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

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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

Provision of no-cost, long-acting contraception and teenage pregnancy.

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Secura, Gina M; Madden, Tessa; McNicholas, Colleen; Mullersman, Jennifer; Buckel, Christina M; Zhao, Qiuhong; Peipert, Jeffrey F

2014-10-02

The rate of teenage pregnancy in the United States is higher than in other developed nations. Teenage births result in substantial costs, including public assistance, health care costs, and income losses due to lower educational attainment and reduced earning potential. The Contraceptive CHOICE Project was a large prospective cohort study designed to promote the use of long-acting, reversible contraceptive (LARC) methods to reduce unintended pregnancy in the St. Louis region. Participants were educated about reversible contraception, with an emphasis on the benefits of LARC methods, were provided with their choice of reversible contraception at no cost, and were followed for 2 to 3 years. We analyzed pregnancy, birth, and induced-abortion rates among teenage girls and women 15 to 19 years of age in this cohort and compared them with those observed nationally among U.S. teens in the same age group. Of the 1404 teenage girls and women enrolled in CHOICE, 72% chose an intrauterine device or implant (LARC methods); the remaining 28% chose another method. During the 2008-2013 period, the mean annual rates of pregnancy, birth, and abortion among CHOICE participants were 34.0, 19.4, and 9.7 per 1000 teens, respectively. In comparison, rates of pregnancy, birth, and abortion among sexually experienced U.S. teens in 2008 were 158.5, 94.0, and 41.5 per 1000, respectively. Teenage girls and women who were provided contraception at no cost and educated about reversible contraception and the benefits of LARC methods had rates of pregnancy, birth, and abortion that were much lower than the national rates for sexually experienced teens. (Funded by the Susan Thompson Buffett Foundation and others.).

Contraceptive method and pregnancy incidence among women in HIV-1-serodiscordant partnerships.

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Ngure, Kenneth; Heffron, Renee; Mugo, Nelly R; Celum, Connie; Cohen, Craig R; Odoyo, Josephine; Rees, Helen; Kiarie, James N; Were, Edwin; Baeten, Jared M

2012-02-20

Effective contraception reduces unintended pregnancies and is a central strategy to reduce vertical HIV-1 transmission for HIV-1-infected women. Among 2269 HIV-1-seropositive and 1085-seronegative women from seven African countries who were members of HIV-1-serodiscordant heterosexual partnerships and who were participating in an HIV-1 prevention clinical trial, we assessed pregnancy incidence according to contraceptive method using multivariate Andersen-Gill analysis. Compared with women using no contraceptive method, pregnancy incidence was significantly reduced among HIV-1-seropositive and HIV-1-seronegative women using injectable contraception [adjusted hazard ratio (aHR) 0.24, P = 0.001 and aHR 0.25, P pregnancy risk only among HIV-1-seropositive women (aHR 0.51, P = 0.004) but not seronegative women (aHR 0.64, P = 0.3), and, for both seropositive and seronegative women, oral contraceptive pill users were more likely to become pregnant than injectable contraceptive users (aHR 2.22, P = 0.01 for HIV-1-seropositive women and aHR 2.65, P = 0.09 for HIV-1-seronegative women). Condoms, when reported as being used as the primary contraceptive method, marginally reduced pregnancy incidence (aHR 0.85, P = 0.1 for seropositive women and aHR 0.67, P = 0.02 for seronegative women). There were no pregnancies among women using intrauterine devices, implantable methods or who had undergone surgical sterilization, although these methods were used relatively infrequently. Family planning programs and HIV-1 prevention trials need innovative ways to motivate uptake and sustained use of longer acting, less user-dependent contraception for women who do not desire pregnancy.

Contraceptive use and risk of unintended pregnancy in California.

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Foster, Diana G; Bley, Julia; Mikanda, John; Induni, Marta; Arons, Abigail; Baumrind, Nikki; Darney, Philip D; Stewart, Felicia

2004-07-01

California is home to more than one out of eight American women of reproductive age. Because California has a large, diverse and growing population, national statistics do not necessarily describe the reproductive health of California women. This article presents risk for pregnancy and sexually transmitted infections among women in California based on the California Women's Health Survey. Over 8900 women of reproductive age who participated in this survey between 1998 and 2001 provide estimates of access to care and use of family-planning methods in the state. We find that 49% of the female population aged 18-44 in California is at risk of unintended pregnancy. Nine percent (9%) of women at risk of an unintended pregnancy are not using any method of contraception, primarily for method-related reasons, such as a concern about side effects or a dislike of available contraceptive methods. Among women at risk for unintended pregnancy, we find disparities by race/ethnicity and education in use of contraceptive methods.

Contraceptive medicalisation, fear of infertility and teenage pregnancy in Brazil.

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Gonçalves, Helen; Souza, Ana D; Tavares, Patrícia A; Cruz, Suélen H; Béhague, Dominique P

2011-02-01

In Brazil, as in many other countries, teenage pregnancy is widely recognised as a public health problem. Buttressed by a public health science of the economics of teenage pregnancy that emphasises the postponement of parenthood as key to poverty reduction, young people's lack of appreciation for medical knowledge of contraceptives is most often credited for failed attempts to reduce teenage pregnancy. Based on a longitudinal ethnographic study conducted in Pelotas, Brazil, with young people over the course of 10 years, our study found that young women who became teenage parents did not lack medical knowledge but were, rather, highly medicalised. Not only were they intensely concerned with the ill-effects of oral contraceptives on possible future fertility, they also engaged in intricate routines of contraceptive-use as a way of testing and safeguarding their fecundity. Our analysis attends to the way these practices are shaped by the problematisation of the economics of teenage pregnancy, as well as by the gendering of cultural norms relating to the transition to adulthood. We theorise the results by considering how contraceptive medicalisation enabled some women to engage with the authority of normative society, while developing a potent off-stage critique of this authority and of what they considered to be discriminatory messages imbedded in scientific discourses on teenage pregnancy.

Contraceptive Use and Pregnancy Incidence Among Women Participating in an HIV Prevention Trial.

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Akello, Carolyne A; Bunge, Katherine E; Nakabiito, Clemensia; Mirembe, Brenda G; Fowler, Mary Glenn; Mishra, Anupam; Marrazzo, Jeanne; Chirenje, Zvavahera M; Celum, Connie; Balkus, Jennifer E

2017-06-01

Recent HIV prevention trials required use of effective contraceptive methods to fulfill eligibility for enrollment. We compared pregnancy rates in a subset of participants enrolled in the Microbicide Trials Network protocol (MTN-003), a randomized trial of chemoprophylaxis to prevent HIV acquisition among women aged 18-45 years who initiated depot medroxyprogesterone acetate (DMPA) or combined oral contraceptives (COCs) at enrollment, relative to those already using DMPA or COCs. Data were analyzed from MTN-003 participants from Uganda. Before enrollment, information on contraceptive type and initiation date was obtained. Urine pregnancy tests were performed at monthly follow-up visits. Cox proportional hazards models were used to compare pregnancy incidence among new users (initiated ≤60 days before enrollment) and established users (initiated >60 days before enrollment). Of 322 women enrolled, 296 were COC or DMPA users, 82 (28%) were new users, and 214 (72%) were established users. Pregnancy incidence was higher among new contraceptive users compared to established users (20.70% vs. 10.55%; adjusted hazard ratio [HR] = 1.66; 95% confidence interval [95% CI] 0.93-2.96). Among DMPA users, pregnancy incidence was 10.20% in new users versus 3.48% in established users (HR = 2.56; 95% CI 0.86-7.65). Among new COC users, pregnancy incidence was 42.67% in new users versus 23.67% in established COC users (adjusted HR = 1.74; 95% CI 0.87-3.48). New contraceptive users, regardless of method, at the Uganda MTN-003 site had an increased pregnancy risk compared to established users, which may be due to contraceptive initiation primarily for trial eligibility. New users may benefit from intensive contraceptive counseling and additional contraceptive options, including longer acting reversible contraceptives.

Contraception and Unintended Pregnancy among Unmarried Female University Students: A Cross-sectional Study from China

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Wang, Hongjing; Long, Lu; Cai, Hui; Wu, Yue; Xu, Jing; Shu, Chang; Wang, Peng; Li, Bo; Wei, Qinyu; Shang, Xuejun; Wang, Xueyi; Zhang, Meimei; Xiong, Chengliang; Yin, Ping

2015-01-01

This study aims to understand the level of contraceptive knowledge and attitudes towards contraception, and then to explore the association between the contraceptive behavior and unintended pregnancy in unmarried female university students in China. A cross-sectional study was conducted of university students in 49 universities across 7 cities in China from September 2007 to January 2008. We distributed 74,800 questionnaires, of which 69,842 were returned. In this paper, the data from 35,383 unmarried female university students were analyzed. The prevalence of sexual intercourse in unmarried female university students was 10.2%. The prevalence of unintended pregnancy in those sexually active female university students, was 31.8%. Among students with pregnancy, 53.5% experienced two or more pregnancies. 28.3% of the students with sexual intercourse reported that they always adopted contraceptive methods, and of those 82.9% chose to use male condoms. The majority (83.9%) of students with unintended pregnancy chose to terminate the latest pregnancy by surgical abortion or medical abortion. The contraceptive knowledge level of students who experienced unintended pregnancy was lower than those who did not. In China, about one third of unmarried female students with sexual intercourse experience unintended pregnancy. A variety of contraceptive methods are adopted, but the frequency of contraceptive use is low. Most of unmarried female students who experienced unintended pregnancy would choose to terminate the pregnancy with surgical or medical abortion. University students, especially the ones who have experienced unintended pregnancy, lack contraceptive and reproductive health knowledge. PMID:26091505

Pre-exposure prophylaxis for HIV-1 prevention does not diminish the pregnancy prevention effectiveness of hormonal contraception.

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Murnane, Pamela M; Heffron, Renee; Ronald, Allan; Bukusi, Elizabeth A; Donnell, Deborah; Mugo, Nelly R; Were, Edwin; Mujugira, Andrew; Kiarie, James; Celum, Connie; Baeten, Jared M

2014-07-31

For women at risk of HIV-1, effective contraception and effective HIV-1 prevention are global priorities. In a clinical trial of pre-exposure prophylaxis (PrEP) for HIV-1 prevention in HIV-1-serodiscordant couples, we estimated the effectiveness of hormonal contraceptives (oral contraceptive pills, injectable depot medroxyprogesterone acetate, and hormonal implants) for pregnancy prevention relative to no contraception among 1785 HIV-1-uninfected women followed up to 36 months. We compared the effectiveness of each method among women assigned PrEP versus placebo. Contraception was not required for participation, but was offered on-site and was recorded monthly; incident pregnancy was determined by monthly urine testing. For women using no contraception, overall pregnancy incidence was 15.4% per year. Women reporting oral contraceptive use had comparable pregnancy incidence to women using no contraception, and this lack of contraceptive effectiveness was similar for those assigned PrEP and placebo (17.7 and 10.0% incidence per year, respectively; P-value for difference in effect by PrEP use = 0.24). Women reporting injectable contraception had reduced pregnancy incidence compared to those reporting no contraception, which did not differ by arm (PrEP 5.1%, placebo 5.3% per year; P-value for difference = 0.47). Contraceptive effectiveness was highest among women using implants (pregnancy incidence <1% per year in both arms). PrEP had no adverse impact on hormonal contraceptive effectiveness for pregnancy prevention. As seen previously in similar populations, women reporting contraceptive pill use had little protection from pregnancy, possibly due to poor adherence. Injectable or implantable hormonal contraception and PrEP provide effective prevention for pregnancy and HIV-1.

Contraceptive failure--results from a study conducted among women with accepted and unaccepted pregnancies in Denmark

DEFF Research Database (Denmark)

Rasch, Vibeke

2002-01-01

to use of condom and oral contraception than women aged 25-34 years. In addition, contraceptive failure was found to be associated with being single, a student, and having given birth twice or more previously. Regarding pregnancy acceptance, being 25-34 years of age was positively associated, whereas......Most studies focusing on contraceptive failure in relation to pregnancy have focused on contraceptive failure among women having induced abortions, thereby neglecting those women who, despite contraceptive failure, accept the pregnancy and intend to carry the fetus to term. To get a more complete...... picture of the problem of contraceptive failure, this study focuses on contraceptive failure among women with diverse pregnancy outcomes.In all, 3520 pregnant women attending Odense University Hospital were included: 373 had induced abortions, 435 had spontaneous abortions, 97 had ectopic pregnancies...

Contraceptive method and pregnancy incidence among African women in HIV-1 serodiscordant partnerships

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NGURE, Kenneth; HEFFRON, Renee; MUGO, Nelly R.; CELUM, Connie; COHEN, Craig R.; ODOYO, Josephine; REES, Helen; KIARIE, James N.; WERE, Edwin; BAETEN, Jared M.

