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A contraceptive study of rural Bangladeshi women indicated that the previous death of children, number of living children, desire for additional children and son preference were important determinants of contraceptive continuation. The importance of these factors varies to some extent with use of different contraceptive methods.
A study of a random sample of 3,564 oral contraceptive acceptors in the Singapore national program clinics with a maximum of 60 months of experience produced findings as follows: The typical pill acceptor was aged 26.9 years with 2.5 children, married for 4.2 years, had at least primary education, was not working, and started on the pill 2.3 months after her last pregnancy. Thirty-three percent of the oral contraceptive acceptors were still continuing with the pill by the cutoff date for the study, 30 June 1972, and the median period of pill use among those still using was 33.6 cycles. The median number of cycles of pill use among discontinued users was only 5.2. The main reasons for discontinuation were side effects of the pill and planned pregnancy. For the discontinued users, 43 percent had used alternative methods of protection, mainly condoms. Cumulative continuation rates per thousand women were 792 after the first cycle, 680 after the third, and 475, 346, 247, and 225 after cycles 12, 24, 48, and 59, respectively.
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The continuation contraceptive practise of 3,293 I.U.D., 1985 pill and 749 depo-provera acceptors was analysed by a survey of family planning records. The proportions of grand multiporae were 40.3%, 24.2% and 40.4% in the three groups. Pap smears were taken in from 12 to 38.5% of acceptors and the proportions of pathological smears varied from 8.9 to 13.3%. The percentages of acceptors who attended only once more were 11% (I.U.D.), 18.1% (pill) and 25.1% (d-p.), Pregnancy rates were for the I.U.D., 1.7 per Hundred Woman Years, for the 2.1 per H.W.Y. and for d-p, 0.4, per H.W.Y. Temporary interruptions of the contraceptive methods were common with the pill and d-p. In the long run the I.U.D. is superior to the other temporary methods of contraceptives. Continuation rates with the I.U.D. were 89.9% after one year and 70.9% after five years (similar rates for the pill were 55% and 16.5% and for d-p 50.5% and 10.3%). The importance of a proper pelvic examination and the need to have all methods available for any individual receiving contraceptives are emphasized in the discussion. Tubal ligations should always be considered as an alternative to the temporary methods of contraceptives in ground multiporae and others at special risk from further pregnancies.
Programs and contraceptive use continuation rates were obtained for a rural Georgia family planning clinic. Program continuation is a measurement of maintenance of clinic attendance, while use continuation is related to actual use of effective contraceptives regardless of clinic activity status. Program continuation rates ranged from 0.77 at 12 months to 0.48 at 36 months. Contraceptive use continuation rates were 0.78 at 12 months and 0.58 at 36 months. Women who moved or were otherwise lost to follow-up formed the largest category of discontinuation. The highest rate of discontinuation from clinic attendance occurred after the first visit with secondary peaks around the time of scheduled annual checkups. Women who were younger and had fewer living children had a greater likelihood of discontinuing clinic attendance and contraceptive use. The reasons for and timing of discontinuation from clinic attendance suggest that clinic personnel should place special emphasis on the first visits, arrange referral for women who might have plans to leave the service area before the scheduled return visit, send reminders before first revisits, and follow up patients soon after missed visits. Priority might be assigned to the younger women of low parity who have been shown to be at higher risk of discontinuation. Other factors which might influence continuation include method of contraception, marital status, and race. Program continuation can be determined by analysis of clinic records alone while contraceptive use continuation often requires follow-up of patients. Although the two continuation rates were not equivalent, program and use continuation were roughly parallel through much of the study period. This suggests that a simple review of records in the clinic or on computer tape, when available, to determine program continuation may give an estimate of actual contraceptive use in the population.
Contraceptive continuation rates-the rates at which people continue to use a particular contraceptive method-can be a great help in determining whether a family planning program is effective or whether new contraceptive methods should be introduced. Until now, very little systematic work has been done to study contraceptive continuation rates in Latin America. The present article reports the results of one of the few existing studies on this subject, which examined the IUD experiences of women admitted to a large family planning clinic in Guatemala City. The study showed that these experiences compared favorably with the IUD experience of groups previously studied in Costa Rica, Taiwan, and the United States.
A study was undertaken at the main PROFAMILIA clinic in Bogota, Colombia to compare the effectiveness of nurses and physicians in the delivery of family planning services. Contraceptive method continuation was the major outcome variable in this analysis. Clients were randomly assigned to physicians or nurses on their first visit and for the duration of care. On all revisits, data were collected pertaining to method prescribed, side effects, pregnancy, and method changes. There was a field survey at eight months to locate clinic drop-outs and determine their contraceptive use status. There were no significant differences in method continuation between clients who received services from physicians and those who received services from nurses. At nine months, the overall continuation of the first method prescribed was 79.1 per cent in the physicians' group and 75.8 per cent in the nurses' group (t = 1.057, p greater than .20). When controlling for first method used, the IUD users in the physicians' group had a continuation rate of 86.1 per cent and in the nurses' group 84.0 per cent (t = 0.556, p greater than .50). Of the pill users who received services from physicians, 78.1 per cent were continuing at nine months and 74.3 per cent of the pill clients in the nurses' group were continuing at nine months (t = 0.573, p greater than .50). There were no differences in pregnancy rates, side effects rates, and method change rates between the two groups. It may be concluded that these nurses were as effective as physicians in the delivery of family planning services.
