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J Cottingham

Publications and source records attributed to J Cottingham.

5 recordsLinked to original sources
PubMed2001

Assessing the acceptability, service delivery requirements, and use-effectiveness of the diaphragm in Colombia, Philippines, and Turkey.

The diaphragm is not available in many countries, despite the recommendations of numerous authors that it has important advantages as a woman-controlled method that offers some protection against sexually transmitted diseases, and one that is safe and free of side effects. An interagency team collaborated to introduce the diaphragm in Colombia, the Philippines, and Turkey, using the same protocol to assess the acceptability, service delivery requirements and use-effectiveness of the method. Eighteen public and private sector service delivery sites were involved and a total of 550 women were enrolled in the study. Provider training aimed to improve the quality of care with which all methods were delivered and included counseling about sexuality and reproductive health risks. The cumulative 12-month pregnancy rate of 10.1 (SE 1.7) per 100 woman-years is on the low end of previous studies of the diaphragm, and the 12-month continuation rate (57.2 [SE 2.4] per 100) compares favorably with that for oral contraceptives and the intrauterine device. Focus group discussions conducted with clients and providers indicated that the method was an important alternative for some women, particularly those who had experienced health problems with other methods or were unable to negotiate condom use with their partners. Provider biases diminished as they observed the strategic niche that the diaphragm filled for their clients. While providing the diaphragm requires training and good client-provider interaction, the requirements are consistent with those called for in the Programme of Action of the International Conference on Population and Development (ICPD, 1994). With proper attention to quality of care, the diaphragm can be successfully offered in resource-poor settings.

Adolescent↗
PubMed1997

Contraceptive methods: potential for abuse.

Contraceptive technologies are one of the most extraordinary advances of the twentieth century, enabling women and men to prevent unwanted pregnancy. They have also been criticized for giving rise to abusive practices in the name of population control. Some people have even argued that contraceptive methods which have a potential for abuse should not be developed. We maintain that eliminating research on such methods does not address the problem of abuse. Abuse has been defined as the violation of the right to liberty and security of the person, which requires that an individual's free and informed consent be given before research is done on, or treatment is provided to, that individual. A number of international guidelines on the ethical conduct of research involving human subjects, and on the provision of medical services, emphasise the importance of informed consent as part of informed decision-making of individuals. Irrespective of the contraceptive methods already available or under development, much public education is needed to ensure that investigators, health providers, users of services and research participants fully understand what informed consent means, what it implies and how it should protect people. Non-governmental organizations and others can use the various national and international mechanisms that exist to investigate cases of alleged abuse and to bring redress in such situations. The international community has a duty to foster and strengthen ethical practices in research and service provision of contraceptive methods.

Contraception↗
PubMed1992

Chlamydia trachomatis and oral contraceptive use: a quantitative review.

OBJECTIVES: Chlamydia trachomatis is now recognised as a major sexually transmitted disease; oral contraceptive use is rapidly increasing particularly in developing countries. There are thus important public health implications of the many reports that isolation of C trachomatis is more frequent among users of oral contraceptives. The aim of this analysis was to assess the strength and consistency of this association by summarising published studies between 1972 and 1990. DESIGN: Studies identified were grouped according to whether they were prospective or case-control studies. Data were extracted and pooled estimates of the unadjusted odds ratios were made for all studies, as well as for sub-groups defined by an index of study quality, background prevalence of C trachomatis, and the contraceptive comparison being made. LOCATION: Studies in the analysis were mainly conducted in Europe and North America; the meta-analysis was done at the Harvard School of Public Health, Boston, MA, USA. RESULTS: The pooled estimated unadjusted odds ratio for 29 case-control studies examined was 1.93 (95% CI, 1.77-2.11), indicating an almost twofold increased risk of chlamydial infection for oral contraceptive users. Neither study quality nor prevalence of C trachomatis modified this risk. When compared to the use of barrier contraceptives, however, the risk of infection for women using oral contraceptives increased to 2.91 (95% CI, 1.86-4.55). The pooled estimated protective effect of barrier methods in these studies was 0.34 (95% CI, 0.22-0.54). CONCLUSIONS: Cross-study comparisons of the relationship between oral contraceptive use and chlamydial infection are limited by the design and analysis of many component studies which did not control for confounding factors such as sexual behaviour and age. The almost twofold risk of increased chlamydial infection for oral contraceptive users, supported by the findings of two prospective studies, however, points to the importance of considering the risks and benefits of oral contraceptive use in women who are likely to be exposed to C trachomatis and other STDs. The protective effect of barrier methods emphasizes the continued need for promoting barrier methods of contraception.

Case-Control Studies↗