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Contraceptive use, pregnancy and fertility patterns among single American women in their 20s.

Eighty-two percent of never-married American women aged 20-29 have had sexual intercourse; black women are somewhat more likely than white women to have had intercourse. In all, 53 percent of never-married women in this age-group had intercourse at least once in the four weeks preceding the 1983 National Survey of Unmarried Women. Black women are more likely than white women to have done so (62 percent compared with 51 percent). Nearly all of the women who ever had intercourse have used a contraceptive method at some time; 78 percent practiced contraception at the time of their most recent intercourse. A high proportion did not start using birth control until some time after first intercourse, however: On average, the delay between first coitus and first contraceptive use was eight months, and one-fifth of the respondents said that they began using a method only after their first pregnancy. Most of the women who did use a method at the time of first intercourse relied on the condom or withdrawal; in contrast, about two-thirds of white women and three-quarters of black women now rely on the pill, IUD or sterilization. Eighty-six percent of the women who had intercourse in the four weeks before the interview were current users--88 percent of the white women and 77 percent of the black women. Catholic women are no less likely than others to have ever had intercourse, to be currently sexually active or to be using contraceptives. However, Catholic women who receive communion at least once a week are less likely to be sexually active and substantially less likely to use medical contraceptive methods. Women who consider themselves very religious are less likely to be sexually active, but the sexually active among them are about as likely as others to use contraceptives. Better-educated women are much more likely than less-educated women to practice contraception, and women who work outside of the home are more likely than those who do not to use contraceptives. Thirty-three percent of unmarried 20-29-year-olds have had at least one pregnancy (about 40 percent of those who have ever had intercourse). Thirty-two percent of sexually active white women have been pregnant, compared with 70 percent of comparable black women. Furthermore, whereas 14 percent of white 20-29-year-olds have had an out-of-wedlock birth, 62 percent of black women have done so.(ABSTRACT TRUNCATED AT 400 WORDS)

Abortion, Induced↗

Assessing changes in vaginal bleeding patterns in contracepting women.

In clinical trials comparing alternative contraceptive methods, women often discontinue for disturbances in menstrual bleeding patterns. Vaginal bleeding diaries have been used to monitor these patterns, and this paper suggests two new methods of analysis of these data. One analysis measures trends over time in the occurrence of specific patterns and, a second analysis, the relation between a woman's current experience and the probability of continuing method use. Contrasts between these approaches and the reference period method of analysis are made. A randomised clinical trial of the relative efficacy of 100 and 150 mg doses of depot-medroxyprogesterone acetate (DMPA) is used for illustration.

Amenorrhea↗

Acceptability of Norplant implants for fertility regulation in Singapore.

The continuation rate at the end of this five-year clinical study was 60% with no accidental pregnancy occurring throughout the five years. The post-removal conception rate in women desiring pregnancy was 92% at the end of two years. The majority of acceptors described the overall experience with the implants as favourable. In fact, 75% of the women planning to use contraception after removal of the implants were going to use implants again.

Adult↗

The relationship of tubal infertility to barrier method and oral contraceptive use.

We studied past contraceptive use in 283 nulliparous infertile women who had a diagnosis of tubal adhesions or occlusion and in 3833 women admitted for delivery at seven collaborating hospitals from 1981 to 1983. The relative risk of tubal infertility associated with barrier contraceptive use or oral contraceptive use was calculated using multivariate logistic regression to control for confounding by region, age, religion, education, smoking, number of sexual partners, time since menarche, and use of other contraceptive methods. Women who had ever used barrier methods of contraception were at a significantly decreased risk of tubal infertility (relative risk = 0.6; 95% confidence limits, 0.5 and 0.8). When type of barrier method used for the longest time was evaluated, those who used the diaphragm or condoms plus spermicides were at lower risk than those who used condoms or spermicides alone. Overall, past use of oral contraceptives neither increased nor decreased a woman's risk of tubal infertility, but there was evidence that the association between oral contraceptives and tubal infertility may vary by the amount of estrogen and type of progestogen in the oral contraceptive used. We conclude that contraceptive users who use barrier methods that combine both a mechanical and chemical barrier, such as diaphragms, cervical caps, and condoms plus spermicides, have the clearest protection against tubal damage.

