Chester B; Gellad, Walid F

2013-08-01

The objective of the study was to assess the adherence to hormonal contraception (pill, patch, ring, or injectable) among women veterans and examine the relationships between race/ethnicity and the months of contraceptive supply dispensed with contraceptive adherence. We conducted a retrospective analysis of the Department of Veterans Affairs (VA) national databases to examine the adherence to hormonal contraception over 12 months among women aged 18-45 years who had hormonal contraceptive coverage during the first week of fiscal year 2008. We examined several adherence indicators including gaps between refills and months of contraceptive coverage. Descriptive statistics and multivariable models were used to examine the associations between race/ethnicity and contraceptive supply dispensed with adherence. Our cohort included 6946 women: 47% were white, 6% were Hispanic, 22% were black, and 25% were other race or had missing race information. Most women (83%) received a 3 month supply of contraception at each fill. More than 64% of women had at least 1 gap in coverage of 7 days or longer. Only 22% of women received a full 12 months of contraception without any gaps (perfect adherence). Compared with whites, Hispanics were significantly more likely to experience gaps (64% vs 70%; P = .02), and Hispanics and blacks received fewer months of contraceptive coverage (9.3 vs 8.9 and 9.0, P < .001). Compared with women receiving 3 month supplies, those receiving 1 month supplies had a higher likelihood of a gap (63% vs 72%, P < .001), fewer months of coverage (9.3 vs 6.9, P < .001), and a lower likelihood of perfect adherence (22% vs 11%, P < .001). Adherence to hormonal contraception among women veterans is poor. Efforts to improve contraceptive adherence and lower risk of unintended pregnancy are needed; dispensing more months of supply for hormonal contraception may be a promising strategy. Copyright © 2013 Mosby, Inc. All rights reserved.

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.

Contraceptive development: why the snail's pace?

PubMed

Kaeser, L

1990-01-01

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.

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.

Assessing systemic barriers to permanency achievement for children in out-of-home care: development of the child permanency barriers scale.

PubMed

Murphy, April L; Van Zyl, Riaan; Collins-Camargo, Crystal; Sullivan, Dana

2012-01-01

State and local child welfare agencies are engaged in multiple efforts to enact systems change to improve outcomes, particularly in regard to achievement of child permanency. The Child and Family Services Review process, conducted by the Administration Children and Families, requires states to implement program improvement plans designed to improve outcomes for which they are not meeting national standards. However, a tool has not been demonstrated as useful in assessing the barriers to achievement of permanency across the out-of-home service continuum, from recruitment of families to placement stability. This article reports on the development and refinement of such a tool in one Midwestern state. The Child Permanency Barriers Scale has four factors: kinship, placement and matching, adequate services and resources, and communication and collaboration. Implications for use in state-specific and multisystem assessment and system reform are discussed.

Post-coital contraception.

PubMed

Ashton, J R; Chambers, J; Hall, D J

1984-03-01

137,000 British women chose to have an abortion in 1981 and about 25% were teenagers. A recent estimate noted that 10% of unintended pregnancies could have been avoided if postcoital contraception had been obtainable. The availability of postcoital contraception is limited and few doctors have much knowledge of or interest in this contraceptive method. 2 questions that arise are why have doctors been so slow to adopt this effective method of birth control and what are the chances of its availability in the National Health Service (NHS) improving. Postcoital contraception is a comparatively new and until recently unpublicized fertility control method, and there was little knowledge of it among the general population or the medical profession. Doctors' ignorance and reluctance to provide the method may have been due in part to the fact that the pharmaceutical firms have been hesitant to recommend oral contraceptive (OC) pills for this use. There is no specially packaged product, and it is necessary for a patient to be given 4 pills from a 21-pill pack. This has meant that the method has not been advertized, as most new methods would be, in the medical magazines. Hopefully, this lack of knowledge has been rectified by the Family Planning Association. As part of its campaign to launch the method, it has sent details to all general practitioners. Attitudes to postcoital contraception are important, and clearly there are strong parallels with the abortion issues and legal and moral undercurrents as well. Many doctors might have been put off providing postcoital contraception by the experience of the 2 clinics (BPAS in Sheffield and the Caithorpe Nursing Home in Birmingham) which had been reported by Life, an antiabortion pressure group, to the Director of Public Prosecutions under the Offences Against the Persons Act 1863. But on May 10, 1983 the Attorney General announced that the provisionof postcoital contraception is not a criminal offense. This statement may not be

An update on emergency contraception.

PubMed

Bosworth, Michele C; Olusola, Patti L; Low, Sarah B

2014-04-01

Emergency contraception decreases the risk of unintended pregnancy after unprotected sexual intercourse or after suspected failure of routine contraception (e.g., a condom breaking). Oral methods include combined contraceptive pills (i.e., Yuzpe method), single- or split-dose levonorgestrel, and ulipristal. The Yuzpe method and levonorgestrel are U.S. Food and Drug Administration-approved for use 72 hours postcoitus, whereas the newest method, ulipristal, is approved for up to 120 hours postcoitus. The copper intrauterine device may be used as emergency contraception up to seven days after unprotected intercourse. It is nonhormonal and has the added benefit of long-term contraception. Advanced provision of emergency contraception may be useful for all patients, and for persons using ulipristal because it is available only by prescription. Physicians should counsel patients on the use and effectiveness of emergency contraception, the methods available, and the benefits of routine and consistent contraception use.

The 1998 Canadian Contraception Study.

ERIC Educational Resources Information Center

Fisher, William A.; Boroditsky, Richard; Bridges, Martha L.

1999-01-01

Describes the 1998 Canadian Contraception Study, a mailed survey which asked women about contraceptive practices past, present, and future (including use of oral contraceptives, condoms, and sterilization); familiarity with and opinion about different contraception methods; and general sexual and reproductive health. The paper also examines…

Does an expansion in private sector contraceptive supply increase inequality in modern contraceptive use?

PubMed

Agha, Sohail; Do, Mai

2008-11-01

To determine whether an expansion in private sector contraceptive supply is associated with increased socio-economic inequality in the modern contraceptive prevalence rate (MCPR inequality). Multiple rounds of Demographic and Health Surveys data were analysed for five countries that experienced an increase in the private sector supply of contraceptives: Morocco, Indonesia, Kenya, Ghana and Bangladesh. Information on household assets and amenities was used to construct wealth quintiles. A concentration index, which calculates the degree of inequality in contraceptive use by wealth, was calculated for each survey round. Socio-economic inequality in the MCPR (MCPR inequality) declined in Morocco and Indonesia, where substantial expansion in private sector contraceptive supply occurred. In both countries, poor women continued to rely heavily on contraceptives supplied by the public sector even as they increased use of contraceptives obtained from the private sector. A marginally significant decline in MCPR inequality occurred in Bangladesh, where the increase in private sector supply was modest. There was no significant overall change in MCPR inequality in Kenya or Ghana. In Kenya, this lack of significant overall change disguised trends moving in opposite directions in urban and rural areas. In urban Kenya, MCPR inequality declined as low-income urban women increased use of contraceptives obtained primarily from the public sector. In rural Kenya, MCPR inequality increased. This increase was associated with a decline in the supply of contraceptives by the public sector and non-governmental organizations to the poorest, rural, women. The study found no support for the hypothesis that an increase in private sector contraceptive supply leads to higher MCPR inequality. The findings suggest that continued public sector supply of contraceptives to the poorest women protects against increased MCPR inequality. The study highlights the role of the public sector in building

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.

[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

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.

Pipeline for Contraceptive Development

PubMed Central

Blithe, Diana L.

2016-01-01

The high rates of unplanned pregnancy reflect 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 with regard to safety for women who have contraindications to effective contraceptive methods but want to protect against pregnancy. It also will address a huge unmet need for men who want to control their fertility. Products under development for men would not introduce eco-toxic hormones in the waste water. Investment in contraceptive research to identify new products for women has been limited in the pharmaceutical industry relative to investment in drug development for other indications. Pharmaceutical R&D for male contraception was active in the 1990’s but was abandoned over a decade ago. The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) has supported a contraceptive development program since 1969. Through a variety of programs including research grants and contracts, NICHD has developed a pipeline of new targets/products for male and female contraception. A number of lead candidates are under evaluation in the NICHD Contraceptive Clinical Trials Network (CCTN) (1–3). PMID:27523300

[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.

Obesity and hormonal contraceptive efficacy.

PubMed

Robinson, Jennifer A; Burke, Anne E

2013-09-01

Obesity is a major public health concern affecting an increasing proportion of reproductive-aged women. Avoiding unintended pregnancy is of major importance, given the increased risks associated with pregnancy, but obesity may affect the efficacy of hormonal contraceptives by altering how these drugs are absorbed, distributed, metabolized or eliminated. Limited data suggest that long-acting, reversible contraceptives maintain excellent efficacy in obese women. Some studies demonstrating altered pharmacokinetic parameters and increased failure rates with combined oral contraceptives, the contraceptive patch and emergency contraceptive pills suggest decreased efficacy of these methods. It is unclear whether bariatric surgery affects hormonal contraceptive efficacy. Obese women should be offered the full range of contraceptive options, with counseling that balances the risks and benefits of each method, including the risk of unintended pregnancy.

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

Contraceptive needs of the adolescent.

PubMed

Steyn, Petrus S; Goldstuck, Norman D

2014-08-01

The provision of contraception to adolescents requires specific attention. Adolescents require contraceptive methods which are safe, effective and simple to use. While long-acting reversible contraceptive methods are preferable, they should have a choice and not be forced or mandated especially in situations where this may compromise safety. After counselling they should have the ability to choose any method of contraception. Under the appropriate circumstances, each method of contraception may have a place. This chapter will be devoted to evaluating the most current scientific rationale for the indication for use of each method of contraception in adolescents. Copyright © 2014. Published by Elsevier Ltd.

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.

Predicting high risk births with contraceptive prevalence and contraceptive method-mix in an ecologic analysis.

PubMed

Perin, Jamie; Amouzou, Agbessi; Walker, Neff

2017-11-07

Increased contraceptive use has been associated with a decrease in high parity births, births that occur close together in time, and births to very young or to older women. These types of births are also associated with high risk of under-five mortality. Previous studies have looked at the change in the level of contraception use and the average change in these types of high-risk births. We aim to predict the distribution of births in a specific country when there is a change in the level and method of modern contraception. We used data from full birth histories and modern contraceptive use from 207 nationally representative Demographic and Health Surveys covering 71 countries to describe the distribution of births in each survey based on birth order, preceding birth space, and mother's age at birth. We estimated the ecologic associations between the prevalence and method-mix of modern contraceptives and the proportion of births in each category. Hierarchical modelling was applied to these aggregated cross sectional proportions, so that random effects were estimated for countries with multiple surveys. We use these results to predict the change in type of births associated with scaling up modern contraception in three different scenarios. We observed marked differences between regions, in the absolute rates of contraception, the types of contraceptives in use, and in the distribution of type of birth. Contraceptive method-mix was a significant determinant of proportion of high-risk births, especially for birth spacing, but also for mother's age and parity. Increased use of modern contraceptives is especially predictive of reduced parity and more births with longer preceding space. However, increased contraception alone is not associated with fewer births to women younger than 18 years or a decrease in short-spaced births. Both the level and the type of contraception are important factors in determining the effects of family planning on changes in distribution of

A quality of care issue: appropriate use and efficacy knowledge of five contraceptive methods: views of men and women living in low socioeconomic settlements of Karachi, Pakistan.

PubMed

Fikree, Fariyal F; Saleem, Sarah; Sami, Neelofar

2005-09-01

To assess knowledge regarding availability, affordability, appropriate use and efficacy for five non-permanent contraceptive methods. Married Muslim women and men (500 each) were randomly selected from two low socioeconomic settlements in Karachi, Pakistan. Interviews to assess their knowledge on a range of contraceptive and abortion themes were conducted. Four hundred men and 357 women were selected from this larger sample based on their knowledge of condoms, withdrawal, oral pills, injectables and IUDs. Nearly half of the sampled men (56%) and women (48%) were contraceptive users. Knowledge regarding contraception, a specific method, its availability and affordability was high. Appropriate use knowledge for condoms was 73% among men (users 78%, non-users 60%; p-value < or = 0.001 ) and 5% among women. Efficacy knowledge was generally poor. Low knowledge levels regarding appropriate use and efficacy even among contraceptive users suggests, that quality of family planning services should not be limited to service delivery issues but extend to appropriate use and efficacy knowledge levels among clients.

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…

Pregnancy, contraception and emergency contraception: the language of urban adolescent young women.

PubMed

Mollen, C J; Fernando, M; Hayes, K L; Barg, F K

2012-08-01

We sought to characterize how a group of urban adolescent females understands the domains of pregnancy, contraception, and emergency contraception (EC). We used the research strategy of freelisting as part of an in-depth interview study. Urban adolescent females presenting to a Pediatric Emergency Department. Participants were enrolled using a purposive sampling strategy if they were black, English-speaking females, 15-19 years old, who resided in 1 of 11 zip codes surrounding the hospital. Smith's saliency score. Freelists were analyzed for the entire sample, as well as for subgroups. Thirty adolescents completed the interview. We found that this group of adolescents uses different words to characterize the domains of pregnancy, contraception, and EC. The only overlapping salient term was "abortion," which appeared in the overall lists for pregnancy and EC and in the younger group's list for contraception. In addition, lack of knowledge was cited as an important factor related to contraception. Adolescent patients may not fully understand the concepts of contraception and EC. Providers should consider the potential need to provide an explanation for terms used, and they should consider explicitly differentiating between routine forms of contraception and EC, as well as between EC and abortion. Copyright © 2012 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Pregnancy, Contraception and Emergency Contraception: The Language of Urban Adolescent Young Women

PubMed Central

Mollen, Cynthia J.; Fernando, Melissa; Hayes, Katie L.; Barg, Frances K.

2012-01-01

Study Objective We sought to characterize how a group of urban adolescent females understands the domains of pregnancy, contraception and emergency contraception (EC). Design We utilized the research strategy of freelisting as part of an in-depth interview study. Setting and Participants Urban adolescent females presenting to a Pediatric Emergency Department. Participants were enrolled using a purposive sampling strategy if they were Black, English-speaking females ages 15 through 19 years old who resided in one of 11 zip codes surrounding the hospital. Main Outcome Measure Smith’s saliency score. Freelists were analyzed for the entire sample as well as for subgroups. Results Thirty adolescents completed the interview. We found that this group of adolescents uses different words to characterize the domains of pregnancy, contraception and EC. The only overlapping salient term was “abortion,” which appeared in the overall lists for pregnancy and EC and in the younger group’s list for contraception. In addition, lack of knowledge was cited as an important factor related to contraception. Conclusions Adolescent patients may not understand the concepts of contraception and EC fully. Providers should consider the potential need to provide an explanation for terms used, and should consider explicitly differentiating between routine forms of contraception and EC, as well as between EC and abortion. PMID:22840933

Contraception and the obese woman

PubMed Central

Reifsnider, Elizabeth; Mendias, Nonie; Davila, Yolanda; Babendure, Jennie Bever

2016-01-01

Purpose Obesity has reached epidemic rates among U.S. women of reproductive age, many of whom want to use contraception. However, some forms of contraception can have adverse effects on an obese woman's health. This article explores risks of contraception available in the United States and provides clinical recommendations for use by obese women. Data sources Information was compiled by reviewing the scientific literature on contraception and female obesity using CINAHL, MEDLINE, PubMed search engines. Conclusions The evidence is largely supportive of combined oral contraceptive (COC) use in carefully screened obese women without known risks factors for cardiovascular disease. The efficacy of COCs may be slightly reduced in obese women because of increased body mass. Other types of hormonal contraceptives have varying safety and efficacy reports when used by obese women. Intrauterine devices do not have reduced efficacy nor increased risks for obese women but insertion may be more difficult. Obesity has no effect on efficacy of barrier methods of contraception. Implications Clinicians should conduct a careful history and physical exam with selected supporting laboratory tests when considering prescription of hormonal contraceptives for obese women. Obese women require health counseling to carefully follow directions for contraceptive use to avoid unintended pregnancy. PMID:24170564

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…

Postpartum adolescents' contraceptive counselling preferences.

PubMed

Sober, Stephanie; Shea, Judy A; Shaber, Allison G; Whittaker, Paul G; Schreiber, Courtney A

2017-04-01

The optimal approach for provision and timing of postpartum contraceptive counselling for adolescents has not been established. To reduce repeat pregnancies from current USA levels of nearly 20%, a better understanding is needed of postpartum adolescent females' preferences regarding contraceptive counselling and delivery. Semi-structured interviews with 30 USA postpartum teens (97% Black) explored pregnancy prevention and contraceptive counselling. Transcripts were independently coded by two researchers and inter-rater reliability calculated using Kappa coefficients. With a standard content analysis approach, common themes were identified, coded and summarized. Findings indicated pregnancy prevention was important - two thirds of subjects reported becoming pregnant 'too soon', almost all did not desire another child for at least 6 years and most indicated that pregnancy prevention was either 'very' or 'extremely' important right now. The subjects described doctors and their prenatal clinic as their most accurate sources of contraception information, but stated that doctors and parents were the most helpful sources. All were comfortable discussing contraception with providers and had a desire for shared decision making. While many had received written materials, most preferred in-person contraceptive counselling. Optimally, participants suggested that contraceptive counselling would be provided by a physician, begin antepartum and almost all preferred to leave the hospital with their chosen method of contraception. Pregnancy prevention is important for postpartum adolescents as most desired to delay future childbearing. In-person contraceptive counselling should begin in the antepartum period and include provision of contraception prior to discharge.

Communication about Contraception and Knowledge of Oral Contraceptives amongst Norwegian High School Students.

ERIC Educational Resources Information Center

Hansen, Thomas; Skjeldestad, Finn Egil

2003-01-01

Examines communication about contraception and specific knowledge of oral contraceptives (OCs) in a sample of Norwegian high school students. More females than males discussed contraception at least monthly. Discussions were predominantly held with peers and not adults. Females were far more knowledgeable about OCs than males. The most significant…

Permanent Rabi oscillations in coupled exciton-photon systems with PT -symmetry

PubMed Central

Chestnov, Igor Yu.; Demirchyan, Sevak S.; Alodjants, Alexander P.; Rubo, Yuri G.; Kavokin, Alexey V.

2016-01-01

We propose a physical mechanism which enables permanent Rabi oscillations in driven-dissipative condensates of exciton-polaritons in semiconductor microcavities subjected to external magnetic fields. The method is based on stimulated scattering of excitons from the incoherent reservoir. We demonstrate that permanent non-decaying oscillations may appear due to the parity-time symmetry of the coupled exciton-photon system realized in a specific regime of pumping to the exciton state and depletion of the reservoir. At non-zero exciton-photon detuning, robust permanent Rabi oscillations occur with unequal amplitudes of exciton and photon components. Our predictions pave way to realization of integrated circuits based on exciton-polariton Rabi oscillators. PMID:26790534

Permanent Rabi oscillations in coupled exciton-photon systems with PT-symmetry.

PubMed

Chestnov, Igor Yu; Demirchyan, Sevak S; Alodjants, Alexander P; Rubo, Yuri G; Kavokin, Alexey V

2016-01-21

We propose a physical mechanism which enables permanent Rabi oscillations in driven-dissipative condensates of exciton-polaritons in semiconductor microcavities subjected to external magnetic fields. The method is based on stimulated scattering of excitons from the incoherent reservoir. We demonstrate that permanent non-decaying oscillations may appear due to the parity-time symmetry of the coupled exciton-photon system realized in a specific regime of pumping to the exciton state and depletion of the reservoir. At non-zero exciton-photon detuning, robust permanent Rabi oscillations occur with unequal amplitudes of exciton and photon components. Our predictions pave way to realization of integrated circuits based on exciton-polariton Rabi oscillators.

Non-hormonal male contraception: A review and development of an Eppin based contraceptive.

PubMed

O'Rand, Michael G; Silva, Erick J R; Hamil, Katherine G

2016-01-01

Developing a non-hormonal male contraceptive requires identifying and characterizing an appropriate target and demonstrating its essential role in reproduction. Here we review the development of male contraceptive targets and the current therapeutic agents under consideration. In addition, the development of EPPIN as a target for contraception is reviewed. EPPIN is a well characterized surface protein on human spermatozoa that has an essential function in primate reproduction. EPPIN is discussed as an example of target development, testing in non-human primates, and the search for small organic compounds that mimic contraceptive antibodies; binding EPPIN and blocking sperm motility. Although many hurdles remain before the success of a non-hormonal male contraceptive, continued persistence should yield a marketable product. Copyright © 2015 Elsevier Inc. All rights reserved.

Design of permanent magnet synchronous motor speed control system based on SVPWM

NASA Astrophysics Data System (ADS)

Wu, Haibo

2017-04-01

The control system is designed to realize TMS320F28335 based on the permanent magnet synchronous motor speed control system, and put it to quoting all electric of injection molding machine. The system of the control method used SVPWM, through the sampling motor current and rotating transformer position information, realize speed, current double closed loop control. Through the TMS320F28335 hardware floating-point processing core, realize the application for permanent magnet synchronous motor in the floating point arithmetic, to replace the past fixed-point algorithm, and improve the efficiency of the code.

The Brazilian national system of forest permanent plots

Treesearch

Yeda Maria Malheiros de Oliveira; Maria Augusta Doetzer Rosot; Patricia Povoa de Mottos; Joberto Veloso de Freitas; Guilherme Luis Augusto Gomide; < i> et al< /i>

2009-01-01

The Brazilian National System of Forest Permanent Plots (SisPP) is a governmental initiative designed and being implemented in partnership by the Ministry of Environment (MMA), represented by the National Forest Programme (PNF) and the Brazilian Forest Service (SFB) and the Embrapa Forestry (a research center of the Brazilian Agricultural Research Corporation - Embrapa...

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

Contraception for the older woman.

PubMed

Glasier, A; Gebbie, A

1996-04-01

Contraception presents particular problems for women over the age of 40. Although fertility is declining and the risk of pregnancy may be small, the consequences of an unplanned pregnancy may be socially devastating and medically ill-advised. Menstrual dysfunction and psychosexual difficulties increase with age and may exacerbate the side-effects of some methods of contraception. The long-term risks of combined hormonal contraception, particularly cardiovascular disease, become more pertinent to women whose natural risk of disease increases with age. Patterns of sexual activity and contraceptive use change with age. The advantages and disadvantages of currently available methods of contraception are difficult to quantify, and the choice of method is very much a matter for individual concern. The increasing prevalence of HRT may complicate matters for some women who are unsure for how long to continue using contraception. Contraceptives of the future may be designed to improve the reproductive health of all women, particularly those approaching the menopause.

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

Regional differences in unmet need for contraception in Kenya: insights from survey data.

PubMed

Wafula, Sam W

2015-10-14

further births stood at 14.1 % among women residing in high unmet need zones while those in low unmet need zones had 10.5 %. Further analysis based on seemingly unrelated estimation found that in general, a comparison of the coefficients been the high and low unmet need regions were significantly different (p < 0.05). Evidence from the nationally representative KDHS 2008/09 shows that regional differentials in the covariates of unmet need for contraception exist. There is need to address religious inhibitions that stymie contraceptive uptake especially in the high unmet need regions. Efforts should promote maternal education and economically empower women in order to reinforce individual and contextual attitudes towards the benefits of contraception. The government should also establish social franchise programs to increase access to costly long acting and permanent methods of contraception to poor women.

[Emergency contraception with levonorgestrel].

PubMed

Saraví, Fernando D

2007-01-01

Emergency contraception may avoid pregnancy after unprotected intercourse or when regular contraceptive measures fail. Levonorgestrel, a synthetic gestagen, is recommended for emergency contraception as a single 1.5-mg dose or, alternatively, two 0.75-mg doses taken 12 h apart. Its efficacy is moderate, preventing about 80% of pregnancies. Efficacy is higher the earlier after unprotected intercourse the drug is taken, but it may be administered up to 5 days post-coitum. Tolerance is similar to, or better than, those of other oral emergency contraceptives. Adverse effects include nausea, vomiting, headache, breast tenderness and transient alteration of menstrual bleeding pattern. It is not known whether levonogestrel increases the risk of ectopic pregnancy when the treatment fails. Its use as an ongoing contraceptive method is discouraged. When given before the preovulatory LH peak, levonorgestrel blocks or delays ovulation. It may also affect sperm migration in the female reproductive tract and have an effect on fertilization. Although it has been often postulated, there is no evidence for an anti-implantatory effect. Acquaintance with the method is quite variable among different societies, but it remains underutilized even where it is well known. Advance provision of the drug has been proposed as a way to promote its use. In clinical trials, advance provision did not adversely modify sexual or regular contraceptive behavior, but it did not reduce pregnancy or abortion rate either. Therefore, emergency contraception with levonorgestrel should be regarded as a backup method which is not a substitute for the continued use of more effective contraceptive methods.

Permanent-magnet-less synchronous reluctance system

DOEpatents

Hsu, John S

2012-09-11

A permanent magnet-less synchronous system includes a stator that generates a magnetic revolving field when sourced by an alternating current. An uncluttered rotor is disposed within the magnetic revolving field and spaced apart from the stator to form an air gap relative to an axis of rotation. The rotor includes a plurality of rotor pole stacks having an inner periphery biased by single polarity of a north-pole field and a south-pole field, respectively. The outer periphery of each of the rotor pole stacks are biased by an alternating polarity.

About Implantable Contraception

MedlinePlus

... Health Food & Fitness Diseases & Conditions Infections Drugs & Alcohol School & Jobs Sports Expert Answers (Q&A) Staying Safe Videos for Educators Search English Español About Implantable Contraception KidsHealth / For Parents / About Implantable Contraception Print What ...

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

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

The underutilization of emergency contraception.

PubMed

Devine, Kit S

2012-04-01

Despite the availability of effective contraceptive methods, unintended pregnancy continues to be a significant health problem for women throughout the world. The reasons for unplanned pregnancy include failure to use contraception, incorrect use of contraception, unplanned consensual intercourse, and rape. Emergency contraception was once heralded as a means of reducing the rates of unintended pregnancy, elective abortion, and unwanted childbirth. But more than three decades after the first oral form was introduced, the use of emergency contraception remains suboptimal-even in the United States, where it is available to most women of childbearing age without a prescription. Nurses can help narrow this clinical gap in women's health care by increasing awareness of emergency contraception, correcting common misconceptions about its mechanism of action and potential adverse effects, and facilitating patient access.

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

[Arterial diseases in women using combined hormonal contraceptives].

PubMed

Novotná, M; Unzeitig, V; Novotný, T

2002-05-01

To determine the association between myocardial infarction and cerebral stroke and use of combined oral contraceptives. Review of literature. Department of Obstetrics and Gynaecology, Hospital of Merciful Brothers, Brno, Czech Republic. Identification of methodologically sound studies able to address the topic. Studies were identified by Medline database search. Five the most recent and important studies were the main source of information (Oxford Family Planning Association Contraception Study 1984, Royal College of General Practitioners' Study 1994, WHO Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception 1996, 1997, Transnational Study on Oral Contraceptives and the Health of Young Women 1997, Myocardial Infarction and Oral Contraceptives Study, 1997). Generally there was no evidence of a significantly increased risk of arterial wall disease in healthy non smoked users younger than 35 years. No difference between second and third generation oral contraceptives on risk of arterial wall disease were found. In the most of cases of myocardial infarction or stroke one or more risk factor were identified. Two of the most relevant risk factors are smoking and the absence of blood pressure control. The risk of arterial cardiovascular system diseases seems not to be increased at no-risk users (healthy non-smoker younger than 35 years).

Contraceptive Utilisation Among Mothers of Reproductive Age in Ajman, United Arab Emirates

PubMed Central

Kanwal, Naila; Muttappallymyalil, Jayakumary; Al-Sharbatti, Shatha; Ismail, Iman

2017-01-01

Objectives This study aimed to determine contraceptive utilisation among mothers aged 18–49 years old in Ajman, United Arab Emirates (UAE). Methods This cross-sectional study was carried out from May to November 2013. A total of 400 participants were recruited from two primary healthcare centres and one private hospital in Ajman. An interviewer-administered validated questionnaire was used for data collection. Results The frequency of previous and current contraceptive use was 68.0% and 61.8%, respectively. Expatriates more frequently used contraceptives in comparison to Emiratis (77.3% versus 54.3%, respectively). Contraceptive use increased significantly with age (75.5% among >35-year-olds versus 57.3% among ≤25-year-olds; P <0.050) and education level (83.3% among postgraduates versus 60.0% among those with primary education; P <0.050). In addition, contraceptive use was significantly higher among those living in a nuclear family system (P <0.050). A univariate analysis indicated significant associations between contraceptive use and age, nationality, education level, type of family system, employment sector, parity, knowledge of birth control measures and source of birth control information (P <0.050 each). However, no significant associations were found via multivariate analysis. Conclusion Healthcare practitioners can play a pivotal role in providing contraceptive advice which could lead to an improvement in contraceptive utilisation. Efforts are recommended to raise awareness regarding newer forms of contraceptives among mothers of reproductive age in the UAE. PMID:28417029

Contraceptive Utilisation Among Mothers of Reproductive Age in Ajman, United Arab Emirates.

PubMed

Kanwal, Naila; Muttappallymyalil, Jayakumary; Al-Sharbatti, Shatha; Ismail, Iman

2017-02-01

This study aimed to determine contraceptive utilisation among mothers aged 18-49 years old in Ajman, United Arab Emirates (UAE). This cross-sectional study was carried out from May to November 2013. A total of 400 participants were recruited from two primary healthcare centres and one private hospital in Ajman. An interviewer-administered validated questionnaire was used for data collection. The frequency of previous and current contraceptive use was 68.0% and 61.8%, respectively. Expatriates more frequently used contraceptives in comparison to Emiratis (77.3% versus 54.3%, respectively). Contraceptive use increased significantly with age (75.5% among >35-year-olds versus 57.3% among ≤25-year-olds; P <0.050) and education level (83.3% among postgraduates versus 60.0% among those with primary education; P <0.050). In addition, contraceptive use was significantly higher among those living in a nuclear family system ( P <0.050). A univariate analysis indicated significant associations between contraceptive use and age, nationality, education level, type of family system, employment sector, parity, knowledge of birth control measures and source of birth control information ( P <0.050 each). However, no significant associations were found via multivariate analysis. Healthcare practitioners can play a pivotal role in providing contraceptive advice which could lead to an improvement in contraceptive utilisation. Efforts are recommended to raise awareness regarding newer forms of contraceptives among mothers of reproductive age in the UAE.