2014-01-01

Background Effective contraception reduces unintended pregnancies and is a central strategy to reduce vertical HIV-1 transmission for HIV-1 infected women. Methods Among 2269 HIV-1 seropositive and 1085 seronegative women from 7 African countries who were members of HIV-1 serodiscordant heterosexual partnerships and who were participating in an HIV-1 prevention clinical trial, we assessed pregnancy incidence for women using various contraceptive methods using multivariate Andersen-Gill analysis. Results Compared with women using no contraceptive method, pregnancy incidence was significantly reduced among HIV-1 seropositive and seronegative women using injectable contraception (adjusted hazard ratio (aHR) 0.24, p=0.001 and aHR 0.25, ppregnancy risk only among HIV-1 seropositive women (aHR 0.51, p=0.004) but not seronegative women (aHR 0.64, p=0.3), and, for both seropositive and seronegative women, oral contraceptive pill users were more likely to become pregnant than injectable contraceptive users (aHR 2.22, p=0.01 for HIV-1 seropositive women and aHR 2.65, p=0.09 for HIV-1 seronegative women). Condoms, when reported as being used as the primary contraceptive method, marginally reduced pregnancy incidence (aHR 0.85, p=0.1 for seropositive women and aHR 0.67, p=0.02 for seronegative women). There were no pregnancies among women using intrauterine devices, implantable methods or who had undergone surgical sterilization, although these methods were used relatively infrequently. Conclusions Family planning programs and HIV-1 prevention trials need innovative ways to motivate uptake and sustained use of longer acting, less user-dependent contraception for women who do not desire pregnancy. PMID:22156966

Contraception and pregnancy then and now: examining the experiences of a cohort of mid-age Australian women.

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Read, Christine; Bateson, Deborah; Weisberg, Edith; Estoesta, Jane

2009-08-01

More than 50% of women who have an unplanned pregnancy report using a contraceptive method. Since the launch of the pill 50 years ago, a number of cross-sectional surveys have examined contraceptive use in the Australian context. There is, however, little data on contraceptive use and efficacy over a woman's reproductive years. To determine the pattern of contraceptive use of Australian women over their reproductive lifespan, with particular emphasis on the relationship between contraceptive use and pregnancy. One thousand women from the mid-age cohort of the Australian Women's Longitudinal Study were invited to participate in the Family Planning survey by completing a questionnaire about their reproductive histories. Completed questionnaires were received for 812 women. The contraceptive pill was the most commonly ever used contraceptive method at 94% and also the most commonly used method prior to all pregnancies. Contraceptive failure increased with increasing gravidity; 11.4% with the first pregnancy to 23.0% with the fourth pregnancy, while 28.8% of the respondents reported an 'accidental' pregnancy due to stopping contraception for reasons such as concern about long-term effects and media stories. While surveys indicate that 66-70% of Australian women use a contraceptive method, more than half of unplanned pregnancies apparently occur in women using contraception. The modern Australian woman, in common with her predecessors, still faces significant challenges in her fertility management. This survey provides a longitudinal perspective on contraceptive use in relation to pregnancy and highlights the issue of efficacy of contraceptives in real-life situations.

Linking Changes in Contraceptive Use to Declines in Teen Pregnancy Rates

Directory of Open Access Journals (Sweden)

Jennifer Manlove

2015-12-01

Full Text Available Using a unique microsimulation tool, Teen FamilyScape, the present study explores how changes in the mix of contraceptive methods used by teens contributed to the decline in the U.S. teen pregnancy rate between 2002 and 2010. Results indicate that changes in contraceptive use contributed to approximately half of the decline in the teen pregnancy rate during this time period (48% and that a little more than half of this “contraceptive effect” was due to an increase in teen condom use (58%. The remaining share of the contraceptive effect can be attributed to an increase in the use of more effective hormonal (pill, patch, ring and long-acting reversible contraceptive (LARC/injectable methods (Intrauterine Devices (IUD, implant and injectable. Results from an additional counterfactual analysis suggest that the contraceptive effect was driven by the fact that the percentage of teens using no birth control fell during the study time period, rather than by the fact that some teens switched from less effective methods (condoms to more effective hormonal and LARC/injectable methods. However, very high typical use failure rates for teen condom users suggest the need for a two-pronged approach for continuing reductions in teen pregnancy for sexually active teens: first, targeting the youth most at risk of not using contraception and helping them choose contraception, and second, increasing the effectiveness of method use among existing contraceptors.

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

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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.

One-year contraceptive continuation and pregnancy in adolescent girls and women initiating hormonal contraceptives.

Science.gov (United States)

Raine, Tina R; Foster-Rosales, Anne; Upadhyay, Ushma D; Boyer, Cherrie B; Brown, Beth A; Sokoloff, Abby; Harper, Cynthia C

2011-02-01

To assess contraceptive discontinuation, switching, factors associated with method discontinuation, and pregnancy among women initiating hormonal contraceptives. This was a 12-month longitudinal cohort study of adolescent girls and women (n=1,387) aged 15 to 24 years attending public family planning clinics who did not desire pregnancy for at least 1 year and selected to initiate the patch, ring, depot medroxyprogesterone acetate, or pills. Participants completed follow-up assessments at 3, 6, and 12 months after baseline. Life table analysis was used to estimate survival rates for contraceptive continuation. Cox proportional hazards models were used to estimate factors associated with method discontinuation. The continuation rate (per 100 person-years) at 12 months was low for all methods; however, it was lowest for patch and depot medroxyprogesterone acetate initiators, 10.9 and 12.1 per 100 person years, respectively (P≤.003); continuation among ring initiators was comparable to pill initiators, 29.4 and 32.7 per 100 person-years, respectively (P=.06). Discontinuation was independently associated with method initiated and younger age. The only factors associated with lower risk of discontinuation were greater intent to use the method and being in school or working. The pregnancy rate (per 100 person-years) was highest for patch and ring initiators (30.1 and 30.5) and comparable for pill and depot medroxyprogesterone acetate initiators (16.5 and 16.1; Pcontraceptive continuation, education about longer-acting methods, and developing new contraceptives that women may be more likely to continue. II.

Pregnancy and contraceptive use among women participating in the FEM-PrEP trial.

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Callahan, Rebecca; Nanda, Kavita; Kapiga, Saidi; Malahleha, Mookho; Mandala, Justin; Ogada, Teresa; Van Damme, Lut; Taylor, Douglas

2015-02-01

Pregnancy among study participants remains a challenge for trials of new HIV prevention agents despite promotion and provision of contraception. We evaluated contraceptive use, pregnancy incidence, and study drug adherence by contraceptive method among women enrolled in the FEM-PrEP trial of once-daily oral tenofovir disoproxil fumarate and emtricitabine (TDF-FTC) for HIV prevention. We required women to be using effective non-barrier contraception at enrollment. At each monthly follow-up visit, women were counseled on contraceptive use and tested for pregnancy. TDF-FTC adherence was determined by measuring plasma drug concentrations at 4-week intervals. We used Cox proportional hazards models to assess factors associated with incident pregnancy and multivariate logistic regression to examine the relationship between contraceptive method used at enrollment and TDF-FTC adherence. More than half of women were not using effective contraception before enrollment. Ninety-eight percent of these women adopted either injectable (55%) or oral (43%) contraceptives. The overall pregnancy rate was 9.6 per 100 woman-years. Among injectable users and new users of combined oral contraceptives (COCs), the rates were 1.6 and 35.1, respectively. New users of injectables had significantly greater odds of adhering to TDF-FTC than new COC users [odds ratio (95% confidence interval): 4.4 (1.7 to 11.6), P = 0.002], existing COC users [3.1 (1.3 to 7.3), P = 0.01], and existing injectable users [2.4 (1.1 to 5.6), P = 0.04]. Women using COCs during FEM-PrEP, particularly new adopters, were more likely to become pregnant and less likely to adhere to study product than injectable users. HIV prevention trials should consider requiring long-acting methods, including injectables, for study participation.

Documentation of Contraception and Pregnancy Intention In Medicaid Managed Care

Directory of Open Access Journals (Sweden)

Heike Thiel de Bocanegra

2018-01-01

Full Text Available Context: Clinical guidelines recommend the documentation of pregnancy intention and family planning needs during primary care visits. Prior to the 2014 Medicaid expansion and release of these guidelines, the documentation practices of Medicaid managed care providers are unknown. Methods: We performed a chart review of 1054 Medicaid managed care visits of women aged 13 to 49 to explore client, provider, and visit characteristics associated with documentation of immediate or future plans for having children and contraceptive method use. Five managed care plans used Current Procedural Terminology and International Classification of Diseases, Ninth Revision codes to identify providers with at least 15 women who had received family planning or well-woman care in 2013. We conducted multilevel logistic regression analyses with documentation of contraceptive method and pregnancy intention as outcome variables and clinic site as the level 2 random effect. Results: Only 12% of charts had documentation of pregnancy intention and 59% documented contraceptive use. Compared to women with a family planning visit reason, women with an annual, reproductive health, or primary care reason for their visit were significantly less likely to have contraception documented (odds ratio [OR] = 11.0; 95% confidence interval [CI] = 6.8-17.7. Age was also a significant predictor with women aged 30 to 49 (OR = 0.6; 95% CI = 0.4-0.9, and women aged 13 to 19 (OR = 0.2; 95% CI = 0.1-0.6 being less likely to have a note about pregnancy intention in their chart. Pregnancy intention was more likely to be documented in multispecialty clinics (OR = 15.5; 95% CI = 2.7-89.2. Conclusions: Interventions to improve routine medical record documentation of contraception and pregnancy intention regardless of patient age and visit characteristics are needed to facilitate the provision of family planning in managed care visits and, ultimately, achieving better maternal infant health outcomes

Managing Unplanned Pregnancies in Five Countries: Perspectives on Contraception and Abortion Decisions

Science.gov (United States)

2014-01-01

Why is induced abortion common in environments when modern contraception is readily available? This study analyzes qualitative data collected from focus group discussions and in-depth interviews with women and men from low income areas in five countries -- the U.S., Nigeria, Pakistan, Peru and Mexico -- to better understand how couples manage their pregnancy risk. Across all settings, women and men rarely weigh the advantages and disadvantages of contraception and abortion before beginning a sexual relationship or engaging in sexual intercourse. Contraception is viewed independently of abortion, and the two are linked only when the former is invoked as a preferred means to avoiding repeat abortion. Contraceptive methods are viewed as suspect because of perceived side effects, while abortion experience, often at significant personal risk, raised the specter of social stigma and motivation for better contraceptive practice. In all settings, male partners figure importantly in pregnancy decisions and management. Although there are inherent limitations from small sample sizes, the study narratives reveal psychosocial barriers to effective contraceptive use and identify nodal points in pregnancy decision-making that can inform and structure future investigation. PMID:21756080

Use of long-acting reversible contraceptives to reduce the rate of teen pregnancy.

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Rome, Ellen

2015-11-01

Long-acting reversible contraceptives (LARCs) are safe for use in adolescents and do not rely on compliance or adherence for effectiveness. Continuation rates are higher and pregnancy rates are lower for adolescent users of LARCs compared with short-acting methods such as oral contraceptives. Similarly, repeat pregnancy rates are lower when LARCs are used compared with other forms of contraception. Myths and misconceptions about LARCs and other contraceptives remain a barrier to their use. Health care providers are in a unique position to provide confidential care to adolescents, and should provide education to them about the various contraceptive options, especially LARCs. Copyright © 2015 Cleveland Clinic.

Contraceptive use and pregnancies in adolescents' romantic relationships: role of relationship activities and parental attitudes and communication.

Science.gov (United States)

Amialchuk, Aliaksandr; Gerhardinger, Laura

2015-01-01

In a unified framework, the authors estimate whether romantic relationship activities and parental attitudes predict contraception use and consistency, and whether contraception use and consistency predict pregnancy risk among male and females adolescents in the United States. Data on 3717 participants of the first 2 waves of the National Longitudinal Study of Adolescent Health (Add Health) who were sexually experienced in their recent romantic relationship were analyzed to examine how presex activities in the romantic relationship and parental attitudes and communication are associated with contraception choices and how contraception choices are associated with pregnancies. In multivariate logistic regression analysis, only some relationship activities and parental communication about contraception were significant predictors of contraception, and their influence differed by gender. Going out with the partner increased contraception consistency among males (odds ratio, 2.04). Discussing contraception with the partner before having first sex increased the odds of ever using contraception for both genders (2.61 for females and 1.59 for males) and increased the odds of consistent contraception for females (1.505). Discussing contraception with parent increased the odds of consistent contraception among females (1.383). Merely, using contraception was not a significant predictor of the risk of pregnancy, whereas using contraception consistently significantly reduced the odds of getting partner pregnant for males (0.413) and the odds of pregnancy of females (0.343). Contraception and pregnancy education programs should take into account qualities of romantic relationship and emphasize consistent use of contraception and communication about contraception between partners and with parents.

