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PubMed1993

Contraceptive health programs for adolescents: a critical review.

Many adolescents are neither educated about contraception nor consistently practice it as part of their sexual health behavior. Contraceptive education has taken many forms and has been questioned as to its effectiveness. This paper reviews some of the contraceptive education programs that have been designed for adolescents. These programs, although targeting the adolescent population, differ in educational process based on the delivery setting. School-based, community-based, and college/university-based programs are reviewed and discussed in terms of their effectiveness, potential, and limitations. Educating adolescents about contraception should incorporate the cognitive, affective, and skill-based domains of learning, with outcome expectations based on the specific delivery setting. However, not all settings have the freedom to select from a variety of teaching methodologies. Thus, educational accountability in each setting should differ in terms of outcome expectations, particularly if the program evaluation includes behavioral components.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Teen home pregnancy test takers: more worried or more wishful?

OBJECTIVE: To test the hypothesis that teenagers who have taken home pregnancy tests are more ambivalent about remaining nonpregnant than those who have not and, for this reason, use contraceptives less consistently. METHODS: A racially diverse group of 340 inadequately contracepting, nulligravida teens, 94 (28%) of whom had taken a home pregnancy test, was studied. At enrollment, participants completed a self-administered questionnaire, were counseled about contraceptive options, and were given the opportunity to initiate their method of choice. The enrollment tool assessed traditional teen-pregnancy risk factors, expectations about the effects of childbearing, common deterrents to contraceptive use, the desirability of remaining nonpregnant, and contraceptive use and plans. RESULTS: Home pregnancy test takers were more apt to be unsure that they wanted to remain nonpregnant (relative risk [RR]:1.3; 95% confidence interval [CI]:1.1-1.6), principally because they were more likely to lack negative expectations about the effects of childbearing on their lives (odds ratio: 2.2; 95% CI = 1.2-4.0). Although no more likely to perceive deterrents to contraceptive use, pregnancy-test-kit users were more apt to have had unprotected sexual intercourse in the past (RR:1.3; 95% CI:1.1-1.5) and to plan to do so in the future (RR:1.7; 95% CI:1.1-3.3). Group differences in the desire to remain nonpregnant accounted for differences in contraceptive behavior and plans. CONCLUSION: Home pregnancy test taking should be regarded as a red flag by those who care for adolescents; although they are as capable of using contraceptives as their peers, test takers are less apt to do so because they expect less negative consequences from childbearing and, for this reason, may benefit more from discussing childbearing expectations than contraceptive options.

Adolescent↗
PubMedDate not supplied

Are there unmet family planning needs in Europe?

CONTEXT: The measurement of unmet need for family planning--the discrepancy between individuals' sexual and contraceptive behavior and their stated fertility preferences--has generally focused on developing countries. There has so far been little effort to measure how low unmet family planning needs can go in more developed countries, where contraceptive practice is supposedly (nearly) perfect. METHODS: Data were taken from Fertility and Family Surveys (FFS) conducted in recent years in selected member states of the United Nations Economic Commission for Europe, and minimum and maximum estimates of unmet need were calculated for 10 countries with the requisite data. RESULTS: The proportion of individuals with an unmet need for family planning (i.e., who have a current unwanted pregnancy or who are fecund, are sexually active, want no more births but are not using contraceptives) is as low as 3% in two European countries and below 10% in most. However, levels of unmet need in countries with economies in transition (13% in Latvia and Lithuania and 23% in Bulgaria) surpass some of the lowest levels observed for developing countries. Considerable within-country variations are seen. For instance, unmet need is more prominent among men than among women in seven of the nine countries for which there are data. Moreover, unmet need increases with family size and with age, suggesting an unmet need for limiting rather than for spacing births. In all of the countries except Hungary, unmet need is higher among those in marital unions than among those in less formal relationships. Level of education is another important dimension of unmet need, with less-educated respondents having the highest level of unmet need in nine of the 10 countries. Multivariate analyses confirm most of these results. Moreover, there is a clear association between unmet need and abortion ratios: Where levels of unmet need are high, the number of abortions per 100 live births is also relatively high. CONCLUSIONS: Data on unmet need, supplemented with information on induced abortion and related issues, could provide countries in Europe with useful inputs for formulating and implementing responsive reproductive health policies and programs.