Contraceptive implants: long acting and provider dependent contraception raises concerns about freedom of choice.

PubMed

Thompson, M S

1996-11-30

David Bromham's editorial on contraceptive implants ignores the wider issues to voice concern that trial by media could limit contraceptive choice by jeopardising research into new methods. However, it is more beneficial to the public for points of conflict to be debated openly. Furthermore, the impetus for research into new contraceptive technology is driven by profit and political motives and is only marginally affected by the media. Implanted contraceptives may increase the choice of contraceptive methods, but they put control of fertility increasingly into the hands of the medical profession. Herein lies their greatest problem: their potential to increase providers' control over clients' choice. There is the danger that certain groups of women may be targeted for their use: in the United States the coercive use of Norplant for mothers receiving welfare benefit has been suggested. Long acting contraceptives are a contraceptive of choice only when they are available without pressure, as part of a wider menu; when instant removal on request is guaranteed; and when there is an open and free flow of information and opinions between users, health professionals, and special interest groups.

Contraceptive method choice and use by married women of reproductive age in two Districts of East Harerge.

PubMed

Dubiwak, Rahel; Seme, Assefa

2014-01-01

Contraceptive method mix and choice is not uniform across all countries. Literatures have shown that a significant variation exists in contraceptive method mix among regions and countries. In Africa most mothers rely on short-term contraceptives such as pills and injectables or traditional methods while in Asia and Latin America permanent methods mainly male and female sterilizations are commonly used. Though long-term methods of contraception are recommended for its effectiveness and efficiencies in countries like Ethiopia where high fertility rate is a concern, its choice and utilization remains low. The main objective of the study was to assess factors influencing contraceptive method choice and use among married women of reproductive age in rural Districts of East Harerge Zone of Oromia Region. A community-based cross-sectional study using both quantitative and qualitative methods was conducted among 473 married women of reproductive age in two rural districts of East Harerge Zone. A systematic random sampling method was used to select the study participants from the list of all married women who have been using contraceptives in the project sites. Data was collected using structured and pretested questionnaires. Data entry and analysis was done using EPI Info version 6.04d and SPSS for Windows version 15, respectively. Frequencies and proportions were used for description while odds ratio with 95% CI was used to determine the strength and significance of association between independent and outcome variables. Multiple logistic regression analysis was used to control confounding variables. A total of 473 currently married women who were using modern contraceptives were interviewed for the survey. About 6 in ten (58.8%) were in the age range of 25-34 years with the mean (+/- SD) age of 29.5 (+/- 5.7) years. About three-fourth (74%) were short-term contraceptive method users while only 26% were long-term contraceptive method users. Duration of family planning use

Prescribing contraception for young women.

PubMed

Skjeldestad, Finn Egil

2012-02-07

Since 2002, specially qualified nursing sisters and midwives have had the right to prescribe contraceptive pills for women aged 16 to 19. This arrangement has since been expanded to cover hormonal contraception, with the exception of the hormonal coil. The purpose of this study is to evaluate the arrangement. The prescription register uses pseudonyms and contains a number of facts about user, medication and prescriber. A database of women born in 1989, totalling 29,821, has been designed as a unit for analysis. 75 and 79% of the cohort had filled at least one prescription for contraceptive pills or hormonal contraception by the end of the calendar year in which they turned 19. Almost 12% had filled at least one prescription for the mini-pill, while far fewer had filled prescriptions for vaginal hormone ring, contraceptive injection, contraceptive patch or hormonal coil. Doctors issued two third of the prescriptions. Nursing sisters wrote more prescriptions than doctors for the age group 17-18. The period of time during which they had been using the contraceptive pill and the mini-pill did not depend on who prescribed them. The fact that close to 80% of the cohort born in 1989 has filled at least one prescription for hormonal contraception shows that there is a high degree of awareness about preventing unplanned pregnancy. Extending the right to write prescriptions to nurses and midwives has increased the availability of contraception, and young women are taking advantage of this option.

Emergency contraception: Focus on the facts.

PubMed

Najera, Deanna Bridge

2016-01-01

Significant progress on contraception, and in particular emergency contraception, has been made in the past decade. Emergency contraception was first introduced as a stand-alone prescription in 1998, and the interaction of politics and medicine meant a tumultuous course to the drug becoming available over the counter. This article reviews how emergency contraception works, the effectiveness of different methods, pros and cons, and the history of emergency contraception.

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.

Strategies for communicating contraceptive effectiveness.

PubMed

Lopez, Laureen M; Steiner, Markus; Grimes, David A; Hilgenberg, Deborah; Schulz, Kenneth F

2013-04-30

Knowledge of contraceptive effectiveness is crucial to making an informed choice. The consumer has to comprehend the pros and cons of the contraceptive methods being considered. Choice may be influenced by understanding the likelihood of pregnancy with each method and factors that influence effectiveness. To review all randomized controlled trials comparing strategies for communicating to consumers the effectiveness of contraceptives in preventing pregnancy. Through February 2013, we searched the computerized databases of MEDLINE, POPLINE, CENTRAL, PsycINFO and CINAHL, ClinicalTrials.gov, and ICTRP. Previous searches also included EMBASE. We also examined references lists of relevant articles. For the initial review, we wrote to known investigators for information about other published or unpublished trials. We included randomized controlled trials that compared methods for communicating contraceptive effectiveness to consumers. The comparison could be usual practice or an alternative to the experimental intervention.Outcome measures were knowledge of contraceptive effectiveness, attitude about contraception or toward any particular contraceptive, and choice or use of contraceptive method. For the initial review, two authors independently extracted the data. One author entered the data into RevMan, and a second author verified accuracy. For the update, an author and a research associate extracted, entered, and checked the data.For dichotomous variables, we calculated the Mantel-Haenszel odds ratio with 95% confidence intervals (CI). For continuous variables, we computed the mean difference (MD) with 95% CI. Seven trials met the inclusion criteria and had a total of 4526 women. Five were multi-site studies. Four trials were conducted in the USA, while Nigeria and Zambia were represented by one study each, and one trial was done in both Jamaica and India.Two trials provided multiple sessions for participants. In one study that examined contraceptive choice, women in

Injectable contraception. New and existing options.

PubMed

Kaunitz, A M

2000-12-01

DMPA and MPA/E2C contraception offer women safe, effective, convenient, and reversible birth control choices. The use of DMPA, a 3-month injectable, is characteristically associated with amenorrhea. Lactating women and women in whom contraceptive doses of estrogen are contraindicated can use this progestin-only birth control method. Return of fertility can be delayed in women discontinuing DMPA to become pregnant. In some cases, the use of DMPA also confers important noncontraceptive and therapeutic benefits. A monthly estrogen/progestin injectable contraceptive, MPA/E2C should appeal to women who are concerned about daily pill taking, who prefer regular cycles to amenorrhea, and who find monthly injections acceptable and accessible. As is true for oral contraceptives, MPA/E2C represents an appropriate choice for women who prefer a rapidly reversible contraceptive. Currently, the proposed contraindications for MPA/E2C parallel those for combined oral contraceptives. As MPA/E2C contraception becomes available for American women, clinicians will learn how to best include this new method among the array of contraceptive choices. By individualizing contraceptive selection, counseling, and management approaches based on the relevant behavioral and medical considerations reviewed herein, clinicians can maximize their patients' success with injectable contraceptives. The more innovative that clinicians, family planning agencies, and insurers are in facilitating access to care (including reinjections), the more women will be able to avail themselves of safe, effective, and reversible methods of contraception. In addition to the physician's office or health clinic, other sites at which women might receive contraceptive injections include employee health clinics, college health clinics, or perhaps the pharmacy where the prescription is filled. Self-administration may become an appropriate option for some users of injectable contraception.

Reasons for discontinuation of reversible contraceptive methods by women with epilepsy.

PubMed

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

2017-05-01

To report the reasons for discontinuation of contraceptive methods by women with epilepsy (WWE). These retrospective data come from a web-based survey regarding the contraceptive practices of 1,144 WWE in the community, ages 18-47 years. We determined the frequencies of contraceptive discontinuations and the reasons for discontinuation. We compared risk ratios for rates of discontinuation among contraceptive methods and categories. We used chi-square analysis to test the independence of discontinuation reasons among the various contraceptive methods and categories and when stratified by antiepileptic drug (AED) categories. Nine hundred fifty-nine of 2,393 (40.6%) individual, reversible contraceptive methods were discontinued. One-half (51.8%) of the WWE who discontinued a method discontinued at least two methods. Hormonal contraception was discontinued most often (553/1,091, 50.7%) with a risk ratio of 1.94 (1.54-2.45, p < 0.0001) compared to intrauterine devices (IUDs), the category that was discontinued the least (57/227, 25.1%). Among all individual methods, the contraceptive patch was stopped most often (79.7%) and the progestin-IUD was stopped the least (20.1%). The top three reasons for discontinuation among all methods were reliability concerns (13.9%), menstrual problems (13.5%), and increased seizures (8.6%). There were significant differences among discontinuation rates and reasons when stratified by AED category for hormonal contraception but not for any other contraceptive category. Contraception counseling for WWE should consider the special experience profiles that are unique to this special population on systemic hormonal contraception. Wiley Periodicals, Inc. © 2017 International League Against Epilepsy.

Evaluation of quality of life and sexual functioning of women using levonorgestrel-releasing intrauterine contraceptive system--Mirena.

PubMed

Skrzypulec, Violetta; Drosdzol, Agnieszka

2008-12-01

The advantages ensuing from the high contraceptive efficacy, positive effect on the parameters of the menstrual cycle as well as other values of the levonorgestrel-releasing intrauterine system may play an important role in women's sexual life. The aim of the study was to evaluate the effect of the levonorgestrel-releasing intrauterine system on the quality of life and sexual functioning of women. The research encompassed 200 women aged between 30 and 45. 52 women using the levonorgestrel-releasing intrauterine system were qualified to the study as the research group (Mirena Group). The control groups consisted of 48 women using a different type of intrauterine device (Control Group I--Other IUD) and 50 women using no contraception (Control Group II). A specific questionnaire with a general part concerning socio-demographic conditions, a part dealing with contraception and Polish version of self-evaluation inventories: Short Form-36 Health Survey, Female Sexual Function Index and Mell-Krat Scale was used as a research tool. Quality of life parameters for women using the Mirena system were higher than for the control groups, especially in the aspect of general health, energy/fatigue and emotional well-being. A significant beneficial effect of the levonorgestrel-releasing intrauterine system on sexual functioning (sexual desire and arousal) was also revealed in the study. Sexual dysfunctions were diagnosed in 20.8% of Other IUD, 34.7% of Control Group II and 9.6% of Mirena Group. Levonorgestrel-releasing intrauterine system increases female quality of life and sexual functioning parameters.

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

Theory-based interventions for contraception.

PubMed

Lopez, Laureen M; Tolley, Elizabeth E; Grimes, David A; Chen-Mok, Mario

2011-03-16

The explicit use of theory in research helps expand the knowledge base. Theories and models have been used extensively in HIV-prevention research and in interventions for preventing sexually transmitted infections (STIs). The health behavior field uses many theories or models of change. However, educational interventions addressing contraception often have no stated theoretical base. Review randomized controlled trials (RCTs) that tested a theoretical approach to inform contraceptive choice; encourage contraceptive use; or promote adherence to, or continuation of, a contraceptive regimen. We searched computerized databases for trials that tested a theory-based intervention for improving contraceptive use (MEDLINE, POPLINE, CENTRAL, PsycINFO, EMBASE, ClinicalTrials.gov, and ICTRP). We also wrote to researchers to find other trials. Trials tested a theory-based intervention for improving contraceptive use. We excluded trials focused on high-risk groups and preventing sexually transmitted infections or HIV. Interventions addressed the use of one or more contraceptive methods for contraception. The reports provided evidence that the intervention was based on a specific theory or model. The primary outcomes were pregnancy, contraceptive choice, initiating or changing contraceptive use, contraceptive regimen adherence, and contraception continuation. The primary author evaluated abstracts for eligibility. Two authors extracted data from included studies. We calculated the odds ratio for dichotomous outcomes. No meta-analysis was conducted due to intervention differences. Fourteen RCTs met our inclusion criteria. In 2 of 10 trials with pregnancy or birth data, a theory-based group showed better results. Four of 10 trials with contraceptive use data (other than condoms) showed better outcomes in an experimental group. For condom use, a theory-based group had favorable results in three of eight trials. Social Cognitive Theory was the main theoretical basis for five trials

Theory-based interventions for contraception.

PubMed

Lopez, Laureen M; Tolley, Elizabeth E; Grimes, David A; Chen-Mok, Mario

2009-01-21

The explicit use of theory in research helps expand the knowledge base. Theories and models have been used extensively in HIV-prevention research and in interventions for preventing sexually transmitted infections (STIs). The health behavior field uses many theories or models of change. However, educational interventions addressing contraception often have no stated theoretical base. Review randomized controlled trials that tested a theoretical approach to inform contraceptive choice; encourage contraceptive use; or promote adherence to, or continuation of, a contraceptive regimen. We searched computerized databases for trials that tested a theory-based intervention for improving contraceptive use (MEDLINE, POPLINE, CENTRAL, PsycINFO, EMBASE, ClinicalTrials.gov, and ICTRP). We also wrote to researchers to find other trials. Trials tested a theory-based intervention for improving contraceptive use. We excluded trials focused on high-risk groups. Interventions addressed the use of one or more contraceptive methods. The reports provided evidence that the intervention was based on a specific theory or model. The primary outcomes were pregnancy, contraceptive choice, initiating or changing contraceptive use, contraceptive regimen adherence, and contraception continuation. The primary author evaluated abstracts for eligibility. Two authors extracted data from included studies. We calculated the odds ratio for dichotomous outcomes and the mean difference for continuous data. No meta-analysis was conducted due to intervention differences. Of 26 trials, 12 interventions addressed contraception (other than condoms), while 14 focused on condom use for preventing HIV or STIs. In 2 of 10 trials with pregnancy or birth data, a theory-based group showed better results. Four of nine trials with contraceptive use (other than condoms) showed better outcomes in an experimental group. For condom use, a theory-based group had favorable results in 14 of 20 trials, but the number was

When can a woman resume or initiate contraception after taking emergency contraceptive pills? A systematic review.

PubMed

Salcedo, Jennifer; Rodriguez, Maria I; Curtis, Kathryn M; Kapp, Nathalie

2013-05-01

Hormonal emergency contraception can postpone ovulation, making a woman vulnerable to pregnancy later in the same cycle. However, concern exists as to whether concurrently administered emergency contraception pills (ECP) and other hormonal methods of contraception may affect the effectiveness of both medications. A systematic review of the literature using PubMed and the Cochrane databases was performed to identify articles concerning the resumption or initiation of regular contraception within the same cycle as ECP use. We searched for articles in any language, published between 1980 and April 2012 and included all methods of emergency contraception pills available in the USA. The search strategy identified 184 articles in the PubMed and Cochrane databases, of which none met inclusion criteria. The drug manufacturer advises continuation or initiation of routine contraception as soon as possible after use of ulipristal acetate, with concomitant use of a reliable barrier method until next menses. However, a theoretical concern exists that given ulipristal acetate's function as a selective progesterone receptor modulator, coadministration of a progestin could decrease its effectiveness as an emergency contraceptive. Initiation of hormonal contraception following levonorgestrel or the Yuzpe regimen for emergency contraception carries no similar concern for decreased method effectiveness. Copyright © 2013 Elsevier Inc. All rights reserved.

Emergency contraceptive use in Addis Ababa, Ethiopia: Challenging common assumptions about young people's contraceptive practices.

PubMed

Both, Rosalijn

2015-05-01

Drawing on an ethnographic case study of young people's (aged 18-29) use of emergency contraceptives (ECs) in Addis Ababa, Ethiopia, this article highlights areas of disconnect between how reproductive health experts envision EC use and local meanings ascribed to ECs by young people. ECs - designed by reproductive health experts to be used only in case of emergency - were preferred by study participants over other contraceptive methods because of their ease of use, discreetness, perceived minimal side effects on beauty and future fertility, and usefulness in navigating reproductive intentions. The findings point to features that young people find desirable when it comes to contraceptive methods and suggest that common assumptions of reproductive health experts about young people's contraceptive practices need to be reconsidered, namely: 1) that young people can plan for prevention of unwanted pregnancy by buying a contraceptive method in advance; 2) that existing contraceptive technologies are appropriate for young people; 3) that young people prefer to use modern contraceptive methods; and 4) that young people in premarital relationships aim to prevent unplanned pregnancy. Copyright © 2015. Published by Elsevier Ltd.

Contraceptive efficacy of the personal hormone monitoring system Persona.

PubMed

Trussell, J

1999-07-01

This is a commentary on the contraceptive effectiveness of the personal hormone-monitoring system Persona; it points out the various errors committed in computing method pregnancy rates. The modifications presented by Bonnar et al. on the incorrect procedure for computing method pregnancy rates are criticized as erroneous because the denominator includes cycles in which there is no risk of a method pregnancy according to the authors' algorithm for classifying pregnancy in an imperfect-use cycle. It is also claimed that the new exercise is a more complicated and less accurate way of computing for pregnancy rates by comparison with the simpler alternative. Since this new algorithm, used in the Persona system, is based on flawed logic, the annual risk of pregnancy is actually higher than the estimated 6% among women using Persona and having intercourse in each cycle except on red days.

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

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.

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.

Contraceptives: choice for the millions?

PubMed

Dhall, A

1994-06-01

India adds each year the population of Sub-Saharan Africa to the earth. User based factors determining the type of contraceptive that is used most often in a country are sociocultural practices including religion, literacy, women's status and their role in decision making, men's status, misconceptions, and convenience of use. Service related factors include knowledge and skill of the provider, attitude of the provider, accessibility of family planning services, cost of the contraceptives, and quality of services. The government, nongovernmental organizations, and the pharmaceutical firms tend to be the contraceptive researchers and suppliers. The mass media are used to disseminate information on contraceptives. They often relay sensational reports about a contraceptive method that results in its reduced use. Temporary or spacing family planning methods include natural family planning methods, condoms, IUDs, oral contraceptives, implants, and injectables, spermicides and vaginal barriers. The natural family planning methods are sexual abstinence, especially in the postpartum period; rhythm or calendar method; and coitus interruptus. The most cost-effective method is also the most popular method--sexual sterilization. Even though female sterilization is more difficult to perform than vasectomy, it is more common than vasectomy. Contraception should become a people's movement rather than be forced upon the people. People should insist on good quality, affordable contraceptive services as their basic right.

Contemporary Hormonal Contraception and the Risk of Breast Cancer.

PubMed

Mørch, Lina S; Skovlund, Charlotte W; Hannaford, Philip C; Iversen, Lisa; Fielding, Shona; Lidegaard, Øjvind

2017-12-07

Little is known about whether contemporary hormonal contraception is associated with an increased risk of breast cancer. We assessed associations between the use of hormonal contraception and the risk of invasive breast cancer in a nationwide prospective cohort study involving all women in Denmark between 15 and 49 years of age who had not had cancer or venous thromboembolism and who had not received treatment for infertility. Nationwide registries provided individually updated information about the use of hormonal contraception, breast-cancer diagnoses, and potential confounders. Among 1.8 million women who were followed on average for 10.9 years (a total of 19.6 million person-years), 11,517 cases of breast cancer occurred. As compared with women who had never used hormonal contraception, the relative risk of breast cancer among all current and recent users of hormonal contraception was 1.20 (95% confidence interval [CI], 1.14 to 1.26). This risk increased from 1.09 (95% CI, 0.96 to 1.23) with less than 1 year of use to 1.38 (95% CI, 1.26 to 1.51) with more than 10 years of use (P=0.002). After discontinuation of hormonal contraception, the risk of breast cancer was still higher among the women who had used hormonal contraceptives for 5 years or more than among women who had not used hormonal contraceptives. Risk estimates associated with current or recent use of various oral combination (estrogen-progestin) contraceptives varied between 1.0 and 1.6. Women who currently or recently used the progestin-only intrauterine system also had a higher risk of breast cancer than women who had never used hormonal contraceptives (relative risk, 1.21; 95% CI, 1.11 to 1.33). The overall absolute increase in breast cancers diagnosed among current and recent users of any hormonal contraceptive was 13 (95% CI, 10 to 16) per 100,000 person-years, or approximately 1 extra breast cancer for every 7690 women using hormonal contraception for 1 year. The risk of breast cancer was

Emergency contraception - Potential for women's health

PubMed Central

Mittal, Suneeta

2014-01-01

Emergency contraception (EC) is a safe and effective method which is used to prevent unwanted pregnancy after unprotected sexual intercourse. Many of the unwanted pregnancies end in unsafe abortions. The search for an ideal contraceptive, which does not interfere with spontaneity or pleasure of the sexual act, yet effectively controls the fertility, is still continuing. Numerous contraceptive techniques are available, yet contraceptive coverage continues to be poor in India. Thus, even when not planning for a pregnancy, exposure to unprotected sex takes place often, necessitating the use of emergency contraception. This need may also arise due to failure of contraceptive method being used (condom rupture, diaphragm slippage, forgotten oral pills) or following sexual assault. Emergency contraception is an intervention that can prevent a large number of unwanted pregnancies resulting from failure of regular contraception or unplanned sexual activity, which in turn helps in reducing the maternal mortality and morbidity due to unsafe abortions. However, a concern has been expressed regarding repeated and indiscriminate usage of e-pill, currently the rational use of emergency contraception is being promoted as it is expected to make a significant dent in reducing the number of unwanted pregnancies and unsafe abortions. In fact, since the introduction of emergency contraception, the contribution of unsafe abortion towards maternal mortality has declined from 13 to 8 per cent. PMID:25673542

Emergency contraception - potential for women's health.

PubMed

Mittal, Suneeta

2014-11-01

Emergency contraception (EC) is a safe and effective method which is used to prevent unwanted pregnancy after unprotected sexual intercourse. Many of the unwanted pregnancies end in unsafe abortions. The search for an ideal contraceptive, which does not interfere with spontaneity or pleasure of the sexual act, yet effectively controls the fertility, is still continuing. Numerous contraceptive techniques are available, yet contraceptive coverage continues to be poor in India. Thus, even when not planning for a pregnancy, exposure to unprotected sex takes place often, necessitating the use of emergency contraception. This need may also arise due to failure of contraceptive method being used (condom rupture, diaphragm slippage, forgotten oral pills) or following sexual assault. Emergency contraception is an intervention that can prevent a large number of unwanted pregnancies resulting from failure of regular contraception or unplanned sexual activity, which in turn helps in reducing the maternal mortality and morbidity due to unsafe abortions. However, a concern has been expressed regarding repeated and indiscriminate usage of e-pill, currently the rational use of emergency contraception is being promoted as it is expected to make a significant dent in reducing the number of unwanted pregnancies and unsafe abortions. In fact, since the introduction of emergency contraception, the contribution of unsafe abortion towards maternal mortality has declined from 13 to 8 per cent.

Permanent-File-Validation Utility Computer Program

NASA Technical Reports Server (NTRS)

Derry, Stephen D.

1988-01-01

Errors in files detected and corrected during operation. Permanent File Validation (PFVAL) utility computer program provides CDC CYBER NOS sites with mechanism to verify integrity of permanent file base. Locates and identifies permanent file errors in Mass Storage Table (MST) and Track Reservation Table (TRT), in permanent file catalog entries (PFC's) in permit sectors, and in disk sector linkage. All detected errors written to listing file and system and job day files. Program operates by reading system tables , catalog track, permit sectors, and disk linkage bytes to vaidate expected and actual file linkages. Used extensively to identify and locate errors in permanent files and enable online correction, reducing computer-system downtime.

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.

Gender inequality and the 'East-West' divide in contraception: An analysis at the individual, the couple, and the country level.

PubMed

Dereuddre, Rozemarijn; Van de Velde, Sarah; Bracke, Piet

2016-07-01

Despite generally low fertility rates in Europe, contraceptive behavior varies to a substantial extent. The dichotomy between Western, and Central and Eastern European countries is particularly relevant. Whereas the former are characterized by the widespread use of modern contraception, the latter show a high prevalence of traditional methods to control fertility. The current study aims to examine whether these differences can be attributed to differences in women's individual status, and in gender inequality at the couple and the country level. We combine data from the Generations and Gender Survey (2004-2011) and the Demographic Health Survey (2005-2009), covering seventeen European countries, to perform multinomial multilevel analyses. The results confirm that higher educated and employed women, and women who have an equal occupational status relative to their partner are more likely to use modern reversible contraception instead of no, traditional, or permanent methods. Absolute and relative employment are also positively related to using female instead of male methods. Furthermore, it is shown that higher levels of country-level gender equality are associated with a higher likelihood of using modern reversible and female methods, but not sterilization. Particularly country levels of gender equality are linked to the East-West divide in type of contraceptive method used. Our findings underscore that women's higher status is closely related to their use of effective, female contraception. Copyright © 2016 Elsevier Ltd. All rights reserved.

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.

Contraception in women with medical problems

PubMed Central

Dhanjal, Mandish K

2008-01-01

Women with medical disease have a higher incidence of maternal mortality compared with healthy women, with cardiac disease now being the most common cause of maternal death in the UK. A handful of medical conditions exist where pregnancy is not recommended due to mortality rates approaching 50%. It is imperative that such women have the most reliable methods of contraception available. Contraceptive agents may themselves affect medical disease, or may interact with medications used by such women. There may be a range of contraceptive agents suitable for each medical condition. The contraceptive selected should be tailored to suit the individual. The following points should be considered when deciding on the most appropriate contraceptive agent: efficacy, thrombotic risk (oestrogen containing contraceptives), arterial risks (oestrogen containing contraceptives), infective risk (e.g. insertion of intrauterine device [IUD]), vagal stimulation (e.g. insertion of IUD, ESSURE®), bleeding risks with patients on anticoagulants, interaction with concomitant drugs, effects of anaesthesia and ease of use. This review aims to cover the different contraceptive agents available and the best ones to use for certain medical illnesses. PMID:27582790

Barriers to contraceptive services.

PubMed

Silverman, J; Torres, A; Forrest, J D

1987-01-01

More than 1/2 of the pregnancies that occur each year in the US are unintended and 1/2 of these end in abortion. An attempt was made to determine the contraceptive availability, needs and preferences of low-income women via a telephone survey of 760 women, 18-35 years of age, living in 4 urban locations and a mail survey of all family planning clinics and private obstetrician-gynecologists in each of the 4 communities, as well as other physicians and clinics mentioned by the women. Although 94% of the women said they had used some contraceptive method at some time, 23% were not currently practicing contraception. Both nonuse and the use of less effective methods appear to be caused by method-related fears, dislike of available methods, and a general negative feeling about contraception. Less effective methods may be avoided because women view them as offering less protection and dislike their coitus-dependent qualities. Structural or provider-related concerns, such as cost, were seldom reported as barriers to contraceptive use. The primary barrier to clinic use is the apparent belief of many women that clinics do not offer personalized care and provide lower quality care than private physicians. Private physicians are avoided because of high cost and their lesser acceptance of Medicaid or Medi-Cal reimbursement. Encouraging more favorable attitudes toward contraceptive methods and improving access to and knowledge of inexpensive, personalized family planning services appear to be critical factors in fostering better contraceptive practice among low-income women in the US.

Permanent spin currents in cavity-qubit systems

NASA Astrophysics Data System (ADS)

Kulkarni, Manas; Hein, Sven M.; Kapit, Eliot; Aron, Camille

2018-02-01

In a recent experiment [P. Roushan et al., Nat. Phys. 13, 146 (2017), 10.1038/nphys3930], a spin current in an architecture of three superconducting qubits was produced during a few microseconds by creating synthetic magnetic fields. The lifetime of the current was set by the typical dissipative mechanisms that occur in those systems. We propose a scheme for the generation of permanent currents, even in the presence of such imperfections, and scalable to larger system sizes. It relies on striking a subtle balance between multiple nonequilibrium drives and the dissipation mechanisms, in order to engineer and stimulate chiral excited states which can carry current.

Stagnant contraceptive sales after the Zika epidemic in Brazil.

PubMed

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

2017-10-01

Our aim was to assess national hormonal and non-hormonal contraceptive sales in Brazil after the Zika virus outbreak. Pharmaceutical companies based in Brazil provided data on monthly sales from September 2016 to June 2017. Data from both the public and private sectors were obtained about sales of registered, available modern contraceptive methods: combined oral contraceptive pill; progestin-only pill; vaginal and transdermal contraceptives; injectable contraceptives; long-acting reversible contraceptive (LARC) methods, including the copper-releasing intrauterine device, the levonorgestrel-releasing intrauterine system and the etonogestrel-releasing subdermal implant; and emergency contraceptive pills. Seventy-eight percent of sales comprised pills, patches and vaginal rings (11.1-13.8 million cycles/units per month), followed by emergency contraceptive pills (1.8-2.6 million pills), injectables (1.2-1.4 million ampoules) and LARC methods (6500-17,000 devices). The data showed much higher sales of short-acting methods compared with more effective LARC methods. The public sector needs to strengthen its focus on ensuring better access to LARC methods through a systematic approach ensuring regular supply, improved professional skills and better demand generation to couples wishing to avoid or delay pregnancy. In Zika virus-affected areas, many women of reproductive age may want to delay or postpone pregnancy by using an effective LARC method. The public sector should review its policies on LARC, as the need for these methods especially in Zika virus endemic areas may increase. A clear emphasis on quality in services, access and use is warranted.