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The renal function of a total of 137 women without renal diseases taking contraceptive steroids continuously but for different periods of time (up to a maximum of 8 years) was investigated by isotope nephrography. Checking is done by using the semiquantitative evaluation prameters according to Zum Winkel. The results show that the application of hormonal contraceptives does not induce significant changes of renal function in the isotope nephrogram.
This paper examines oral contraceptive continuation rates and reported side effects in a large scale clinical research project conducted in Sri Lanka. The project evaluated standard- and low-dose pills used with and without vitamin supplements. Differences in continuation rates and perception of side effects are used to illustrate the impact that family planning field-workers can have on women's use of oral contraceptives.
This study investigates sustained use of contraceptives among women in East Java, Indonesia. Interest is focused on the effect of whether the client's choice of contraceptive method was granted or denied, and the interaction between whether choice was granted or denied and husband-wife concurrence concerning method choice. Data were collected twice in a panel survey. The first round was conducted in family planning clinics among women initiating contraceptive use; the second was a follow-up household survey carried out 12 months later. Whether the user was granted her choice of method was found to be a very important determinant of sustained use of contraceptives. The interaction between whether choice was granted and whether there was husband-wife concurrence on method choice was also important. The highest rate of discontinuation occurred when method choice was denied in the presence of husband-wife agreement on method choice, and the lowest rate occurred when method choice was granted in the presence of such concurrence. The results imply that contraceptive continuation can be enhanced either when family planning workers pay more attention to the stated desires of their clients, or when policy is instituted allowing clients to use their method of choice.
A study in Bangladesh showed that couples who lost a child often stopped practising contraception in order to have another child. Logistic regression analysis revealed that contraceptive continuation was related to maternal age, parity, husband's education and the sex of the last child.
This article describes the first use of ultrasound in locating in vivo NORPLANT subdermal contraceptive implants. Providing low dose, continuous contraception for women. the NORPLANT system utilizes Silastic tubing filled with levonorgestrel. The progestin-filled tubing is not radiopaque. Anticipating the large scale use of NORPLANT subdermal implants, the potential, but rare problem of difficult localization of an implant is recognized. The feasibility of using ultrasound for the painless and safe localization of NORPLANT rods and capsules is demonstrated.
Historically, various interpretations of the menstrual process have been reflected in a wide, and usually negative, range of social attitudes toward menstruation. Recent clinical experience with continuation of the modern hormonal and mechanical methods of contraception that induce changes in the normal menstrual pattern suggests the need to understand current variations in attitudes and practices related to menstruation. This paper briefly outlines historical Western, Orthodox Jewish and Muslim, and contemporary US women's attitudes toward menstruation and begins to explore their relationship to contraceptive continuation.
There is no one best method of contraception for postpregnant teenagers. Most emphasis, however, needs to be on preventing unwanted teenage pregnancies. Contraceptive history must be considered in prescribing. Effective and continuing contraceptive use is enhanced by careful counseling and follow-up and sensitivity to the special needs of teenage users of contraceptives for support, reinstruction, reassurance, guarantee of privacy, and comfort in the clinical setting. Use of oral contraceptives or IUDs should be encouraged since their use-effectiveness in teenagers is so much greater than other methods. But even more important is acceptability to the teenager as this provides the greatest assurance that the method will be used effectively.
A pilot study of a health services program for never-pregnant high-school students, which stresses development of incentives for personal involvement in their own health care, reports a low incidence of unintended pregnancy among girls who requested contraceptives. The social and emotional characteristics of those who continued contraceptive use are compared with the small group who had uninteneded pregnancies.
Contraceptive prevalence rates and estimates of continuation rates are derived from unique longitudinal data on post-partum behaviour collected in the Cebu region of the Philippines. Continuation rates vary by base-line and time-varying socioeconomic characteristics for certain contraceptive methods and for using no contraception. Calendar rhythm users have a much lower relative continuation rate than has been found in cross-sectional samples. For women who use a contraceptive method, breast-feeding does not appear to influence contraceptive continuation, but for those who use no methods, breast-feeding appears to substitute for other forms of contraception. Profiles by socioeconomic characteristics of those who continue to use each type of contraceptive method and who use no method could be used to direct family planning programmes towards population sub-groups. The results suggest that for women wishing to postpone a pregnancy, a family planning programme aimed at the young and less educated could effectively increase contraceptive use and continuation.