Contraception Behavior↗
PubMed2001

The role of changes in contraceptive use in the decline of induced abortion in Turkey.

The induced abortion rate in Turkey declined from a peak of 4.5 abortions per 100 women in 1988 to 2.4 in 1998. This study examines the extent to which the decline in abortion in Turkey can be attributed to increased use of modern contraceptives. Trends in induced abortion rates and in contraceptive use are examined among Turkish women together with fertility preferences, changes in the contraceptive behavior associated with abortion, and changes in the propensity to abort unwanted pregnancies. The analysis includes a number of simulations that examine what abortion levels might be in different contraceptive-use scenarios. Results indicate that the decline in abortion is due to a decrease in the number of abortions associated with traditional method failure. This decrease is related to three factors: a shift from traditional method use to modern method use, a decline in the traditional method failure rate, and a decline in the proportion of pregnancies resulting from traditional method failures that are aborted.

Abortion, Induced↗
PubMed1996

How effective are contraceptives? The determination and measurement of pregnancy rates.

OBJECTIVES: To provide an overview of contraceptive effectiveness and its determinants as well as reasons for the gap between the actual and expected number of unplanned pregnancies for various categories of users; to provide some guidelines for more precise, consistent terminology and measurements for use in future research; and to provide specific counseling guidelines; using combined oral contraceptives (OCs) as the example. DATA SOURCES: Fifty-three articles on contraceptive effectiveness were reviewed, with a particular focus on pregnancy rates among OC users and the quality of use contributing to those rates. Definitions and measurement of contraceptive effectiveness, its components, and its determinants were examined and discrepancies explored. METHODS OF STUDY SELECTION: Papers discussed were selected because they had special relevance. Only a few of the papers discussed in this article were quantitative studies of contraceptive behavior and effectiveness. Others were review articles, discussions of the appropriate measurement of various components of effectiveness. Others provided conceptual frameworks for studying method effectiveness. All published studies of OC compliance were reviewed. TABULATION, INTEGRATION, AND RESULTS: Comparing the definitions and measurement of both compliance and effectiveness revealed important inconsistencies. However, some trends did emerge, and these papers did provide a framework for the following discussion. The findings were used to develop a more coherent set of definitions, measurement approaches, and counseling strategies. Characteristics of the user, the method, and the service delivery system all play a role in contraceptive effectiveness. However, it is the quality of use, ie, the user's own behavior, that is the immediate determinant of the effectiveness of any short-term contraceptive method. The mean pregnancy rate for better-than-average users is 4%; for poorer-than-average users, it is 8%. CONCLUSIONS: The range of contraceptive effectiveness rates is closely associated with user characteristics. Oral contraceptive users need to know that their own chance of becoming pregnant will vary with their fecundability, when and how frequently they have sexual intercourse, and, especially, how consistently and correctly they take their pills. The likelihood that any one user will take OCs correctly and consistently also is associated with her life-style, socioeconomic status, age, and other factors. Further research is needed to determine how forgiving OCs are of various pill-taking errors, to determine the impact of dual method use (eg, OCs and condoms), and to assess the effects of user, method, and programmatic characteristics on correct and consistent use and, in turn, on effectiveness.

Adolescent↗
PubMed1999

Psychosocial correlates of contraceptive practices during late adolescence.