Knowledge, Perceptions, and Motivations for Contraception: Influence on Teens' Contraceptive Consistency

ERIC Educational Resources Information Center

Ryan, Suzanne; Franzetta, Kerry; Manlove, Jennifer

2007-01-01

Using data from the National Longitudinal Study of Adolescent Health, the authors examine the association between contraceptive use patterns in teens' first sexual relationships and their knowledge of, perceptions of, and motivations for contraception and pregnancy prevention. Results from logistic regression analyses show that knowledge,…

[Anti-infectious defense of vagina during use of low-dose monophasic contraceptives].

PubMed

Lebedeva, O P; Kalutskiĭ, P V

2007-01-01

Increase in incidence of candidal colpitis has been observed during use of contraceptive drugs. Elimination of staphylococci from genital tract after use of contraceptives was detected in 34,7% of patients. Composition of other aerobic microflora did not change. Nonspecific immune reaction was characterized by intensified phagocytosis, increase of results of NBT reduction test and level of proinflammatory cytokines. Conclusion about inappropriateness of using low-dose oral contraceptives in patients with recurrent vulvovaginal candidosis was made. Such contraceptives can be recommended to women with prolonged inflammatory diseases of reproductive system.

Practices and perceptions among pediatricians regarding adolescent contraception with emphasis on intrauterine contraception.

PubMed

Wilson, S F; Strohsnitter, W; Baecher-Lind, L

2013-10-01

This study was conducted to characterize pediatricians' current practice patterns and perceived barriers related to adolescent contraception counseling with an emphasis on intrauterine contraception (IUC). We performed a mailed survey study to 400 general pediatricians. Surveys were mailed to pediatricians at their individual office locations. General pediatricians belonging to the Massachusetts Pediatric Society were included in the study. The survey instrument assessed current practice patterns and perspectives as related to contraception counseling for adolescents. Use of contraception among adolescent patients, policy to recommend IUC to adolescents in various clinical scenarios, and barriers to adolescent contraceptive counseling. Over 50% of pediatricians considered abstinence their favored method of contraception for adolescents, while fewer than 20% reported discussing IUC as an option. Female pediatricians were more likely to discuss IUC (25% vs 8%, P = .01), as were younger pediatricians (28% vs 14%, P = .13). Given 8 clinical scenarios suitable for IUC use, less than 25% of pediatricians would offer IUC to a teen unless she had a history of a vaginal delivery or abortion. Seventy percent of pediatricians reported lack of training with IUC, and more than 30% reported legal, fertility and parental concerns as barriers to discussing IUC with adolescents. Efforts are warranted to improve the education of pediatricians regarding the most current guidelines for proper IUC use in adolescents with the goal to increase the frequency with which this effective contraceptive method is discussed with this vulnerable population. Copyright © 2013 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Contraceptive Use Before and After Gastric Bypass: a Questionnaire Study.

PubMed

Ginstman, Charlotte; Frisk, Jessica; Ottosson, Johan; Brynhildsen, Jan

2015-11-01

At present, women are recommended to avoid pregnancy 12-18 months after bariatric surgery. Our aim in this study was to describe patterns of contraceptive use before and after gastric bypass in Sweden, and to describe the contraceptive counseling given preoperatively to women undergoing gastric bypass. In October 2012, a questionnaire was sent to 1000 Swedish women who all had undergone gastric bypass during 2010. The women had been included in the Scandinavian Obesity Surgery Register at time of surgery. The main outcome measures were patterns of use of contraception before and after bariatric surgery. The response rate was 57 %. The most commonly used contraceptive methods were intrauterine devices, 29 % preoperatively and 26 % postoperatively even though there was a postoperative switch from the copper intrauterine device to the levonorgestrel intrauterine system. Thirty percent did not use any contraceptive during the first 12 months after surgery. Sixty percent of the responders were aware of the recommendations to avoid pregnancy after surgery. Many women who undergo bariatric surgery are not using any contraceptive method despite the recommendation that they should avoid pregnancy for at least 12 months. There is a great need to improve contraceptive counseling for this growing group of women.

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

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.

Diagnostics Systems for Permanent Hall Thrusters Development

NASA Astrophysics Data System (ADS)

Ferreira, Jose Leonardo; Soares Ferreira, Ivan; Santos, Jean; Miranda, Rodrigo; Possa, M. Gabriela

This work describes the development of Permanent Magnet Hall Effect Plasma Thruster (PHALL) and its diagnostic systems at The Plasma Physics Laboratory of University of Brasilia. The project consists on the construction and characterization of plasma propulsion engines based on the Hall Effect. Electric thrusters have been employed in over 220 successful space missions. Two types stand out: the Hall-Effect Thruster (HET) and the Gridded Ion Engine (GIE). The first, which we deal with in this project, has the advantage of greater simplicity of operation, a smaller weight for the propulsion subsystem and a longer shelf life. It can operate in two configurations: magnetic layer and anode layer, the difference between the two lying in the positioning of the anode inside the plasma channel. A Hall-Effect Thruster-HET is a type of plasma thruster in which the propellant gas is ionized and accelerated by a magneto hydrodynamic effect combined with electrostatic ion acceleration. So the essential operating principle of the HET is that it uses a J x B force and an electrostatic potential to accelerate ions up to high speeds. In a HET, the attractive negative charge is provided by electrons at the open end of the Thruster instead of a grid, as in the case of the electrostatic ion thrusters. A strong radial magnetic field is used to hold the electrons in place, with the combination of the magnetic field and the electrostatic potential force generating a fast circulating electron current, the Hall current, around the axis of the Thruster, mainly composed by drifting electrons in an ion plasma background. Only a slow axial drift towards the anode occurs. The main attractive features of the Hall-Effect Thruster are its simple design and operating principles. Most of the Hall-Effect Thrusters use electromagnet coils to produce the main magnetic field responsible for plasma generation and acceleration. In this paper we present a different new concept, a Permanent Magnet Hall

Factors Influencing Contraceptive Use in Sub-Saharan Africa: A Systematic Review.

PubMed

Blackstone, Sarah R; Nwaozuru, Ucheoma; Iwelunmor, Juliet

2017-01-01

The purpose of this study was to systematically review the literature regarding factors influencing contraceptive use in sub-Saharan Africa between 2005 and 2015. A total of 58 studies from twelve Sub-Saharan African countries were reviewed. Keywords were grouped using the PEN-3 cultural model. Negative factors prohibiting or reducing contraceptive use were women's misconceptions of contraceptive side-effects, male partner disapproval, and social/cultural norms surrounding fertility. Positive factors included education, employment, and communication with male partner. Increasing modern contraceptive use in Sub-Saharan Africa is a multi-faceted problem that will require community and systems wide interventions that aim to counteract negative perceptions and misinformation.

Contraceptive Methods Accessed in Volta Region, Ghana, 2009-2014.

PubMed

Wilson, Himiede W; Ameme, Donne K; Ilesanmi, Olayinka Stephen

2017-01-01

In 2016, Volta Region was one of the two regions in Ghana that recorded a high prevalence of teenage pregnancy, accounting for 15.5% of all adolescent pregnancies in the country. This study aimed to determine the prevalence of contraceptive methods accessed by person, place, and time in Volta Region, Ghana, 2009-2014. We carried out a secondary analysis of contraceptive use data derived from the District Health Information Management System (DHIMS) 2 for Volta Region, between 2009 and 2014. We calculated proportions and described trends. Over the five-year period, there were 673,409 (75.0%) acceptors of family planning out of a total 897, 645 males and females of reproductive age. The proportion of family planning acceptors increased gradually from 18% in 2009 to 23% in 2014. Contraceptive methods were most commonly accessed by male and female between 20 and 29 years. The most common methods of contraceptives accessed were injectables among females accounting for about 70% and condoms accounting for over 90% among males. All the districts in Volta Region did not access contraceptives adequately. The Volta Regional Health Directorate should encourage and support research to ascertain factors influencing uptake of contraceptive methods in all the districts.

Polygamy and the use of contraceptives.

PubMed

Audu, Bala; Yahya, Shaibu; Geidam, Ado; Abdussalam, Hadiza; Takai, Idrisa; Kyari, Othman

2008-04-01

To compare contraceptive use among women in monogamous and polygamous marriages in Nigeria. Structured questionnaires administered to married women enquired about their marriage type, sociodemographic characteristics, and contraceptive use. Of the 532 respondents, 33.6% were in polygamous marriages. There was a statistically significant association between monogamy and nonutilization of contraception (P=0.03); however, women in polygamous marriages were more likely not to use contraception when they were older than 35 years, had 4 or more living children, had no male child, had 3 or more female children, or lived in rural areas. There was also a statistically significant association between nonutilization of contraception and number of male children of co-wives (P=0.003), number of female children of co-wives (P=0.05), and use of contraception by co-wives (P=0.002). Polygamy influences contraceptive use and the role of co-wives in this regard merits further study.

Contraceptive awareness among men in Bangladesh.

PubMed

Islam, Mohammad Amirul; Padmadas, Sabu S; Smith, Peter W F

2006-04-01

A considerable gap exists between contraceptive awareness and use. Traditional approaches to measuring awareness are inadequate to properly understand the linkages between awareness and use. The objective of this study was to examine the degree of men's modern contraceptive awareness in Bangladesh and the associated determinants and further testing of a hypothesis that current contraceptive use confers a high degree of method awareness. This study used the couple data set from the Bangladesh Demographic and Health Survey (1999-2000). A two-level, multinomial logistic regression was used with the degree of contraceptive awareness as the dependent variable. The degree of awareness was measured by the reported number of modern contraceptive methods known among men aged 15-59 years. Men's responses on method awareness were classified according to those reported spontaneously and probed. Nearly 100% of the study participants reported having heard of at least one method and about half reported awareness of at least eight different methods of contraception. Multinomial logistic regression analyses showed that older and educated men were more likely to have reported a high degree of awareness. The findings confirmed our hypothesis that current contraceptive use is likely to confer a high degree of modern method awareness among men (p<0.001), after controlling for other important characteristics. Men who had a low degree of contraceptive awareness seem not properly informed of the wide range of contraceptive options. It is imperative that family planning intervention strategies in Bangladesh should focus on the degree and functional knowledge of contraceptive methods to improve the uptake of especially male-based modern methods.

Contraception supply chain challenges: a review of evidence from low- and middle-income countries.

PubMed

Mukasa, Bakali; Ali, Moazzam; Farron, Madeline; Van de Weerdt, Renee

2017-10-01

To identify and assess factors determining the functioning of supply chain systems for modern contraception in low- and middle-income countries (LMICs), and to identify challenges contributing to contraception stockouts that may lead to unmet need. Scientific databases and grey literature were searched including Database of Abstracts of Reviews of Effectiveness (DARE), PubMed, MEDLINE, POPLINE, CINAHL, Academic Search Complete, Science Direct, Web of Science, Cochrane Central, Google Scholar, WHO databases and websites of key international organisations. Studies indicated that supply chain system inefficiencies significantly affect availability of modern FP and contraception commodities in LMICs, especially in rural public facilities where distribution barriers may be acute. Supply chain failures or bottlenecks may be attributed to: weak and poorly institutionalized logistic management information systems (LMIS), poor physical infrastructures in LMICs, lack of trained and dedicated staff for supply chain management, inadequate funding, and rigid government policies on task sharing. However, there is evidence that implementing effective LMISs and involving public and private providers will distribution channels resulted in reduction in medical commodities' stockout rates. Supply chain bottlenecks contribute significantly to persistent high stockout rates for modern contraceptives in LMICs. Interventions aimed at enhancing uptake of contraceptives to reduce the problem of unmet need in LMICs should make strong commitments towards strengthening these countries' health commodities supply chain management systems. Current evidence is limited and additional, and well-designed implementation research on contraception supply chain systems is warranted to gain further understanding and insights on the determinants of supply chain bottlenecks and their impact on stockouts of contraception commodities.

HIV/AIDS and contraceptive use: factors associated with contraceptive use among sexually active HIV-positive women in Kenya.

PubMed

Magadi, Monica A; Magadi, Winnie A

2017-03-01

With increased availability of antiretroviral therapy and improved survival for people living with HIV, more HIV-positive women are leading full reproductive lives. However, HIV-positive women have special contraceptive needs/concerns. This paper examines the individual and community-level HIV/AIDS factors associated with contraceptive use and compares predictors of contraceptive uptake between HIV-positive and HIV-negative women in Kenya. The study is based on secondary analysis of cross-sectional data of a sample of 9132 sexually active women of reproductive age from the Kenya Demographic and Health Surveys collected in 2003 and 2008. Multilevel logistic regression models are used to examine individual and contextual community-level factors associated with current contraceptive use. The study provides evidence of lower contraceptive uptake among women living in high HIV-prevalence communities. It further reveals striking differences in factors associated with contraceptive uptake between HIV-positive and HIV-negative women. Education and the desire to stop childbearing are strongly associated with contraceptive uptake among uninfected women, but both factors are not significant among HIV-positive women for whom wealth is the most important factor. While HIV-negative women in the richest wealth quintile are about twice as likely to use contraceptives as their counterparts of similar characteristics in the poorest quintile, this gap is about sevenfold among HIV-positive women. These findings suggest that having the desire and relevant knowledge to use contraceptives does not necessarily translate into expected contraceptive behavior for HIV-positive women in Kenya and that poor HIV-positive women may be particularly in need of increased access to contraceptive services. • Study provides evidence of lower contraceptive uptake among women living in high HIV-prevalence communities in Kenya. • Results reveal striking differences in factors associated with

Peer-driven contraceptive choices and preferences for contraceptive methods among students of tertiary educational institutions in Enugu, Nigeria.

PubMed

Iyoke, Ca; Ezugwu, Fo; Lawani, Ol; Ugwu, Go; Ajah, Lo; Mba, Sg

2014-01-01

To describe the methods preferred for contraception, evaluate preferences and adherence to modern contraceptive methods, and determine the factors associated with contraceptive choices among tertiary students in South East Nigeria. A questionnaire-based cross-sectional study of sexual habits, knowledge of contraceptive methods, and patterns of contraceptive choices among a pooled sample of unmarried students from the three largest tertiary educational institutions in Enugu city, Nigeria was done. Statistical analysis involved descriptive and inferential statistics at the 95% level of confidence. A total of 313 unmarried students were studied (194 males; 119 females). Their mean age was 22.5±5.1 years. Over 98% of males and 85% of females made their contraceptive choices based on information from peers. Preferences for contraceptive methods among female students were 49.2% for traditional methods of contraception, 28% for modern methods, 10% for nonpharmacological agents, and 8% for off-label drugs. Adherence to modern contraceptives among female students was 35%. Among male students, the preference for the male condom was 45.2% and the adherence to condom use was 21.7%. Multivariate analysis showed that receiving information from health personnel/media/workshops (odds ratio 9.54, 95% confidence interval 3.5-26.3), health science-related course of study (odds ratio 3.5, 95% confidence interval 1.3-9.6), and previous sexual exposure prior to university admission (odds ratio 3.48, 95% confidence interval 1.5-8.0) all increased the likelihood of adherence to modern contraceptive methods. An overwhelming reliance on peers for contraceptive information in the context of poor knowledge of modern methods of contraception among young people could have contributed to the low preferences and adherence to modern contraceptive methods among students in tertiary educational institutions. Programs to reduce risky sexual behavior among these students may need to focus on

Women's Contraceptive Preference-Use Mismatch

PubMed Central

He, Katherine; Dalton, Vanessa K.; Zochowski, Melissa K.

2017-01-01

Abstract Background: Family planning research has not adequately addressed women's preferences for different contraceptive methods and whether women's contraceptive experiences match their preferences. Methods: Data were drawn from the Women's Healthcare Experiences and Preferences Study, an Internet survey of 1,078 women aged 18–55 randomly sampled from a national probability panel. Survey items assessed women's preferences for contraceptive methods, match between methods preferred and used, and perceived reasons for mismatch. We estimated predictors of contraceptive preference with multinomial logistic regression models. Results: Among women at risk for pregnancy who responded with their preferred method (n = 363), hormonal methods (non-LARC [long-acting reversible contraception]) were the most preferred method (34%), followed by no method (23%) and LARC (18%). Sociodemographic differences in contraception method preferences were noted (p-values <0.05), generally with minority, married, and older women having higher rates of preferring less effective methods, compared to their counterparts. Thirty-six percent of women reported preference-use mismatch, with the majority preferring more effective methods than those they were using. Rates of match between preferred and usual methods were highest for LARC (76%), hormonal (non-LARC) (65%), and no method (65%). The most common reasons for mismatch were cost/insurance (41%), lack of perceived/actual need (34%), and method-specific preference concerns (19%). Conclusion: While preference for effective contraception was common among this sample of women, we found substantial mismatch between preferred and usual methods, notably among women of lower socioeconomic status and women using less effective methods. Findings may have implications for patient-centered contraceptive interventions. PMID:27710196

Emergency Contraception in Mexico: Trends in Knowledge and Ever-Use 2006-2014.

PubMed

Han, Leo; Saavedra-Avendano, Biani; Lambert, William; Fu, Rongwei; Rodriguez, Maria I; Edelman, Alison; Darney, Blair

2017-11-01

Objectives A package of interventions to introduce emergency contraception (EC) to Mexico was implemented, resulting in the addition of EC to the national family planning guidelines in 2004. We describe EC knowledge and use among women in Mexico over time. Methods We used the 2006, 2009, and 2014 of waves of a nationally representative demographic survey (ENADID). We assessed EC knowledge and usage in women ages 15-29 who are not using permanent methods and tested whether EC knowledge and use is changing over time after controlling for socio-demographic characteristics using logistic regression. Results Our sample included n = 99,223 (population N = 40,234,355) women ages 15-29. Overall, knowledge of EC increased over time: 62% in 2006 to 79% in 2009 to 83% in 2014 (p < 0.001). Among young women who have used contraception (n = 42,883; N = 16,816,701), the proportion that reported EC use increased from 3 to 11% to 29% (p < 0.001). Compared to non-users, women who had ever used EC were more likely to be using no method of contraception (44 vs. 35%) or barrier method (22 vs. 17%). Demographic factors including lower wealth, lower education, indigenous status and rural living are significantly associated with less EC knowledge and use. Stratified multivariate analysis found that demographic disadvantages magnify lower EC use among rural residents compared to non-rural residents. Conclusions for Practice Knowledge and use of EC are growing rapidly in Mexico, but disparities persist in demographically disadvantaged women, particularly those living in rural areas. Women who use EC appear to be at higher risk of unintended pregnancy based on current contraceptive use.

Advances in male hormonal contraception.

PubMed

Costantino, Antonietta; Gava, Giulia; Berra, Marta; Meriggiola Maria, Cristina

2014-11-01

Contraception is a basic human right for its role on health, quality of life and wellbeing of the woman and of the society as a whole. Since the introduction of female hormonal contraception the responsibility of family planning has always been with women. Currently there are only a few contraceptive methods available for men, but recently, men have become more interested in supporting their partners actively. Over the last few decades different trials have been performed providing important advances in the development of a safe and effective hormonal contraceptive for men. This paper summarizes some of the most recent trials.

[Place of persistence trouble during oral contraception and subsequent use of emergency contraception].

PubMed

Jamin, C; Lachowsky, M

2015-10-01

In order to improve the understanding of hormonal contraceptive failures, this study evaluates the persistence of oral contraception and the use of emergency contraception (EC) during persistence incidents. We made the hypothesis of the existence of a strong link between the risk of unplanned pregnancies and these two parameters. In this study, we also evaluated women's perception of EC in order to elucidate the reasons of EC insufficient use. One survey was carried out on Internet on a representative sample of women, aged 16-45. In this survey, 3775 French women were interviewed (source-population). We defined a target population of 2415 fertile women who had heterosexual intercourse during the last 12 months, and a population of 760 women at risk of unintended pregnancy who had unprotected sexual intercourse during the last 12 months(risk-population). A little more than 30% of the target population, meaning 20% of the source-population (n=745) stopped their contraceptive method temporarily for an average time of two months. Almost 60% of women had a risk of unwanted pregnancy during this period without contraception, which is 59% of the risk-population. Only 20% of women among the population at risk used EC. The main reasons given for EC insufficient use were the misperception of the risk of pregnancy, the lack of knowledge about EC and its way of use. For the first time, this survey shows that 13% of women (of the source population) decide to stop temporarily their contraceptive method for an average time of two months per year. Fifty-nine percent of unplanned pregnancy situations are due to this poor contraception persistence. Although there is a need to reduce the risk of women being at risk, it seems also highly desirable to overcome the consequences of this poor persistence. Giving information about EC and a systematic prescription during contraception consultations would lead to an increased use of EC. Copyright © 2014 Elsevier Masson SAS. All rights

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.

Determinants of contraceptive use and future contraceptive intentions of women attending child welfare clinics in urban Ghana.

PubMed

Wuni, Caroline; Turpin, Cornelius A; Dassah, Edward T

2017-08-01

Family planning is an integral component of maternal and child health services in Ghana. Although knowledge on contraception is universal and most women attend maternal and child health services, contraceptive use remains low among women after delivery. This study aimed to determine factors influencing current use and future contraceptive intentions of women who were attending child welfare clinics within 2 years of delivery in Sunyani Municipality, Ghana. We conducted an analytical cross-sectional study among mothers in six selected health care facilities. Data was collected on their socio-demographic characteristics, reproductive and contraceptive experiences and future contraceptive intentions. Categorical variables were compared using the chi-squared (χ 2 ) test. Factors associated with current use and future contraceptive intentions were determined using Poisson regression with a robust error variance to estimate crude and adjusted relative risks (RRs) with 95% confidence intervals (CIs). P < 0.1 was considered statistically significant. A total of 590 women were recruited into the study. Overall, 50.2% of the women were using contraception, 30.7% modern and 19.5% traditional methods. Compared to previous use, more women were using and would prefer the more effective contraceptive methods in future. Significant factors associated with current contraceptive use were, level of education (p = 0.02), discussing family planning during antenatal care (adjusted RR, 1.28; 95% CI, 1.07-1.53), or with one's partner (adjusted RR, 1.22; 95% CI, 1.01-1.47) and previous contraceptive use (adjusted RR, 1.91; 95% CI, 1.56-2.33). Family planning discussions during child welfare clinic (adjusted RR, 1.12; 95% CI, 0.99-1.26) or with one's spouse (adjusted RR, 1.20; 95% CI, 1.08-1.34), desire to space children (adjusted RR, 1.35; 95% CI, 1.17-1.55), previous (adjusted RR, 1.15; 95% CI, 1.05-1.27) and current (adjusted RR, 1.11; 95% CI, 1.01-1.22) contraceptive use were

Perceived competence and contraceptive use during adolescence.

PubMed

Hillman, Jennifer B; Negriff, Sonya; Dorn, Lorah D

2010-03-01

Little is known about psychosocial correlates of different contraceptive methods in adolescence. Cross-sectional analyses of 209 postmenarcheal girls [mean age (years)+/-SD=15.68+/-1.74], primarily Caucasian (62.8%) or African American (32.8%). Competence (activities and social) and rule-breaking behavior were assessed by the Youth Self Report (YSR; adolescent) and the Child Behavior Checklist (CBCL; parent). Three contraceptive-use groups were created: no hormonal contraceptive (n=142), combined oral contraceptives or the transdermal patch (COCs/patch, n=41), and depot medroxyprogesterone acetate (DMPA, n=20). There was a significant effect of contraceptive-use group on competence (p=.003). The DMPA group had lower competence (CBCL activities and social; YSR social) than the no-hormonal-contraceptive and COCs/patch groups. The COCs/patch group scored lower than the no-hormonal-contraceptive group on YSR activities competence, but was not different from the DMPA group. Lastly, there was an effect of contraceptive-use group on CBCL (but not YSR) rule-breaking behavior (p=.029) with the DMPA group having higher rule-breaking behavior than the other groups. Type of contraceptive method was associated with parent and adolescent's perceived competence. For rule-breaking behavior, parental perception may be more relevant to contraceptive use. Copyright (c) 2010 Elsevier Inc. All rights reserved.

Factors influencing the contraceptive method choice: a university hospital experience

PubMed Central

Kahraman, Korhan; Göç, Göksu; Taşkın, Salih; Haznedar, Pınar; Karagözlü, Selen; Kale, Burak; Kurtipek, Zeynep; Özmen, Batuhan

2012-01-01

Objective To analyze the factors influencing behavior of women in choosing contraceptive methods. Material and Methods A total of 4022 women who were admitted to our clinic in a year, were the subjects in this current study for contraception choices. Relationship between the current contraceptive choice and the age, marital status, educational level, gravidity and induced abortions were evaluated. Results Current users of any contraceptive methods were found to make up thirty-three percent of the entire study population. The most preferred method of contraception was an intrauterine device (46.4%), followed by, condom (19.2%), coitus interruptus (16.4%), tubal sterilization (11%), oral contraceptives (5.7%) and lastly the “other methods” that consisted of depot injectables and implants (1.2%). Among other contraceptive methods, the condom was found to be used mostly by the younger age group (OR:0.956, 95% CI:0.936–0.976, p<0.001), while tubal sterilization was preferred mainly by the elderly population (p<0.001, OR:1.091, 95% CI:1.062–1.122). Women that have a higher educational level, were found to use OC (76.3%, OR:5.970, 95% CI:3.233–11.022), tubal sterilization (59.6%, OR:4.110, 95% CI:2.694–6.271) and other methods (62.5%, OR:3.279, 95% CI:1.033–10.402) more commonly than the low educational group (p<0.001). Conclusion These results demonstrated that the rates of both contraception utilization and the usage of more effective methods of contraception need to be increased by providing better family planning systems and counselling opportunities. PMID:24592017

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.

Theoretical validation for changing magnetic fields of systems of permanent magnets of drum separators

NASA Astrophysics Data System (ADS)

Lozovaya, S. Y.; Lozovoy, N. M.; Okunev, A. N.

2018-03-01

This article is devoted to the theoretical validation of the change in magnetic fields created by the permanent magnet systems of the drum separators. In the article, using the example of a magnetic separator for enrichment of highly magnetic ores, the method of analytical calculation of the magnetic fields of systems of permanent magnets based on the Biot-Savart-Laplace law, the equivalent solenoid method, and the superposition principle of fields is considered.

Zero Power Non-Contact Suspension System with Permanent Magnet Motion Feedback

NASA Astrophysics Data System (ADS)

Sun, Feng; Oka, Koichi

This paper proposes a zero power control method for a permanent magnetic suspension system consisting mainly of a permanent magnet, an actuator, sensors, a suspended iron ball and a spring. A system using this zero power control method will consume quasi-zero power when the levitated object is suspended in an equilibrium state. To realize zero power control, a spring is installed in the magnetic suspension device to counterbalance the gravitational force on the actuator in the equilibrium position. In addition, an integral feedback loop in the controller affords zero actuator current when the device is in a balanced state. In this study, a model was set up for feasibility analysis, a prototype was manufactured for experimental confirmation, numerical simulations of zero power control with nonlinear attractive force were carried out based on the model, and experiments were completed to confirm the practicality of the prototype. The simulations and experiments were performed under varied conditions, such as without springs and without zero power control, with springs and without zero power control, with springs and with zero power control, using different springs and integral feedback gains. Some results are shown and analyzed in this paper. All results indicate that this zero power control method is feasible and effective for use in this suspension system with a permanent magnet motion feedback loop.

High Lifetime Pregnancy and Low Contraceptive Usage Among Sex Workers Who Use Drugs- An Unmet Reproductive Health Need

PubMed Central

2011-01-01

Background The objective of this study was to describe levels of pregnancy and contraceptive usage among a cohort of street-based female sex workers (FSWs) in Vancouver. Methods The study sample was obtained from a community-based prospective cohort study (2006-2008) of 211 women in street-based sex work who use drugs, 176 of whom had reported at least one prior pregnancy. Descriptive statistics were used to estimate lifetime pregnancy prevalence, pregnancy outcomes (miscarriage, abortion, adoption, child apprehension, child custody), and contraceptive usage. In secondary analyses, associations between contraceptive usage, individual and interpersonal risk factors and high number of lifetime pregnancies (defined as greater than the sample mean of 4) were examined. Results Among our sample, 84% reported a prior pregnancy, with a mean of 4 lifetime pregnancies (median = 3; IQR: 2-5). The median age of women reporting 5+ pregnancies was 38 years old [interquartile range (IQR): 25.0-39.0] compared to 34 years [IQR: 25.0-39.0] among women reporting 4 or fewer prior pregnancies. 45% were Caucasian and 47% were of Aboriginal ancestry. We observed high rates of previous abortion (median = 1;IQR:1-3), apprehension (median = 2; IQR:1-4) and adoption (median = 1; IQR:1-2) among FSWs who reported prior pregnancy. The use of hormonal and insertive contraceptives was limited. In bivariate analysis, tubal ligation (OR = 2.49; [95%CI = 1.14-5.45]), and permanent contraceptives (e.g., tubal ligation and hysterectomy) (OR = 2.76; [95%CI = 1.36-5.59]) were both significantly associated with having five or more pregnancies. Conclusion These findings demonstrate high levels of unwanted pregnancy in the context of low utilization of effective contraceptives and suggest a need to improve the accessibility and utilization of reproductive health services, including family planning, which are appropriately targeted and tailored for FSWs in Vancouver. PMID:21851622

The copper intrauterine device for emergency contraception: an opportunity to provide the optimal emergency contraception method and transition to highly effective contraception.

PubMed

Dermish, Amna I; Turok, David K

2013-07-01

Worldwide, 40% of all pregnancies are unintended. Widespread, over-the-counter availability of oral emergency contraception (EC) has not reduced unintended pregnancy rates. The EC visit presents an opportunity to initiate a highly effective method of contraception in a population at high risk of unintended pregnancy who are actively seeking to avoid pregnancy. The copper intrauterine device (IUD), the most effective method of EC, continues to provide contraception as effective as sterilization for up to 12 years, and it should be offered as the first-line method of EC wherever possible. Increased demand for and supply of the copper IUD for EC may have an important role in reducing rates of unintended pregnancy. The EC visit should include access to the copper IUD as optimal care but should ideally include access to all highly effective methods of contraception.