The COX-2 inhibitor meloxicam prevents pregnancy when administered as an emergency contraceptive to nonhuman primates.

Science.gov (United States)

McCann, Nicole C; Lynch, Terrie J; Kim, Soon Ok; Duffy, Diane M

2013-12-01

Cyclooxygenase-2 (COX-2) inhibitors reduce prostaglandin synthesis and disrupt essential reproductive processes. Ultrasound studies in women demonstrated that oral COX-2 inhibitors can delay or prevent follicle collapse associated with ovulation. The goal of this study was to determine if oral administration of a COX-2 inhibitor can inhibit reproductive function with sufficient efficacy to prevent pregnancy in primates. The COX-2 inhibitor meloxicam (or vehicle) was administered orally to proven fertile female cynomolgus macaques using one emergency contraceptive model and three monthly contraceptive models. In the emergency contraceptive model, females were bred with a proven fertile male once 2±1 days before ovulation, returned to the females' home cage, and then received 5 days of meloxicam treatment. In the monthly contraceptive models, females were co-caged for breeding with a proven fertile male for a total of 5 days beginning 2±1 days before ovulation. Animals received meloxicam treatment (1) cycle days 5-22, or (2) every day, or (3) each day of the 5-day breeding period. Female were then assessed for pregnancy. The pregnancy rate with meloxicam administration using the emergency contraception model was 6.5%, significantly lower than the pregnancy rate of 33.3% when vehicle without meloxicam was administered. Pregnancy rates with the three monthly contraceptive models (75%-100%) were not consistent with preventing pregnancy. Oral COX-2 inhibitor administration can prevent pregnancy after a single instance of breeding in primates. While meloxicam may be ineffective for regular contraception, pharmacological inhibition of COX-2 may be an effective method of emergency contraception for women. COX-2 inhibitors can interfere with ovulation, but the contraceptive efficacy of drugs of this class has not been directly tested. This study, conducted in nonhuman primates, is the first to suggest that a COX-2 inhibitor may be effective as an emergency contraceptive. �

Unintended pregnancy and subsequent use of modern contraceptive among slum and non-slum women in Nairobi, Kenya.

Science.gov (United States)

Fotso, Jean Christophe; Izugbara, Chimaraoke; Saliku, Teresa; Ochako, Rhoune

2014-07-10

In spite of major gains in contraceptive prevalence over the last few decades, many women in most parts of the developing world who would like to delay or avoid pregnancy do not use any method of contraception. This paper seeks to: a) examine whether experiencing an unintended pregnancy is associated with future use of contraception controlling for a number factors including poverty at the household and community levels; and b) investigate the mechanisms through which experiencing an unintended pregnancy leads to uptake of contraception. Quantitative and qualitative data from a cross-sectional research project conducted in 2009/10 in two slum settlements and two non-slum settings of Nairobi, Kenya are used. The quantitative component of the project was based on a random sample of 1,259 women aged 15-49 years. Logistic regression models were used to assess the effect of unintended pregnancy on future contraceptive use. The qualitative component of the project successfully interviewed a total of 80 women randomly selected from survey participants who had reported having at least one unintended pregnancy. Women whose last pregnancy was unintended were more likely to be using a modern method of contraception, compared to their peers whose last pregnancy was intended, especially among the wealthier group as shown in the interaction model. Among poor women, unintended pregnancy was not associated with subsequent use of contraception. The qualitative investigation with women who had an unplanned pregnancy reveals that experiencing an unintended pregnancy seems to have served as a "wake-up call", resulting in greater attention to personal risks, including increased interest in pregnancy prevention. For some women, unintended pregnancy was a consequence of strong opposition by their partners to family planning, while others reported they started using contraceptives following their unintended pregnancy, but discontinued after experiencing side effects. This study provides

Contraceptive failure

DEFF Research Database (Denmark)

Rasch, Vibeke

2002-01-01

Most studies focusing on contraceptive failure in relation to pregnancy have focused on contraceptive failure among women having induced abortions, thereby neglecting those women who, despite contraceptive failure, accept the pregnancy and intend to carry the fetus to term. To get a more complete...... picture of the problem of contraceptive failure, this study focuses on contraceptive failure among women with diverse pregnancy outcomes. In all, 3520 pregnant women attending Odense University Hospital were included: 373 had induced abortions, 435 had spontaneous abortions, 97 had ectopic pregnancies......, and 2614 received antenatal care. The variables studied comprise age, partner relationship, number of births, occupational and economical situation, and contraceptive use.Contraceptive failure, defined as contraceptive use (condom, diaphragm, IUD, oral contraception, or another modern method...

A checklist approach to caring for women seeking pregnancy testing: effects on contraceptive knowledge and use.

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Lee, Jessica; Papic, Melissa; Baldauf, Erin; Updike, Glenn; Schwarz, E Bimla

2015-02-01

To assess how a checklist reminding clinicians to deliver a bundled intervention affects contraceptive knowledge and use 3 months after women seek walk-in pregnancy testing. Pre-intervention, an inner-city family planning clinic provided unstructured care; during the intervention period, clinic staff used a checklist to ensure women received needed services. Women seeking walk-in pregnancy testing who wished to avoid pregnancy for at least 6 months were asked to complete surveys about their contraceptive knowledge and use immediately after and 3-months after visiting the study clinic. To assess the significance of changes over time, we used logistic regression models. Between January 2011 and May 2013, over 1500 women sought pregnancy testing from the study clinic; 323 completed surveys (95 pre-intervention and 228 during the intervention period). With this checklist intervention, participants were more likely to receive emergency contraception (EC) (22% vs. 5%, [aOR 4.66 (1.76-12.35)], [corrected] have an intrauterine device or implant placed at the time of their clinic visit (5% vs. 0%, p=0.02), or receive a contraceptive prescription (23% vs. 10%, pcontraception and were more likely to report at 3-month follow-up a method of contraception more effective than the method they used prior to seeking pregnancy testing from the study clinic (aOR=2.02, 95% CI=1.03-3.96). The authors would like to apologize for any inconvenience caused. [corrected]. Women seeking walk-in pregnancy testing appear more likely to receive EC and to have switched to a more effective form of birth control in the 3 months following their visit when clinic staff used a 3-item checklist and provided scripted counseling. A checklist reminding clinic staff to assess pregnancy intentions, provide scripted counseling about both emergency and highly-effective reversible contraception, and offer same-day contraceptive initiation to women seeking walk-in pregnancy testing appears to increase use of

Use of Dicloxacillin and Risk of Pregnancy among Users of Oral Contraceptives

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Pottegård, Anton; Broe, Anne; Stage, Tore B

2018-01-01

The antibiotic dicloxacillin has been shown to induce drug-metabolizing CYP enzymes to a clinically relevant extent. In the present study, we investigated whether use of dicloxacillin confers an increased risk of unwanted pregnancy among oral contraceptive users. The study population comprised...... Danish women falling pregnant (1997-2015) during oral contraceptive use, defined as having filled a prescription for an oral contraceptive within 120 days both before and after the estimated date of conception. Data were analysed using a case-cross-over approach. For each woman, we assessed the use......, yielding an odds ratio (OR) associating use of dicloxacillin to unintended pregnancy of 1.18 (95% CI 0.84-1.65). Supplementary and sensitivity analyses generally returned similar estimates, except for a slightly increased risk among users of progestogen-only oral contraceptives (OR 1.83, 95%CI 0...

Unintended pregnancy, contraceptive use, and childbearing desires among HIV-infected and HIV-uninfected women in Botswana: across-sectional study.

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Mayondi, Gloria K; Wirth, Kathleen; Morroni, Chelsea; Moyo, Sikhulile; Ajibola, Gbolahan; Diseko, Modiegi; Sakoi, Maureen; Magetse, Jane Dipuo; Moabi, Kebaiphe; Leidner, Jean; Makhema, Joseph; Kammerer, Betsy; Lockman, Shahin

2016-01-16

Little is known about the impact of knowledge of HIV serostatus on pregnancy intention and contraceptive use in high-HIV-burden southern African settings in the era of widespread antiretroviral treatment availability. We analyzed interview data collected among 473 HIV-uninfected and 468 HIV-infected pregnant and recently postpartum women at two sites in southern Botswana. Participants were interviewed about their knowledge of their HIV status prior to pregnancy, intendedness of the pregnancy, contraceptive use, and future childbearing desires. The median age of the 941 women was 27 years, median lifetime pregnancies was 2, and 416 (44%) of pregnancies were unintended. Among women reporting unintended pregnancy, 36% were not using a contraceptive method prior to conception. Among contraception users, 81% used condoms, 13% oral contraceptives and 5% an injectable contraceptive. In univariable analysis, women with unintended pregnancy had a higher number of previous pregnancies (P = HIV-infected, 48% reported knowing they were HIV-uninfected, and 22% reported not knowing their HIV status prior to conception. In multivariable analysis, women who did not know their HIV status pre-conception were more likely to report their pregnancy as unintended compared to women who knew that they were HIV-uninfected (aOR = 1.7; 95%CI: 1.2-2.5). After controlling for other factors, unintended pregnancy was not associated with knowing one's HIV positive status prior to conception (compared with knowing one's negative HIV status prior to conception). Among women with unintended pregnancy, there was no association between knowing their HIV status and contraceptive use prior to pregnancy in adjusted analyses. Sixty-one percent of women reported not wanting any more children after this pregnancy, with HIV-infected women significantly more likely to report not wanting any more children compared to HIV-uninfected women (aOR = 3.9; 95%CI: 2.6-5.8). The high rates of reported unintended

Combined hormonal contraception and risk of venous thromboembolism within the first year following pregnancy

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Petersen, Jesper Friis; Bergholt, T; Nielsen, A. K.

2014-01-01

Estimating the risk of venous thromboembolism (VTE) associated with combined hormonal contraceptives following early terminated pregnancies or birth, a Danish nationwide retrospective cohort observing a one-year follow-up was defined using three unique registries. All Danish women with confirmed...... pregnancies aged 15-49 during the period of 1995-2009 were included. The main outcomes were relative and absolute risks of first time venous thromboembolism in users as well as non-users of combined hormonal contraceptives. In 985,569 person-years, 598 venous thromboembolisms were recorded. After early...... terminated pregnancies and births, respectively, 113 and 485 events occurred in 212,552 and 773,017 person-years. After early terminated pregnancies, the crude VTE incidence ratios were similar, and the numbers needed to harm were equal between groups that did or did not use combined hormonal contraceptives...

Socioeconomic Status As a Risk Factor for Unintended Pregnancy in the Contraceptive CHOICE Project.

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Iseyemi, Abigail; Zhao, Qiuhong; McNicholas, Colleen; Peipert, Jeffrey F

2017-09-01

To evaluate the association of low socioeconomic status as an independent risk factor for unintended pregnancy. We performed a secondary analysis of data from the Contraceptive CHOICE project. Between 2007 and 2011, 9,256 participants were recruited and followed for up to 3 years. The primary outcome of interest was unintended pregnancy; the primary exposure variable was low socioeconomic status, defined as self-report of either receiving public assistance or having difficulty paying for basic necessities. Four contraceptive groups were evaluated: 1) long-acting reversible contraceptive method (hormonal or copper intrauterine device or subdermal implant); 2) depot medroxyprogesterone acetate injection; 3) oral contraceptive pills, a transdermal patch, or a vaginal ring; or 4) other or no method. Confounders were adjusted for in the multivariable Cox proportional hazard model to estimate the effect of socioeconomic status on risk of unintended pregnancy. Participants with low socioeconomic status experienced 515 unintended pregnancies during 14,001 women-years of follow-up (3.68/100 women-years; 95% CI 3.37-4.01) compared with 200 unintended pregnancies during 10,296 women-years (1.94/100 women-years; 95% CI 1.68-2.23) among participants without low socioeconomic status. Women with low socioeconomic status were more likely to have an unintended pregnancy (unadjusted hazard ratio [HR] 1.8, 95% CI 1.5-2.2). After adjusting for age, education level, insurance status, and history of unintended pregnancy, low socioeconomic status was associated with an increased risk of unintended pregnancy (adjusted HR 1.4, 95% CI 1.1-1.7). Despite the removal of cost barriers, low socioeconomic status is associated with a higher incidence of unintended pregnancy.