This article reviews the literature on psychosocial correlates of contraceptive practices among sexually active late adolescents (primarily college undergraduates). It seeks to help identify subgroups of adolescents who either do not use or misuse contraceptive means, putting them at risk for unwanted pregnancy, AIDS, and other sexually transmitted diseases. The intent is to promote further research on those variables with the most potential for predicting contraceptive behaviors, which will assist in the development and implementation of effective prevention and intervention programs.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Patterns of contraceptive use in China.

This article uses demographic and contraceptive use data from China's 1982 census, 1982 national fertility survey, and National Family Planning Commission to examine the country's patterns of reproductive and contraceptive behavior. Although China's fertility is near replacement level, it varies considerably among the country's subregions. One-half of all 15-49-year-old married fecund women who practice contraception are using intrauterine devices (IUDs); this means that about 70 percent of the world's IUD users are in China. Although China and the United States have similar overall contraceptive use rates, pronounced differences exist regarding the types of contraceptive methods used. Among China's subregions, contraceptive use rates vary considerably. The greater the percentage of minority groups in a subregion, the lower its contraceptive prevalence rate. The lower the proportion urban in an area, the greater the use of the IUD, except in areas with large numbers of minorities. Among the subregions, associations between urban/health variables and pill/condom use rates are strongly positive, and associations between urban/health variables and IUD use rates are strongly negative.

Adolescent↗
PubMed1999

Contraceptive services for adolescents in Latin America: facts, problems and perspectives.

This review presents facts about sexual and contraceptive behavior of Latin American adolescents, analyzes barriers to contraception, and summarizes present perspectives. Between 13 and 30% of Latin American adolescent women live in union before their 20th birthday and between 46 and 63% have had sexual relations. The prevalence of contraceptive use among adolescents at risk of pregnancy remains very low. The pill is the best known contraceptive method. When sexual activity becomes a permanent practice, contraceptive use increases but remains low. Barriers to contraception can be identified as: (1) arising from adolescents themselves (moral objections, alleged medical reasons, lack of confidence in adults and in the health system, promiscuity; (2) arising from the sexual partner (partner's opposition, masculine irresponsibility); (3) arising from adults (moral objections, fear of sex education, adult control and power of decision-making); (4) arising from the health system (inappropriateness of services, regulatory barriers, gender inequality); (5) arising from health professionals (medical barriers to contraceptive use, discomfort with sexual matters); (6) arising from the educational system (educational failure, teachers' reluctance); and (7) arising from other social agents (religious opposition, media ambivalent messages, fund restraints). There have been improvements in recent years, including the achievements of groups working for and with adolescents, and the support from distinguished personalities.

Adolescent↗
PubMed2002

Spousal communication and family planning behavior in Navrongo: a longitudinal assessment.

The poor performance of most family planning programs in the 1980s, especially in sub-Saharan Africa, generated concern among researchers and led to a quest for explanations. In most countries, the alienation of men from participation in these programs was subsequently identified as one of the major causes, a finding that led researchers to redirect their attention to couples instead of individuals as the focus of such programs. Lack of spousal communication about family planning was identified as one reason for the low level of contraceptive use among women. Subsequent research has persistently demonstrated a positive relationship between spousal communication and contraceptive use. Most prior studies on this topic have been based on cross-sectional data, so that whether the identified relationships are causal remains unclear. Does communication, in fact, predict contraceptive use, or does the use of contraceptives generate communication among couples? This study addresses the question of causality by using longitudinal data from the Navrongo Health Research Centre panel survey. Results from both cross-sectional and longitudinal analysis demonstrate that spousal communication does, indeed, predict contraceptive behavior, even when other factors are controlled.

Adolescent↗
PubMed1994

A decade of change in contraceptive behaviour in Latin America: a multivariate decomposition analysis.