Adult↗

Evaluation of the effects of a female condom on the female lower genital tract.

The purposes of this study were to determine if use of the female condom (Reality) was traumatic to the vaginal mucosa and/or vulvar skin and to determine its effect on resident vaginal bacterial flora. Thirty subjects were randomly assigned to utilize the female condom or diaphragm during the study period. Initially and during 3 follow-up visits, each subject underwent colposcopic examination of the vagina, cervix, and vulva with photographic record, and qualitative fungal, aerobic and anaerobic cultures of the vagina. The two groups were compared with respect to the frequency of abnormal physical findings determined by both macroscopic and colposcopic examination. Visits were compared within each contraceptive group with respect to changes in resident vaginal flora. There was no evidence of significant trauma associated with the use of either contraceptive device during the study period. The resident vaginal flora did not significantly change during the three follow-up visits in patients using the female condom. In diaphragm users, lactobacilli were less frequently isolated at the third (14/15 vs 6/15, P = 0.008) and fourth (14/15 vs 7/15, P = 0.039) follow-up visits when compared to the initial visit. In addition, aerobic gram-negative rods were more frequently isolated during the fourth visit (1/15 vs 9/15, P = 0.021) when compared to the first visit. We conclude that neither the female condom (Reality) nor the diaphragm is associated with trauma to the lower genital tract. Subjects using the diaphragm undergo a significant change in vaginal bacterial flora, becoming more likely to be colonized with coliform microorganisms and less likely to maintain lactobacilli colonization.

Adult↗

[Sociologic problems of contraception in the opinion of women from urban and rural areas].

The paper, having a diagnostic character, discusses the problems of birth control, family planning and contraception methods. The methods of the investigation were a questionnaire, interview and analysis of documentation. The investigation was carried out in two areas: urban--Katowice and rural--Istebna. The investigation was carried out among a group of 100 women between 20 and 55 years of age. All the women questioned have been married for 1-30 years. Most of them have two children--30%. Most women from both the urban and rural areas use natural methods of contraception, in. the town--Billings method and in the country--conjugal diary. Thermal method is less popular as it is time-consuming. The main reasons for choosing a natural method of contraception control are moral, religious and biological aspects, which give the women a psychic comfort and a strong feeling of attachment to the husband. Women from the urban area say that they started to use contraceptive methods after getting married whereas women from the rural area--after giving birth to a child. Contraceptive devices are used by about 30% of women. The most popular are: among women from the town--coitus interruptus, artificial abortion and less popular contraceptive devices such as oral contraceptives, intrauterine devices and chemical substances. Among women from the rural area the most common is coitus interruptus and then 2-1 cases of each of the remaining methods. Women applying contraceptive devices are aware of their harmful effects, their unreliability, immorality and violating nature. Women in the country face a lot of difficulties in buying contraceptive devices and they also (22%) use artificial abortion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Attitudes and knowledge regarding contraception and prepregnancy counselling in insulin dependent diabetes.