Reproductive counseling, contraception, and unplanned pregnancy in fertile women treated by gynecologic oncologists

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Sarah M Crafton

2017-02-01

Members of the Society of Gynecologic Oncology (SGO were surveyed electronically regarding consistency of counseling patterns of contraception and fertility concerns, most and least common contraceptive methods utilized, referral patterns, and incidence of unplanned pregnancy. Of the 1424 SGO members identified, 261 participated in the questionnaire, yielding a response rate of 18%. Eighty-two percent of respondents agreed unplanned pregnancy is a potential problem, but only 57% believed their patients understood unplanned pregnancy is possible during treatment. Half of respondents report “always” in terms of frequency that contraception is addressed among their high-risk patients. After adjustment for gender, we found that the odds of reporting providing fertility counseling were nearly three times higher among attendings as compared to fellows [AOR = 2.72; 95% CI = (1.44, 5.12, three times higher in women as compared to men [AOR = 2.80; 95% CI = (1.46, 5.38], as well as in individuals 50+ years as compared to those <40 years old [AOR = 4.91; 95% CI = (2.05, 11.74]. Ninety-six percent reported <5 unplanned pregnancies, to their knowledge, in the previous five years of clinical practice. Most providers acknowledge that unplanned pregnancy is a potential risk in fertile gynecologic oncology patients, but only half believe their patients understand an unplanned pregnancy is possible. An opportunity exists to provide more directed counseling regarding fertility during and after cancer therapy, and to educate patients and providers regarding more reliable, long acting contraceptive methods.

Is pregnancy fatalism normal? An attitudinal assessment among women trying to get pregnant and those not using contraception.

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Jones, Rachel K

2018-05-21

To assess factors associated with pregnancy fatalism among U.S. adult women. I used data from the Change and Consistency in Contraceptive Use study, which collected information from a national sample of 4634U.S. women aged 18-39 at baseline (59% response rate). I assessed pregnancy fatalism based on agreement with the statement: "It doesn't matter whether I use birth control, when it is my time to get pregnant, it will happen." I compare fatalism among all respondents to fatalism among respondents who were trying to get pregnant and those who did not want to get pregnant but were not using contraception. I used logistic regression to assess associations between nonuse of contraception and pregnancy fatalism at baseline and whether respondents were trying to get pregnant six months later. Overall, 36% of the sample expressed some degree of pregnancy fatalism, and proportions were higher for respondents trying to get pregnant (55%) and those not using contraception (57%). The association between pregnancy fatalism and trying to get pregnant was maintained after controlling for other characteristics (OR 1.4, p=.01), as was the association for nonuse of contraception (OR 2.08, p<.001). Contraceptive nonusers at baseline were more likely than users to be trying to get pregnant six months later, especially if they expressed a fatalistic outlook at baseline. Pregnancy fatalism may be a common outlook among women who are trying to get pregnant. Associations between fatalism and nonuse of contraception may be more complex than previously recognized. Gaining a better understanding of the dynamics of pregnancy planning might inform our understanding of why some women do not use contraception. Copyright © 2018. Published by Elsevier Inc.

Awareness and use of contraception by women seeking termination of pregnancy in south eastern Nigeria

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Echendu Dolly Adinma

2011-03-01

Full Text Available Objective: To determine the awareness and use of contraception by women seeking for termination of pregnancy in south eastern Nigeria. Methods: A descriptive cross-sectional questionnaire based on the study of one hundred consecutive abortion seekers attending a clinic in southeastern Nigeria was utilized. Results: Mean age of the respondents was (23.5暲 4.4 years. The majority were students (55.0% with 64.0% having secondary education and 33.0% possesing tertiary educational qualifications. Seventy five percent were nulliparous while 49% had one or more previous pregnancy termination. The majority of the respondents (73% were aware of contraceptive methods but only 10% had ever used including 6% using male condom. Only 38% of the respondents desired to use contraceptives after the termination of index pregnancy. Conclusions: It is concluded that the majority have the high level of contraceptive awareness but contraceptive usage is shockingly low. Therefore, there is a strong need to conduct further and wide spread research not only into the various factors that influence access to contraception but also factors that promote induced abortion and overall unsafe abortion morbidity and mortality as a basis towards the enrichment of discussion related to family planning and contraception, the magnitude of abortion problems, and abortion laws in Nigeria.

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

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Alexson Debbie

2011-08-01

Full Text Available Abstract 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.

Helping Clinicians Prevent Pregnancy among Sexually Active Adolescents: U.S. Medical Eligibility Criteria for Contraceptive Use and U.S. Selected Practice Recommendations for Contraceptive Use.

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Godfrey, Emily M

2015-08-01

The United States has made substantial progress in reducing teenage birth rates in recent decades, but rates remain high. Teen pregnancy can increase the risk of poor health outcomes and lead to decreased educational attainment, increased poverty, and welfare use, as well as increased cost to taxpayers. One of the most effective ways to prevent teenage pregnancy is through the use of effective birth control methods. The Centers for Disease Control (CDC) and Prevention has made the prevention of teenage pregnancy 1 of its 10 winnable battles. The CDC has released 2 evidence-based clinical guideline documents regarding contraceptive use for adolescents and adults. The first guideline, US Medical Eligibility Criteria for Contraceptive Use, 2010, helps clinicians recognize when a contraceptive method may not be safe to use for a particular adolescent but also when not to withhold a contraceptive method that is safe to use. The second document, US Selected Practice Recommendations for Contraceptive Use, 2013, provides guidance for how to use contraceptive methods safely and effectively once they are deemed safe. Health care providers are encouraged to use these documents to provide safe and effective contraceptive care to patients seeking family planning, including adolescents. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. All rights reserved.

Scaling up postabortion contraceptive service--results from a study conducted among women having unwanted pregnancies in urban and rural Tanzania

DEFF Research Database (Denmark)

Rasch, Vibeke; Yambesi, Fortunata; Kipingili, Rose

2005-01-01

Tanzania and 42% in rural Tanzania stated that their pregnancy was unwanted. Contraceptive acceptance among women with unwanted pregnancies was high; 93% in urban Tanzania and 71% in rural Tanzania left with a contraceptive method. CONCLUSION: The high proportion of women with unwanted pregnancies in urban...... and rural Tanzania underlines the need of scaling up postabortion contraceptive service....

Sexual orientation differences in teen pregnancy and hormonal contraceptive use: an examination across 2 generations.

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Charlton, Brittany M; Corliss, Heather L; Missmer, Stacey A; Rosario, Margaret; Spiegelman, Donna; Austin, S Bryn

2013-09-01

To examine whether sexual orientation is associated with disparities in teen pregnancy and hormonal contraception use among adolescent females in 2 intergenerational cohorts. Data were collected from 91,003 women in the Nurses' Health Study II (NHSII), born between 1947-1964, and 6463 of their children, born between 1982-1987, enrolled in the Growing Up Today Study (GUTS). Log-binomial models were used to estimate risk ratios for teen pregnancy and hormonal contraception use in sexual minorities compared with heterosexuals and metaanalysis techniques were used to compare the 2 cohorts. Overall, teen hormonal contraception use was lower and teen pregnancy was higher in NHSII than GUTS. In both cohorts, lesbians were less likely, whereas the other sexual minorities were more likely, to use hormonal contraception as teenagers compared with their heterosexual peers. All sexual minority groups in both cohorts, except NHSII lesbians, were at significantly increased risk for teen pregnancy, with risk ratios ranging from 1.61 (95% confidence interval, 0.40-6.55) to 5.82 (95% confidence interval, 2.89-11.73). Having an NHSII mother who was pregnant as a teen was not associated with teen pregnancy in GUTS participants. Finally, significant heterogeneity was found between the 2 cohorts. Adolescent sexual minorities have been, and continue to be, at increased risk for pregnancy. Public health and clinical efforts are needed to address teen pregnancy in this population. Copyright © 2013 Mosby, Inc. All rights reserved.

Sexual orientation differences in teen pregnancy and hormonal contraceptive use: An examination across two generations

Science.gov (United States)

Charlton, Brittany M.; Corliss, Heather L.; Missmer, Stacey A.; Rosario, Margaret; Spiegelman, Donna; Austin, S. Bryn

2013-01-01

Objectives To examine whether sexual orientation is associated with disparities in teen pregnancy and hormonal contraception use among adolescent females in two intergenerational cohorts. Study Design Data were collected from 91,003 women in the Nurses’ Health Study II (NHSII),born between 1947–1964, and 6,463 of their children, born between 1982–1987, enrolled in the Growing Up Today Study (GUTS). Log-binomial models were used to estimate risk ratios (RR) for teen pregnancy and hormonal contraception use in sexual minorities compared to heterosexuals and meta-analysis techniques were used to compare the two cohorts. Results Overall, teen hormonal contraception use was lower and teen pregnancy was higher in NHSII than GUTS. In both cohorts, lesbians were less likely, whereas the other sexual minorities were more likely, to use hormonal contraception as teenagers compared to their heterosexual peers. All sexual minority groups in both cohorts, except NHSII lesbians, were at significantly increased risk for teen pregnancy, with RRs ranging from 1.61 (95%CI 0.40, 6.55) to 5.82 (95%CI 2.89, 11.73). Having a NHSII mother who was pregnant as a teen was not associated with teen pregnancy in GUTS participants. Finally, significant heterogeneity was found between the two cohorts. Conclusions Adolescent sexual minorities have been, and continue to be, at increased risk for pregnancy. Public health and clinical efforts are needed to address teen pregnancy in this population. PMID:23796650

Venous thromboembolism during pregnancy, postpartum or during contraceptive use.

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Blanco-Molina, A; Rota, L L; Di Micco, P; Brenner, B; Trujillo-Santos, J; Ruiz-Gamietea, A; Monreal, M

2010-02-01

Venous thromboembolism (VTE) is a leading cause of maternal death during pregnancy or postpartum, and in women using hormonal contraceptives. However, important issues concerning its natural history and therapy remain unsolved, and most of the protocols for treatment of VTE in this patient population are based on data extrapolated from other populations. RIETE is an ongoing registry of consecutive patients with objectively confirmed, symptomatic, acute VTE. We examined the clinical characteristics and three-month outcome of all enrolled women with pregnancy, postpartum or using hormonal contraceptives. As of December 2008, 173 pregnant women, 135 postpartum, and 798 contraceptive users were enrolled. Of these, 438 (40%) presented with pulmonary embolism (PE) and 668 with deep-vein thrombosis (DVT). Most women with acute PE had dyspnea (72%) or chest pain (75%), but only 2.0% had hypoxaemia. During the three-month study period, five women (0.45%; 95% CI: 0.17-1.00) died (3 had fatal PE), 13 (1.18%; 95% CI: 0.66-1.95) had VTE recurrences, and seven (0.63%; 95% CI: 0.28-1.25) major bleeding. Two of the three women with fatal PE died during the first few hours after arriving at the emergency ward, with no time to start any therapy. The outcome of pregnant or postpartum women with VTE is similar to that in contraceptive users, even though the treatment is different. The non-specific nature of PE signs may have caused some delay in PE diagnosis.

Contraception and hormonal management in the perimenopause.

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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).

Contraceptive Use Effectiveness and Pregnancy Prevention Information Preferences Among Heterosexual and Sexual Minority College Women.

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Blunt-Vinti, Heather D; Thompson, Erika L; Griner, Stacey B

2018-04-14

Previous research shows that sexual minority women have higher rates of unintended pregnancy than heterosexual women, but has not considered the wide range of contraceptive method effectiveness when exploring this disparity. We examine contraceptive use effectiveness and desire for pregnancy prevention information among college women across sexual orientation identity as a risk factor for unintended pregnancy. Using the National College Health Assessment Fall-2015 dataset, restricted to women who reported engaging in vaginal sex and not wanting to be pregnant (N = 6,486), logistic regression models estimated the odds of contraceptive method effectiveness and desire for pregnancy prevention information by sexual orientation. Most women (57%) reported using a moderately effective contraceptive method (e.g., pill, patch, ring, shot) at last vaginal sex. Compared with heterosexual women, bisexual (adjusted odds ratio [aOR], 0.48; 95% confidence interval [CI], 0.37-0.62), lesbian (aOR, 0.03; 95% CI, 0.02-0.06), pansexual/queer (aOR, 0.38; 95% CI, 0.25-.56) and other (aOR, 0.50; 95% CI, 0.30-0.81) women were significantly less likely to have used a moderately effective method compared with no method. Only 9% of the sample used a highly effective method; asexual (aOR, 0.58; 95% CI, 0.37-0.92) and lesbian (aOR, 0.07; 95% CI, 0.03-0.20) women were significantly less likely than heterosexual women to have used these methods. Pansexual/queer and bisexual women were more likely than heterosexual women to desire pregnancy prevention information. Several groups of sexual minority women were less likely than heterosexual women to use highly or moderately effective contraceptive methods, putting them at increased risk for unintended pregnancy, but desired pregnancy prevention information. These findings bring attention to the importance of patient-centered sexual and reproductive care to reduce unintended pregnancy. Copyright © 2018 Jacobs Institute of Women's Health. Published

Motivational antecedents to contraceptive method change following a pregnancy scare: a couple analysis.