Women's perceptions of contraceptive efficacy and safety.

PubMed

Kakaiya, Roshni; Lopez, Lia L; Nelson, Anita L

2017-01-01

Adoption of contraceptive implants and intrauterine devices has been less than might be expected given their superior efficacy and convenience. The purpose of this study was to assess knowledge and beliefs held by women, which may influence their contraceptive choices and theirongoing utilization of contraceptive methods. English speaking, nonpregnant, reproductive-age women, who were not surgically sterilized, were individually interviewed to obtain limited demographic characteristics and to assess their knowledge about the efficacy of various contraceptive methods in typical use and about the relative safety of oral contraceptives. A convenience sample of 500 women aged 18-45 years, with education levels that ranged from middle school to postdoctoral level was interviewed. The efficacy in typical use of both combined oral contraceptives and male condoms was correctly estimated by 2.2%; over two-thirds of women significantly over estimated the efficacy of each of those methods in typical use. Oral contraceptives were thought to be at least as hazardous to a woman's health as pregnancy by 56% of women. The majority of reproductive aged women surveyed substantially overestimated the efficacy of the two most popular contraceptive methods, often saying that they were 99% effective. Women with higher education levels were most likely to overestimate efficacy of oral contraceptives. Women of all ages and education levels significantly overestimated the health hazards of oral contraceptives compared to pregnancy. Overestimation of effectiveness of these methods of contraception, may contribute to lower adoption of implants and intrauterine devices. When individualizing patient counselling, misperceptions must be identified and addressed with women of all educational backgrounds. Not applicable.

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.

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

Improving the Quality of Postabortion Care Services in Togo Increased Uptake of Contraception

PubMed Central

Mugore, Stembile; Kassouta, Ntapi Tchiguiri K; Sebikali, Boniface; Lundstrom, Laurel; Saad, Abdulmumin

2016-01-01

ABSTRACT High-quality postabortion care (PAC) services that include family planning counseling and a full range of contraceptives at point of treatment for abortion complications have great potential to break the cycle of repeat unintended pregnancies and demand for abortions. We describe the first application of a systematic approach to quality improvement of PAC services in a West African country. This approach—IntraHealth International’s Optimizing Performance and Quality (OPQ) approach—was applied at 5 health care facilities in Togo starting in November 2014. A baseline assessment identified the following needs: reorganizing services to ensure that contraceptives are provided at point of treatment for abortion complications, before PAC clients are discharged; improving provider competencies in family planning services, including in providing long-acting reversible contraceptive implants and intrauterine devices; ensuring that contraceptive methods are available to all PAC clients free of charge; standardizing PAC registers and enhancing data collection and reporting systems; enhancing internal supervision systems at facilities and teamwork among PAC providers; and engaging PAC providers in community talks. Solutions devised and applied at the facilities during OPQ resulted in significant increases in contraceptive counseling and uptake among PAC clients: During the 5-month baseline period, 31% of PAC clients were counseled, while during the 13-month intervention period, 91% were counseled. Of all PAC clients counseled during the baseline period, 37% accepted a contraceptive, compared with 60% of those counseled during the intervention period. Oral contraceptive pills remained the most popular method during both periods, yet uptake of implants increased significantly during the intervention period—from 4% to 27% of those accepting contraceptives. This result demonstrates that the solutions applied maintained method choice while expanding access to

[Contraception in immigrant women: influence of sociocultural aspects on the choice of contraceptive method].

PubMed

Paraíso Torras, B; Maldonado Del Valle, M D; López Muñoz, A; Cañete Palomo, M L

2013-01-01

There are currently 6 million immigrants living in Spain. Half of them are women, the majority of whom are of childbearing age. These women, who suffer high rates of induced abortion, form a special group who require a special approach to their reproductive health. In order to study the use of contraceptive methods in this population, a review was made of 1100 clinical histories from our Sexual Health and Reproduction Clinic. Latin American women were the most prevalent group who came to seek information about contraception, followed by Eastern Europeans and Moroccans. Fewer Asian and Sub-Saharan women sought these services. The contraceptives most frequently used were the intrauterine device (used mostly by Latin American and Eastern European women), and combined oral contraception, most used by Moroccan women. It is important to advise the immigrant women about contraceptive methods, taking into account their preferences, in order to improve adherence to the method. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

10 CFR 60.112 - Overall system performance objective for the geologic repository after permanent closure.

Code of Federal Regulations, 2010 CFR

2010-01-01

... repository after permanent closure. 60.112 Section 60.112 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) DISPOSAL OF HIGH-LEVEL RADIOACTIVE WASTES IN GEOLOGIC REPOSITORIES Technical Criteria Performance Objectives § 60.112 Overall system performance objective for the geologic repository after permanent closure...

INTIMATE PARTNER VIOLENCE AND CONTRACEPTIVE USE IN INDIA: THE MODERATING INFLUENCE OF CONFLICTING FERTILITY PREFERENCES AND CONTRACEPTIVE INTENTIONS.

PubMed

Forrest, Walter; Arunachalam, Dharmalingam; Navaneetham, Kannan

2018-03-01

Several studies report that women exposed to intimate partner violence (IPV) are less likely to use contraception, but the evidence that violence consistently constrains contraceptive use is inconclusive. One plausible explanation for this ambiguity is that the effects of violence on contraceptive use depend on whether couples are likely to have conflicting attitudes to it. In particular, although some men may engage in violence to prevent their partners from using contraception, they are only likely to do so if they have reason to oppose its use. Using a longitudinal follow-up to the Indian National Family Health Survey (NFHS-2), conducted among a sample of rural, married women of childbearing age, this study investigated whether the relationship between IPV and contraceptive use is contingent on whether women's contraceptive intentions contradict men's fertility preferences. Results indicate that women experiencing IPV are less likely to undergo sterilization, but only if they intended to use contraception and their partners wanted more children (Average Marginal Effect (AME)=-0.06; CI=-0.10, -0.01). Violence had no effect on sterilization among women who did not plan to use contraception (AME=-0.02; CI=-0.06, 0.03) or whose spouses did not want more children (AME=-0.01; CI=-0.9, 0.06). These results imply that violence enables some men to resolve disagreements over the use of contraception by imposing their fertility preferences on their partners. They also indicate that unmet need for contraception could be an intended consequence of violence.

Fertility intentions and contraceptive practices among clinic-users living with HIV in Kenya: a mixed methods study.

PubMed

Mayhew, Susannah H; Colombini, Manuela; Kimani, James Kelly; Tomlin, Keith; Warren, Charlotte E; Mutemwa, Richard

2017-07-05

Preventing unwanted pregnancies in Women Living with HIV (WLHIV) is a recognised HIV-prevention strategy. This study explores the fertility intentions and contraceptive practices of WLHIV using services in Kenya. Two hundred forty women self-identifying as WLHIV who attended reproductive health services in Kenya were interviewed with a structured questionnaire in 2011; 48 were also interviewed in-depth. STATA SE/13.1, Nvivo 8 and thematic analysis were used. Seventy one percent participants did not want another child; this was associated with having at least two living children and being the bread-winner. FP use was high (92%) but so were unintended pregnancies (40%) while living with HIV. 56 women reported becoming pregnant "while using FP": all were using condoms or short-term methods. Only 16% participants used effective long-acting reversible contraceptives or permanent methods (LARC-PM). Being older than 25 years and separated, widowed or divorced were significant predictors of long-term method use. Qualitative data revealed strong motivation among WLHIV to plan or prevent pregnancies to avoid negative health consequences. Few participants received good information about contraceptive choices. WLHIV need better access to FP advice and a wider range of contraceptives including LARC to enable informed choices that will protect their fertility intentions, ensure planned pregnancies and promote safe child-bearing. Integra is a non-randomised pre-post intervention trial registered with Current Controlled Trials ID: NCT01694862 .

[Mechanical Shimming Method and Implementation for Permanent Magnet of MRI System].

PubMed

Xue, Tingqiang; Chen, Jinjun

2015-03-01

A mechanical shimming method and device for permanent magnet of MRI system has been developed to meet its stringent homogeneity requirement without time-consuming passive shimming on site, installation and adjustment efficiency has been increased.

Physiologic and psychologic symptoms associated with use of injectable contraception and 20 microg oral contraceptive pills.

PubMed

Berenson, Abbey B; Odom, Susan D; Breitkopf, Carmen Radecki; Rahman, Mahbubur

2008-10-01

The objective of the study was to compare menstrual, physiologic, and psychologic symptoms over 2 years among women initiating use of depot medroxyprogesterone acetate or an oral contraceptive pill with a reduced pill-free interval and those not using hormonal contraception. A total of 608 women reported their experience regarding 17 symptoms prior to initiating contraception and every 6 months thereafter for 24 months. Longitudinal relationships between symptoms and contraceptives were assessed after adjusting for age, visits, and baseline status of symptoms. Oral contraceptive pills were protective against mastalgia (odds ratio [OR], 0.7), cramping (OR, 0.5), hair loss (OR, 0.6), acne (OR, 0.4), nervousness (OR, 0.5), and mood swings (OR, 0.7). Depot medroxyprogesterone acetate (DMPA) was protective against bloating (OR, 0.5) and mood swings (OR, 0.7) but caused weight gain (OR, 2.3), bleeding episodes more than 20 days (OR, 13.4), and missed periods (OR, 96.9). Both methods caused intermenstrual bleeding. Evidence-based data regarding beneficial and adverse symptoms associated with these methods may help clinicians counsel patients appropriately prior to contraceptive initiation.

Impact of having a high-risk pregnancy on future postpartum contraceptive method choice.

PubMed

Kiykac Altinbas, Sadiman; Bayoglu Tekin, Yesim; Dilbaz, Berna; Kilic, Selim; Khalil, Susan S; Kandemir, Omer

2014-12-01

To compare the knowledge and preference of preconceptional contraception to future postpartum contraceptive method choice in high-risk pregnancies. Does a high-risk pregnancy condition affect future postpartum contraceptive method choice? Women hospitalised at the High Risk Pregnancy unit of a tertiary research and training hospital were asked to complete a self-reported questionnaire that included demographic characteristics, presence of unintended pregnancy, contraceptive method of choice before the current pregnancy, plans for contraceptive use following delivery and requests for any contraceptive counselling in the postpartum period. A total of 655 pregnant women were recruited. The mean age, gravidity and parity of the women were 27.48 ± 6.25 years, 2.81 ± 2.15 and 1.40 ± 1.77, respectively. High-risk pregnancy indications included 207 (31.6%) maternal, 396 (60.5%) foetal and 52 (7.9%) uterine factors. All postpartum contraceptive choices except for combined oral contraceptives (COCs) usage were significantly different from preconceptional contraceptive preferences (p<0.001). High-risk pregnancy indications, future child bearing, ideal number of children, income and education levels were the most important factors influencing postpartum contraceptive choices. While the leading contraceptive method in the postpartum period was long-acting reversible contraceptive methods (non-hormonal copper intrauterine device Cu-IUD, the levonorgestrel-releasing intrauterine system (LNG-IUS) (40%), the least preferred method was COCs use (5.2%) and preference of COCs use showed no difference between the preconceptional and postpartum periods (p=0.202). Overall 73.7% of the women wanted to receive contraceptive counselling before their discharge. A high-risk pregnancy condition may change the opinion and preference of contraceptive use, and also seems to affect the awareness of family planning methods. Copyright © 2014 Australian College of Midwives. All rights reserved.

Dominance of Sterilization and Alternative Choices of Contraception in India: An Appraisal of the Socioeconomic Impact

PubMed Central

de Oliveira, Isabel Tiago; Dias, José G.; Padmadas, Sabu S.

2014-01-01

Background The recent decline in fertility in India has been unprecedented especially in southern India, where fertility is almost exclusively controlled by means of permanent contraceptive methods, mainly female sterilization, which constitutes about two-thirds of overall contraceptive use. Many Indian women undergo sterilization at relatively young ages as a consequence of early marriage and childbearing in short birth intervals. This research aims to investigate the socioeconomic factors determining the choices for alternative contraceptive choices against the dominant preference for sterilization among married women in India. Methods Data for this study are drawn from the 2005–06 National Family Health Surveys focusing on a sample of married women who reported having used a method of contraception in the five years preceding the survey. A multilevel multinomial logit regression is used to estimate the impact of socioeconomic factors on contraceptive choices, differentiating temporary modern or traditional methods versus sterilization. Findings Religious affiliation, women's education and occupation had overarching influence on method choices amongst recent users. Muslim women were at higher odds of choosing a traditional or modern temporary method than sterilization. Higher level of women's education increased the odds of modern temporary method choices but the education effect on traditional method choices was only marginally significant. Recent users belonging to wealthier households had higher odds of choosing modern methods over sterilization. Exposure to family planning messages through radio had a positive effect on modern and traditional method choices. Community variations in method choices were highly significant. Conclusion The persistent dominance of sterilization in the Indian family planning programme is largely determined by socioeconomic conditions. Reproductive health programmes should address the socioeconomic barriers and consider multiple

Dominance of sterilization and alternative choices of contraception in India: an appraisal of the socioeconomic impact.

PubMed

de Oliveira, Isabel Tiago; Dias, José G; Padmadas, Sabu S

2014-01-01

The recent decline in fertility in India has been unprecedented especially in southern India, where fertility is almost exclusively controlled by means of permanent contraceptive methods, mainly female sterilization, which constitutes about two-thirds of overall contraceptive use. Many Indian women undergo sterilization at relatively young ages as a consequence of early marriage and childbearing in short birth intervals. This research aims to investigate the socioeconomic factors determining the choices for alternative contraceptive choices against the dominant preference for sterilization among married women in India. Data for this study are drawn from the 2005-06 National Family Health Surveys focusing on a sample of married women who reported having used a method of contraception in the five years preceding the survey. A multilevel multinomial logit regression is used to estimate the impact of socioeconomic factors on contraceptive choices, differentiating temporary modern or traditional methods versus sterilization. Religious affiliation, women's education and occupation had overarching influence on method choices amongst recent users. Muslim women were at higher odds of choosing a traditional or modern temporary method than sterilization. Higher level of women's education increased the odds of modern temporary method choices but the education effect on traditional method choices was only marginally significant. Recent users belonging to wealthier households had higher odds of choosing modern methods over sterilization. Exposure to family planning messages through radio had a positive effect on modern and traditional method choices. Community variations in method choices were highly significant. The persistent dominance of sterilization in the Indian family planning programme is largely determined by socioeconomic conditions. Reproductive health programmes should address the socioeconomic barriers and consider multiple cost-effective strategies such as mass

Progestin-only pills for contraception.

PubMed

Grimes, David A; Lopez, Laureen M; O'Brien, Paul A; Raymond, Elizabeth G

2010-01-20

The introduction of a new progestin-only oral contraceptive in Europe has renewed interest in this class of oral contraceptives. Unlike the more widely used combined oral contraceptives containing an estrogen plus progestin, these pills contain only a progestin (progestogen) and are taken without interruption. How these pills compare to others in their class or to combined oral contraceptives is not clear. This review examined randomized controlled trials of progestin-only pills for differences in efficacy, acceptability, and continuation rates. We searched the computerized databases MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), POPLINE, LILACS, and EMBASE for studies of progestin-only pills. We also searched for current trials via ClinicalTrials.gov and ICTRP. We included all randomized controlled trials in any language that included progestin-only pills for contraception. We incorporated any comparison with a progestin-only pill; this could include different doses, other progestin-only pills, combined oral contraceptives, or other contraceptives. The first author abstracted the data and entered the information into RevMan 5. Another author performed a second, independent data abstraction to verify the initial data entry. Because of disparate exposures, we were not able to combine studies in meta-analysis. Six trials met the inclusion criteria. In the trial comparing the desogestrel versus levonorgestrel progestin-only pill, desogestrel was not associated with a significantly lower risk of accidental pregnancy; the rate ratio was 0.27 (95% CI 0.06 to 1.19). However, the desogestrel progestin-only pill caused more bleeding problems, although this difference was not statistically significant. The trial comparing low-dose mifepristone versus a levonorgestrel progestin-only pill found similar pregnancy rates. In the trial comparing ethynodiol diacetate versus a combined oral contraceptive, irregular cycles occurred in all women assigned to the

Using the Electronic Medical Record to Refer Women Taking Category D or X Medications for Teratogen and Contraceptive Counseling

PubMed Central

Mody, Sheila K.; Wu, Jennifer; Ornelas, Marla; Kernahan, Colleen; Salas, Elizabeth; Kao, Kelly; Felix, Robert; Chambers, Christina

2015-01-01

Background Women taking teratogens may not receive teratogen and contraceptive counseling. The objective of this study is to explore the feasibility of an electronic medical record (EMR) alert and referral system to improve teratogen and contraceptive counseling. Methods We conducted a descriptive study in an academic outpatient setting to evaluate the feasibility of an EMR alert and referral system. Reproductive age women taking category D or X medications seen in family medicine clinics were referred by means of an EMR alert for teratogen and contraceptive counseling. A subset of these women consented to follow-up surveys assessing contraceptive usage before counseling, intended contraceptive method after counseling and satisfaction with the counseling. Participants were contacted at 1 and 3 months to assess contraceptive usage. Results A total of 354 women were prescribed category D or X medications by clinicians who received the EMR alert, 170 women were referred, 59 women received counseling, and 33 participants enrolled in the study. One participant did not use any contraception. Among the 32 participants using contraception, 12 (37.5%) used oral contraceptives, 11 (34.4%) used condoms, 3 (9.4%) used withdrawal, 3 (9.4%) used intrauterine devices, 2 (6.3%) used contraceptive rings, and 1 (3.1%) used the diaphragm. After counseling, one-third of participants were considering more effective contraception. Almost all participants strongly agreed or agreed that the counseling was helpful. Conclusion Creating an EMR alert and referral system for women prescribed category X or D medications is feasible. Counseling on teratogen exposure and contraception may improve the acceptability of more effective contraception. PMID:26100297

Louisiana and Mississippi Family Physicians' Contraception Counseling for Adolescents with a Focus on Intrauterine Contraception.

PubMed

Rubin, Susan E; Coy, Lauren N; Yu, Qingzhao; Muncie, Herbert L

2016-10-01

The adolescent pregnancy rate in Louisiana (LA) and Mississippi (MS) is one of the highest in the United States. One approach to decrease that rate is to increase contraceptive use. We sought to characterize LA and MS family physicians' (FPs) contraception counseling for adolescents with a focus on the intrauterine contraceptive device (IUD). DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Online survey of resident and practicing physician members of the LA and MS Academy of FPs. Three hundred ninety-eight of 1616 invited FPs responded; 244 were included in our analysis. When counseling adolescents about contraception, respondents "frequently discussed" oral contraceptives and condoms 87.5% (210/240) and 83.8% (202/241) of the time, respectively. Newer and more highly effective contraceptives such as the ring, patch, IUD, and implant were "frequently discussed" only 34.6% (82/237)-39.3% (92/234) of the time. In the previous 6 months, 56% (136/243) of respondents ever discussed an IUD with an adolescent. Respondents were more likely to have discussed IUDs if they learned IUD insertion during residency, had on-site access to IUD inserters, believed they were competent and/or comfortable with IUD counseling. In 5 clinical scenarios asking whether the respondent would recommend an IUD to a 17- or a 27-year-old patient (in all scenarios patients were eligible for an IUD), respondents were restrictive overall and significantly fewer would recommend an IUD for the adolescent. Our results suggest that there are missed opportunities for full-scope contraception counseling by LA and MS FPs. When these FPs counsel adolescents about contraception they less frequently discuss newer methods and more highly effective methods. Additionally many LA and MS FPs use overly restrictive eligibility criteria when considering IUDs. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

iContraception(®): a software tool to assist professionals in choosing contraceptive methods according to WHO medical eligibility criteria.

PubMed

Lopez, Ramón Guisado; Polo, Isabel Ramirez; Berral, Jose Eduardo Arjona; Fernandez, Julia Guisado; Castelo-Branco, Camil

2015-04-01

To design software to assist health care providers with contraceptive counselling. The Model-View-Controller software architecture pattern was used. Decision logic was incorporated to automatically compute the safety category of each contraceptive option. Decisions are made according to the specific characteristics or known medical conditions of each potential contraception user. The software is an app designed for the iOS and Android platforms and is available in four languages. iContraception(®) facilitates presentation of visual data on medical eligibility criteria for contraceptive treatments. The use of this software was evaluated by a sample of 54 health care providers. The general satisfaction with the use of the app was over 8 on a 0-10 visual analogue scale in 96.3% of cases. iContraception provides easy access to medical eligibility criteria of contraceptive options and may help with contraceptive counselling. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

[Male contraception - the current state of knowledge].

PubMed

Zdrojewicz, Zygmynt; Kasperska, Karolina; Lewandowska, Marta

2016-08-01

Contraception is important from a health, psychological and socioeconomic point of view. Due to the fact that male-based contraceptive methods are mostly represented by condoms and vasectomy, researchers are working on the new solutions, which could let the men be more involved in a conscious family planning. In this review we will present the current state of knowledge on this subject. There is a lot going on in the field of hormonal contraception. Studies including testosterone, progestins, synthetic androgens and other derivatives are on a different stages of clinical trials and mostly demonstrate high efficacy rates. Recent discovers of Izumo and Juno proteins, essential for the fertilization process, give hope for an easily reversible, non-hormonal method. Researchers are also trying to interfere with the process of spermatogenesis using BRDT inhibitor - JQ1, or neutralize the sperm by injecting styrene maleic anhydride (SMA) into the lumen of the vas deferens. The other studies explore processes involved in proper sperm motility. A vaccine which induces an immune response to the reproductive system is also an interesting method. The latest research use ultrasound waves and mechanical device which blocks the patency of vas deferens. The aim of the study current state of knowledge male contraception. © 2016 MEDPRESS.

Routine counseling about intrauterine contraception for women seeking emergency contraception.

PubMed

Schwarz, E Bimla; Papic, Melissa; Parisi, Sara M; Baldauf, Erin; Rapkin, Rachel; Updike, Glenn

2014-07-01

To compare contraceptive knowledge and use among women seeking emergency contraception (EC) before and after an inner-city clinic began providing structured counseling and offering same-day intrauterine device (IUD) or implant placement to all women seeking EC. For 8 months before and 21 months after this change in clinic policy, women aged 15-45 who wanted to avoid pregnancy for at least 6 months were asked to complete surveys immediately, 3 and 12 months after their clinic visit. In addition, we abstracted electronic medical record (EMR) data on all women who sought EC (n=328) during this period. We used chi-squared tests to assess pre/post differences in survey and EMR data. Surveys were completed by 186 women. After the clinic began offering structured counseling, more women had accurate knowledge of the effectiveness of IUDs, immediately and 3 months after their clinic visit. In addition, more women initiated IUD or implant use (survey: 40% vs. 17% preintervention, p=0.04; EMR: 22% vs. 10% preintervention, p=0.01), and fewer had no contraceptive use (survey: 3% vs. 17% preintervention, p<0.01; EMR: 32% vs. 68%, p<0.01) in the 3 months after seeking EC. EMR data indicate that when same-day placement was offered, 11.0% of women received a same-day IUD. Of those who received a same-day IUD, 88% (23/26) reported IUD use at 3-months and 80% (12/15) at 12 months. Routine provision of structured counseling with the offer of same-day IUD placement increases knowledge and use of IUDs 3 months after women seek EC. Women seeking EC from family planning clinics should be offered counseling about highly effective reversible contraceptives with the option of same-day contraceptive placement. Copyright © 2014 Elsevier Inc. All rights reserved.

Efficacy of contraceptive methods: a review of the literature.

PubMed

Mansour, Diana; Inki, Pirjo; Gemzell-Danielsson, Kristina

2010-12-01

To provide a comprehensive and objective summary of contraceptive failure rates for a variety of methods based on a systematic review of the literature. Medline and Embase were searched using the Ovid interface from January 1990 to February 2008, as well as the reference lists of published articles, to identify studies reporting contraceptive efficacy as a Pearl Index or life-table estimate. Reports that recruited less than 400 subjects per study group and those covering less than six cycles/six months were excluded. In addition, unlicensed products or those not internationally available, emergency contraception, and vasectomy studies were excluded. Information was identified and extracted from 139 studies. One-year Pearl Indices reported for short-acting user-dependent hormonal methods were generally less than 2.5. Gross life-table rates for long-acting hormonal methods (implants and the levonorgestrel releasing-intrauterine system [LNG-IUS]) generally ranged between 0-0.6 per 100 at one year, but wider ranges (0.1-1.5 per 100) were observed for the copper intrauterine devices (0.1-1.4 per 100 for Cu-UIDs with surface area ≥ 300 mm2 and 0.6-1.5 per 100 for those with surface area < 300 mm2). Barrier and natural methods were the least effective. Our review broadly confirms the hierarchy of contraceptive effectiveness in descending order as: (1) female sterilisation, long-acting hormonal contraceptives (LNG-IUS and implants); (2) Cu-IUDs with ≥ 300 mm2 surface area; (3) Cu-IUDs with < 300 mm2 surface area and short-acting hormonal contraceptives ( injectables, oral contraceptives, the patch and vaginal rings), (4) barrier methods and natural methods.

Efficacy of contraceptive methods: A review of the literature.

PubMed

Mansour, Diana; Inki, Pirjo; Gemzell-Danielsson, Kristina

2010-02-01

To provide a comprehensive and objective summary of contraceptive failure rates for a variety of methods based on a systematic review of the literature. Medline and Embase were searched using the Ovid interface from January 1990 to February 2008, as well as the reference lists of published articles, to identify studies reporting contraceptive efficacy as a Pearl Index or life-table estimate. Reports that recruited less than 400 subjects per study group and those covering less than six cycles/six months were excluded. In addition, unlicensed products or those not internationally available, emergency contraception, and vasectomy studies were excluded. Information was identified and extracted from 139 studies. One-year Pearl Indices reported for short-acting user-dependent hormonal methods were generally less than 2.5. Gross life-table rates for long-acting hormonal methods (implants and the levonorgestrel releasing-intrauterine system [LNG-IUS]) generally ranged between 0-0.6 per 100 at one year, but wider ranges (0.1-1.5 per 100) were observed for the copper intrauterine devices (0.1-1.4 per 100 for Cu-IUDs with surface area > or =300 mm( 2 ) and 0.6-1.5 per 100 for those with surface area <300 mm( 2 )). Barrier and natural methods were the least effective. Our review broadly confirms the hierarchy of contraceptive effectiveness in descending order as: (1) female sterilisation, long-acting hormonal contraceptives (LNG-IUS and implants); (2) Cu-IUDs with > or =300 mm( 2 ) surface area; (3) Cu-IUDs with <300 mm( 2 ) surface area and short-acting hormonal contraceptives (injectables, oral contraceptives, the patch and vaginal ring), and (4) barrier methods and natural methods.

Contraceptive usage patterns in North American medical students

PubMed Central

Rowen, Tami S.; Smith, James F.; Eisenberg, Michael L.; Breyer, Benjamin N.; Drey, Eleanor A.; Shindel, Alan W.

2013-01-01

Background Previous studies indicate that the sexual beliefs and mores of students in medical professions may influence their capacity to care for patients’ sexuality and contraception issues. Students also represent a large sample of reproductive-age individuals. In this study, we examined contraceptive usage patterns in North American medical students. Study Design Students using online medical student social and information networks enrolled in allopathic and osteopathic medical schools in North America between February and July of 2008 were invited to participate via email and published announcements in an Internet-based survey consisting of a questionnaire that assessed ethnodemographic factors, year in school and sexual history. We also collected information about current use of contraceptive and barrier methods. Descriptive statistics and logistic regression were utilized to analyze responses. Results Among our 2269 complete responses, at least one form of contraception was being utilized by 71% of men and 76% of women. Condoms were the most popular form of contraceptive, utilized by 1011 respondents (50% of men and 40% of women). Oral contraceptive pills were the contraceptive of choice for 34% of men and 41% of women. Decreased rates of contraception use were associated with being black or Asian, not being in a relationship and having more sexual dysfunction in female respondents. Students who reported comfort discussing sexual issues with patients were more likely to use effective contraceptive methods themselves. Ten percent of this of sexually active medical students was not currently using contraception. Conclusions There are significant differences in contraceptive use based on demographics, even at the highest education levels. The personal contraception choices of medical students may influence their ability to accurately convey information about contraception to their patients. In addition, medical students may personally benefit from improved

Contraceptive usage patterns in North American medical students.

PubMed

Rowen, Tami S; Smith, James F; Eisenberg, Michael L; Breyer, Benjamin N; Drey, Eleanor A; Shindel, Alan W

2011-05-01

Previous studies indicate that the sexual beliefs and mores of students in medical professions may influence their capacity to care for patients' sexuality and contraception issues. Students also represent a large sample of reproductive-age individuals. In this study, we examined contraceptive usage patterns in North American medical students. Students using online medical student social and information networks enrolled in allopathic and osteopathic medical schools in North America between February and July of 2008 were invited to participate via email and published announcements in an Internet-based survey consisting of a questionnaire that assessed ethnodemographic factors, year in school and sexual history. We also collected information about current use of contraceptive and barrier methods. Descriptive statistics and logistic regression were utilized to analyze responses. Among our 2269 complete responses, at least one form of contraception was being utilized by 71% of men and 76% of women. Condoms were the most popular form of contraceptive, utilized by 1011 respondents (50% of men and 40% of women). Oral contraceptive pills were the contraceptive of choice for 34% of men and 41% of women. Decreased rates of contraception use were associated with being black or Asian, not being in a relationship and having more sexual dysfunction in female respondents. Students who reported comfort discussing sexual issues with patients were more likely to use effective contraceptive methods themselves. Ten percent of this of sexually active medical students was not currently using contraception. There are significant differences in contraceptive use based on demographics, even at the highest education levels. The personal contraception choices of medical students may influence their ability to accurately convey information about contraception to their patients. In addition, medical students may personally benefit from improved knowledge of effective contraceptive practices

Male Adolescent Contraceptive Utilization.