This study relies heavily on World Fertility Survey and Demographic and Health Surveys data to examine recent trends and determinants of contraceptive use in five Latin American countries: Colombia, Dominican Republic, Ecuador, Mexico, and Peru. These countries experienced a substantial increase in contraceptive prevalence in the inter-survey period. Within countries, however, the increase was not equally shared by all social and demographic groups. The study found that relatively disadvantaged groups experienced greater gains in contraceptive use. Despite the prevailing tendency towards convergence, wide differentials in contraceptive behavior among social sectors still persist. A decomposition analysis based on logistic regression revealed that certain shifts in the population composition--i.e., increased proportion of urban and better educated women and a growing proportion of mothers who want to discontinue child-bearing--contributed substantially to the aggregate increase in contraceptive prevalence in most countries. Structural changes, understood as changes in the relations between the explanatory variables and the likelihood of using contraception, were also found to play a significant role in contraceptive use trends, particularly in Colombia.

Birth Rate↗
PubMed1994

[Two out of three young women use the pill].

Data from the 1993 Netherlands Fertility and Family Survey are analyzed. Results show that "three out of every four women aged 18-42 years use some method of birth control. Some 10% is pregnant or wants to become pregnant, 5% is infecund and 10% does not use a method for other reasons. Compared with the previous surveys, held in 1982 and 1988, more women use the pill, whereas the popularity of the IUD has decreased.... Among women in their thirties sterilization has decreased, but that is related to the fact that women nowadays have their children at a later age....Furthermore it can be concluded that of the women who have no male partner, 50% used some reliable method of birth control (pill, IUD or condom)." (SUMMARY IN ENG)

Age Factors↗
PubMed1997

Self-esteem and the relation between risk behavior and perceptions of vulnerability to unplanned pregnancy in college women.

This article reports 2 studies testing the hypothesis that individuals with high self-esteem are more likely than those with low self-esteem to interpret information about their personal vulnerability to health risks in a self-serving manner. Study 1 used an experimental paradigm to demonstrate that self-esteem moderates the influence of review of sexual and contraceptive behavior on college women's perceptions of vulnerability to unplanned pregnancy (N = 125). Study 2 used a longitudinal design to demonstrate that self-esteem also moderates the relation between naturally occurring changes in college women's sexual behavior and changes in their risk perception (N = 273). Together, these studies provide evidence that people with high self-esteem use self-serving cognitive strategies to maintain their risk perceptions.

Adaptation, Psychological↗
PubMed1997

Contraceptive knowledge and attitudes of Austrian adolescents after mass media reports linking third-generation oral contraceptives with an increased risk of venous thromboembolism.

We performed a representative survey to determine the level of knowledge of 1,010 Austrian adolescents aged 14 to 24 years about selected facts relating to the recent massive news coverage of the increase in the risk of venous thromboembolism in users of third-generation oral contraceptives and to assess the contraceptive behavior of this population. The overall use rate of oral contraceptives and condoms had increased significantly between 1991 and 1996. Sixty-six percent of the adolescents surveyed stated not having heard or read any media reports on oral contraceptives. Only 8% of those who had knew that most reports focused on the pill as a possible cause of venous thromboembolism, whereas the majority of respondents indicated that the media conveyed doubts regarding the health safety of oral contraceptives in general. Nearly half of adolescents were unable to define what a thrombosis was. Thus, although the mass media play an important role in transmitting medical information, the dissemination of practical, accurate advice on the risks of a drug and competent patient counseling is reserved for the health care professionals.

Adolescent↗
PubMed1994

Neighborhood context and the transition to sexual activity among young black women.

Previous studies report that neighborhood characteristics influence pregnancy and childbearing risk among African-American adolescent women. These studies, however, leave unidentified the effects of many neighborhood properties on the proximate determinants of nonmarital fertility. In this study I examine the effects of neighborhood characteristics on the risk of nonmarital first intercourse and on contraceptive use among black female adolescents. The results suggest that neighborhood socioeconomic status, female employment and marital dissolution rates, and peers' departure from mainstream lifecourse trajectories influence young black women's sexual and contraceptive behavior. The effects of female employment and socioeconomic status are greater for teens in urban neighborhoods than for teens living elsewhere.

Adolescent↗