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Miller, W B; Pasta, D J

2001-01-01

In this study we develop and then test a couple model of contraceptive method choice decision-making following a pregnancy scare. The central constructs in our model are satisfaction with one's current method and confidence in the use of it. Downstream in the decision sequence, satisfaction and confidence predict desires and intentions to change methods. Upstream they are predicted by childbearing motivations, contraceptive attitudes, and the residual effects of the couples' previous method decisions. We collected data from 175 mostly unmarried and racially/ethnically diverse couples who were seeking pregnancy tests. We used LISREL and its latent variable capacity to estimate a structural equation model of the couple decision-making sequence leading to a change (or not) in contraceptive method. Results confirm most elements in our model and demonstrate a number of important cross-partner effects. Almost one-half of the sample had positive pregnancy tests and the base model fitted to this subsample indicates less accuracy in partner perception and greater influence of the female partner on method change decision-making. The introduction of some hypothesis-generating exogenous variables to our base couple model, together with some unexpected findings for the contraceptive attitude variables, suggest interesting questions that require further exploration.

How do levonorgestrel-only emergency contraceptive pills prevent pregnancy? Some considerations.

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Mozzanega, Bruno; Cosmi, Erich

2011-06-01

Controversial opinions exist about the possible mechanisms throughout emergency contraception prevents pregnancy. Recently, the International Federation of Gynaecology and Obstetrics and the International Consortium for Emergency Contraception released a Joint Statement declaring that 'inhibition or delay of ovulation should be their primary and possibly only mechanism of action'. They still added that 'Review of the evidence suggests that LNG-ECPs cannot prevent implantation'. Concerning levonorgestrel-only emergency contraceptive pills effects on ovulation, the Statement based on seven reference papers which considered a total of only 142 patients, divided into still different subgroups. Basing on their same references we got quite different conclusions.

Contraceptive failure after hysteroscopic sterilization: Analysis of clinical and demographic data from 103 unplanned pregnancies

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Li, Xiang; Jones, Christopher A.; Wood, Samuel H.

2015-01-01

Objective This investigation examined data on unplanned pregnancies following hysteroscopic sterilization (HS). Methods A confidential questionnaire was used to collect data from women with medically confirmed pregnancy (n=103) registered after undergoing HS. Results Mean (±SD) patient age and body mass index (BMI) were 29.5±4.6 years and 27.7±6.1 kg/m2, respectively. Peak pregnancy incidence was reported at 10 months after HS, although <3% of unplanned pregnancies occurred within the first three months following HS. Mean (±SD) interval between HS and pregnancy was 19.6±14.9 (range, 2 to 84) months. Patients age ≥30 years and BMI <25 reported conception after HS somewhat sooner than younger patients, although the differences in time to pregnancy were not significant (P=0.24 and 0.09, respectively). The recommended post-HS hysterosalpingogram (to confirm proper placement and bilateral tubal occlusion) was obtained by 66% (68/103) of respondents. Conclusion This report is the first to provide patient-derived data on contraceptive failures after HS. While adherence to backup contraception 3 months after HS can be poor, many unintended pregnancies with HS occur long after the interval when alternate contraceptive is required. Many patients who obtain HS appear to ignore the manufacturer's guidance regarding the post-procedure hysterosalpingogram to confirm proper device placement, although limited insurance coverage likely contributes to this problem. The greatest number of unplanned pregnancies occurred 10 months after HS, but some unplanned pregnancies were reported up to 7 years later. Age, BMI, or surgical history are unlikely to predict contraceptive failure with HS. Further follow-up studies are planned to capture additional data on this issue. PMID:26623413

Unplanned pregnancy-risks and use of emergency contraception: a survey of two Nigerian Universities.

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

2017-06-02

The vulnerabilities of young women of low socio-economic status and those with little or no formal education tend to dominate the discourse on unplanned pregnancy, unsafe abortion and emergency contraception (EC) in sub-Saharan Africa. This article draws on a survey conducted among female undergraduate students to shed light on sexual behaviour and the dynamics of emergency contraceptive use among this cohort. The survey involved 420 female undergraduate students drawn using a multistage sampling technique, while a self-administered questionnaire was used for data collection. Univariate and bivariate analyses were applied to examine the factors associated with the use of emergency contraception. Of the 176 female students who reported being sexually active in the year preceding the survey, only 38.6% reported the use of condom during the entire year. Of those who reported unplanned pregnancy anxiety n = 94, about 30.1% used EC, 20.4% used non-EC pills as EC, while others reported having used no EC. A few respondents (n = 3) had terminated a pregnancy under unsafe conditions. Awareness of EC (p contraceptive methods. Poor knowledge of EC methods and timing of use, as well as wrong perception about EC side effects, are barriers to the utilisation of EC for the prevention of unplanned pregnancy among the study participants.

Knowledge and attitudes of Latin American gynecologists regarding unplanned pregnancy and use of combined oral contraceptives

Directory of Open Access Journals (Sweden)

Bahamondes L

2015-05-01

Full Text Available Luis Bahamondes,1 Josefina Lira-Plasencia,2 Ricardo Martin,3 Victor Marin,4 Maria Y Makuch1 1Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP, Campinas, Brazil; 2Instituto Nacional de Perinatología, México, DF, México; 3Hospital Universitario, Fundación Santa Fe de Bogotá, Bogotá, Colombia; 4Hospital Central, Petróleos Mexicanos, México, DF, México Background: Unintended pregnancy is a public health problem and unmet medical need worldwide. It is estimated that in the year 2012, almost 213 million pregnancies occurred, and the global pregnancy rate decreased only slightly from 2008 to 2012. It was also estimated that 85 million pregnancies (40% of all pregnancies were unintended and that 38% ended in an unintended birth. Objectives: To assess knowledge and attitudes of Latin American (LA obstetricians and gynecologists (OBGYNs regarding unintended pregnancies and aspects of combined oral contraceptive (COC use. Methods: A survey was conducted during a scientific meeting about contraception in 2014, in which OBGYNs from 12 LA countries who provide attention in contraception were invited to respond to a multiple-choice questionnaire to assess their knowledge and attitudes regarding unplanned pregnancy and some aspects regarding COC use. Results: A total of 210 OBGYNs participated in the study. Their knowledge regarding COC failure was low. The participants reported they believed that their patients habitually forgot to take a pill and that their patients did not know what to do in these situations. They were aware of the benefits of COC use; however, they were less prone to prescribe COCs for the purpose of protecting against ovarian and endometrial cancer, and one-quarter of them had doubts about the association between COC use and cancer risk. Conclusion: The interviewed LA OBGYNs showed some flaws in terms of knowledge of COC failure rates and the non-contraceptive benefits and risks

Unintended pregnancy and use of emergency contraception among a large cohort of women attending for antenatal care or abortion in Scotland.

Science.gov (United States)

Lakha, Fatim; Glasier, Anna

2006-11-18

Unintended pregnancy is common. Although many unintended pregnancies end in induced abortion, up to a third of those proceeding to birth might be unplanned. Some of these pregnancies could be prevented by emergency contraception. We have sought to establish how many pregnancies ending in either childbirth or abortion are unintended, and what proportion of women use emergency contraception to try to prevent pregnancy. 2908 women who attended an Edinburgh hospital for antenatal care and 907 attending for abortion fully completed a self-administered questionnaire including a validated measure of pregnancy intention and questions about emergency contraceptive use. 814 (89.7%) of 907 pregnancies among women requesting abortion were unintended compared with only 250 (8.6%) among 2908 women who planned to continue pregnancy. However, only 1909 (65.6%) of continuing pregnancies were intended. The rest of the women were ambivalent about pregnancy intention. In women who continued with their pregnancies intendedness was related to age, with unintended pregnancy most probable in young women (pconceiving, and is thus unlikely to reduce unintended pregnancy rates. Rather, we need to find ways to improve the use of regular contraception.

Unmet Need for Family Planning, Contraceptive Failure, and Unintended Pregnancy among HIV-Infected and HIV-Uninfected Women in Zimbabwe

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McCoy, Sandra I.; Buzdugan, Raluca; Ralph, Lauren J.; Mushavi, Angela; Mahomva, Agnes; Hakobyan, Anna; Watadzaushe, Constancia; Dirawo, Jeffrey; Cowan, Frances M.; Padian, Nancy S.

2014-01-01

Background Prevention of unintended pregnancies among women living with HIV infection is a strategy recommended by the World Health Organization for prevention of mother-to-child transmission of HIV (PMTCT). We assessed pregnancy intentions and contraceptive use among HIV-positive and HIV-negative women with a recent pregnancy in Zimbabwe. Methods We analyzed baseline data from the evaluation of Zimbabwe’s Accelerated National PMTCT Program. Eligible women were randomly sampled from the catchment areas of 157 health facilities offering PMTCT services in five provinces. Eligible women were ≥16 years old and mothers of infants (alive or deceased) born 9 to 18 months prior to the interview. Participants were interviewed about their HIV status, intendedness of the birth, and contraceptive use. Results Of 8,797 women, the mean age was 26.7 years, 92.8% were married or had a regular sexual partner, and they had an average of 2.7 lifetime births. Overall, 3,090 (35.1%) reported that their births were unintended; of these women, 1,477 (47.8%) and 1,613 (52.2%) were and were not using a contraceptive method prior to learning that they were pregnant, respectively. Twelve percent of women reported that they were HIV-positive at the time of the survey; women who reported that they were HIV-infected were significantly more likely to report that their pregnancy was unintended compared to women who reported that they were HIV-uninfected (44.9% vs. 33.8%, pHIV status and lack of contraception use prior to pregnancy. Conclusions Unmet need for family planning and contraceptive failure contribute to unintended pregnancies among women in Zimbabwe. Both HIV-infected and HIV-uninfected women reported unintended pregnancies despite intending to avoid or delay pregnancy, highlighting the need for effective contraceptive methods that align with pregnancy intentions. PMID:25144229

The Contraceptive Cycle

OpenAIRE

Picavet, C.

2016-01-01

Background: There are relatively few unwanted pregnancies in the Netherlands, as evidenced by low abortion and teenage pregnancy rates. However, even in the Netherlands, one in eight pregnancies end in an induced abortion. Many unwanted pregnancies could have been prevented by better use of reliable contraceptive methods. In this thesis, contraceptive behaviour is studied with an emphasis on where the use of contraception goes wrong and the demographic profile of the women who have difficulty...

Pregnancy in HIV clinical trials in Sub Saharan Africa: failure of consent or contraception?

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Agnes Ssali

Full Text Available Higher than expected pregnancy rates have been observed in HIV related clinical trials in Sub-Saharan Africa. We designed a qualitative study to explore the factors contributing to high pregnancy rates among participants in two HIV clinical trials in Sub-Saharan Africa.Female and male participants enrolled in one of two clinical HIV trials in south-west Uganda were approached. The trials were a phase III microbicide efficacy trial among HIV negative women using vaginal gel (MDP; and a trial of primary prevention prophylaxis for invasive cryptococcal disease using fluconazole among HIV infected men and women in Uganda (CRYPTOPRO. 14 focus group discussions and 8 in-depth interviews were conducted with HIV positive and negative women and their male partners over a six month period. Areas explored were their experiences about why and when one should get pregnant, factors affecting use of contraceptives, HIV status disclosure and trial product use.All respondents acknowledged being advised of the importance of avoiding pregnancy during the trial. Factors reported to contribute to pregnancy included; trust that the investigational product (oral capsules/vaginal gel would not harm the baby, need for children, side effects that led to inconsistent contraceptive use, low acceptance of condom use among male partners. Attitudes towards getting pregnant are fluid within couples over time and the trials often last for more than a year. Researchers need to account for high pregnancy rates in their sample size calculations, and consider lesser used female initiated contraceptive options e.g. diaphragm or female condoms. In long clinical trials where there is a high fetal or maternal risk due to investigational product, researchers and ethics committees should consider a review of participants contraceptive needs/pregnancy desire review after a fixed period, as need for children, partners and health status of participants may alter over time.

Pregnancy intention and use of contraception among Hispanic women in the United States: data from the National Survey of Family Growth, 2006-2010.