AIMS: To assess knowledge and attitudes of women with insulin dependent diabetes to contraception, prepregnancy planning, and genetic risk. METHOD: Women with insulin dependent diabetes, aged 18 to 40, were identified from a population-based register of insulin users in North Canterbury. Participating subjects underwent a structured face to face interview, assessing current contraceptive practices and their knowledge and attitudes to the areas outlined above. RESULTS: One hundred and twenty four women, representing 86% of eligible women, agreed to participate. Eighty five subjects were using some form of contraception. The most popular choices were the combined oral contraceptive pill (35%), the progesterone only pill (12%), condoms (24%), vasectomy (12%) and tubal ligation (12%). All subjects recognised the importance of good blood glucose control during pregnancy. Thirty nine percent of subjects using contraception avoided the combined oral contraceptive pill because of concerns about metabolic and vascular side effects. Only 52% of subjects knew the correct figure for genetic risk of passing insulin dependent diabetes on to an offspring. CONCLUSIONS: Patient education regarding the need for prepregnancy planning in women with insulin dependent diabetes appeared adequate and the percentage of subjects using contraception was higher than that described in overseas diabetic populations. Over a third of subjects were however concerned about the risks of contraceptive options in insulin dependent diabetes, particularly with regard to the use of the combined oral contraceptive pill. This finding suggests that discussion about the advantages and disadvantages of contraceptive choices should be an integral part of patient education for women with insulin dependent diabetes mellitus of child-bearing age. Knowledge about genetic risk was inadequate in half the subjects interviewed, and this area of patient education could also be improved.

Adolescent↗

Contraception with subdermal levonorgestrel implants as an alternative to surgical contraception at Ilorin, Nigeria.

Acceptability and social characteristics of a cohort of Norplant, IUD, pill and depo-med-roxyprogesterone acetate (DMPA) acceptors who were seen at the University of Ilorin Family Planning Clinic over a 10-week period of the pre-introductory clinical trial of Norplant, are compared. Findings indicate that Norplant and DMPA are adopted as an alternative to sterilization by women advanced in reproductive age and of high parity. The pill and IUD are adopted mainly as birth-spacing methods. Women's education, but not previous use of a contraceptive method, influenced the adoption of Norplant. The continuation rate at 12 months, a measure of acceptability, was highest, 93.7 per 100 women, for Norplant and 77.9, 46.7 and 27.7 per 100 women for the IUD, DMPA and the pill, respectively. The need to address the high family size norms in the African subregion is discussed.

Adolescent↗

Use of hormonal contraceptives in an institutional setting: reasons for use, consent and safety in women with psychiatric and intellectual disabilities.

AIM: To describe the use of hormonal contraceptives in institutionalised women with psychiatric and/or intellectual disabilities. METHODS: Women who had been disability or mental health service inpatients for six months or more and were prescribed hormonal contraceptives were included. Data were collected from their clinical files and from structured interviews of the women and of their primary care givers. RESULTS: Forty two women were prescribed contraceptives, of whom 23 were intellectually disabled and 28 had mental illnesses. Most women had no children; four had had one child and two, two children. Thirteen were not sexually active. Depot medroxyprogesterone acetate (Depo Provera) was prescribed for 69%, combined oral contraceptive agents for 14% and progestin-only oral contraceptives for 17%. Contraceptives were initially prescribed by hospital staff for all but 1 woman, and were administered without consent for over half the group, including 11 women for whom this administration was not legally authorized. Less than half the group had blood pressure measured within the previous 12 months and only a third had a cervical smear within the previous 3 years. Of the women who were sexually active, less than half knew how to protect themselves from sexually transmitted diseases and less than 10% regularly used condoms. CONCLUSIONS: Improvements in reproductive health care for these women are needed, in particular attention to education and client participation in decisions about contraceptive treatment. It is suggested that gynaecological and family planning services be provided separately from psychiatric services.

Adult↗

HIV prevention: the need for methods women can use.

Efforts to prevent heterosexual transmission of HIV (human immunodeficiency virus) infection have thus far focused on modifying sexual behaviors and the use of condoms. While the experience of family planners, particularly in those countries most threatened by heterosexual HIV transmission, has shown that the most effective measures of pregnancy prevention have relied on women, little attention has been given to barriers to HIV transmission that depend on the woman and are under her control. Tactics which interrupt transmission of the virus should be considered in their own right and separated from those that interrupt pregnancy, for insurance, the diaphragm. Greater emphasis is urged for research on preventive methods women could use, including the possibility of a topical virucide that might block transmission through the vaginal route.