ERIC Educational Resources Information Center

Finkel, Madelon Lubin; Finkel, David J.

1978-01-01

The contraceptive utilization of a sample of sexually active, urban, high school males (Black, Hispanic, and White) was examined by anonymous questionnaire. Contraceptive use was haphazard, but White males tended to be more effective contraceptors than the other two groups. Reasons for nonuse were also studied. (Author/SJL)

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.

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

Indicators of young women's modern contraceptive use in Burkina Faso and Mali from Demographic and Health Survey data.

PubMed

O'Regan, Amy; Thompson, Gretchen

2017-01-01

High total fertility rates in Burkina Faso and Mali are leading to population growth beyond the agricultural and fiscal means of its citizens. Providing access to affordable family planning methods is a key step in driving the demographic transition where fertility and mortality rates decline. Furthermore, both nations face significant challenges as climate change is projected to disproportionately impact the western Sahel region undermining environmental, social and economic stability within the region. This analysis was included in formative research to inform family planning programming. The aim of this study was to examine possible indicators of long acting and permanent contraceptive method (LAPM) and short-term method (STM) use for young women in Burkina Faso and Mali. Secondary data analysis was conducted using the three most recent Demographic and Health Survey (DHS) datasets for Burkina Faso (1998, 2003, 2010) and Mali (2001, 2006, 2012). Women ages 15-24, at risk for unwanted pregnancy were included in these analyses. Summary descriptive statistics across all time points are reported and multinomial logistic regression was used with the most recent data to determine potential indicators of different types of modern contraceptive methods. In Burkina Faso in 2010, 24% of women ages 15-24 were using modern contraceptives. Only 2.9% reported using LAPMs in 2010, an increase from 0.3% in 1998. In Mali, modern contraceptive use increased more recently, rising from 9.4% in 2001 to 10.2% in 2006 to 15.3% in 2012. LAPM use also increased from 0.3% in 2001 to 4.1% in 2012. Significant indicators of LAPM contraceptive use in both countries included educational attainment, ideal family size, home ownership and husband's desire for more children. Young women in Burkina Faso and Mali are increasingly using modern contraceptives for family planning; however, the LAPM contraceptive prevalence rate remains low. Our analysis indicates that social norms around ideal family

An exploratory analysis of contraceptive method choice and symptoms of depression in adolescent females initiating prescription contraception.

PubMed

Francis, Jenny; Presser, Liandra; Malbon, Katherine; Braun-Courville, Debra; Linares, Lourdes Oriana

2015-04-01

We examine the association between depressive symptoms and contraceptive method choice among adolescents initiating prescription contraception. This cross-sectional study analyzes baseline data of 220 urban, minority adolescent females (ages 15-19 years) presenting for prescription contraceptive initiation at a comprehensive, free-of-cost, adolescent health center in New York City. All participants met with a health care provider who provided standard contraception counseling before initiating contraception. Each participant then selected a short- or long-acting contraceptive: a 3-month supply of the pill, patch, ring or a medroxyprogesterone acetate depot injection (short-acting), or placement/referral for an intrauterine device (IUD; long-acting). We assess the independent association between contraceptive method selection and symptoms of depression [assessed by the Center for Epidemiological Studies - Depression (CES-D) scale]. Ten percent (n=21/220) of adolescent females selected an IUD. Bivariate analysis revealed that those with elevated levels of depressive symptoms were more likely to select an IUD as compared to those with minimal symptoms (mean CES-D score 20 vs. 13; t=3.052, p=.003). In multivariate logistic regressions, adolescent females had increased odds of selecting an IUD if they reported moderate to severe depressive symptoms (adjusted odds ratio=4.93; confidence interval, 1.53-15.83; p=.007) after controlling for ethnicity/race, education, number of lifetime partners and gravidity. Inner-city, minority adolescents with elevated symptoms of depression who present for prescription contraceptive initiation may be more likely to select an IUD rather than shorter-acting methods. By recognizing adolescent females with depressive symptoms, providers can strategize their approach to effective contraception counseling. Copyright © 2015 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 use-effectiveness and the American adolescent.

PubMed

Lyle, K C; Segal, S J

1979-05-01

Contraceptive use-effectiveness is significantly shaped by the contraceptors' ages, for pregnancy rates are found to be a function of age. Teenagers are more failure prone than older contracepting women, regardless of method. This higher teenage failure rate can indicate clearly the use-effectiveness of various contraceptive methods. Consequently, both user and method (whether modern or traditional) determine outcome levels of contraceptive use-effectiveness.

Fertility and contraception in Puerto Rico.

PubMed

Beebe, G W; Belaval, J S

1942-09-01

A contraceptive service was established in Puerto Rico in 1937. Detailed study of the reproductive history of low income families admitted to the service provides information for the basis of the present high fertility of the population and the likelihood of its continuance. The experience of these families following admission to the contraceptive service shows the impact of the service upon their fertility, testing the view that Puerto Rico might respond to an organized birth control effort. The sample consisted of 1962 families selected not randomly but on the basis of indigence and interest in contraceptive advice. 1/3 of the couples reported some previous effort at contraception, with most of the contraceptive practice depending on withdrawal. Residence, education, occupation, and income are all associated with the marked variation in the proportions who reported contraceptive experience. The percentages are 26 and 52 for rural and urban residence; 21, 27, 44, and 59 for the educational groupings with less than 5 to 7 and 8 or more completed grades. For the low, medium, and high occupational groups, the percentages are 20, 45, and 69, and for the corresponding income classes they are 22, 42, and 66. Women aged 25 to 29 and 30 to 34 report contraceptive practice with much greater relative frequency than younger women. Clearly marked differences are found in the rates for contraceptors of different social and economic classes. Although the reason for high fertility in Puerto Rico is due to lack of cultural and economic pressure to limit families, there is evidence to suggest that use of birth control has begun. It appears that fertility reduction would be implemented if the population possessed better knowledge of birth control measures and readier access to contraceptive materials, particularly condoms. A clinical program to encourage the use of contraception might also prove effective.

Pharmacy-based interventions for initiating effective contraception following the use of emergency contraception: a pilot study.

PubMed

Michie, L; Cameron, S T; Glasier, A; Larke, N; Muir, A; Lorimer, A

2014-10-01

In Scotland most women get emergency contraception (EC) from pharmacies. Pharmacists currently cannot provide effective ongoing contraception after EC. In this pilot study, we aimed to determine the feasibility of a larger study designed to ascertain if pharmacy-based interventions can increase the uptake of effective contraception after EC. This is a pilot study of women presenting for levonorgestrel EC to community pharmacies in Edinburgh, UK, in 2012. Pharmacies were cluster randomized to provide either standard care or one of two interventions: (a) one packet of progestogen-only pills (POPs), giving women 1 month to arrange ongoing contraception; (b) invitation to present the empty EC packet to a family planning clinic (FPC) for contraceptive advice (rapid access). One hundred sixty-eight women were recruited from 11 pharmacies to POP (n=56), rapid access (n=58) and standard care (N=54) groups, respectively. Telephone follow-up was conducted successfully in 102 women (61%) 6-8 weeks later to determine current contraceptive use. In the POP arm, 35/39 (90%) women used the pills provided, and 9/28 women (32%) in the rapid access arm attended the FPC. The proportion of women using effective contraception at follow-up was significantly greater in both POP [56% (22/39), p=<0.001] and rapid access [52% (13/25), p=0.006] groups compared to standard care [16% (5/31)]. The relative probability of a woman using an effective method of contraception versus barrier/no method, after use of EC, was 3.13 [95% confidence interval (CI), 1.90-5.13] in the POP group and 2.57 (95% CI, 1.55-4.27) in the rapid access group. This promising pilot study suggests that simple pharmacy-based interventions may increase the uptake of effective contraception after EC. A larger study is required to provide further validation of these findings. For women obtaining EC from a pharmacy, simple interventions such as supplying 1 month of a POP, or offering rapid access to a FPC, hold promise as

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.

Informing the introduction of contraceptive implants in the Pacific: a mixed methods study of contraceptive beliefs and behaviours in Tonga.

PubMed

Winn-Dix, Edward A; Nathan, Sally A; Rawstorne, Patrick

2016-04-01

To explore the knowledge and attitudes underlying contraceptive use and non-use among Tongan adults and investigate the potential acceptability of contraceptive implants. A mixed methods study was conducted that used two focus groups and a short self-completed survey (n=109). Participants were recruited from a Tongan non-governmental sexual and reproductive health clinic. Contraceptive method discontinuation was high among the study group, with reasons for discontinuation often relating to misconceptions circulating in the community about the side effects of contraceptives. A high proportion (38%) reported using 'natural' contraceptive methods. A total of 47% of survey participants reported having heard of implants and 37% indicated they would be willing to try them. Current Tongan contraceptive uptake and continuation is hampered by misconceptions about side effects of methods and their risks, particularly among long-acting and reversible methods. Contraceptive implants may be acceptable to Tongans given their arm placement, reversibility and long-lasting effect. Efforts to improve contraceptive continuation in Tonga should focus on improving counselling on potential side effects for all methods. The introduction of contraceptive implants as an additional long-acting reversible method should be considered. © 2015 Public Health Association of Australia.

EMERGENCY CONTRACEPTION: AN OVERVIEW AMONG USERS.

PubMed

Khan, Shazia Amir; Hafeez, Humaira; Akbar, Rabiya

2015-01-01

Emergency contraception Pills (ECP) provides a safe and effective means of post coital treatment and prevents at least 75% of expected pregnancies resulting from unprotected intercourse. The purpose of the study was to assess the awareness regarding emergency contraception and to see the knowledge attitude and preference about emergency contraception. This was a descriptive cross sectional study carried out at Combined Military Hospital (CMH) Khuzdar. A total of 200 married women of reproductive age group who agreed to participate in the study were interviewed using a self-reported comprehensive, structured closed ended questionnaire. 77% of the women were practicing some contraceptive method at the time of study. Most were using condoms for contraception. 16% of all respondents have never used any contraceptive in their life. 70% believe that religion of Islam is not a barrier in family planning. Only 7.5% of the women were aware about ECP. Knowledge about ECP is poor among the women of child bearing age. There is a room for improvement regarding the awareness and use of ECP which can contribute to prevention of unwanted pregnancies.

Contraceptive practice in China: 1970-2004.

PubMed

Wang, Cuntong

2015-03-01

Using large-scale data from the national conventional statistics and nationally representative sample surveys, the current study aims to assess the level, mode, and determinants of modern contraceptive use from 1970 to 2004 among married couples aged 20 to 49 years in China. A relatively stable Chinese mode of contraception has been established and maintained since the 1980s, characterized by prominent, long-acting contraceptive use and the highest overall prevalence in the world during the past 3 decades. In recent years, the composition of contraceptive use has changed, characterized by the increasing use of the intrauterine device and short-acting methods and a drastic decrease in male and female sterilization. However, the dominance of the long-acting methods has not undergone substantial change. The results from a multinomial logit model employed in this study indicate that family planning policy and socioeconomic and demographic factors jointly influence contraceptive choice. In particular, contraceptive choice is closely associated with the strength of family planning policy in China. © 2011 APJPH.

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.

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.

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.

Contraceptive social marketing in Albania - the NESMARK story.

PubMed

Paravani, Ardian; Orgocka, Aida

2013-06-01

To present the history of social marketing of modern contraceptives in Albania. We review documentation and activity of NESMARK, an Albanian non-governmental social marketing organisation, and national data on adoption of modern contraception. During 15 years of awareness raising, sales of affordable products, and provider training, NESMARK has impacted the introduction and adoption of modern contraception in Albania. NESMARK is the country's main distributor of emergency contraception (EC) and complements the public sector in the distribution of condoms and oral contraceptives. NESMARK has made major efforts to overcome prevalent taboos and misinformation held by medical and nursing personnel, pharmacists and the general public, regarding the effectiveness and safety of condoms, oral contraceptives, and EC. NESMARK has contributed to increasing the choices for modern contraception methods in Albania by providing affordable contraceptives, training providers, and educating the general population. However, widespread use of withdrawal coupled with the belief that it is as or more effective than modern contraception, continues to limit uptake of new methods and is a significant challenge to comprehensive and sustained social marketing programmes.

Community pharmacists providing emergency contraception give little advice about future contraceptive use: a mystery shopper study.

PubMed

Glasier, Anna; Manners, Rachel; Loudon, Joanna C; Muir, Aileen

2010-12-01

UK women increasingly prefer to attend a pharmacy for emergency contraception (EC) rather than a doctor. Most women who use EC do not conceive and remain at risk of pregnancy unless they start regular contraception. We undertook a study to evaluate the quality of service provision in community pharmacies in Lothian, Scotland, and to determine what advice is given about contraception after EC use. Mystery shopper study. EC was unobtainable from 5/40 pharmacies (12.5%), refused because of "contraindications" in 7 (17.5%) and offered in 28 (70%). Most pharmacists appeared nonjudgemental, over 75% asked appropriate questions about eligibility, and over 90% gave appropriate advice about use. EC was universally refused beyond 72 h after sex but universally provided when the date of the last menstrual period was uncertain. Ongoing contraception after EC use was discussed in only 32.5% of all pharmacies and only 43% of those issuing EC. The quality of consultations for EC in pharmacies is generally good but only a minority discuss ongoing contraception after EC use. The implications for contraceptive use and unintended pregnancy rates are worrying. Copyright © 2010 Elsevier Inc. All rights reserved.

[Unwanted adolescent pregnancy and post-partum utilization of contraceptive methods].

PubMed

Núñez-Urquiza, Rosa María; Hernández-Prado, Bernardo; García-Barrios, Cecilia; González, Dolores; Walker, Dylis

2003-01-01

To describe the proportion of unwanted pregnancies among all pregnant adolescents, its association with sociodemographic characteristics, and the use of post-partum contraceptive methods. A cross-sectional study was conducted among 220 women between 13 and 19 years of age, in two semi-urban municipalities of the State of Morelos, Mexico, interviewed between 1992 and 1994. Women were interviewed at home, six to twelve weeks after their delivery date. Women were asked whether they had wanted their last pregnancy, and about knowledge and use of contraceptive methods after delivery. Adolescent pregnancies accounted for 17% of all births registered in these two municipalities. Among all adolescent mother 22.73% reported that their pregnancy had not been wanted. A positive association was found between the lack of access to health services provided by public medical insurance systems (Instituto Mexicano del Seguro Social IMSS and Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado ISSSTE) and unwanted pregnancy (adjusted OR = 3.03, 95% CI (1.31, 7.) An association was also found between living in an urban community (adjusted OR = 2.16, 95% CI (1.08, 4.33) and an unwanted pregnancy. Among all adolescent mothers, 91.3% were familiar with "the pill" as a contraceptive method; 84.72% knew about the IUD, and 63.68% knew about the condom. However, only 35% of them were actually using an effective contraceptive method six weeks after delivery. No difference in frequency of contraceptive use was found among the adolescent mothers, according to whether they wanted their last pregnancy. Only 43.39% of mothers who delivered at hospitals or health centers were using an effective contraceptive method. These findings suggest that there is a great potential for family planning programs to target adolescents, and that the use of contraceptive methods after delivery should be promoted among adolescent mothers, especially those lacking access to public medical

Twelve-month contraceptive continuation among women initiating short- and long-acting reversible contraceptives in North Kivu, Democratic Republic of the Congo.

PubMed

Casey, Sara E; Cannon, Amy; Mushagalusa Balikubirhi, Benjamin; Muyisa, Jean-Bosco; Amsalu, Ribka; Tsolka, Maria

2017-01-01

Despite the inclusion of sexual and reproductive health (SRH) services in the minimum standards of health care in humanitarian settings, access to SRH services, and especially to contraception, is often compromised in war. Very little is known about continuation and switching of contraceptive methods in these settings. An evaluation of a contraceptive services program in North Kivu, Democratic Republic of the Congo (DRC) was conducted to measure 12-month contraceptive continuation by type of contraceptive method (short-acting or long-acting). A stratified systematic sample of women who initiated a contraceptive method 12-18 months prior to data collection was selected retrospectively from facility registers. A total of 548 women was interviewed about their contraceptive use: 304 who began a short-acting method (pills, injectables) and 244 who began a long-acting method (intra-uterine devices, implants). Key characteristics of short-acting method versus long-acting method acceptors were compared using chi-square statistics for categorical data and t-tests for continuous data. Unadjusted and adjusted Cox proportional hazard ratios were estimated to assess factors associated with discontinuation. At 12 months, 81.6% women reported using their baseline contraceptive method continuously, with more long-acting than short-acting contraceptive acceptors (86.1% versus 78.0%, p = .02) continuing contraceptive use. Use of a short-acting method (Hazard ratio (HR) 1.74 [95%CI 1.13-2.67]) and desiring a child within two years (HR 2.58 [95%CI 1.45-4.54]) were associated with discontinuation within the first 12 months of use. The vast majority (88.3%) of women reported no prior contraceptive use. This is the first study of contraceptive continuation in a humanitarian setting. The high percentages of women continuing contraceptive use found here demonstrates that women will choose to initiate and continue use of their desired contraceptive method, even in a difficult, unstable and

A multicentre, open-label, randomised phase III study comparing a new levonorgestrel intrauterine contraceptive system (LNG-IUS 8) with combined oral contraception in young women of reproductive age.

PubMed

Borgatta, Lynn; Buhling, Kai J; Rybowski, Sarah; Roth, Katrin; Rosen, Kimberly

2016-10-01

To compare user satisfaction and adverse events (AEs) with a levonorgestrel intrauterine system (LNG-IUS 8; average levonorgestrel release rate approximately 8 μg/24 h over the first year [total content 13.5 mg]) and a 30 μg ethinyl estradiol/3 mg drospirenone (EE/DRSP) combined oral contraceptive (COC) in a population of young women. Nulliparous and parous women (aged 18-29 years) with regular menstrual cycles (21-35 days) were randomised to LNG-IUS 8 or EE/DRSP for 18 months. The primary endpoint was the overall user satisfaction rate at month 18/end of study visit. Overall, 279 women were randomised to LNG-IUS 8 with attempted placement and 281 women were randomised to EE/DRSP and took ≥1 pill; the mean age was 23.7 and 23.9 years, and 77.4% and 73.3% were nulliparous, respectively. At month 18/end of study, 82.1% and 81.9% of women, respectively, reported being 'very satisfied' or 'satisfied' with their treatment; however, significantly more LNG-IUS 8 users reported a preference to continue their treatment post-study (66.2% vs 48.8%; p = 0.0001). There were two pregnancies (one ectopic pregnancy, one spontaneous abortion) reported in the LNG-IUS 8 group and six (three live births, two spontaneous abortions, one induced abortion) in the EE/DRSP group. LNG-IUS 8 and EE/DRSP were associated with similarly high user satisfaction rates. However, LNG-IUS 8 users were significantly more likely to prefer to continue their contraceptive method post-study, indicating that a levonorgestrel intrauterine system is an appealing contraceptive option for young women.

Factors associated with the use of irreversible contraception and continuous use of reversible contraception in a cohort of HIV-positive women.

PubMed

Kancheva Landolt, Nadia; Ramautarsing, Reshmie Ashmanie; Phanuphak, Nittaya; Teeratakulpisarn, Nipat; Pinyakorn, Suteeraporn; Rodbamrung, Piyanee; Chaithongwongwatthana, Surasith; Ananworanich, Jintanat

2013-07-01

Effective contraception can be lifesaving by reducing maternal mortality linked to childbirth and unsafe abortion and by reducing vertical and horizontal transmission of HIV, in the case of an HIV-positive woman. This study is a secondary analysis of a prospective cohort study. We assessed factors associated with the use of irreversible contraception and the continuous use of reversible contraception in HIV-positive Thai women. We used descriptive statistics to present baseline characteristics and logistic regression to assess the association between contraceptive use and factors in the study. Of 196 women included in the analysis, 87% self-reported always using male condoms and 56% continuously using another effective contraceptive method during the period of the study (12-18 months). The choice of effective contraceptive methods was suboptimal--42% were sterilized, 14% used hormonal contraception and no participant reported the use of an intrauterine device. Sexual activity and past contraceptive use were factors associated positively with current continuous contraceptive use. Live births and lower levels of education were additional factors associated positively with sterilization. Despite high contraceptive use, there are still uncovered contraceptive needs among HIV-positive women in Thailand. HIV-positive women need established specialized family planning services, offering an optimal variety of contraceptive choices and tailored to their individual needs. As sterilization is an irreversible choice, it cannot be a viable alternative for every woman. Due to the positive trend between current and past contraceptive use, we consider that it may be possible to improve family planning programs if they start as early as possible in a woman's life and are continued throughout her sexually active and reproductive years. Copyright © 2013 Elsevier Inc. All rights reserved.

Contraceptive introduction and the management of choice: the role of Cyclofem in Indonesia.

PubMed

Simmons, R; Fajans, P; Lubis, F

1994-05-01

This paper presents a programmatic perspective on the relationship between the introduction of new contraceptive technology and expanding contraceptive options, using the example of Cyclofem in Indonesia. Past approaches to contraceptive introduction have considered only the characteristics of the new method in the decision-making process. In assessing whether the introduction of a new method actually expands contraceptive choice for women and whether the program has the managerial capabilities to assure quality of care in this process, the authors argue that consideration must be given to all methods within a delivery system and how new technology relates to the management of contraceptive choice. Using this perspective, the authors suggest that choice would not necessarily be expanded with scaled-up service delivery of a new once-a month injectable in the Indonesian public sector context.

Are women benefiting from the Affordable Care Act? A real-world evaluation of the impact of the Affordable Care Act on out-of-pocket costs for contraceptives.

PubMed

Law, A; Wen, L; Lin, J; Tangirala, M; Schwartz, J S; Zampaglione, E

2016-05-01

The Affordable Care Act (ACA) mandated that, starting between August 1, 2012 and July 31, 2013, health plans cover most Food and Drug Administration (FDA)-approved contraceptive methods for women without cost sharing. This study examined the impact of the ACA on out-of-pocket expenses for contraceptives. Women (ages 15-44years) with claims for any contraceptives in years 2011, 2012 and 2013 were identified from the MarketScan Commercial database. The proportions of women using contraceptives [including permanent contraceptives (PCs) and non-PCs: oral contraceptives (OCs), injectables, patches, rings, implants and intrauterine devices (IUDs)] in study years were determined, as well as changes in out-of-pocket expenses for contraceptives during 2011-2013. Demographics, including age, U.S. geographic region of residence and health plan type, were also evaluated. The number of women identified with any contraceptive usage in 2011 was 2,447,316 (mean age: 27.6years), in 2012 was 2,515,296 (mean age: 27.4years) and in 2013 was 2,243,253 (mean age: 27.4years). In 2011, 2012 and 2013, the proportions of women with any contraceptive usage were 26.3%, 26.2% and 26.9%, respectively. Over the three study years, mean total out-of-pocket expenses for PCs and non-PCs decreased from $298 to $82 and from $94 to $30, respectively. For non-PCs, mean total out-of-pocket expenses for OCs and IUDs decreased from $86 to $26 and from $83 to $20. Implementation of the ACA has saved women a substantial amount in out-of-pocket expenses for contraceptives. Mean total out-of-pocket expenses for FDA-approved contraceptives decreased approximately 70% from 2011 to 2013. Implementation of the ACA has saved women a substantial amount in out-of-pocket expenses for contraceptives. Longer-term studies, including clinical outcomes, are warranted. Copyright © 2016 Elsevier Inc. All rights reserved.

Mothers' attitude to the use of a combined oral contraceptive pill by their daughters for menstrual disorders or contraception.

PubMed

Yiu, K W; Chan, S Sc; Chung, T Kh

2017-04-01

Mothers' attitude may affect use of combined oral contraceptive pills by their daughters. We explored Chinese mothers' knowledge of and attitudes towards the use of combined oral contraceptive pills by their daughters for menstrual disorders or contraception, and evaluate the factors affecting their attitude. This survey was conducted from October 2012 to March 2013, and recruited Chinese women who attended a gynaecology clinic or accompanied their daughter to a gynaecology clinic, and who had one or more daughters aged 10 to 18 years. They completed a 41-item questionnaire to assess their knowledge of and attitude towards use of the combined oral contraceptive pills by their daughters. The demographic data of the mothers and their personal experience in using the pills were also collected. A total of 300 women with a mean age of 45.2 (standard deviation, 5.0) years completed the questionnaire. Only 58.3% of women reported that they had knowledge about the combined oral contraceptive pills; among them, a majority (63.3%) reported that their source of knowledge came from medical professionals. Of a total possible score of 22, their mean knowledge score for risk, side-effects, benefits, and contra-indications to use of combined oral contraceptive pills was only 5.0 (standard deviation, 4.7). If the medical recommendation to use an oral contraceptive was to manage their daughter's dysmenorrhoea, menorrhagia, acne, or contraception needs, 32.0%, 39.3%, 21.0% and 29.7%, respectively would accept this advice. Women who were an ever-user of combined oral contraceptive pills or who were more knowledgeable about combined oral contraceptives had a higher acceptance rate. Chinese women had a low acceptance level of using combined oral contraceptive pills as a legitimate treatment for their daughters. This was associated with lack of knowledge or a high degree of uncertainty about their risks and benefits. It is important that health caregivers provide up-to-date information

Emerging Options for Emergency Contraception

PubMed Central

Koyama, Atsuko; Hagopian, Laura; Linden, Judith

2013-01-01

Emergency post-coital contraception (EC) is an effective method of preventing pregnancy when used appropriately. EC has been available since the 1970s, and its availability and use have become widespread. Options for EC are broad and include the copper intrauterine device (IUD) and emergency contraceptive pills such as levonorgestrel, ulipristal acetate, combined oral contraceptive pills (Yuzpe method), and less commonly, mifepristone. Some options are available over-the-counter, while others require provider prescription or placement. There are no absolute contraindications to the use of emergency contraceptive pills, with the exception of ulipristal acetate and mifepristone. This article reviews the mechanisms of action, efficacy, safety, side effects, clinical considerations, and patient preferences with respect to EC usage. The decision of which regimen to use is influenced by local availability, cost, and patient preference. PMID:24453516

Use of and access to oral and injectable contraceptives in Brazil

PubMed Central

Farias, Mareni Rocha; Leite, Silvana Nair; Tavares, Noemia Urruth Leão; Oliveira, Maria Auxiliadora; Arrais, Paulo Sergio Dourado; Bertoldi, Andréa Dâmaso; Pizzol, Tatiane da Silva Dal; Luiza, Vera Lucia; Ramos, Luiz Roberto; Mengue, Sotero Serrate

2016-01-01

ABSTRACT OBJECTIVE To analyze the prevalence of current use of oral and injectable contraceptives by Brazilian women, according to demographic and socioeconomic variables and issues related to access to those medicines. METHODS A cross-sectional, population-based analytical study with probability sampling based on data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), carried out between September 2013 and February 2014 in 20,404 Brazilian urban households. Prevalence was calculated based on reports from non-pregnant women aged 15-49 on the use of oral or injectable contraceptives. The independent variables were gender, age, level of education, socioeconomic class, Brazilian region and marital status. Also analyzed were access, means of payment, sources, and reported medicines. Statistical analyses considered 95% confidence intervals (95%CI) and Pearson Chi-square test to evaluate the statistical significance of differences between groups, considering a 5% significance level. RESULTS Prevalence of use was 28.2% for oral contraceptives (OC) and 4.5% for injectable contraceptives (IC). The highest prevalence of oral contraceptives was in the South region (37.5%) and the lowest in the North region (15.7%). For injectable contraceptives there was no difference between regions. Access was higher for oral contraceptive users (90.7%) than injectable contraceptives users (81.2%), as was direct payment (OC 78.1%, IC 58.0%). Users who paid for contraceptives acquired them at retail pharmacies (OC 95.0% and IC 86.6%) and at Farmácia Popular (Popular Pharmacy Program) (OC 4.8% and IC 12.7%). Free of charge contraceptives were mostly obtained from the Brazilian Unified Health System – SUS (OC 86.7%; IC 96.0%). Free samples were reported by 10.4% of users who did not pay for oral contraceptives. Most of paying users did not try to obtain

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

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

PubMed

Potts, M; Siemens, A; Burton, N

1986-03-01

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.

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

Physical examination prior to initiating hormonal contraception: a systematic review.

PubMed

Tepper, Naomi K; Curtis, Kathryn M; Steenland, Maria W; Marchbanks, Polly A

2013-05-01

Provision of contraception is often linked with physical examination, including clinical breast examination (CBE) and pelvic examination. This review was conducted to evaluate the evidence regarding outcomes among women with and without physical examination prior to initiating hormonal contraceptives. The PubMed database was searched from database inception through March 2012 for all peer-reviewed articles in any language concerning CBE and pelvic examination prior to initiating hormonal contraceptives. The quality of each study was assessed using the United States Preventive Services Task Force grading system. The search did not identify any evidence regarding outcomes among women screened versus not screened with CBE prior to initiation of hormonal contraceptives. The search identified two case-control studies of fair quality which compared women who did or did not undergo pelvic examination prior to initiating oral contraceptives (OCs) or depot medroxyprogesterone acetate (DMPA). No differences in risk factors for cervical neoplasia, incidence of sexually transmitted infections, incidence of abnormal Pap smears or incidence of abnormal wet mount findings were observed. Although women with breast cancer should not use hormonal contraceptives, there is little utility in screening prior to initiation, due to the low incidence of breast cancer and uncertain value of CBE among women of reproductive age. Two fair quality studies demonstrated no differences between women who did or did not undergo pelvic examination prior to initiating OCs or DMPA with respect to risk factors or clinical outcomes. In addition, pelvic examination is not likely to detect any conditions for which hormonal contraceptives would be unsafe. Published by Elsevier Inc.