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Masinter, Lisa M; Feinglass, Joe; Simon, Melissa A

2013-10-01

Both unintended and adolescent childbearing disproportionately impact the Hispanic population of the United States. We used the 2006-2010 National Survey of Family Growth (NSFG) to provide the most recent, nationally representative description of pregnancy, childbearing, and contraception for Hispanic females aged 15-44. We determined baseline fertility data for self-identified Hispanic female respondents. Among those reporting a pregnancy history, we calculated the proportion of pregnancies identified as unintended and their association with sociodemographic variables. We also assessed outcomes and estimates of relative risk for unintended pregnancy. Finally, we examined contraceptive use prior to self-reported unintended pregnancies. Approximately 70% of Hispanic women reported ever being pregnant, including 18% of teenagers. Over half (51%) of those pregnancies were unintended, including 81% among teenagers. The adjusted risk of unintended pregnancy was highest in women 15 to 19 years old and those with three or more pregnancies (incidence rate ratio [IRR] 1.64, 95% confidence interval [CI]: 1.44-1.88 and IRR 1.77, 95% CI: 1.53-2.06, respectively). Half of unintended pregnancies were preceded by no contraception. The most common reason for unintended pregnancy preceded by contraception was "improper use" (45%) and among pregnancies without use, the most common response (37%) was "I did not think I could get pregnant." There is a high frequency of unintended pregnancy and lack of contraceptive use among Hispanic women. These findings highlight the need for improved reproductive education and contraceptive counseling in this population.

Contraception, pregnancy, childbirth--when things go wrong.

Science.gov (United States)

Samuels, A

1986-01-01

This discussion of contraception, pregnancy, and childbirth covers the following: accepting and discharging patients; legal duty of care; contract law; consent; records; time limit; criminal law; sanctions; children under 16; contraception; failed sterilization, vasectomy, and abortion; abortions; pregnancy; delivery; postnatal care; birth at home; and unqualified persons. The relationship of the doctor to the private patient is governed by the law of contract and in a particular case may impose a greater duty on the doctor than that imposed by tort. The doctor must obtain the consent of the patient and must adhere to the proper standards of competent professional practice, either the generally accepted practice or, if there are 2 or more alternative procedures, one which can be professional supported. Where sterilization (tubal occlusion) is proposed, advice and counseling should be offered. On the birth of a child, drugs may not be administered without the mother's consent. The records of the National Health Service patient appear to belong to the Secretary of State for Social Services and the records of the private patient to the patient. The patient may sue within 3 years from the date of the alleged negligence or the discovery of the negligence. The doctor is most unlikely to be prosecuted for a criminal offense but failure to attend the patient, or gross carelessness, could possibly lead to a manslaughter charge. The Family Practitioner Committee may give a warning, a reprimand, and may stop the payment of fees. The doctor may give contraceptive advice and treatment to an adolescent female under age 16, but the doctor must first conform to 5 guidelines, known as the Fraser Guidelines. These guidelines are listed. The doctor must be aware of the possible risks and side effects of the various contraceptive methods and must evaluate each method and each patient accordingly. A doctor may be liable under the law of contract for a failed sterilization, vasectomy

Emergency contraception: knowledge and use among Danish women requesting termination of pregnancy

DEFF Research Database (Denmark)

Perslev, A; Rørbye, C; Boesen, H C

2002-01-01

as knowledge about both the correct time limit and where to acquire the EC. We found adequate knowledge in 44.7%. These women were typically younger, better educated and more often singles, nulliparae, and users of contraception. No relation was found to the type of contraception used or to previous......The aim of this study was to describe knowledge about and use of emergency contraception (EC) among Danish women requesting termination of pregnancy. The study included 1514 women (response rate 83.7%) referred during the period August 2000 to May 2001. Sufficient knowledge of EC was defined...

Concordance between intention to use and current use of contraceptives among six-month postpartum women in Brazil: The role of unplanned pregnancy.

Science.gov (United States)

Borges, Ana Luiza Vilela; Dos Santos, Osmara Alves; Fujimori, Elizabeth

2018-01-01

to examine the effect of pregnancy planning status in the concordance between intention to use and current use of contraceptives among postpartum women. a prospective study was conducted in 12 primary health care facilities in São Paulo, Brazil, from November 2013 to September 2014. A total of 264 woman aged 15-44 years old completed a face-to-face interview when they were pregnant (baseline), and were interviewed by phone at 6 months postpartum. At baseline, participants were questioned about the contraceptive method they would prefer to be using at 6 months postpartum. At 6 months postpartum, they answered about the contraceptive method they were currently using. Pregnancy planning status was measured using the Brazilian Portuguese London Measure of Unplanned Pregnancy. We conducted logistic regression, considering contraceptive preference-use concordance as the dependent variable and the main covariate as pregnancy planning status. Only 28.9% of postpartum women were using the method they preferred to use when they were pregnant. The agreement between preference and contraceptive use was higher for injectables (60.9%) and lowest for IUD, as nobody who preferred it was actually using it. Women who were not sure about what method they intended to use after childbirth more frequently reported no use at six months postpartum. Multivariate logistic regression showed that postpartum women whose pregnancy was unplanned were less likely to use the contraceptive methods that they intended to use when they were pregnant [aOR=0.36; 95%CI=0.14-0.97]. Brazilian women were able to access contraceptives in the postpartum period. However, there is a considerable discordance between their contraceptive intention to use and use at the sixth postpartum month. A higher unmet demand for IUD and sterilization should be highlighted. The pregnancy planning status is associated to postpartum contraceptive preference-use concordance, so interventions before pregnancy may affect

Childhood Sexual Violence and Consistent, Effective Contraception Use among Young, Sexually Active Urban Women.

Science.gov (United States)

Nelson, Deborah B; Lepore, Stephen J; Mastrogiannis, Dimitrios S

2015-05-22

Unintended pregnancy (UP) is a significant public health problem. The consistent use of effective contraception is the primary method to prevent UP. We examined the role of childhood sexual and physical violence and current interpersonal violence on the risk of unintended pregnancy among young, urban, sexually active women. In particular, we were interested in examining the role of childhood violence and interpersonal violence while recognizing the psychological correlates of experiencing violence (i.e., high depressive symptoms and low self-esteem) and consistent use of contraception. For this assessment, 315 sexually active women living in Philadelphia PA were recruited from family planning clinics in 2013. A self-administered, computer-assisted interview was used to collect data on method of contraception use in the past month, consistency of use, experiences with violence, levels of depressive symptoms, self-esteem and sexual self-efficacy, substance use and health services utilization. Fifty percent of young sexually active women reported inconsistent or no contraception use in the past month. Inconsistent users were significantly more likely to report at least one prior episode of childhood sexual violence and were significantly less likely to have received a prescription for contraception from a health care provider. Inconsistent contraception users also reported significantly higher levels of depressive symptoms and significantly lower levels of self-esteem. The relation between childhood sexual violence and UP remained unchanged in the multivariate models adjusting for self-esteem or depressive symptoms. These findings highlight the long-term consequences of childhood sexual violence, independent of current depressive symptoms and low self-esteem, on consistent use of contraception.

Happiness about unintended pregnancy and its relationship to contraceptive desires among a predominantly Latina cohort.

Science.gov (United States)

Aiken, Abigail R A

2015-06-01

Women frequently profess happiness about unintended pregnancies; such incongruence is associated with use of less effective contraceptive methods and inconsistent or incorrect method use. Yet, the methods women use may differ from those they desire. Data on 578 women were drawn from a prospective survey of postpartum women aged 18-44 recruited from three hospitals in Texas between 2012 and 2014. Jonckheere-Terpstra tests were used to compare women's feelings about a future pregnancy with their childbearing intentions. Fisher-Freeman-Halton tests compared distributions of contraceptive methods currently used and desired by women who professed happiness about a future unintended pregnancy, as well as distributions of desired methods by women's reported feelings. The proportion of women who reported happiness about a future pregnancy was 59% among those intending to wait two or three years for another child, 46% among those intending to wait four or more years, and 36% among those intending to have no more children. Among women who professed happiness, a greater proportion desired to use a highly effective contraceptive method than were currently using one (72% vs. 15% among those intending no more children; 55% vs. 23% among those intending to wait at least four years; and 36% vs. 10% among those intending to wait two or three years). Across intention categories, the types of methods desired did not differ by whether women professed happiness or unhappiness. Women who profess happiness about a future unintended pregnancy may nonetheless desire highly effective contraceptive methods. Copyright © 2015 by the Guttmacher Institute.

Pregnancy and oral contraceptive use do not significantly influence outcome in long term rheumatoid arthritis

NARCIS (Netherlands)

Drossaers-Bakker, K. W.; Zwinderman, A. H.; van Zeben, D.; Breedveld, F. C.; Hazes, J. M. W.

2002-01-01

BACKGROUND: Oral contraceptives (OC) and pregnancy are known to have an influence on the risk of onset of rheumatoid arthritis (RA). Pregnancy itself has beneficial effects on the activity of the disease, with relapses post partum. It is not known, however, whether OC and pregnancies influence the

Unmet need for family planning, contraceptive failure, and unintended pregnancy among HIV-infected and HIV-uninfected women in Zimbabwe.

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Sandra I McCoy

Full Text Available Prevention of unintended pregnancies among women living with HIV infection is a strategy recommended by the World Health Organization for prevention of mother-to-child transmission of HIV (PMTCT. We assessed pregnancy intentions and contraceptive use among HIV-positive and HIV-negative women with a recent pregnancy in Zimbabwe.We analyzed baseline data from the evaluation of Zimbabwe's Accelerated National PMTCT Program. Eligible women were randomly sampled from the catchment areas of 157 health facilities offering PMTCT services in five provinces. Eligible women were ≥16 years old and mothers of infants (alive or deceased born 9 to 18 months prior to the interview. Participants were interviewed about their HIV status, intendedness of the birth, and contraceptive use.Of 8,797 women, the mean age was 26.7 years, 92.8% were married or had a regular sexual partner, and they had an average of 2.7 lifetime births. Overall, 3,090 (35.1% reported that their births were unintended; of these women, 1,477 (47.8% and 1,613 (52.2% were and were not using a contraceptive method prior to learning that they were pregnant, respectively. Twelve percent of women reported that they were HIV-positive at the time of the survey; women who reported that they were HIV-infected were significantly more likely to report that their pregnancy was unintended compared to women who reported that they were HIV-uninfected (44.9% vs. 33.8%, p<0.01. After adjustment for covariates, among women with unintended births, there was no association between self-reported HIV status and lack of contraception use prior to pregnancy.Unmet need for family planning and contraceptive failure contribute to unintended pregnancies among women in Zimbabwe. Both HIV-infected and HIV-uninfected women reported unintended pregnancies despite intending to avoid or delay pregnancy, highlighting the need for effective contraceptive methods that align with pregnancy intentions.

Pregnancy Outcomes Following Ulipristal Acetate Emergency Contraception Failure: A Report of Five Cases.

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Ozturk, Zeynep; Akgul, Emine

2017-06-01

The emergency contraceptive ulipristal acetate (UPA) 30 mg is increasingly used by women, but there is no published data on UPA exposure in pregnancy. Here we describe five cases of unintended pregnancies following the use of UPA for emergency contraception. Of five pregnant women exposed to UPA, one decided to terminate the pregnancy for personal reasons. Two of them experienced premature rupture of membranes and the babies were born large for gestational age (LGA). The other two women experienced gestational diabetes, and one of them also delivered a LGA baby. The blood glucose levels of the mothers were normal after delivery and at six weeks postpartum. No birth defects and no growth or developmental abnormalities for the infants were reported during 6 months follow-up. Pregnant women inadvertently exposed to UPA should be monitored carefully, unless further data are available.

Contraceptive Use and the Risk of Ectopic Pregnancy: A Multi-Center Case-Control Study.