Adult↗

The fertility of women after cervical laser surgery.

OBJECTIVE: To retrospectively survey our population of women who had undergone cervical laser surgery to determine if it adversely affected their ability to conceive or to carry a pregnancy to term. METHODS: Women who had undergone laser surgery during the period 1979-1989 were contacted and surveyed regarding each of their pregnancies. Information obtained included their age at the time of each pregnancy, pregnancy outcome, how long they were trying to conceive, and their use of contraception. The post-laser experience of the study group was matched individually for age and parity with a control population taken from the pre-laser interval of the same patients. RESULTS: We contacted 1069 women; 512 responded to the survey and 433 were matched with controls. The mean study interval was 3.8 years. The study group had significantly more total pregnancies (277 versus 177 for controls, P < .001), total births (163 versus 112 for controls, P < .002), full-term pregnancies (145 versus 100 for controls, P < .005), and terminations of pregnancy (75 versus 28 for controls, P < .001). There was no significant difference in the number of spontaneous abortions (31 for the study group and 33 for controls), premature deliveries (18 for the study group and 12 for controls) or ectopic pregnancies (eight for the study group and four for controls). There was no difference in the pregnancy rate (compared with controls) between laser vaporizations and excisions. CONCLUSION: Cervical laser surgery does not appear to impair a woman's ability to conceive or carry a pregnancy to term. There is no difference in the effect on fertility between laser vaporization and laser excisional cone biopsies.

Adult↗

First family planning visits by young women.

Data from the 1982 National Survey of Family Growth indicate that among sexually active women aged 15-24, friends and parents are the main sources of referral for first family planning visits. Friends are the leading referral source for women who attend clinics, and parents are the leading referral source for those who go to private doctors. Despite the importance of confidentiality to many teenagers, women who make their first family planning visit before the age of 17 are more likely to be referred by their parents than are those whose first visit occurs when they are 17 or older. Race, age at first visit and income influence women's choice of a provider (clinic or private doctor). Black women, low-income women and younger women are considerably more likely than their counterparts to use a clinic at first family planning visit. At their first visit, sixty-seven percent of women receive birth control counseling, and only 50 percent begin using a contraceptive method. Among clinic users, white women are more likely than black women to begin a birth control method (50 percent vs. 40 percent). Women whose first visit takes place before their first conception (including those who have never been pregnant) are much more likely than women whose first visit occurs after their first pregnancy ends to begin a method. Women who make their first visit during their first pregnancy are more likely than those who are not pregnant to receive a pregnancy test or counseling on matters other than birth control.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Reproductive health in young women with cystic fibrosis: knowledge, behavior and attitudes.

PURPOSE: The improved life-expectancy in cystic fibrosis (CF) results in the fact that the majority of affected young women now survive to face the same reproductive health decisions as other women, in addition to those that specifically relate to CF. The aim of this study was to assess the reproductive health knowledge of women with CF, to investigate the range of their reproductive health problems, and to review their reproductive health attitudes and behaviors. METHODS: Women aged 18 years and over attending CF services in the state of Victoria, Australia were invited to complete a reproductive health questionnaire. Comparison subjects (n = 76) were enrolled from 2 primary care practices. RESULTS: Fifty-five women participated (89%), with a median age of 22 years (range 18-50). There was no significant difference in marital status between the two groups and a similar proportion were sexually active, yet women with CF were less likely to use contraception. A majority of women with CF believed that fertility was reduced, and there was poor knowledge of the potentially deleterious effect of pregnancy. A relatively high proportion were planning to become pregnant in the near future. Twenty-two percent had tried to conceive, with a success rate of 67%. CONCLUSIONS: Women with CF are currently lacking important information about reproductive health that potentially has a major impact on their health and their lives.