Contraceptive use at the time of unintended pregnancy: Findings from the Contraceptive Use, Pregnancy Intention and Decisions study.

PubMed

Coombe, Jacqueline; Harris, Melissa L; Wigginton, Britta; Lucke, Jayne; Loxton, Deborah

2016-11-01

Unintended pregnancy disproportionately affects young Australian women. However, contraceptive behaviours associated with unintended pregnancy are unclear. The objective of this article was to examine contraceptive use before unintended conception. Data from 3795 women (aged 18-23 years) who completed the baseline Contraceptive Use, Pregnancy Intention and Decisions (CUPID) study were analysed. The study found that 21.1% of participants reported ever being pregnant, of whom 84.6% indicated 'accidental' pregnancy. Most (73.4%) of these participants reported using contraception at the first unintended pregnancy, with the combined oral contraceptive pill being the most frequently used form (39.1%). Participants who reported unintended pregnancy were older (21.2 years of age ± 1.7) than those who had never been pregnant (20.5 years of age ± 1.7). They were also more likely to be in cohabitating relationships (34.7% versus 26.0%) or engaged/married (20.1% versus 8.4%). Most participants in this study considered their pregnancy to be accidental. The high rate of contraceptive use before becoming pregnant indicates the need to examine better ways to enhance the efficacy of contraceptive use among young Australian women.

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.

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.

Association of Hormonal Contraception with depression in the postpartum period.

PubMed

Roberts, Timothy A; Hansen, Shana

2017-12-01

Studies have demonstrated an association between hormonal contraception use with subsequent depression and antidepressant use. This association has not been assessed among postpartum women. This study is a secondary analysis of insurance records from 75,528 postpartum women enrolled in the US military medical system, who delivered between October 2012 and September 2014. Our analyses excluded women who used antidepressants or had a diagnosis of depression in the 24months prior to delivery. We assessed the relationship of hormonal contraception use with subsequent antidepressant use or diagnosis with depression in the first 12months postpartum using Cox proportional hazards regression, with a time dependent covariate measuring exposure to hormonal contraception. Antidepressants were prescribed to 7.8% of women and 5.0% were diagnosed with depression. In multivariable analysis adjusting for demographics, both antidepressant use and diagnosis with depression were associated with: younger age, lower socioeconomic status, and a history of military service. Compared to women with no hormonal contraceptive use, use of etonogestrel containing contraception was associated with a higher risk of antidepressant use (Implant: adjHR:1.22(95%CI:1.06-1.41), p<0.001; Ring:1.45(1.16-1.80), p=0.001). Use of norethindrone-only pills was associated with a lower risk of antidepressant use (0.58(0.52-0.64), p<0.001) and depression diagnosis (0.56(0.49-0.64), p<0.001). Use of a levonorgestrel intrauterine system was associated with a lower risk of depression diagnoses (0.65(0.52-0.82), p<0.001). The risk of major depression diagnosis and antidepressant use in the postpartum period varies with the type of hormonal contraception used. Further research is required to describe the mechanisms of these relationships. Published by Elsevier Inc.

Postpartum contraceptive use among women with a recent preterm birth.

PubMed

Robbins, Cheryl L; Farr, Sherry L; Zapata, Lauren B; D'Angelo, Denise V; Callaghan, William M

2015-10-01

The objective of the study was to evaluate the associations between postpartum contraception and having a recent preterm birth. Population-based data from the Pregnancy Risk Assessment Monitoring System in 9 states were used to estimate the postpartum use of highly or moderately effective contraception (sterilization, intrauterine device, implants, shots, pills, patch, and ring) and user-independent contraception (sterilization, implants, and intrauterine device) among women with recent live births (2009-2011). We assessed the differences in contraception by gestational age (≤27, 28-33, or 34-36 weeks vs term [≥37 weeks]) and modeled the associations using multivariable logistic regression with weighted data. A higher percentage of women with recent extreme preterm birth (≤27 weeks) reported using no postpartum method (31%) compared with all other women (15-16%). Women delivering extreme preterm infants had a decreased odds of using highly or moderately effective methods (adjusted odds ratio, 0.5; 95% confidence interval, 0.4-0.6) and user-independent methods (adjusted odds ratio, 0.5; 95% confidence interval, 0.4-0.7) compared with women having term births. Wanting to get pregnant was more frequently reported as a reason for contraceptive nonuse by women with an extreme preterm birth overall (45%) compared with all other women (15-18%, P < .0001). Infant death occurred in 41% of extreme preterm births and more than half of these mothers (54%) reported wanting to become pregnant as the reason for contraceptive nonuse. During contraceptive counseling with women who had recent preterm births, providers should address an optimal pregnancy interval and consider that women with recent extreme preterm birth, particularly those whose infants died, may not use contraception because they want to get pregnant. Published by Elsevier Inc.

Sources of contraceptive commodities for users in Nigeria.

PubMed

Oye-Adeniran, Boniface A; Adewole, Isaac F; Umoh, Augustine V; Oladokun, Adesina; Gbadegesin, Abidoye; Odeyemi, Kofo A; Ekanem, Ekanem E

2005-11-01

Understanding the sources of contraceptive commodities is an important aspect of the delivery of family planning services and is required by planning programme managers for strategic planning purposes. Findings from the 2003 Nigeria Demographic and Health Survey have previously showed that the private sector was the most frequently reported source of contraceptive supply, providing contraception to two and a half times as many women as the public sector. We conducted a community-based study to examine further the sources of contraceptive commodity for users in Nigeria with a view to identifying their preferences for distribution centres. This information would be useful to improve commodity distribution and to build the necessary capacity for satisfactory delivery of contraceptives. A multi-stage random sampling technique was used. A state was randomly selected to represent each of the four health zones in Nigeria. Two local government areas (LGAs) were then selected representing both urban and rural areas. Ten enumeration areas were subsequently selected from each LGA. Of the 2,001 respondents aged 15-49 years, 1,647 (82.3%) were sexually active, out of which 244 were found to be using contraceptive methods at the time of the study, giving a contraceptive prevalence of 14.8%. The commonest source of information on contraceptives was through friends (34%), followed by the radio (11.5%) and husbands (10.2%). Most respondents procured their contraceptives from chemist/patent medicine shops (19.7%), while only 0.8% obtained them from designated family planning clinics. The younger groups in this study (15-24 years), single people, Catholics, and Muslims, showed a greater preference for chemist/patent medicine shops for their sources of contraceptives. The older groups and married respondents, however, made use of government and private hospitals to obtain their contraceptives. Strategies to increase contraceptive use must take into consideration these identified

Sources of Contraceptive Commodities for Users in Nigeria

PubMed Central

Oye-Adeniran, Boniface A; Adewole, Isaac F; Umoh, Augustine V; Oladokun, Adesina; Gbadegesin, Abidoye; Odeyemi, Kofo A; Ekanem, Ekanem E

2005-01-01

Background Understanding the sources of contraceptive commodities is an important aspect of the delivery of family planning services and is required by planning programme managers for strategic planning purposes. Findings from the 2003 Nigeria Demographic and Health Survey have previously showed that the private sector was the most frequently reported source of contraceptive supply, providing contraception to two and a half times as many women as the public sector. We conducted a community-based study to examine further the sources of contraceptive commodity for users in Nigeria with a view to identifying their preferences for distribution centres. This information would be useful to improve commodity distribution and to build the necessary capacity for satisfactory delivery of contraceptives. Methods and Findings A multi-stage random sampling technique was used. A state was randomly selected to represent each of the four health zones in Nigeria. Two local government areas (LGAs) were then selected representing both urban and rural areas. Ten enumeration areas were subsequently selected from each LGA. Of the 2,001 respondents aged 15–49 years, 1,647 (82.3%) were sexually active, out of which 244 were found to be using contraceptive methods at the time of the study, giving a contraceptive prevalence of 14.8%. The commonest source of information on contraceptives was through friends (34%), followed by the radio (11.5%) and husbands (10.2%). Most respondents procured their contraceptives from chemist/patent medicine shops (19.7%), while only 0.8% obtained them from designated family planning clinics. The younger groups in this study (15–24 years), single people, Catholics, and Muslims, showed a greater preference for chemist/patent medicine shops for their sources of contraceptives. The older groups and married respondents, however, made use of government and private hospitals to obtain their contraceptives. Conclusion Strategies to increase contraceptive use must

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

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.

[The difficulties of contraception: conflicts and paradoxes].

PubMed

Cribier, F

1988-06-01

This work uses clinical examples to explore sources of conflict and denial of patients and physicians during contraception consultations. The discovery of oral contraceptives (OCs) and improvements in mechanical contraception raised hopes that couples could achieve total control of their fertility. But continued high abortion rates and the persistence of sexual problems and maladjustments have demonstrated that contraception alone is not a panacea. Conflicts about contraception may be conscious and quickly expressed during a consultation, even if a medical pretext is given. The resentment when 1 partner desires a child and the other does not for example can translate into a conflict about contraception. Some women are fully aware of their own ambivalence about pregnancy and contraception and able to express it openly, but very often the woman's concerns are expressed by questions, fears, and verbal slips. The fear that pills are unnatural or will cause congenital defects can be interpreted as an expression of guilt over the pleasure that pills permit. Sterility is the ultimate fear caused by this unlimited possibility for pleasure. In the majority of cases, physical complaints are the means by which contraception clients address their physicians. In some cases, intolerance to OCs may actually be a hysterical manifestation that is not understood. Such symptoms as nausea, breast swelling, dizziness, vomiting, nervousness, and insomnia may be signs of early pregnancy as well as of intolerance for pills. Intolerance to pills may be caused by intolerance of a sexuality in which all things seem possible but in which the individual feels unrecognized by the partner. The resulting aggression may be turned inward in the form of a morbid symptom or of forgetting or stopping pill use, recourse to abortion, and demand for recognition. Acting out, especially by adolescents, is common in the area of contraception. In some cases the psychological or emotional needs of the patient

Contraception Insurance Coverage and Receipt of Long-Acting Reversible Contraception or Depot Medroxyprogesterone Acetate on the Day of Abortion.

PubMed

Krashin, Jamie W; Stuart, Gretchen S; Garrett, Joanne; Spector, Hannah; Bryant, Amy G; Charm, Samantha; Morse, Jessica E

2017-07-01

To evaluate whether contraceptive insurance coverage for women who present for an abortion is associated with obtaining long-acting reversible contraception or depot medroxyprogesterone acetate (DMPA) on the day the abortion is completed. We conducted a prospective cohort study of women presenting for medical or surgical abortion at a single health center in North Carolina. Eligible women were 18 years or older and fluent in English or Spanish. Data were from participant questionnaires, medical charts, and financial records. Our main exposure was whether the woman had insurance coverage for contraception at clinic intake. Our primary outcome was receiving DMPA, an intrauterine device, or a contraceptive subdermal implant on the same day of their surgical abortion or at the visit that determined their medication abortion was complete. We used univariable, bivariable, and multivariable analysis to report our findings. Five hundred seventy-five women enrolled in our cohort between September 2015 and April 2016. One hundred twenty-eight (22%) had insurance coverage and 447 (78%) did not. In the group with insurance coverage for contraception, 38% (49/128) received a long-acting reversible contraception method or DMPA compared with 7% (33/447) in the group without insurance coverage for contraception. After adjusting for confounding, women with contraceptive coverage were more than five times as likely to receive immediate postabortion contraception with one of these methods compared with women without coverage (relative risk 5.6, 95% confidence interval 3.8-8.3). Women with contraceptive insurance coverage on the day of their abortion were more likely to leave the abortion clinic with an intrauterine device or implant in place or receive DMPA injection compared with women without coverage.

CUP: contraceptive users pamphlet.

PubMed

1986-02-01

This pamphlet, edited by an ad hoc committee of several consultants, scientists, theologians, public health and family planning directors, and an international attorney, covers the following topics: contra-conception; choices of contraceptives; contraceptive package information; copper IUDs; pelvic inflammatory disease (PID); sexually transmitted diseases; and acquired immunodeficiency syndrome. It includes a questionnaire for sexually transmitted diseases (STDs). Professor Joseph Goldzieher describes the "Contra-Conception" database as "a synthesis of up-to-date literature and contemporary guidelines, designed to provide ready access for practicing physicians and medical students." It contains data on several types of hormonal contraception. "Contra-Conceptions" is designed to allow the physician to set his or her own pace when working with the computer, and no previous computer experience is required. 1 of the program's many innovative features is the patient-profiling/decisionmaking section which can be used in the doctor's office to help decide what type of hormonal contraceptive is appropriate for a particular patient. The program permits the doctor to evaluate the significance of patient variables such as parity, smoking, menstrual difficulties and helps the doctor to identify the risks and benefits of the various methods and, ultimately, to make a balanced decision in the context of the most recent data. Contraceptive drugs and devices should include detailed information on the following: description of formula or device; indication, usage, and contraindications, clinical pharmacology and toxicology; dose-related risk; pregnancies per 100 women year; and detailed warning. The sequence of major pathophysiological reactions associated with copper IUDs is identified as are special problems of pelvic infections in users of copper IUDs. Those women who use oral contraceptives (OCs) or a barrier method of contraception or whose partners use a condom have a lower

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.

Contraception counselling of female soldiers in primary healthcare facilities.

PubMed

Crabb, Sarah L

2015-06-01

Effectiveness of barrier and oral contraceptive pills is dependent on daily adherence and consistency that cannot always be guaranteed by military lifestyle. Long-acting reversible contraceptive (LARC) methods could provide a good alternative to guarantee effective contraception in unpredictable scenarios, and recent studies have suggested they could provide wider non-contraceptive benefits. LARC has been proven to be more cost effective than the combined oral contraceptive pill. The National Institute of Health and Care Excellence (NICE) has released guidelines on contraception provision to ensure all women receive the contraception method that is most appropriate to the individual. A retrospective audit of 105 sets of primary healthcare notes of serving female soldiers was assessed to establish contraceptive choices and whether appropriate information had been provided within the last year of their last consultation. 100% had seen a healthcare provider capable of providing contraceptive advice in the last year. 69% documented as using some form of non-surgical contraception versus 58% quoted as national usage. 21% were using some form of LARC versus 8% national usage. 66% of eligible women had not had LARC discussed with them, and of these 50% did not have any contraceptive usage documented. Among other consultations, 41% had had a medical within the year period, of which over half had no documented contraceptive status. As military healthcare providers, we have more exposure to our patients than NHS equivalents and this small study suggests there is an increased demand for contraception. Contraceptive choice counselling should be a mandatory part of routine initial medicals. If the situation demands a medical for any other reason, a documented contraception status should form an important part of the risk assessment process. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Theory-based interventions for contraception.

PubMed

Lopez, Laureen M; Tolley, Elizabeth E; Grimes, David A; Chen, Mario; Stockton, Laurie L

2013-08-07

The explicit use of theory in research helps expand the knowledge base. Theories and models have been used extensively in HIV-prevention research and in interventions for preventing sexually transmitted infections (STIs). The health behavior field uses many theories or models of change. However, educational interventions addressing contraception often have no stated theoretical base. Review randomized controlled trials (RCTs) that tested a theoretical approach to inform contraceptive choice; encourage contraceptive use; or promote adherence to, or continuation of, a contraceptive regimen. Through June 2013, we searched computerized databases for trials that tested a theory-based intervention for improving contraceptive use (MEDLINE, POPLINE, CENTRAL, PsycINFO, ClinicalTrials.gov, and ICTRP). Previous searches also included EMBASE. For the initial review, we wrote to investigators to find other trials. Trials tested a theory-based intervention for improving contraceptive use. We excluded trials focused on high-risk groups and preventing sexually transmitted infections or HIV. Interventions addressed the use of one or more contraceptive methods for contraception. The reports provided evidence that the intervention was based on a specific theory or model. The primary outcomes were pregnancy, contraceptive choice or use, and contraceptive adherence or continuation. The primary author evaluated abstracts for eligibility. Two authors extracted data from included studies. For the dichotomous outcomes, the Mantel-Haenszel odds ratio (OR) with 95% CI was calculated using a fixed-effect model. Cluster randomized trials used various methods of accounting for the clustering, such as multilevel modeling. Most reports did not provide information to calculate the effective sample size. Therefore, we presented the results as reported by the investigators. No meta-analysis was conducted due to differences in interventions and outcome measures. We included three new trials for a

Contraceptive choices for women with endocrine complications.

PubMed

Loriaux, D L; Wild, R A

1993-06-01

Previous confusion regarding the interference by oral contraceptives in measurements of endocrine function have been largely eliminated by the advent of improved, more sensitive assays. There are few if any contraindications to oral contraceptive use in patients with thyroid disease. Patients with prolactinoma can be treated with bromocriptine to restore fertility and prevent mineral loss. However, as a less expensive alternative, oral contraceptives can be prescribed to correct mineral loss, because there is no convincing evidence of an adverse effect on prolactinomas by the steroidal content of the pill. Oral contraceptives comprise a near ideal treatment modality for women with polycystic ovary disease because, among other effects, oral contraceptives reduce synthesis of androgen by inhibiting pituitary gonadotropin secretion.

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.

Contraceptive update Y2K: need for contraception and new contraceptive options.

PubMed

Nelson, A

2000-01-01

Despite the major strides made in birth control, which have produced a decline in unintended pregnancies over the past decade and the lowest rates of teen pregnancies seen since 1974 (1,2), significant problems still remain. Almost half (48%) of US pregnancies in 1995 were unintended (1) and many more that were "intended" were not planned or prepared for (3). To optimize maternal and fetal outcomes, it is incumbent that physicians both emphasize the need for women to be physically, emotionally, and socially prepared for pregnancy before they conceive as well as ensure the availability of effective methods to allow them to do so. Today, contraceptives are available that permit couples to choose if and when to have children. Although only 5% of women who are sexually active and say they do not want to become pregnant are using no method of birth control (4), that group accounts for nearly 40% of the unintended pregnancies. More than half of all unintended pregnancies occur in women who had used a method in the month of conception (1). The strategy with these women should be to find ways to make the method they select work better for them or to switch them to more effective methods. Unfortunately, the most effective reversible methods are among the least utilized--in part because they have the highest initial costs. Some states, such as California and Maryland, have passed Contraceptive Equity Acts, which require insurance companies that provide any prescriptive drug coverage to cover all forms of prescription contraception. Many other states, as well as the federal government, are now considering similar legislation. It is important, therefore, both from the perspective of quality patient care and also from a fiscal standpoint, that all who care for reproductive-aged women become familiar with the full array of contraceptive options. This article will review the methods of reversible birth control now available in the United States, including the most recent efficacy

Historical review about contraception in Islam.

PubMed

Shaaban, A H

1972-01-01

There is nothing in the Koran which is for or against contraception. Scripture references are given which show that concern for safety of both parents and offspring and a desire for strong children have been in Islam from the beginning. Contraception during lactation is encouraged; a quotation from the Hadis or Prophet sayings shows that an infant conceived while its mother is breast feeding is weak in constitution. Throughout the Middle Ages Islamic physicians preached contraceptives measures. In the 9th century Abu Bakr al Razi illustrated many different methods in his ''Quintessence of Experience.'' He especially urged contraception to protect the health of the mother and to space children. Contraception was indicated solely on medical grounds. On January 29, 1937 the Imam of Moslems in Egypt was asked for an opinion on contraception and abortion and his answer was: 1) married couples can practice contraception for medical and social reasons; 2) before 16 weeks of gestation drugs can be taken or measures taken to produce abortion if there is no risk to the mother and if a reasonable indication is present; and 3) abortion should by no means be induced after 16 weeks. Religious opposition to family planning differs by countries. In Egypt family planning is accepted as it is in Turkey and other countries. However, greater cooperation among Islamic nations is needed to attack the problems of rapid population growth and its resulting ill effects for both individual families and nations as a whole.

Unscheduled vaginal bleeding with progestin-only contraceptive use.

PubMed

Zigler, Rachel E; McNicholas, Colleen

2017-05-01

Nearly 20% of women using contraception are using progestin-only contraception, including progestin-only pills, depot-medroxyprogesterone acetate, subdermal etonogestrel implants, and levonorgestrel intrauterine devices. This number will continue to grow with the increased provision of long-acting reversible contraception. Although overall satisfaction among women using progestin-only contraception is high, dissatisfaction and discontinuation may be associated with unscheduled bleeding and spotting. The exact etiology of irregular bleeding associated with progestin-containing contraceptives is not completely understood, yet several mechanisms have been suggested. Several therapies targeting these mechanisms have been evaluated with mixed results. This paper will review the physiology and management of unscheduled bleeding with progestin-containing contraceptives. Copyright © 2016 Elsevier Inc. All rights reserved.

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.

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.

Contraceptive knowledge, sexual behavior, and factors associated with contraceptive use among female undergraduate university students in Kilimanjaro region in Tanzania

PubMed Central

Sweya, Mussa N; Msuya, Sia E; Mahande, Michael J; Manongi, Rachel

2016-01-01

Background Previous studies have shown that knowledge of contraceptives, especially among the youth in universities, remains limited, and the rate of premarital sexual activity, unwanted pregnancies, and illegal abortions remains higher among university students. This study aimed to assess contraceptive knowledge, sexual behavior, and factors associated with contraceptive use among female undergraduate university students in Kilimanjaro region in Tanzania. Methods A cross-sectional analytical study was conducted from May to June 2015 among undergraduate female students in four universities in Kilimanjaro region. A self-administered questionnaire was given to the participants. Data analysis was performed using Statistical Package for Social Sciences. Descriptive statistics were used to summarize the data. An odds ratio with 95% confidence interval for factors associated with modern contraceptive use was computed using multiple logistic regression models. A P-value of <5% (two-tailed) was considered statistically significant. Results A total of 401 students were involved in the study. Two-thirds (260, 64.8%) of the participants had had sexual intercourse. The majority (93.8%) of the participants had knowledge of contraception. One hundred and seventy-five (43.6%) sexually active women reported that they used contraceptives in the past, while 162 (40.4%) were current contraceptive users. More than half (54.2%) of the sexually active group started sexual activity between the ages of 20–24 years. The most popular methods of contraception used were condoms, withdrawal, and periodic abstinence. The main sources of information about contraception were friends, television, and health care workers (44.8%, 40.3%, and 39.0%, respectively). Conclusion Most of the participants had knowledge of contraception. However, the rate of contraceptive use was low. The majority of the respondents were sexually active and started sexual activity at >18 years of age. Hence, advocacy for

Empirical lessons regarding contraception in a protracted refugee setting: A descriptive study from Maela camp on the Thai-Myanmar border 1996 – 2015

PubMed Central

Parker, Amber L.; Lee, Tracey; Min, Aung Myat; Ontuwong, Pranee; Oo Tan, Saw; Sirinonthachai, Supachai; McGready, Rose

2017-01-01

Conflict settings and refugee camps can be chaotic places, with large and rapid population movements, exacerbated public health problems, and ad hoc health services. Reproductive health care that includes family planning is of heightened importance in such settings, however, funding and resources tend to be constrained and geared towards acute health services such as trauma management and infectious disease containment. Here we report on the complexities and challenges of providing family planning in a post-emergency refugee setting, using the example of the largest refugee camp on the Thai-Myanmar border, in existence now for over 30 years. Data from 2009 demonstrates an upward trend in uptake of all contraceptives, especially long acting reversible contraception (LARC) and permanent methods (e.g. sterilization) over time. Increased uptake occurred during periods of time when there were boosts in funding or when barriers to access were alleviated. For example a surgeon fluent in local languages is correlated with increased uptake of tubal ligation in females. These data indicate that funding directed toward contraceptives in this refugee setting led to increases in contraceptives use. However, contraceptive uptake estimates depend on the baseline population which is difficult to measure in this setting. As far as we are aware, this is the longest reported review of family planning services for a refugee camp setting to date. The lessons learned from this setting may be valuable given the current global refugee crisis. PMID:28231251

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.

Oral contraceptives and neuroactive steroids.

PubMed

Rapkin, Andrea J; Biggio, Giovanni; Concas, Alessandra

2006-08-01

A deregulation in the peripheral and brain concentrations of neuroactive steroids has been found in certain pathological conditions characterized by emotional or affective disturbances, including major depression and anxiety disorders. In this article we summarize data pertaining to the modulatory effects of oral contraceptive treatment on neuroactive steroids in women and rats. Given that the neuroactive steroids concentrations are reduced by oral contraceptives, together with the evidence that a subset of women taking oral contraceptives experience negative mood symptoms, we propose the use of this pharmacological treatment as a putative model to study the role of neuroactive steroids in the etiopathology of mood disorders. Moreover, since neuroactive steroids are potent modulators of GABA(A) receptor function and plasticity, the treatment with oral contraceptives might also represent a useful experimental model to further investigate the physiological role of these steroids in the modulation of GABAergic transmission.

Emergency Contraception.

PubMed

Batur, Pelin; Kransdorf, Lisa N; Casey, Petra M

2016-06-01

Emergency contraception (EC) may help prevent pregnancy in various circumstances, such as contraceptive method failure, unprotected sexual intercourse, or sexual assault, yet it remains underused. There are 4 approved EC options in the United States. Although ulipristal acetate requires a provider's prescription, oral levonorgestrel (LNG) is available over the counter for women of all ages. The most effective method of EC is the copper intrauterine device, which can be left in place for up to 10 years for efficacious, cost-effective, hormone-free, and convenient long-term primary contraception. Ulipristal acetate tends to be more efficacious in pregnancy prevention than is LNG, especially when taken later than 72 hours postcoitus. The mechanism of action of oral EC is delay of ovulation, and current evidence reveals that it is ineffective postovulation. Women who weigh more than 75 kg or have a body mass index greater than 25 kg/m(2) may have a higher risk of unintended pregnancy when using oral LNG EC; therefore, ulipristal acetate or copper intrauterine devices are preferable in this setting. Providers are often unaware of the range of EC options or are unsure of how to counsel patients regarding the access and use of EC. This article critically reviews current EC literature, summarizes recommendations, and provides guidance for counseling women about EC. Useful tips for health care providers are provided, with a focus on special populations, including breast-feeding women and those transitioning to long-term contraception after EC use. When treating women of reproductive age, clinicians should be prepared to counsel them about EC options, provide EC appropriately, and, if needed, refer for EC in a timely manner. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

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

Contraception services for incarcerated women: a national survey of correctional health providers.

PubMed

Sufrin, Carolyn B; Creinin, Mitchell D; Chang, Judy C

2009-12-01

Incarcerated women have had limited access to health care prior to their arrest. Although their incarceration presents an opportunity to provide them with health care, their reproductive health needs have been overlooked. We performed a cross-sectional study of a nationally representative sample of 950 correctional health providers who are members of the Academy of Correctional Health Providers. A total of 405 surveys (43%) were returned, and 286 (30%) were eligible for analysis. Most ineligible surveys were from clinicians at male-only facilities. Of eligible respondents, 70% reported some degree of contraception counseling for women at their facilities. Only 11% provided routine counseling prior to release. Seventy percent said that their institution had no formal policy on contraception. Thirty-eight percent of clinicians provided birth control methods at their facilities. Although the most frequently counseled and prescribed method was oral contraceptive pills, only 50% of providers rated their oral contraceptive counseling ability as good or very good. Contraception counseling was associated with working at a juvenile facility, and with screening for sexually transmitted infections. Contraception does not appear to be integrated into the routine delivery of clinical services to incarcerated women. Because the correctional health care system can provide important clinical and public health interventions to traditionally marginalized populations, services for incarcerated women should include access to contraception.

Emergency contraception: which is the best?

PubMed

Mittal, Suneeta

2016-12-01

Emergency contraception is a safe and effective method to prevent an unwanted pregnancy after an unprotected or inadequately protected sexual intercourse. Several methods for emergency contraception (EC) are currently registered in many countries for use in an emergency to prevent a pregnancy following an unprotected, possibly fertile intercourse or after a contraceptive accident like condom rupture. Different methods have varying modes of action, time frame of efficacy, dosage schedule and unwanted effects. Since several methods are available it is important to decide the best method. In this article the available literature on emergency contraception has been reviewed and an attempt has been made to discuss the need for emergency contraception and compare different options for emergency contraception in terms of their efficacy in pregnancy prevention, their safety profile and unwanted side effects. EC repeated use and initiating a regular method after EC use are also discussed. Emergency contraceptive methods include copper Intra-uterine devices (IUD) and different types of pills like estrogen progestin combination pill (Yuzpe Regimen), Progestin only pill (LNG), antiprogestin pill (Mifepristone), and progesterone modulator Uripristal Acetate (UPA). There is a marginal difference in the mechanism of action, efficacy including time frame and ability to protect from pregnancy with regular doses in obese women, drug interactions and side effects. These are discussed in detail. Copper IUD is the most effective emergency contraceptive with advantage of providing continued contraception. However, it cannot be used universally due to lack of infrastructure and a trained provider as well as not being suitable option for women at risk of sexually transmitted infections. Amongst different pills LNG is more effective with fewer side effects than Yuzpe regimen. LNG and UPA are comparable with similar efficacy and side effect profile. UPA has a wider window of efficacy, in

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.

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.

[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

Contraceptive Counseling by General Internal Medicine Faculty and Residents

PubMed Central

Shulman, Benjamin; Teal, Stephanie B.; Huebschmann, Amy G.