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Li, Cheng; Zhao, Wei-Hong; Meng, Chun-Xia; Ping, Hua; Qin, Guo-Juan; Cao, Shu-Jun; Xi, Xiaowei; Zhu, Qian; Li, Xiao-Cui; Zhang, Jian

2014-01-01

To evaluate the association between the risk of ectopic pregnancy (EP) and the use of common contraceptives during the previous and current conception/menstrual cycle. A multi-center case-control study was conducted in Shanghai. Women diagnosed with EP were recruited as the case group (n = 2,411). Women with intrauterine pregnancy (IUP) (n = 2,416) and non-pregnant women (n = 2,419) were matched as controls at a ratio of 1∶1. Information regarding the previous and current use of contraceptives was collected. Multivariate logistic regression analyses were performed to calculate odds ratios (ORs) and the corresponding 95% confidential intervals (CIs). Previous use of intrauterine devices (IUDs) was associated with a slight risk of ectopic pregnancy (AOR1 = 1.87 [95% CI: 1.48-2.37]; AOR2 = 1.84 [1.49-2.27]), and the risk increased with the duration of previous use (P1 for trend contraceptives reduced the risk of both unwanted IUP (condom: AOR = 0.04 [0.03-0.05]; withdrawal method: AOR = 0.10 [0.07-0.13]; calendar rhythm method: AOR = 0.54 [0.40-0.73]; oral contraceptive pills [OCPs]: AOR = 0.03 [0.02-0.08]; levonorgestrel emergency contraception [LNG-EC]: AOR = 0.22 [0.16-0.30]; IUDs: AOR = 0.01 [0.005-0.012]; tubal sterilization: AOR = 0.01 [0.001-0.022]) and unwanted EP (condom: AOR1 = 0.05 [0.04-0.06]; withdrawal method: AOR1 = 0.13 [0.09-0.19]; calendar rhythm method: AOR1 = 0.66 [0.48-0.91]; OCPs: AOR1 = 0.14 [0.07-0.26]; IUDs: AOR1 = 0.17 [0.13-0.22]; tubal sterilization: AOR1 = 0.04 [0.02-0.08]). However, when contraception failed and pregnancy occurred, current use of OCPs (AOR2 = 4.06 [1.64-10.07]), LNG-EC (AOR2 = 4.87 [3.88-6.10]), IUDs (AOR2 = 21.08 [13.44-33.07]), and tubal sterilization (AOR2 = 7.68 [1.69-34.80]) increased the risk of EP compared with the non-use of contraceptives. Current use of most contraceptives reduce the risk of both IUP and EP. However, if the

Contraceptive Use and the Risk of Ectopic Pregnancy: A Multi-Center Case-Control Study.

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Cheng Li

Full Text Available To evaluate the association between the risk of ectopic pregnancy (EP and the use of common contraceptives during the previous and current conception/menstrual cycle.A multi-center case-control study was conducted in Shanghai. Women diagnosed with EP were recruited as the case group (n = 2,411. Women with intrauterine pregnancy (IUP (n = 2,416 and non-pregnant women (n = 2,419 were matched as controls at a ratio of 1∶1. Information regarding the previous and current use of contraceptives was collected. Multivariate logistic regression analyses were performed to calculate odds ratios (ORs and the corresponding 95% confidential intervals (CIs.Previous use of intrauterine devices (IUDs was associated with a slight risk of ectopic pregnancy (AOR1 = 1.87 [95% CI: 1.48-2.37]; AOR2 = 1.84 [1.49-2.27], and the risk increased with the duration of previous use (P1 for trend <10-4, P2 for trend <10-4. The current use of most contraceptives reduced the risk of both unwanted IUP (condom: AOR = 0.04 [0.03-0.05]; withdrawal method: AOR = 0.10 [0.07-0.13]; calendar rhythm method: AOR = 0.54 [0.40-0.73]; oral contraceptive pills [OCPs]: AOR = 0.03 [0.02-0.08]; levonorgestrel emergency contraception [LNG-EC]: AOR = 0.22 [0.16-0.30]; IUDs: AOR = 0.01 [0.005-0.012]; tubal sterilization: AOR = 0.01 [0.001-0.022] and unwanted EP (condom: AOR1 = 0.05 [0.04-0.06]; withdrawal method: AOR1 = 0.13 [0.09-0.19]; calendar rhythm method: AOR1 = 0.66 [0.48-0.91]; OCPs: AOR1 = 0.14 [0.07-0.26]; IUDs: AOR1 = 0.17 [0.13-0.22]; tubal sterilization: AOR1 = 0.04 [0.02-0.08]. However, when contraception failed and pregnancy occurred, current use of OCPs (AOR2 = 4.06 [1.64-10.07], LNG-EC (AOR2 = 4.87 [3.88-6.10], IUDs (AOR2 = 21.08 [13.44-33.07], and tubal sterilization (AOR2 = 7.68 [1.69-34.80] increased the risk of EP compared with the non-use of contraceptives.Current use of most

Current Developments In Contraception

Directory of Open Access Journals (Sweden)

Cem Yaşar Sanhal

2012-06-01

Full Text Available Contraception (birth control prevents pregnancy by interfering with the normal process of ovulation, fertilization, and implantation. There are different kinds of birth control that act at different points in the process. The rapid increase in the world population makes it mandatory to develop new contraceptive methods. According to WHO data, every year 200 billion new pregnancies occur and more than 50 billion of them are classified as unintended. To avoid complications of these unintended pregnancies and abortions, the contraception and kinds of contraceptive methods should be well known and understood. Recently, new hormonal contraceptive choices and regimen were adminestered and studies about male contraception and immunocontraception were performed. In this review, we discussed about the new development and progress on contraception.

Characteristics of Women with Unwanted Pregnancies and Reasons for Contraceptive Methods Discontination: Sample of Rural Area

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Semra Ay

2012-06-01

Full Text Available AIM: The aim of the study was to explore the prevalence and characteristics of women with unwanted pregnancy in rural area and to examine pregnant women’s contraceptive method preferences, satisfaction with the methods and reason the methods discontinuation. METHOD: This study was carried out in Manisa city rural area between the dates of January and June 2011 in women who agreed to participate in the study. The sample of the research is composed of 239 pregnant women. The research was a descriptive, cross-sectional and field study and the data was collected by using questionnaire which was prepared by researcher. Data was gathered through the face to face interview with the women at their home. Statistical analyses were undertaken using SPSS version 11.5. Descriptive analysis, Pearson’s Chi-square (χ² test, fisher exact test, and t-test were used statistical evaluation. RESULTS: Of the 239 pregnancies, 64 (26.8% were unwanted pregnancies. The mean age of women was respectively 25.0±5.0, and 29.0±5.4 years, for wanted, and unwanted pregnancies. Women with unwanted pregnancies were older, less educated, they had less educated husbands, had low income level, had more pregnancies, deliveries, had less than two years interval between their births. Unwanted pregnancies were observed in women using the coitus interrupts method (%53.1, effective contraceptive methods (%54.3 and not using any method (%16.3 (p<0.05. The most reasons for discontinuation were reported pregnant women as follows: side effects of methods, disapproval for husband, pregnancy occurs using the method, believe for ineffective contraceptive methods. CONCLUSION: In order to reduce the number of unwanted pregnancies and wanted abortions which reversely affect the women healthy; an appropriate contraception method must be employed. Health care providers should identify women with unwanted pregnancy to understand women's concerns and experiences using contraception. This

Motivational interviews to improve contraceptive use in populations at high risk of unintended pregnancy: a systematic review and meta-analysis.

Science.gov (United States)

Wilson, Amie; Nirantharakumar, Krishnarajah; Truchanowicz, Ewa G; Surenthirakumaran, Rajendra; MacArthur, Christine; Coomarasamy, Arri

2015-08-01

Effective contraceptive use has the potential to prevent around 230 million births each year. An estimated 222 million women want to delay pregnancy or cease childbearing, but are not actively using contraception. Lack of education is a known barrier for effective contraceptive use. Motivational interviews are presumed to improve effective contraceptive use, but studies to date report varied findings. Some studies demonstrate an improvement and others report no effect. A systematic review of evidence on the impact of motivational interviews on contraceptive use in women of childbearing age was carried out using MEDLINE, EMBASE, BNI, Cochrane library, CINHAL, African Index Medicus, Web of Science, the Reproductive Health Library, and the Science Citation Index (inception-January 2013) without language restriction. Search terms included 'motivational interview* AND contraception OR family planning OR maternal OR pregnancy'. Randomised controlled trials comparing the effect of motivational interviews with standard practice on effective contraception use in women of reproductive age were included. The outcome measures were use of effective contraception or use of high-level contraception, and subsequent births or pregnancies. The random effects model was used to pool the risk ratios from individual studies. Eight randomised controlled trials were included in the review with a total of 3424 women at high risk of pregnancy. Meta-analysis showed an increase in effective contraceptive use with motivational interviews when compared with control (RR 1.32 95%CI 1.11, 1.56: P=0.002) in the period of zero to four months post intervention. No difference in effective contraceptive use was shown at four to eight months (RR 1.10, 95%CI 0.93, 1.32: P=0.27), and between eight to twelve months (RR 1.18 95%CI 0.96, 1.46: P=0.12). No evidence of effect in the reduction of subsequent pregnancies or births at twelve to twenty-four months was seen with motivational interviews (RR 0.80 95

Childhood Sexual Violence and Consistent, Effective Contraception Use among Young, Sexually Active Urban Women

Directory of Open Access Journals (Sweden)

Deborah B. Nelson

2015-05-01

Full Text Available Unintended pregnancy (UP is a significant public health problem. The consistent use of effective contraception is the primary method to prevent UP. We examined the role of childhood sexual and physical violence and current interpersonal violence on the risk of unintended pregnancy among young, urban, sexually active women. In particular, we were interested in examining the role of childhood violence and interpersonal violence while recognizing the psychological correlates of experiencing violence (i.e., high depressive symptoms and low self-esteem and consistent use of contraception. For this assessment, 315 sexually active women living in Philadelphia PA were recruited from family planning clinics in 2013. A self-administered, computer-assisted interview was used to collect data on method of contraception use in the past month, consistency of use, experiences with violence, levels of depressive symptoms, self-esteem and sexual self-efficacy, substance use and health services utilization. Fifty percent of young sexually active women reported inconsistent or no contraception use in the past month. Inconsistent users were significantly more likely to report at least one prior episode of childhood sexual violence and were significantly less likely to have received a prescription for contraception from a health care provider. Inconsistent contraception users also reported significantly higher levels of depressive symptoms and significantly lower levels of self-esteem. The relation between childhood sexual violence and UP remained unchanged in the multivariate models adjusting for self-esteem or depressive symptoms. These findings highlight the long-term consequences of childhood sexual violence, independent of current depressive symptoms and low self-esteem, on consistent use of contraception.

Hormonal Contraception, Pregnancy, Breastfeeding, and Risk of HIV Disease Progression Among Zambian Women.

Science.gov (United States)

Wall, Kristin M; Kilembe, William; Haddad, Lisa; Vwalika, Bellington; Lakhi, Shabir; Khu, Naw Htee; Brill, Ilene; Chomba, Elwyn; Mulenga, Joseph; Tichacek, Amanda; Allen, Susan

2016-03-01

Some studies suggest that hormonal contraception, pregnancy, and/or breastfeeding may influence rates of HIV disease progression. From 1994 to 2012, HIV discordant couples recruited at couples' voluntary HIV counseling and testing centers in Lusaka were followed 3-monthly. Multivariate survival analyses explored associations between time-varying contraception, pregnancy, and breastfeeding and 2 outcomes among HIV-positive women: (1) time to death and (2) time to antiretroviral treatment (ART) initiation. Among 1656 female seropositive, male seronegative couples followed for 3359 person-years (PY), 224 women died [6.7/100 PY; 95% confidence interval (CI): 5.8 to 7.6]. After 2003, 290 women initiated ART (14.5/100 PY; 95% CI: 12.9 to 16.2). In a multivariate model of time to death, hormonal implant [adjusted hazard ratio (aHR) = 0.30; 95% CI: 0.10 to 0.98] and injectable (aHR = 0.59; 95% CI: 0.36 to 0.97) were significantly protective relative to nonhormonal method use, whereas oral contraceptive pill (OCP) use was not (aHR = 1.08; 95% CI: 0.74 to 1.57) controlling for baseline HIV disease stage, time-varying pregnancy, time-varying breastfeeding, and year of enrollment. In a multivariate model of time-to-ART initiation, implant was significantly protective (aHR = 0.54; 95% CI: 0.31 to 0.95), whereas OCP (aHR = 0.70; 95% CI: 0.44 to 1.10) and injectable (aHR = 0.85; 95% CI: 0.55 to 1.32) were not relative to nonhormonal method use controlling for variables above, woman's age, and literacy. Pregnancy was not significantly associated with death (aHR = 1.07; 95% CI: 0.68 to 1.66) or ART initiation (aHR = 1.24; 95% CI: 0.83 to 1.86), whereas breastfeeding was protective for death (aHR = 0.34; 95% CI: 0.19 to 0.62) and ART initiation (aHR = 0.49; 95% CI: 0.29 to 0.85). Hormonal implants and injectables significantly predicted lower mortality; implants were protective for ART initiation. OCPs and pregnancy were not associated with death or ART initiation, whereas

Prevalence of pregnancy experiences and contraceptive knowledge among single adults in a low socio-economic suburban community in Kuala Lumpur, Malaysia.