Adolescent↗

Post-partum events and fertility control in Kinshasa, Zaïre.

Contraceptive prevalence surveys from sub-Saharan Africa typically show low rates of method use. The current study of one zone in Kinshasa, Zaïre, provides a more detailed view of fertility control in an urban population by examining the relative duration of breast-feeding, amenorrhoea and sexual abstinence during the post-partum period. While motivations to prevent pregnancy remain high until the youngest child is over 24 months, the average duration of abstinence is only 4 months. This paper describes the methods women use to avoid pregnancy and the changes over the post-partum period.

Adolescent↗

What family planning methods women use and why they change them.

Each woman in a sample of 800 women from a nonprofit, private family planning clinic reported using at least one contraceptive method at some time in her life. Over the 15-year period that the sample represented, women made from 1 to 26 family planning visits. The women reported using as many as eight different methods and making up to 11 changes in method. The reasons for changing methods were, for the most part, logically related to the method, at least as far as common user complaints and side effects were concerned, but they also reflected misperceptions regarding relative risk of methods and a low tolerance for a method's disadvantages. A lack of congruence between choice and use was revealed, as women returned for care and reported that they had not used the contraceptive method they had chosen at the last family planning visit or had changed methods one or more times since that visit.

Adolescent↗

Commentary: methods women can use that may prevent sexually transmitted disease, including HIV.

Although sexually transmitted diseases, including human immunodeficiency virus (HIV), are a major concern for women, few prevention messages are targeted specifically to women. Those that are generally stress abstaining, altering the number or selection of partners, and urging partners to use condoms. But these behaviors may be unrealistic for many women, particularly women who are at highest risk for sexually transmitted diseases, because they require significant changes in life-style or depend on male-controlled condom use. Recommendation of contraceptives for prevention of sexually transmitted diseases depends largely on how well specific methods perform under controlled conditions, either in the laboratory or in clinical trials. Observational studies, which better reflect day-to-day use, indicate that condoms, barriers, and spermicides, used properly and consistently, can provide substantial protection against various sexually transmitted diseases. Condoms can similarly help protect against HIV, but studies of barriers and spermicides are scant and currently inconclusive. Finally, those methods that are controlled by women are consistently more effective in preventing sexually transmitted diseases. Thus, although condoms used well are still the best choice, the imperative for female-controlled methods indicates that diaphragms and spermicides should receive greater emphasis in prevention messages.

Condoms↗

Determinants of contraceptive switching behavior in rural Sri Lanka.

This study examines the influence of a selected set of determinants of contraceptive method switching in rural Sri Lanka. Of interest is the question of how change in contraceptive practice at the individual level can account for patterns observed at the aggregate level. Based on calendar data on contraceptive use over a 3-year period, collected for more than 3,000 married women in a 1986 survey, the multivariate analysis shows that women who attain all or a significant proportion of their desired fertility tend to switch to more effective methods. Women who experience method failure tend to switch methods, usually to a type that is more effective. The woman's background determinants of age and education have small but significant effects on method switching, whereas the effect of household economic well-being is not significant. There is strong indication that rural couples are practicing contraception in a nonrandom fashion, switching methods in accordance with changes in their fertility motivations and contraceptive experience.

Choice Behavior↗

Estrogens and postoperative thrombosis evaluated by the radioactive iodine method.

Women who were to be operated upon for prolapse of the uterus were treated preoperatively with estrogens for atrophic vaginal mucosa and examined postoperatively by the 125I-fibrinogen uptake test and phlebography. Among 11 women who received 50 micrograms of ethinyl estradiol daily for three weeks, fibrin deposits were found in six. Of eight women receiving 200 micrograms daily for 12 days, such deposits developed in four. Corresponding figures for the control group were 18 of 157, p < 0.001. Estrogens, therefore, should not be given preoperatively, and those patients treated with preparations containing estrogens should have such therapy discontinued preoperatively.

Estradiol↗