2014-01-01

Abstract Background: Almost half of US pregnancies are unintended, resulting in many abortions and unwanted or mistimed births. Contraceptive counseling is an effective tool to increase patients' use of contraception. Methods: Using an online 20-item questionnaire, we evaluated the frequency of contraceptive counseling provided to reproductive-age women during a prevention-focused visit by University of Colorado internal medicine resident and faculty providers. We also evaluated factors hypothesized to affect contraceptive counseling frequency. Results: Although more than 95% of the 146 medicine faculty and resident respondents agreed that contraceptive counseling is important, only one-quarter of providers reported providing contraceptive counseling “routinely” (defined as ≥80% of the time) to reproductive-age women during a prevention-focused visit. Providing contraceptive counseling routinely was strongly associated with taking an abbreviated sexual history “often”/“routinely” (odds ratio [OR]=11.6 [3.3 to 40.0]) and with high self-efficacy to provide contraceptive counseling (OR=6.5 [1.5 to 29.0]). However, fewer than two-thirds of providers reported taking an abbreviated sexual history “often”/“routinely.” More than 70% of providers reported inadequate knowledge of contraceptive methods as a contraceptive counseling barrier. However, providers' perceived inadequate knowledge was not associated with traditional educational exposures, such as lectures and women's health electives. Conclusions: In prevention-focused visits with reproductive-age women, a minority of internal medicine faculty and residents reported routine contraceptive counseling. Future efforts to increase contraceptive counseling among internists should include interventions that increase provider contraceptive counseling self-efficacy and ensure that providers obtain an abbreviated sexual history. PMID:24766414

Weight and body mass index among female contraceptive clients.

PubMed

Kohn, Julia E; Lopez, Priscilla M; Simons, Hannah R

2015-06-01

As obesity may affect the efficacy of some contraceptives, we examined weight, body mass index (BMI) and prevalence of obesity among female contraceptive clients at 231 U.S. health centers. A secondary aim was to analyze differences in contraceptive method use by obesity status. Cross-sectional study using de-identified electronic health record data from family planning centers. We analyzed contraceptive visits made by 147,336 females aged 15-44 years in 2013. A total of 46.1% of clients had BMI ≥25. Mean body weight was 154.4 lb (S.D.=41.9); mean BMI was 26.1 (S.D.=6.6). A total of 40% had BMI ≥26, when levonorgestrel emergency contraception may become less effective. Obese clients had higher odds of using a tier 1 or tier 3 contraceptive method and had lower odds of using a tier 2 or hormonal method than non-obese clients. About half of contraceptive clients would be categorized as overweight or obese. Contraceptive method choices differed by obesity status. About half of contraceptive clients in this study population were overweight or obese. Contraceptive method choices differed by obesity status. All women - regardless of body size - should receive unbiased, evidence-based counseling on the full range of contraceptive options so that they can make informed choices. Copyright © 2015 Elsevier Inc. All rights reserved.

Herbal contraceptives: exploring indigenous methods of family planning.

PubMed

Quijano Nv

1986-01-01

The study, "Herbal Contraceptives: An Alternative Strategy in Family Planning", was conducted by the Research Institute for Mindanao Culture, Xavier University, for the Population Center Foundation. The study has 2 phases: 1) phase 1 gathered information from the regional population offices on the areas where herbs are grown, and 2) phase 2 sought to obtain data on the preparation and perceived effectiveness of herbal contraceptives. Results indicate that, in most of the Philippine regions, herbal contraceptives had long been used by women in the rural areas, specifically those in the indigenous groups. The 1984 study found that many rural women in the research area preferred the Kamias drink and other herbal concoctions to the pill and other modern contraceptive methods. Among college-educated women, it was found that acceptance of contraceptives was influenced more by their religion rather than by their education. Most of the respondents said they used herbal contraceptives because they were easily obtained and were inexpensive. Generally, they considered herbal contraceptives much safer than other contraceptives methods. Some women who had been using modern family planning methods are now using herbs in delaying pregnancy; this shift is mainly due to the side effects of the modern methods. There is room for a compromise between folk practices and modern science, as in the case of herbal contraceptives.

Adolescents and oral contraceptives.

PubMed

Sanfilippo, J S

1991-01-01

Oral contraceptive (OC) options for adolescents are provides. Clarification for those desiring a birth control method is necessary and the benefits of decreased acne and dysmenorrhea with low dose OCs should be stressed along with the importance of compliance. A community effort is suggested to communicate the sexual and contraceptive alternatives, including abstinence and outercourse (sexual stimulation to orgasm without intercourse). Attention is given to concerns associated with teenage sexual activity, prevention of adolescent pregnancy, contraceptive options for the adolescent patient, adolescent attitudes toward birth control OCs, management of the adolescent OC user, manipulation of steroid components of OCs to respond to adolescent concerns, and other hormonal contraceptive options such as minipills or abstinence. The text is supplemented with tables: the % of US women by single years of age for 1971, 1976, 1979, and 1982; comparative pregnancy and abortion rates for the US and 5 other countries; federal cost for teen childbearing; adolescent nonhormonal contraceptive methods (advantages, disadvantages, and retail cost); checklist to identify those at risk for noncompliance with OCs; hormonal side effects of OCs; risks from OCs to adolescents; and benefits of OCs. Concern about adolescent pregnancy dates back to Aristotle. A modern profile shows girls form single-parent families are sexually active at an earlier age, adolescent mothers produce offspring who repeat the cycle, victims of sexual abuse are more likely to be sexually active, and teenagers in foster care are 4 times more likely to be sexually active and 8 times more likely to become pregnant. Prevention involves a multifaceted approach. OCs are the most appropriate contraceptive choice for adolescents. Frequency of intercourse is closely associated with OC use after approximately 15 months of unprotected sexual activity. At risk for noncompliance variables are scales of personality development

The Male Role in Contraception: Implications for Health Education.

ERIC Educational Resources Information Center

Chng, Chwee Lye

1983-01-01

Many males still perceive contraception as a woman's responsibility. This paper describes male contraceptives and their effectiveness and draws implications for school and community health education professionals. More equitable sharing of the responsibility for contraception might result in more effective contraception. (PP)

Contraceptive behavior in Ghana: a two-sex model.

PubMed

Dodoo, F N

1995-01-01

This report uses data of the 1988 Ghana Demographic and Health Survey (GDHS), a nationally representative self-weighting sample of 4488 female respondents 15-49 years old. 943 co-resident husbands of the surveyed women were also interviewed, thus the data provided 1010 dyads, which facilitated a couple-level analysis of contraceptive behavior. The determinants of modern contraceptive adoption were examined among dependent variables, including both modern and traditional methods, and the predictors of future usage among the nonusers were also assessed. For each of dependent variables, two logistic regressions were estimated, one for females, and the second one for couple measures of intentions and male preferences. Males were older and more educated than their female counterparts, and women were more likely than men to want to cease and space childbearing. 68.8% of women were in monogamous marriages, and the average age of women was 31.8 years, compared to 41 years for men among 1008 people in the sample. 43.5% of women had lost more than 1 child, and 22.9% had urban residence. 11.7% of couples agreed that contraceptives were needed for stopping childbearing. However, 14.9% said that there was no need for contraception, while 27.7% wanted contraception for spacing of births. 46% of the sample disagreed about contraceptive need and use. 6% of the women used modern contraceptives, while 8.7% used traditional methods. In addition, 29.7% of the women intended to use contraception in the future, while 55.6% did not intend to do this. Examination of contraceptive use and selected background variables indicates urban-rural differences. Also, the advancing age of wives and all levels of female schooling means increasing contraceptive use, but secondary schooling was associated with lower use for men than primary schooling. Use of contraception was also positively associated with the desire to cease childbearing for both sexes whether users or non-users. The findings

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.

Correlates of oral contraception continuation.

PubMed

Ewer, P A; Gibbs, J O

1971-05-01

A sample of 139 predominantly black, young, low-income patients who had accepted oral contraception at a publicly supported family planning clinic has been analyzed for correlates of oral contraception continuation. Interviews were conducted 10-12 months after the clinic visit; at this time 38% of the patients continued taking oral contraceptives. It was found that patients with the highest continuation rates were 18-24 years old, in the 2-3 parity group, living with their husbands, had low-parity mothers, and were able to fill prescriptions in less time with more convenient methods of transportation. Discontinuers tended to have high-parity mothers, live with parents or head their own households, and to be in the 13-17 or 25-45 year old age groups. Fear of long-term use of oral contraceptives and perceived side effects appeared to be implicated in discontinuation. The rate of discontinuation may be associated with irregular coital experience and less consistent exposure to pregnancy.

Progestin-only pills for contraception.

PubMed

Grimes, David A; Lopez, Laureen M; O'Brien, Paul A; Raymond, Elizabeth G

2013-11-13

The introduction of a new progestin-only oral contraceptive in Europe has renewed interest in this class of oral contraceptives. Unlike the more widely used combined oral contraceptives containing an estrogen plus progestin, these pills contain only a progestin (progestogen) and are taken without interruption. How these pills compare to others in their class or to combined oral contraceptives is not clear. This review examined randomized controlled trials of progestin-only pills for differences in efficacy, acceptability, and continuation rates. Through October 2013, we searched the computerized databases MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), POPLINE, and LILACS for studies of progestin-only pills. We also searched for current trials via ClinicalTrials.gov and ICTRP. Previous searches also included EMBASE. We included all randomized controlled trials in any language that included progestin-only pills for contraception.  We incorporated any comparison with a progestin-only pill; this could include different doses, other progestin-only pills, combined oral contraceptives, or other contraceptives. The first author abstracted the data and entered the information into RevMan 5. Another author performed a second, independent data abstraction to verify the initial data entry.We attempted to extract life-table rates (actuarial or continuous) and used the rate difference as the effect measure. Where life-table rates were not published, we used the incidence rate ratio (ratio of Pearl rates). Where only the crude number of events was published, we calculated the Peto odds ratio with 95% confidence interval (CI) using a fixed-effect model. For continuous variables, the mean difference (MD) was computed with 95% CI. Because of disparate exposures, we were not able to combine studies in meta-analysis. Six trials met the inclusion criteria. We have not found any new studies since the initial review. In the trial comparing the desogestrel versus

Rotary Mtwo system versus manual K-file instruments: efficacy in preparing primary and permanent molar root canals.

PubMed

Azar, Mohammad-Reza; Mokhtare, Maziar

2011-01-01

To compare the cleaning ability and preparation time of rotary instruments (Mtwo) and conventional manual instruments (K-file) in preparing primary and permanent molar root canals. Access cavities were prepared in 70 primary and 70 permanent teeth and India ink was injected into 120 canals of selected molars. The teeth were randomly divided into two main subgroups (n=20) and three control groups (n=10). In each of these main subgroups, either the manual instrument (K-file) or the rotary system (Mtwo) was used to prepare root canals. After cleaning the canals and clearing the teeth, dye removal was evaluated with the help of a stereomicroscope. In addition, the time needed for root canal preparation was recorded by a chronometer. Statistical analyses were done using the Kruskal-Wallis, Mann-Whitney and t tests. With regard to the cleaning ability of root canals, there were no significant differences between the K-file and Mtwo rotary system in primary and permanent teeth in the apical, middle or coronal third of the canals. Moreover, there were no significant differences between primary and permanent teeth prepared with K-files and rotary instruments. In all the groups, shorter times were recorded with the rotary technique. The working time was shorter in primary than in permanent teeth. The Mtwo rotary system showed acceptable cleaning ability in both primary and permanent teeth, and achieved results similar to those of K-files in less time.

Skin patch and vaginal ring versus combined oral contraceptives for contraception.

PubMed

Lopez, Laureen M; Grimes, David A; Gallo, Maria F; Stockton, Laurie L; Schulz, Kenneth F

2013-04-30

The delivery of combination contraceptive steroids from a transdermal contraceptive patch or a contraceptive vaginal ring offers potential advantages over the traditional oral route. The transdermal patch and vaginal ring could require a lower dose due to increased bioavailability and improved user compliance. To compare the contraceptive effectiveness, cycle control, compliance (adherence), and safety of the contraceptive patch or the vaginal ring versus combination oral contraceptives (COCs). Through February 2013, we searched MEDLINE, POPLINE, CENTRAL, LILACS, ClinicalTrials.gov, and ICTRP for trials of the contraceptive patch or the vaginal ring. Earlier searches also included EMBASE. For the initial review, we contacted known researchers and manufacturers to identify other trials. We considered randomized controlled trials comparing a transdermal contraceptive patch or a contraceptive vaginal ring with a COC. Data were abstracted by two authors and entered into RevMan. For dichotomous variables, the Peto odds ratio (OR) with 95% confidence intervals (CI) was calculated. For continuous variables, the mean difference was computed. We also assessed the quality of evidence for this review. We found 18 trials that met our inclusion criteria. Of six patch studies, five examined the marketed patch containing norelgestromin plus ethinyl estradiol (EE); one studied a patch in development that contains levonorgestrel (LNG) plus EE. Of 12 vaginal ring trials, 11 examined the same marketing ring containing etonogestrel plus EE; one studied a ring being developed that contains nesterone plus EE.Contraceptive effectiveness was not significantly different for the patch or ring versus the comparison COC. Compliance data were limited. Patch users showed better compliance than COC users in three trials. For the norelgestromin plus EE patch, ORs were 2.05 (95% CI 1.83 to 2.29) and 2.76 (95% CI 2.35 to 3.24). In the levonorgestrel plus EE patch report, patch users were less

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

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

Vouchers in Fragile States: Reducing Barriers to Long-Acting Reversible Contraception in Yemen and Pakistan

PubMed Central

Boddam-Whetham, Luke; Gul, Xaher; Al-Kobati, Eman; Gorter, Anna C

2016-01-01

ABSTRACT In conflict-affected states, vouchers have reduced barriers to reproductive health services and have enabled health programs to use targeted subsidies to increase uptake of specific health services. Vouchers can also be used to channel funds to public- and private-service providers and improve service quality. The Yamaan Foundation for Health and Social Development in Yemen and the Marie Stopes Society (MSS) in Pakistan—both working with Options Consultancy Services—have developed voucher programs that subsidize voluntary access to long-acting reversible contraceptives (LARCs) and permanent methods (PMs) of family planning in their respective fragile countries. The programs focus on LARCs and PMs because these methods are particularly difficult for poor women to access due to their cost and to provider biases against offering them. Using estimates of expected voluntary uptake of LARCs and PMs for 2014 based on contraceptive prevalence rates, and comparing these with uptake of LARCs and PMs through the voucher programs, we show the substantial increase in service utilization that vouchers can enable by contributing to an expanded method choice. In the governorate of Lahj, Yemen, vouchers for family planning led to an estimated 38% increase in 2014 over the expected use of LARCs and PMs (720 vs. 521 expected). We applied the same approach in 13 districts of Punjab, Khyber Pakhtunkhwa (KPK), and Sindh provinces in Pakistan. Our calculations suggest that vouchers enabled 10 times more women than expected to choose LARCs and PMs in 2014 in those areas of Pakistan (73,639 vs. 6,455 expected). Voucher programs can promote and maintain access to family planning services where existing health systems are hampered. Vouchers are a flexible financing approach that enable expansion of contraceptive choice and the inclusion of the private sector in service delivery to the poor. They can keep financial resources flowing where the public sector is prevented from

Trends in direct-to-consumer advertising of prescription contraceptives.

PubMed

Wu, Min H; Bartz, Deborah; Avorn, Jerry; Seeger, John D

2016-05-01

Despite much speculation about the role of direct-to-consumer advertising (DTCA) in increasing demand for prescription contraceptives in the United States, there is little published research on this topic. We sought to quantify the prevalence and magnitude of DTCA for prescription contraceptives over the last decade. Using cross-sectional data from January 2005 through December 2014, we performed descriptive analyses on trends in DTCA expenditure for prescription contraceptives. We also quantified the amount of DTCA according to contraceptive method category and individual brand. During the study period, pharmaceutical companies spent a total of US$1.57 billion in the United States on DTCA of prescription contraceptives. Annual expenditure for contraceptive DTCA reached a peak value of US$260 million in 2008, with a progressive decline to a nadir of US$69 million by 2013. Of the contraceptive methods, oral contraceptive pills (OCPs) have been the most heavily promoted, with Yaz (drospirenone/ethinyl estradiol) - the most advertised brand - accounting for US$347 million of cumulative DTCA expenditure. However, DTCA spending on OCPs peaked in 2007 and was overtaken in 2012 by the DTCA of long-acting reversible contraceptives (LARCs), the contraceptive method now receiving the largest amount of DTCA promotion. DTCA is a major form of promotion for prescription contraceptives. Recent trends in DTCA expenditure indicate a shift from promotion of the OCPs to the LARCs. DTCA's effect on provider and patient utilization of various contraceptive methods has yet to be determined. This study provides the first quantitative evaluation of DTCA of prescription contraceptive methods and reveals DTCA's importance as a form of promotion. Recent DTCA trends indicate increased promotion of LARCs, coinciding with greater uptake of LARC methods by patients and prescribers. Copyright © 2016 Elsevier Inc. All rights reserved.

Supplying emergency contraception to adolescents: the nurse's role.

PubMed

Hopkins, Craig

2014-12-02

This article explores issues surrounding the supply of emergency contraception to adolescents to reduce the risk of unintended pregnancy. It explains the female reproductive cycle, and describes the types of emergency contraception that may be supplied following unprotected sexual intercourse or contraception failure. The aftercare that should be offered to adolescents following the supply of emergency contraception is discussed, alongside issues surrounding the safeguarding of children and vulnerable adults.

[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.

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.

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.

Use of non-emergency contraceptive pills and concoctions as emergency contraception among Nigerian University students: results of a qualitative study.

PubMed

Ajayi, Anthony Idowu; Nwokocha, Ezebunwa Ethelbert; Akpan, Wilson; Adeniyi, Oladele Vincent

2016-10-04

Emergency contraception (EC) can significantly reduce the rate of unintended pregnancies and unsafe abortions especially in sub-Saharan Africa. Despite the increasing awareness of EC among educated young women in Nigeria, the rate of utilisation remains low. This study therefore explores the main barriers to the use of EC among female university students by analysing their knowledge of emergency contraception, methods ever used, perceived efficacy, and its acceptability. This paper brings together the findings from several focus groups (N = 5) and in-depth interviews (N = 20) conducted amongst unmarried female undergraduate students in two Nigerian universities. Participants considered the use of condom and abstinence as the most effective methods of preventing unplanned pregnancy. However, many participants were misinformed about emergency contraception. Generally, participants relied on unconventional and unproven ECs; Ampiclox, "Alabukun", salt water solution, and lime and potash and perceived them to be effective in preventing unplanned pregnancies. Furthermore, respondents' narratives about methods of preventing unwanted pregnancies revealed that inadequate information on emergency contraception, reliance on unproven crude contraceptive methods, and misconception about modern contraception constitute barriers to the use of emergency contraception. The findings suggested that female university students are misinformed about emergency contraception and their reliance on unproven ECs constitutes a barrier to the use of approved EC methods. These barriers have serious implications for prevention of unplanned pregnancies in the cohort. Behavioural interventions targeting the use of unproven emergency contraceptive methods and misperceptions about ECs would be crucial for this cohort in Nigeria.

WOMEN'S EMPOWERMENT, HOUSEHOLD STATUS AND CONTRACEPTION USE IN GHANA.

PubMed

Blackstone, Sarah R

2017-07-01

Gender inequality is often cited as a barrier to improving women's sexual and reproductive health outcomes, including contraceptive use, in low- and middle-income countries such as those in sub-Saharan Africa. To date there is limited, recent, evidence available regarding women's empowerment, household status and contraceptive use in Ghana. The objective of this study was to investigate whether women's empowerment and status in the household were associated with contraceptive use and unmet need for contraception using the 2014 Ghana Demographic and Health Survey. The study sample consisted of 1828 women aged 15-49. Women's empowerment was measured based on two composite indexes created by the DHS: attitudes towards intimate partner violence and decision-making. Women's status in the home was measured using indicators of work status, relationship to household head, control over monetary earnings and land ownership. Decision-making was found to be positively associated with contraceptive use and not having unmet need for contraception. Women who justified wife beating in one or more instances were less likely to use contraception, and more likely to have unmet need for contraception. Current or past employment and higher levels of male partner education were associated with contraceptive use. This study indicates that women's empowerment and household status are influential for contraceptive indicators. Future interventions aimed at improving contraceptive uptake and use should promote women's empowerment, i.e. decision-making, self-worth and education.

Impact of the federal contraceptive coverage guarantee on out-of-pocket payments for contraceptives: 2014 update.

PubMed

Sonfield, Adam; Tapales, Athena; Jones, Rachel K; Finer, Lawrence B

2015-01-01

The Affordable Care Act requires most private health plans to cover contraceptive methods, services and counseling, without any out-of-pocket costs to patients; that requirement took effect for millions of Americans in January 2013. Data for this study come from a subset of the 1842 women aged 18-39 years who responded to all four waves of a national longitudinal survey. This analysis focuses on the 892 women who had private health insurance and who used a prescription contraceptive method during any of the four study periods. Women were asked about the amount they paid out of pocket in an average month for their method of choice. Between fall 2012 and spring 2014, the proportion of privately insured women paying zero dollars out of pocket for oral contraceptives increased substantially, from 15% to 67%. Similar changes occurred among privately insured women using injectable contraception, the vaginal ring and the intrauterine device. The implementation of the federal contraceptive coverage requirement appears to have had a notable impact on the out-of-pocket costs paid by privately insured women, and that impact has increased over time. This study measures the out-of-pocket costs for women with private insurance prior to the federal contraceptive coverage requirement and after it took effect; in doing so, it highlights areas of progress in eliminating these costs. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

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.

Contraception Delivery in Pediatric and Specialist Pediatric Practices.

PubMed

Kaskowitz, Alexa; Quint, Elisabeth; Zochowski, Melissa; Caldwell, Amy; Vinekar, Kavita; Dalton, Vanessa K

2017-04-01

To characterize pediatricians' knowledge, attitudes, and self-efficacy around contraception. Cross-sectional survey. United States. National sample of pediatricians. Assessment of behaviors of providing contraception. Reproductive health practice score. Two hundred twenty-three usable surveys were received, from 163 contraceptive prescribers and 60 nonprescribers. The mean reproductive health practice score was 43.1 (SD, 8.2; total possible score, 84). Prescribers differed in their mean reproductive health score (46.0; SD, 7.0) from nonprescribers (34.0; SD, 4.5; P < .001). Prescribers vs nonprescribers differed in their attitude and efficacy in providing contraception. More prescribers believed it was their responsibility to ask about patients' need for birth control, were confident in their ability to prescribe contraception options, and provided contraception to minors despite parental disapproval. Neither group was confident in their ability to place intrauterine devices or believed that the literature supports intrauterine device placement in adolescents. Only efficacy was related to prescribing contraception in a multivariate regression analysis (odds ratio, 1.7; P < .001). In this study, we showed that most pediatricians are contraception prescribers but the overall reproductive health score was low for prescribers and nonprescribers. The odds of prescribing contraception increased with higher self-efficacy scores rather than knowledge alone. Many prescribers and nonprescribers would not prescribe birth control if parents disapproved and do not believe it is their responsibility to assess patients' need for birth control. In addition very few pediatricians have training in long-acting reversible contraception, despite being the recommended method for adolescents. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Nomegestrol acetate-17b-estradiol for oral contraception

PubMed Central

Burke, Anne

2013-01-01

Oral contraceptives remain a popular method of contraception over 50 years after their introduction. While safe and effective for many women, the failure rate of oral contraception is about 8%. Concerns about the risk of venous thromboembolism continue to drive the search for the safest oral contraceptive formulations. The oral contraceptive NOMAC-E2 contains nomegestrol acetate (NOMAC) 2.5 mg + 17b-estradiol (E2) 1.5 mg. The approved dosing regimen is 24 days of active hormone, followed by a 4-day hormone-free interval. NOMAC is a progestin derived from testosterone, which has high bioavailability, rapid absorption, and a long half-life. Estradiol, though it has a lower bioavailability, has been successfully combined with NOMAC in a monophasic oral contraceptive. Two recently published randomized controlled trials demonstrate that NOMAC-E2 is an effective contraceptive, with a Pearl Index less than one pregnancy per 100 woman-years. The bleeding pattern on NOMAC-E2 is characterized by fewer bleeding/spotting days, shorter withdrawal bleeds, and a higher incidence of amenorrhea than the comparator oral contraceptive containing drospirenone and ethinyl estradiol. The adverse event profile appears to be acceptable. Few severe adverse events were reported in the randomized controlled trials. The most common adverse events were irregular bleeding, acne, and weight gain. Preliminary studies suggest that NOMAC-E2 does not seem to have negative effects on hemostatic and metabolic parameters. While no one oral contraceptive formulation is likely to be the optimum choice for all women, NOMAC-E2 is a formulation with effectiveness comparable with that of other oral contraceptives, and a reassuring safety profile. PMID:23836965

The male role in contraception: implications for health education.

PubMed

Chng, C L

1983-03-01

Today most contraceptive efforts are focused on the female. The resultant diminished male role may have inadvertently undermined the many societal efforts at birth control. Many men, young and old, still perceive contraception as primarily a woman's responsibility, for after all, she suffers most directly from contraceptive failure. This attitude is unfortunate. Since decisions about pregnancy affect both partners, both should share the contraceptive burden equitably. More specifically, the two-fold purpose of the paper is: (1) to examine the available male contraceptives; and (2) to draw implications of the changing male role in contraception for health professionals in the school and community. The paper argues that while the involvement of men in contraception will not automatically solve the problem of unwanted pregnancy among the young, it can certainly make a difference--an important difference.

[Factors associated with maintenance of contraception among adolescents].

PubMed

González, Electra; Molina B, Temístocles; Montero, Adela; Martínez, Vania; Molina, Ramiro

2009-09-01

Factors such as personal issues, family, sexuality and sexual partner characteristics are strongly associated with contraceptive continuation among single, nulliparous female adolescents. To determine factors associated to contraceptive maintenance among female nulliparous adolescents. A cohort of 2,811 adolescents, who confidentially requested contraception in a sexual and reproductive health university center from 1990 to 2006 was analyzed. Two years after the request, their clinical records were reviewed to determine the time and length of contraception. Using life table analysis, the variables related to continuation or discontinuation of contraception were identified. Factors associated with a longer contraceptive use were a lower age at the moment of initiating the method, a better academic achievement and aspirations, higher schooling of the partner, higher age of the mother, having an adolescent mother, supervision of permissions by people different than parents and not attending to religious services. Variables associated with a higher risk for abandonment were a higher age of the adolescent, greater number of sexual partners, lack of communication with parents, non-catholic religious affiliation, use of oral hormonal contraceptive, greater number of siblings, commenting sexual issues with relatives or friends, having a partner without academic activity or working and to live without parents. Several personal, familial and environmental factors influence contraceptive use continuity among adolescents.

Combined oral contraceptives: venous thrombosis.

PubMed

de Bastos, Marcos; Stegeman, Bernardine H; Rosendaal, Frits R; Van Hylckama Vlieg, Astrid; Helmerhorst, Frans M; Stijnen, Theo; Dekkers, Olaf M

2014-03-03

Combined oral contraceptive (COC) use has been associated with venous thrombosis (VT) (i.e., deep venous thrombosis and pulmonary embolism). The VT risk has been evaluated for many estrogen doses and progestagen types contained in COC but no comprehensive comparison involving commonly used COC is available. To provide a comprehensive overview of the risk of venous thrombosis in women using different combined oral contraceptives. Electronic databases (Pubmed, Embase, Web of Science, Cochrane, CINAHL, Academic Search Premier and ScienceDirect) were searched in 22 April 2013 for eligible studies, without language restrictions. We selected studies including healthy women taking COC with VT as outcome. The primary outcome of interest was a fatal or non-fatal first event of venous thrombosis with the main focus on deep venous thrombosis or pulmonary embolism. Publications with at least 10 events in total were eligible. The network meta-analysis was performed using an extension of frequentist random effects models for mixed multiple treatment comparisons. Unadjusted relative risks with 95% confidence intervals were reported.Two independent reviewers extracted data from selected studies. 3110 publications were retrieved through a search strategy; 25 publications reporting on 26 studies were included. Incidence of venous thrombosis in non-users from two included cohorts was 0.19 and 0.37 per 1 000 person years, in line with previously reported incidences of 0,16 per 1 000 person years. Use of combined oral contraceptives increased the risk of venous thrombosis compared with non-use (relative risk 3.5, 95% confidence interval 2.9 to 4.3). The relative risk of venous thrombosis for combined oral contraceptives with 30-35 μg ethinylestradiol and gestodene, desogestrel, cyproterone acetate, or drospirenone were similar and about 50-80% higher than for combined oral contraceptives with levonorgestrel. A dose related effect of ethinylestradiol was observed for gestodene

A review of global access to emergency contraception.

PubMed

Westley, Elizabeth; Kapp, Nathalie; Palermo, Tia; Bleck, Jennifer

2013-10-01

Emergency contraception has been known for several decades, and dedicated products have been on the market for close to 20 years. Yet it is unclear whether women, particularly in low-resource countries, have access to this important second-chance method of contraception. To review relevant policies, regulations, and other factors related to access to emergency contraception worldwide. A wide range of gray literature was reviewed, several specific studies were commissioned, and a number of online databases were searched. Several positive policies and regulations are in place: emergency contraception products are registered in the majority of countries around the world, listed in many countries' essential medicines lists, included in widely used guidance, and supported by most donors. Yet analysis of demographic data shows that the majority of women in low-income countries have never heard of emergency contraception, and surveys find that many providers have negative attitudes toward providing emergency contraception. Despite more than a decade of concerted international and country-level efforts to ensure that women have access to emergency contraception, accessibility remains limited. © 2013.

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.

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.

Emergency Contraception: Do Your Patients Have a Plan B?

PubMed

Bullock, Holly; Salcedo, Jennifer

2015-12-01

Emergency contraception is used after unprotected sex, inadequately protected sex, or sexual assault to reduce the risk of pregnancy. Of emergency contraceptive methods available in the United States, the copper intrauterine device has the highest efficacy, followed by ulipristal acetate, levonorgestrel-containing emergency contraceptive pills, and the Yuzpe method. However, access to the most effective methods is limited. Although advanced prescription of emergency contraceptive pills and counseling on emergency contraception to all reproductive-aged women is recommended, women should be advised to contact their health care providers after taking emergency contraceptive pills to discuss possible copper intrauterine device placement and other follow-up. Copyright © 2015 Elsevier Inc. All rights reserved.

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.

Contraceptive use among migrant women with a history of induced abortion in Finland.

PubMed

Väisänen, Heini; Koponen, Päivikki; Gissler, Mika; Kontula, Osmo

2018-06-25

Women's contraceptive choices may change after an induced abortion, due to contraceptive counselling or a behavioural change prompted by the experience. The effect may vary between women; sociocultural background, for example, may affect their subsequent reproductive choices. We examined whether women's current contraceptive use was differently associated with a history of induced abortion among immigrant groups in Finland (Russian, Kurdish and Somali) and the general Finnish population. We analysed data from two surveys, the Migrant Health and Wellbeing study and the Health 2011 study, linked to the Finnish register of induced abortions. Propensity score weighted logistic regression was used to analyse the data. The likelihood of using contraceptives after an abortion varied depending on women's sociocultural background. A history of induced abortion increased contraceptive use among all groups, except Russian women, in whom there was no effect. The effect was particularly strong for Kurdish women. Sociocultural background was an important determinant of post-abortion contraceptive use. Some immigrants may struggle to navigate the Finnish health care system due to language or literacy issues. Attention should be paid to improving access to family planning among these groups.

Effects of intrauterine contraception on the vaginal microbiota.

PubMed

Bassis, Christine M; Allsworth, Jenifer E; Wahl, Heather N; Sack, Daniel E; Young, Vincent B; Bell, Jason D

2017-09-01

There have been conflicting reports of altered vaginal microbiota and infection susceptibility associated with contraception use. The objectives of this study were to determine if intrauterine contraception altered the vaginal microbiota and to compare the effects of a copper intrauterine device (Cu-IUD) and a levonorgestrel intrauterine system (LNG-IUS) on the vaginal microbiota. DNA was isolated from the vaginal swab samples of 76 women using Cu-IUD (n=36) or LNG-IUS (n=40) collected prior to insertion of intrauterine contraception (baseline) and at 6 months. A third swab from approximately 12 months following insertion was available for 69 (Cu-IUD, n=33; LNG-IUS, n=36) of these women. The V4 region of the bacterial 16S rRNA-encoding gene was amplified from the vaginal swab DNA and sequenced. The 16S rRNA gene sequences were processed and analyzed using the software package mothur to compare the structure and dynamics of the vaginal bacterial communities. The vaginal microbiota from individuals in this study clustered into 3 major vaginal bacterial community types: one dominated by Lactobacillus iners, one dominated by Lactobacillus crispatus and one community type that was not dominated by a single Lactobacillus species. Changes in the vaginal bacterial community composition were not associated with the use of Cu-IUD or LNG-IUS. Additionally, we did not observe a clear difference in vaginal microbiota stability with Cu-IUD versus LNG-IUS use. Although the vaginal microbiota can be highly dynamic, alterations in the community associated with the use of intrauterine contraception (Cu-IUD or LNG-IUS) were not detected over 12 months. We found no evidence that intrauterine contraception (Cu-IUD or LNG-IUS) altered the vaginal microbiota composition. Therefore, the use of intrauterine contraception is unlikely to shift the composition of the vaginal microbiota such that infection susceptibility is altered. Copyright © 2017 Elsevier Inc. All rights reserved.

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

Contraceptive sales in the setting of the Zika virus epidemic

PubMed Central

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

2017-01-01

STUDY QUESTION Has there been any influence of the Zika virus (ZIKV) outbreak on the sales of contraceptive methods in Brazil? SUMMARY ANSWER Contraceptive sales in the 24 months of evaluation showed little variation and no significant change has been observed since the ZIKV outbreak. WHAT IS KNOWN ALREADY 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. STUDY DESIGN, SIZE, DURATION 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. PARTICIPANTS/MATERIALS, SETTING, METHODS 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. MAIN RESULTS AND THE ROLE OF CHANCE Monthly sales of COC, POP, patches and vaginal rings represent the major sales segment of the market, i.e. 12.7–13

Contraception and reproductive counseling in women with peripartum cardiomyopathy.

PubMed

Rosman, Lindsey; Salmoirago-Blotcher, Elena; Wuensch, Karl L; Cahill, John; Sears, Samuel F

2017-07-01

Pregnancies following a diagnosis of peripartum cardiomyopathy (PPCM) are associated with increased risk for maternal morbidity and mortality. Yet patterns of contraceptive use and reproductive counseling have received little attention. This nationwide registry-based study sought to evaluate patterns and clinical characteristics associated with contraceptive use, and examine the prevalence of contraceptive counseling in women with PPCM. From December 2015 to June 2016, 177 PPCM patients (mean age of 34.8±5.7years, median time since diagnosis of 3.0±4.3years) completed questionnaires about contraceptive use and counseling at registry enrollment. T Tests, chi-square and logistic regression were used to compare demographic and clinical characteristics among women who reported contraceptive use vs. nonuse. Tubal ligation (24.3%), condoms (22.0%) and intrauterine devices (IUDs; 16.4%) were the most common forms of contraception. Among sexually active women, 28.9% reported contraceptive nonuse. Contraceptive users had a lower body mass index higher education, and were less likely to be in a dating relationship, have hypertension, wear an external cardioverter-defibrillator, and use antihypertensive medications compared with nonusers (all p<0.05). Two-thirds of women received counseling about risks of subsequent pregnancies and contraceptive strategies. This preliminary study indicates that 1 in 4 PPCM patients are sexually active and are not using contraception to prevent PPCM reoccurrence. Although a majority of women did receive reproductive counseling, as many as 25% of patients reported no discussion of contraceptive strategies to prevent unintended pregnancy and heart failure relapse. Copyright © 2017 Elsevier Inc. All rights reserved.

Fertility and combined oral contraceptives - unintended pregnancies and planned pregnancies following oral contraceptive use - results from the INAS-SCORE study.

PubMed

Barnett, Clare; Hagemann, Christine; Dinger, Jürgen; Do Minh, Thai; Heinemann, Klaas

2017-02-01

To estimate the real-use contraceptive effectiveness of the combined oral contraceptive containing dienogest and estradiol valerate (DNG/EV) and whether DNG/EV compared to other combined oral contraceptives (oCOC) has a negative effect on return to fertility. Transatlantic, prospective, non-interventional cohort study conducted in the USA and seven European countries with two main exposure groups and one exposure subgroup: new users of DNG/EV and other COC (oCOC), particularly levonorgestrel-containing COCs (LNG). In a planned secondary analysis, pregnancy outcomes were investigated including contraceptive effectiveness and pregnancy following contraceptive cessation. The influence of age, parity and OC-type were assessed. 50,203 COC users were followed for 105,761 woman-years (WY). There were 677 unintended pregnancies reported: 451 in the USA and 226 in Europe. The contraceptive failure rate in Europe was 0.5 events/100 WY (95% CI: 0.4-0.5) and in the USA 1.9 events/100 WY (95% CI: 1.7-2.1). Differences in compliance (1.3 pregnancies/100 WY) accounted for 90% of the geographical difference seen between Europe and the USA. DNG/EV showed lower contraceptive failure rates compared to the comparators; 0.9% DNG/EV, 2.1% oCOC and 2.8% LNG after 4 years. Overall, 1167 (2.3%) of women stopped contraceptive use with the intention of becoming pregnant with 89% conceiving within 2 years. No significant differences were seen between groups after adjusting for age. DNG/EV is associated with similar contraceptive effectiveness in typical-use settings when compared to oCOC and LNG. There was no difference observed between cohorts in fertility following OC use.

[Study on the male contraceptive based on epididymis].

PubMed

Cui, Yu-Gui; Tong, Jian-Sun; Wang, Xing-Hai

2002-01-01

More and more study on the epididymal function and sperm maturation has shown that epididymis will be one of the best target organs of male contraception, although at present there is not a male contraceptive medicine based on epididymis for clinical practice. The promoting research aspects in epididymal contraception in animal included affecting directly epididymis (such as Sulpasalazine), interfering energy metabolism and sperm mobility (such as Chlorinated Glycerol), altering the internal environment of epididymis (such as copper particles and TW19). The epididymal specific proteins could bring out some new target antigens for immunological contraception, to produce contraceptive vaccine. Some special genes, which expressed distinctively in epididymis such as SC342, bin1, have been cloned and studied on their function. These works would be helpful not only for clinical diagnosis and treatment of epididymitis and male infertility, but also for male contraceptive research and progress.

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

[Social determinants of contraceptive use in Tunisia].

PubMed

Dimassi, K; Douik, F; Douzi, M A; Saidi, O; Ben Romdhane, H

2017-02-01

In Tunisia, the "Revolution" of January 2011 highlighted significant regional disparities and social inequalities in access to health care, including reproductive health services. The purpose of this study was to analyze the social determinants of the use of contraception in Tunisia. A cross-sectional national study conducted in 2012; on a sample of 15 to 49-year married women (n=4374) drawn by a two levels random sampling. Prevalence of contraception and its association factors were assessed. Logistic regression was used to evaluate the variation of contraception prevalence with area of residence, age, level of education, number of children and household income. The prevalence of contraception was 66.4 %. Eighty-two percent of women used a modern contraceptive method. The use of contraceptive methods was significantly dependent on the age (P<0.001), area of residence (P=0.008), education (P<0.001). The prevalence of contraception was higher in North West (OR=1.1 [0.81-1.5]; P<0.001), among multiparous women (OR=4.49 [3.57-5.66]; P<0.001), among the youngest women (OR=1.4 [0.9-2,19]; P<0.001) and among those with higher levels of education (OR=1.62 [1.19-2.21]; P=0.008). Tunisia, precursor Arab country in family planning, is recording a slowdown in the use of contraception in comparison with other countries of North Africa. Social determinants, such as, age, living conditions, area of residence and level of education are indicators to consider when targeting interventions. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

[Individualization of low-dose oral contraceptives. Pharmacological principles and practical indications for oral contraceptives].

PubMed

Cianci, A; De Leo, V

2007-08-01

The contraceptive pill has been a revolution of the last 40 years. In Italy, however, it is much less widely used than in other countries. Explanations for this phenomenon range from religious implications and customs to misinformation and word-of-mouth communication of negative experiences. The oral contraceptive pill is often used to correct menstrual disorders, leading to poor results and side-effects. Recent advances in oral contraception have led to a substantial reduction in doses and side-effects. Low-dose pills contain minimal doses of progesterones and estrogens and ensure good control of the menstrual cycle. Although reduction of ethinyl estradiol (EE) concentrations has reduced the incidence of negative systemic side effects such as water retention, edema and swollen breasts, the low estrogen dose may be associated with spotting and hypomenorrhea or amenorrhea in the long term, as well as dyspareunia due to reduced vaginal trophism, which may induce women to suspend use of the drug. It is also true that only one type of estrogen is used in the pill, albeit at different doses, whereas the progesterone may differ and in many cases is the cause of common side-effects. The choice of progesterone therefore involves not only its effect on the endometrium in synergy with estrogen, but also possible residual androgenic activity which may have negative metabolic repercussions. Indeed, addition of a progesterone, especially androgen-derived, attenuates the positive metabolic effects of estrogen. Two new monophasic oral contraceptives were recently released. They contain 30 microg (Yasmin) or 20 muicrog (Yasminelle) EE and a new progesterone, drospirenone, derived from spirolactone, which has antiandrogenic and antimineralcorticoid activity similar to endogenous progesterone. Like progesterone, the drospirenone molecule is an aldosterone antagonist and has a natriuretic effect that opposes the sodium retention effect of EE. It may, therefore, help to prevent the

Knowledge and choices of postpartum contraception among pregnant teens.

PubMed

Ortiz-González, Karla M; Benabe, Erika; Rivera-Rosa, Edgardo; Negrón, Ivette; Romaguera, Josefina

2014-09-01

To describe the general knowledge and choices of postpartum contraception among pregnant teens who, at the time of the study, ranged in age from 13 to 19 years old and were receiving prenatal care at a hospital-based prenatal clinic. Questionnaires to obtain information regarding demographic characteristics and to explore contraception knowledge and choices were voluntarily completed by 44 pregnant teens, ranging in age from 13 to 19 years old. The frequency and distribution of the variables under study were analyzed and are presented herein. Forty-four teens participated in the study. They had a mean age of 17.5 years. A significant proportion of the participants, 20 (45.5%), claimed not to know where to find information about contraception. All the participants acknowledged knowing about the male condom; as to other methods of contraception, 41 (93.2%) knew about oral contraceptive pills (OCPs), 31 (70.5%) knew about the patch, 30 (68.2%) knew about Depo-Provera, and 25 (56.8%) knew about intrauterine devices (IUD). The contraception methods about which the participants reported having the least knowledge were the sponge, the diaphragm, implants, the vaginal ring, and various natural methods. The majority (90.0%) of the participants agreed that they would prefer to use postpartum contraception. The contraceptive method of choice for postpartum contraception was the IUD (40%), which was followed in terms of preference by OCPs (17.5%), the patch (12.5%), and Depo-Provera (12.5%). The majority of the pregnant teens who participated in the study professed the desire to use some sort of contraceptive method to ensure that they would not become pregnant again in the near future. To that end, most of them expressed a preference for the IUD, one of the most effective contraceptive methods available today. Nevertheless, they need more access to and information about available contraceptive methods.

Psychosexual well-being in women using oral contraceptives containing drospirenone.

PubMed

Nappi, Rossella E; Albani, Francesca; Tonani, Silvia; Santamaria, Valentina; Pisani, Carla; Terreno, Erica; Martini, Ellis; Polatti, Franco

2009-01-01

Considerable advances have been made in hormonal contraception in recent years, geared at maximizing compliance and minimizing discontinuation. In oral contraceptive (OC) formulations, the estrogenic component, generally ethinyl estradiol (EE), has been reduced significantly and newer progestins like dienogest and drospirenone (DRSP), compounds with different molecular structures, have been introduced; in addition, new regimens (extended, flexible, 24/4 formats instead of the standard 21/7 format) and innovative delivery systems (vaginal rings, transdermal patches, subcutaneous implants and intrauterine devices) are available. The multitude of choices allows hormonal contraception to be tailored to the individual woman in order to obtain non-contraceptive benefits, without significant side effects, and also a favorable risk/benefit profile for her general and reproductive health. Over the past few years, new OC formulations combining DRSP (3 mg), a unique progestin with both antimineralocorticoid and antiandrogenic activities, with estrogen (30 mcg or 20 mcg EE), in two regimens (24/4 and 21/7) of active pills in a 28-day cycle, have shown positive effects on water retention-related weight gain and physical, emotional and psychosexual well-being. It seems likely that the use of a low-dose, well-balanced OC and the shorter 4-day hormone-free interval may minimize the side effects that can impair quality of life and thus increase women's compliance with hormonal contraception therapy.

Active-learning instruction on emergency contraception counseling.

PubMed

Young, Shardae; Griffin, Brooke; Vest, Kathleen

2013-06-12

To increase pharmacy students' knowledge of and confidence in counseling patients regarding emergency contraception and to identify any barriers to counseling patients about emergency contraception. Approximately 200 third-year pharmacy students participated in the Women's Health Therapeutics workshop at Midwestern University Chicago College of Pharmacy. Students observed a 5-minute skit of a counseling session on emergency contraception and then were asked to pair up with a classmate and practice counseling each other regarding the use of emergency contraception following a checklist of key points. One hundred eighty-nine students completed pre- and post-workshop survey instruments. Students' knowledge scores increased from 86% to 93% (p<0.001). Approximately 25% of the students stated they were confident in counseling patients on emergency contraception before completing the active-learning exercise compared to 58.5% after (p<0.001). The most common barrier to counseling that students identified on the pre- and post-workshop survey was lack of knowledge. Participation in an active-learning exercise significantly increased pharmacy students' knowledge of and confidence in counseling patients regarding emergency contraception and significantly reduced several barriers to counseling identified prior to participation.

Active-Learning Instruction on Emergency Contraception Counseling

PubMed Central

Young, Shardae; Vest, Kathleen

2013-01-01

Objective. To increase pharmacy students’ knowledge of and confidence in counseling patients regarding emergency contraception and to identify any barriers to counseling patients about emergency contraception. Design. Approximately 200 third-year pharmacy students participated in the Women’s Health Therapeutics workshop at Midwestern University Chicago College of Pharmacy. Students observed a 5-minute skit of a counseling session on emergency contraception and then were asked to pair up with a classmate and practice counseling each other regarding the use of emergency contraception following a checklist of key points. Assessment. One hundred eighty-nine students completed pre- and post-workshop survey instruments. Students’ knowledge scores increased from 86% to 93% (p<0.001). Approximately 25% of the students stated they were confident in counseling patients on emergency contraception before completing the active-learning exercise compared to 58.5% after (p<0.001). The most common barrier to counseling that students identified on the pre- and post-workshop survey was lack of knowledge. Conclusion. Participation in an active-learning exercise significantly increased pharmacy students’ knowledge of and confidence in counseling patients regarding emergency contraception and significantly reduced several barriers to counseling identified prior to participation. PMID:23788815

Parental influences on adolescent decision making and contraceptive use.

PubMed

Commendador, Kathleen A

2010-01-01

This article reviews the literature in the area of parental and maternal influences on contraceptive decision making, thus determining future directions of research and potential interventions. A review of published literature using PubMed, CINAHL, Infotrak, Science and Technology, and Medline spanning 1980-2007 was used to gather information. Results from 35 research studies and 15 scholarly articles were included. The search terms adolescent decision making, maternal influences on adolescent contraceptive decision making, adolescent contraceptive decision making, paternal influences on adolescent decision making, and contraception were used to gather data. The literature reveals there is an association between parental communication, parenting style, and adolescent sexual activity and contraception use. Maternal communication has been shown to delay sexual intercourse and increase contraceptive use. Maternal communication has rich potential as an intervention to impact positive adolescent sexual decision making and contraception use. Gaps in the research identified were the lack of studies on the influences on parenting style and the father/adolescent influences on sexual initiation and contraceptive decision making.

The use of emergency contraception in Australasian emergency departments.

PubMed

Millar, J R; Leach, D S; Maclean, A V; Kovacs, G T

2001-09-01

To review the prescribing of emergency contraception by emergency departments in Australasia and compare it with other providers. A postal questionnaire was sent to the director of each of the 79 Australasian College for Emergency Medicine accredited emergency departments in Australasia inquiring about the availability and prescribing habits for emergency contraception within each department. Of the 79 emergency departments, 69 (87.3%) responded to the questionnaire and were aware of the 'emergency contraception regimen'. The majority of departments prescribed appropriately (56%) and only one department did not arrange adequate follow up. Anti-emetics are always used by 45 departments (78.9%). Discussion of future contraceptive needs at the time of presentation was only undertaken by 25 departments (43.9%). Written clinical guidelines for emergency contraception were present in 28 departments (40.6%). Emergency departments are accessed by patients requesting contraception following unprotected intercourse or contraceptive failure. The prescribing of emergency contraception in Australasian emergency departments is comparable with other providers but substantial improvements could be made. Suggestions to assist this improvement include written clinical guidelines and patient information and purpose-made medication packs.

Efficacy of a combined contraceptive regimen consisting of condoms and emergency contraception pills.

PubMed

Zhao, Rui; Wu, Jun-Qing; Li, Yu-Yan; Zhou, Ying; Ji, Hong-Lei; Li, Yi-Ran

2014-04-14

To evaluate and compare the effectiveness of the combined regimen (consisting of condoms and emergency contraception pills (ECP)) and using condoms only for the purpose of preventing pregnancy. One-thousand-five-hundred-and-sixty-two (1,562) couples as volunteers enrolled at nine centers in Shanghai. Eight-hundred-and-twelve (812) were randomized to use male condoms and ECP (i.e., Levonorgestrel) as a back-up to condoms (the intervention group) and 750 to use male condoms only(the control group), according to their working unit. Participants were visited at admission and at the end of 1, 3, 6, 9, and 12 months. The cumulative life table rates were calculated for pregnancy and other reasons for discontinuation. The gross cumulative life table rates showed that the cumulative discontinuation rates for all reasons during the year of follow-up in the condoms plus emergency contraception group and the condoms only group were 7.76 ± 0.94 and 6.61 ± 0.91, respectively, per 100 women (χ2 = 0.41, p = 0.5227). The cumulative gross pregnancy rate of the condoms plus emergency contraception group and the condoms only group were 2.17 ± 0.52 and 1.25 ± 0.41, respectively, per 100 women (χ2 = 1.93, p = 0.1645). The Pearl Index in the condoms plus emergency contraception group and the condoms only group were 2.21% and 1.26%, respectively. Male condoms remain a highly effective contraceptive method for a period of one year while consistently and correctly used. In addition, the lowest pregnancy rate followed from perfect use condom.

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.

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.

Contraceptive use among low-income urban married women in India.

PubMed

Kumar, Manisha; Meena, Jyoti; Sharma, Sumedha; Poddar, Anju; Dhalliwal, Vikas; Modi-Satish Chander Modi, S C; Singh, Kamlesh

2011-02-01

The reports of a rise in contraceptive practices have not been matched by a similar decrease in population, so there is a need to look into the causes of this discrepancy. To obtain information from low-income urban married women regarding their contraceptive knowledge, practices, and utilization of the services. Percentage of low-income urban married women using contraception, different types of contraception used, influence of education on choice of contraception. All nonpregnant married women between the ages of 18 and 45 years, belonging to low-income groups were selected for study. Statistical analysis was done using EPI Info ver-5.0. Chi square test was used to test the significance of data. Contraceptive use among these women was 52%; the most common method was tubal ligation. Educated women used spacing methods more often than uneducated women. Women had adequate awareness regarding type of contraceptives available but had no idea about the timing of starting contraception after delivery and about emergency contraception. The low-income urban population is aware of the importance of limiting the family size and has family planning facilities yet has less contraceptive usage because of low level of education, increased rate of discontinuation, and lack of proper knowledge of the use of contraception. © 2010 International Society for Sexual Medicine.

Integrating Pregnancy Ambivalence and Effectiveness in Contraceptive Choice.

PubMed

Sundstrom, Beth; Ferrara, Merissa; DeMaria, Andrea L; Baker-Whitcomb, Annalise; Payne, Jackelyn B

2017-07-01

Approximately 70% of pregnancies among young unmarried women living in the United States are unintended. Unintended pregnancy results in negative health and economic outcomes for infants, children, women, and families. Further research into the decision-making process of contraceptive selection is needed to meet young women's contraceptive needs in the United States. Overall, 53 women ages 18-24 years completed in-depth qualitative interviews. Researchers used analytical techniques from grounded theory and HyperRESEARCH 3.5.2 qualitative data analysis software to identify emergent themes. Problematic integration theory provided a theoretical lens to identify young women's probabilistic and evaluative orientations toward contraception. Researchers identified two profound values at stake to participants regarding their contraceptive decisions: avoiding pregnancy in the present, and protecting future fertility. Participants resisted long-acting reversible contraception (LARC) methods (e.g., the intrauterine device and the implant) due to concerns about safety and fears about infertility. Participants experienced ambivalence toward the idea of pregnancy, which complicated contraceptive decisions, especially regarding long-term methods. Uncertainty led participants to rationalize their use of less effective methods and reduced information seeking. Findings from this study offer practical suggestions for practitioners and health communication campaign planners. Contraceptive access campaigns should focus on the effectiveness, safety, and convenience of LARC methods. Messages should help young women make contraceptive choices that better fit their needs in order to reduce unintended pregnancy.

Young Adults' Contraceptive Practices: An Investigation of Influences.

ERIC Educational Resources Information Center

Lowe, Candace S.; Radius, Susan M.

1987-01-01

Investigated unmarried young adults' (N=283) contraceptive behaviors and attitudes. Results suggest that effective contraceptive behavior associated most strongly with respondents' perceiving relatively few barriers to their use of contraception, their maintenance of extensive interpersonal skills, and their regarding peer norms as consistent with…

Social network effects in contraceptive behavior among adolescents.

PubMed

Ali, Mir M; Amialchuk, Aliaksandr; Dwyer, Debra S

2011-10-01

To quantify empirically the role of peer social networks in contraceptive behavior among adolescents. Using longitudinal data from a nationally representative sample of adolescents, the authors use a multivariate structural model with school-level fixed effects to account for the problems of contextual effects, correlated effects, and peer selection to reduce the potential impact of biases from the estimates of peer influence. The peer group measures are drawn not only from the nominations of close friends but also from classmates. Contraception use among the peer groups was constructed using the peers' own reports of their contraceptive behavior. Controlling for parental characteristics and other demographic variables, the authors find that a 10% increase in the proportion of classmates who use contraception increases the likelihood of individual contraception use by approximately 5%. They also find evidence that the influence of close friends diminishes after accounting for unobserved environmental confounders. The findings of this study support the findings in the literature that peer effects are important determinants of contraception use even after controlling for potential biases in the data. Effective policy aimed at increasing contraception use among adolescents should consider these peer effects.

Spatial and socio-demographic determinants of contraceptive use in the Upper East region of Ghana.

PubMed

Achana, Fabian Sebastian; Bawah, Ayaga A; Jackson, Elizabeth F; Welaga, Paul; Awine, Timothy; Asuo-Mante, Eric; Oduro, Abraham; Awoonor-Williams, John Koku; Phillips, James F

2015-04-02

This paper presents results of baseline data on the determinants of contraceptive use in 7 districts in northern Ghana where there is an ongoing integrated primary health care systems strengthening projectknown as the Ghana Essential Health Intervention Project (GEHIP). We used a household survey data conducted within 66 randomly sampled census enumeration areas in seven rural districts of the Upper East Region of northern Ghana where health systems strengthening interventions are currently ongoing in three of the districts with four of the districts serving as comparison districts. This survey was conducted prior to the introduction of interventions. Data was collected on various indices included geographic information systems (GIS) and contraceptive use. The data was analyzed using survey design techniques that accounts for correct variance estimation. Categorical variables were summarized as proportions and associations between these variables and contraceptive use tested using Chi-square test. Uni-variable and multivariable logistic regression techniques were used to assess the effects of the selected covariates on contraceptive use. All tests were deemed to be statistically significant at 5% level statistical significance. Results show that contraceptive use is generally low (about 13 per cent) and use is nearly evenly for spacing and stopping purposes. Factors associated with the use of contraceptives include exposure to integrated primary healthcare services, the level of education, and socioeconomic status, couple fertility preference, marital status, and parity. For instance, the odds of contraceptive use among 15-45 year old women who live 2 km or more from a CHPS compound is 0.74 compared to women who live less than 2 km from a CHPS compound (p-value = 0.035). The findings suggest that rapid scale up of the Community based Health Planning and Services (CHPS) program accompanied with improved door-to-door health services would kindle uptake of modern

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.

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...

Cost Effectiveness of Contraceptives in the United States

PubMed Central

Trussell, James; Lalla, Anjana M.; Doan, Quan V.; Reyes, Eileen; Pinto, Lionel; Gricar, Joseph

2013-01-01

Background The study was conducted to estimate the relative cost effectiveness of contraceptives in the United States from a payer’s perspective. Methods A Markov model was constructed to simulate costs for 16 contraceptive methods and no method over a 5-year period. Failure rates, adverse event rates, and resource utilization were derived from the literature. Sensitivity analyses were performed on costs and failure rates. Results Any contraceptive method is superior to “no method”. The three least expensive methods were the copper-T IUD ($647), vasectomy ($713) and LNG-20 IUS ($930). Results were sensitive to the cost of contraceptive methods, the cost of an unintended pregnancy, and plan disenrollment rates. Conclusion The copper-T IUD, vasectomy, and the LNG-20 IUS are the most cost-effective contraceptive methods available in the United States. Differences in method costs, the cost of an unintended pregnancy, and time horizon are influential factors that determine the overall value of a contraceptive method. PMID:19041435

Menstrual pattern, sexual behaviors, and contraceptive use among postpartum women in Nairobi urban slums.

PubMed

Ndugwa, Robert P; Cleland, John; Madise, Nyovani J; Fotso, Jean-Christophe; Zulu, Eliya M

2011-06-01

Postpartum months provide a challenging period for poor women. This study examined patterns of menstrual resumption, sexual behaviors and contraceptive use among urban poor postpartum women. Women were eligible for this study if they had a birth after the period September 2006 and were residents of two Nairobi slums of Korogocho and Viwandani. The two communities are under continuous demographic surveillance. A monthly calendar type questionnaire was administered retrospectively to cover the period since birth to the interview date and data on sexual behavior, menstrual resumption, breastfeeding patterns, and contraception were collected. The results show that sexual resumption occurs earlier than menses and postpartum contraceptive use. Out of all postpartum months where women were exposed to the risk of another pregnancy, about 28% were months where no contraceptive method was used. Menstrual resumption acts as a trigger for initiating contraceptive use with a peak of contraceptive initiation occurring shortly after the first month when menses are reported. There was no variation in contraceptive method choice between women who initiate use before and after menstrual resumption. Overall, poor postpartum women in marginalized areas such as slums experience an appreciable risk of unintended pregnancy. Postnatal visits and other subsequent health system contacts provide opportunities for reaching postpartum women with a need for family planning services.

Contraception in The Netherlands: the low abortion rate explained.

PubMed

Ketting, E; Visser, A P

1994-07-01

This article gives a review of the main factors that are related to the low abortion rate in the Netherlands. Attention is payed to figures on abortion and the use of contraceptive methods since the beginning of the 1960s up to the end of the 1980s. The strong acceptance of family planning was influenced by changing values regarding sexuality and the family, the transition from an agricultural to a modern industrial society, rapid economic growth, declining influence of the churches on daily life, introduction of modern mass media and the increased general educational level. The introduction of modern contraceptives (mainly the pill and contraceptive sterilization) was stimulated by a strong voluntary family planning movement, fear for overpopulation, a positive role of GPs, and the public health insurance system. A reduction of unwanted pregnancies has been accomplished through successful strategies for the prevention of teenage pregnancy (including sex education, open discussions on sexuality in mass media, educational campaigns and low barrier services) as well as through wide acceptance of sterilization. The Dutch experience with family planning shows the following characteristics: a strong wish to reduce reliance on abortion, ongoing sexual and contraceptive education related to the actual experiences of the target groups, and low barrier family planning services.

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

Hormonal approaches to male contraception.

PubMed