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Wong, Li Ping; Atefi, Narges; Majid, Hazreen Abd; Su, Tin Tin

2014-01-01

This study aimed to investigate the prevalence of pregnancy experience and its association with contraceptive knowledge among single adults in a low socio-economic suburban community in Kuala Lumpur, Malaysia. A cross-sectional survey was conducted in 2012 among the Kerinchi suburban community. Of the total 3,716 individuals surveyed, young single adults between 18 and 35 years old were questioned with regard to their experience with unplanned pregnancy before marriage. Contraceptive knowledge was assessed by a series of questions on identification of method types and the affectivity of condoms for the prevention of sexually transmitted diseases. A total of 226 female and 257 male participants completed the survey. In total, eight female (3.5%) participants reported experience with an unplanned pregnancy before marriage, and five male (1.9 %) participants had the experience of impregnating their partners. The participants had a mean total score of 3.15 (SD = 1.55) for contraceptive knowledge out of a possible maximum score of five. Female participants who had experienced an unplanned pregnancy had a significantly lower contraceptive knowledge score (2.10 ± 1.48) than who had never experienced pregnancy (3.30 ± 1.35), p<0.05. Likewise, male participants who had experienced impregnating their partners had a significantly lower contraceptive knowledge score (1.60 ± 1.50) than those who did not have such experience (3.02 ± 1.59), p<0.05. The results showed evidence of premarital unplanned pregnancy among this suburban community. The low level of contraceptive knowledge found in this study indicates the need for educational strategies designed to improve contraceptive knowledge.

Nonuse of contraception among women at risk of unintended pregnancy in the United States.

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Mosher, William; Jones, Jo; Abma, Joyce

2015-08-01

This paper seeks to determine factors associated with nonuse of contraception by women at risk of unintended pregnancy in the United States. This nonuse may be associated with about 900,000 unintended births in the US each year. The 2002 and 2006-2010 National Surveys of Family Growth were combined to yield a nationally representative sample of 9,445 women at risk of unintended pregnancy. Logistic regression analyses identified factors associated with nonuse of contraception. This analysis reveals previously undocumented patterns of nonuse: controlling for confounding variables, cohabiting women [adjusted odds ratio (AOR)=2.3, 95% confidence interval (CI)=1.45-3.52] had higher odds of nonuse than married women; women who reported a difficulty getting pregnant (AOR=2.5, 95% CI=2.01-3.01) had higher odds of nonuse than those who did not. Nonuse was also more common among women with a master's degree or more (AOR=1.5, 95% CI=1.11-2.08) compared with those with some college or bachelor's degree, and it was more common among women in their first year after first intercourse than after the first year (AOR 1.6, 95% CI=1.12-2.22). Among women who had a recent unintended birth, the most common reason for not using contraception prior to conception was that she did not think she could get pregnant. This study establishes national estimates of reasons for nonuse of contraception and identifies some new subgroups at risk of nonuse. These results may help better understand factors affecting nonuse of contraception and develop strategies for preventing unintended pregnancy in the United States. Published by Elsevier Inc.

Cluster headache in women: relation with menstruation, use of oral contraceptives, pregnancy, and menopause

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van Vliet, J A; Favier, I; Helmerhorst, F M; Haan, J; Ferrari, M D

2006-01-01

In contrast with migraine, little is known about the relation between cluster headache and menstrual cycle, oral contraceptives, pregnancy, and menopause. A population based questionnaire study was performed among 224 female cluster headache patients, and the possible effect of hormonal influences on cluster headache attacks studied. For control data, a similar but adjusted questionnaire was sent to healthy volunteers and migraine patients. It was found that menstruation, use of oral contraceptives, pregnancy, and menopause had a much smaller influence on cluster headache attacks than in migraine. Cluster headache can, however, have a large impact on individual women, for example to refrain from having children. PMID:16407458

Long-acting reversible contraceptive acceptability and unintended pregnancy among women presenting for short-acting methods: a randomized patient preference trial.

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Hubacher, David; Spector, Hannah; Monteith, Charles; Chen, Pai-Lien; Hart, Catherine

2017-02-01

Measures of contraceptive effectiveness combine technology and user-related factors. Observational studies show higher effectiveness of long-acting reversible contraception compared with short-acting reversible contraception. Women who choose long-acting reversible contraception may differ in key ways from women who choose short-acting reversible contraception, and it may be these differences that are responsible for the high effectiveness of long-acting reversible contraception. Wider use of long-acting reversible contraception is recommended, but scientific evidence of acceptability and successful use is lacking in a population that typically opts for short-acting methods. The objective of the study was to reduce bias in measuring contraceptive effectiveness and better isolate the independent role that long-acting reversible contraception has in preventing unintended pregnancy relative to short-acting reversible contraception. We conducted a partially randomized patient preference trial and recruited women aged 18-29 years who were seeking a short-acting method (pills or injectable). Participants who agreed to randomization were assigned to 1 of 2 categories: long-acting reversible contraception or short-acting reversible contraception. Women who declined randomization but agreed to follow-up in the observational cohort chose their preferred method. Under randomization, participants chose a specific method in the category and received it for free, whereas participants in the preference cohort paid for the contraception in their usual fashion. Participants were followed up prospectively to measure primary outcomes of method continuation and unintended pregnancy at 12 months. Kaplan-Meier techniques were used to estimate method continuation probabilities. Intent-to-treat principles were applied after method initiation for comparing incidence of unintended pregnancy. We also measured acceptability in terms of level of happiness with the products. Of the 916

The Relationship between Contraceptive Use and Unintended Pregnancies among Married Women in Thatta District, Pakistan

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Sumera Ali

2017-07-01

Full Text Available Background & aim: The rate of unintended pregnancy has decreased from 24% to 16% in the last four to five years in Pakistan. However, this rate stills varies among the women living in the rural and urban areas of Pakistan. The females residing in the rural areas are less likely to have many contraceptive choices and receive no/low-quality family planning services; as a result, they end up with birth control failure and unintended pregnancy. Regarding this, more studies are needed to investigate the association between the unintended pregnancy and contraceptive use, particularly in the rural areas of Pakistan.Therefore, the aim of the present study was to determine the relationship between contraceptive use and unintended pregnancy among the women at reproductive age living in Thatta district, Sindh, Pakistan. Methods:This nested case-control study was conducted on the women living in Thatta district during June 2011-July 2012. The pregnant women who did not want more children were considered as cases, and those who intended to have more children were considered as controls. The categorical and continuous variables were analyzed using the Chi-square test and independent t-tests, respectively. Results: According o the results of the present study, the use of contraceptive methods was significantly associated with increased risk of unintended pregnancy among the women living in Thatta district [OR: 2.77 (1.46-5.25]. Moreover, there was 14% increased risk of unintended pregnancy with one year increase in the age of the women [OR: 1.14 (1.10-1.19]. The age at marriage showed negative association with unintended pregnancy [OR: 0.92 (0.87-0.97]. The women having at least one son (alive were almost three times more likely to report their recent pregnancies as unintended, compared to those with no living son [OR: 2.97 (1.82-4.84]. In addition, the husband’s education and their opposition with the use of family planning methods [OR 2.16 (1.06-4.39] were

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

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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

Male contraception.

Science.gov (United States)

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.

Using Behavioral Economic Theory to Increase Use of Effective Contraceptives among Opioid-maintained Women at Risk of Unintended Pregnancy

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Heil, Sarah H.; Hand, Dennis J.; Sigmon, Stacey C.; Badger, Gary J.; Meyer, Marjorie C.; Higgins, Stephen T.

2016-01-01

Objective An unsettling aspect of the US opioid epidemic is the high rate of in utero exposure, especially since most of these pregnancies are unintended, due in part to low rates of effective contraceptive use among opioid-using women. This study tested an intervention informed by behavioral economic theory and aimed at promoting effective contraceptive use among opioid-maintained women at risk of unintended pregnancy in the Burlington, VT area between 2011–2013. Methods Thirty-one women were assigned (initial 5 consecutively, subsequent 26 randomly) to either usual care or an experimental intervention. Participants in usual care received condoms, a dose of emergency contraception, and referral to local providers. Participants in the experimental condition received usual care plus the World Health Organization’s contraception initiation protocol, including free prescription contraceptives, and financial incentives for attending 13 follow-up visits over 6 months to help manage side effects and other issues. Results Significantly more women in the experimental vs. usual care control conditions initiated prescription contraceptive use (100% vs. 29%) and reported prescription contraceptive use at 1-month (63% vs. 13%), 3-month (88% vs. 20%), and 6-month (94% vs. 13%) assessments. None of the experimental condition participants became pregnant during the 6-month protocol vs. three women (20%) in the control condition. Conclusions These results provide the first experimental evidence supporting the efficacy of an intervention for increasing prescription contraceptive use among opioid-maintained women at risk of unintended pregnancy. PMID:27346756

Young women's contraceptive microbicide preferences: associations with contraceptive behavior and sexual relationship characteristics.

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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.

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

Science.gov (United States)

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.

Obesity and hormonal contraceptive efficacy.

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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.

Non-contraceptive benefits of hormonal and intrauterine reversible contraceptive methods.

Science.gov (United States)

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

Is education the best contraception: the case of teenage pregnancy in England?

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Girma, Sourafel; Paton, David

2015-04-01

This paper examines potential explanations for recent declines in teenage pregnancy in England. We estimate panel data models of teenage conception, birth and abortion rates from regions in England. Although point estimates are consistent with the promotion of long acting reversible contraception (LARC) having a negative impact on teenage pregnancy rates, the effects are generally small and statistically insignificant. In contrast, improvements in educational achievement and, to a lesser extent, increases in the non-white proportion of the population are associated with large and statistically significant reductions in teenage pregnancy. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

Science.gov (United States)

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

Contraception usage and timing of pregnancy among pregnant teenagers in Cape Town, South Africa.

Science.gov (United States)

Vollmer, Linda R; van der Spuy, Zephne M

2016-06-01

To evaluate knowledge and use of contraception among pregnant teenagers in the Cape Town metropolitan area. A cross-sectional study enrolled women aged 16 to 19 years who were pregnant and attending prenatal clinics, and prenatal and labor wards at regional hospitals and midwife-run obstetric clinics in the Cape Town area between March 1, 2011 and September 30, 2011. Data were collected using an administered questionnaire. The study enrolled 314 participants. Of the participants, 240 (76.4%) felt their pregnancies had occurred at the "wrong time" but only 38 (12.1%) were using contraception at the time of conception. The form of contraception that participants most commonly had knowledge of was injectable hormonal contraception (274 [87.3%]). Contraception use was low, with 126 (40.1%) participants having never used contraception. The forms of contraception used most commonly were the male condom (106 [33.8%]) and injectable contraception (98 [31.2%]). The majority of participants found it easy to get contraception (192 [61.1%]) and felt that information regarding contraception was readily available (233 [74.2%]). Contraception use is suboptimal but this may not simply be a reflection of ineffective family-planning services. Further research is needed to fully explain the lack of contraceptive use in this population. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Role of young women's depression and stress symptoms in their weekly use and nonuse of contraceptive methods.

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Hall, Kelli Stidham; Moreau, Caroline; Trussell, James; Barber, Jennifer

2013-08-01

We prospectively examined the influence of young women's depression and psychological stress symptoms on their weekly contraceptive method use. We examined data from 689 women ages 18-20 years participating in a longitudinal cohort study. Women completed 8,877 weekly journals over the first year, which assessed reproductive, relationship, and health information. We focused on baseline depression (Center for Epidemiologic Studies-Depression Scale) and stress (Perceived Stress Scale) symptoms and weekly contraceptive method use. Analyses used multivariate random effects and multinomial logistic regression. Approximately one quarter of women exhibited moderate/severe depression (27%) and stress (25%) symptoms at baseline. Contraception was not used in 10% of weekly journals, whereas coital and noncoital methods were used in 42% and 48% of weeks, respectively. In adjusted models, women with moderate/severe stress symptoms had more than twice the odds of contraception nonuse than women without stress (odds ratio [OR] 2.23, confidence interval [CI] 1.02-4.89, p = .04). Additionally, women with moderate/severe depression (RR .52, CI .40-.68, p contraceptives (OCs; reference category). Women with stress symptoms also had higher relative risks of using condoms (RR 1.17, CI 1.00-1.34, p = .02) and withdrawal (RR 1.29, CI 1.10-1.51, p = .001) than OCs. The relative risk of dual versus single method use was also lower for women with stress symptoms. Women's psychological symptoms predicted their weekly contraceptive nonuse and use of less effective methods. Further research can determine the influence of dynamic psychological symptoms on contraceptive choices and failures over time. Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Prevention of unintended pregnancies in Nigeria; the effect of socio-demographic characteristic on the knowledge and use of emergency contraceptives among female university students

OpenAIRE

Olumide A. Abiodun; John Sotunsa; Olusoji Jagun; Bukola Faturoti; Franklin Ani; Imaralu John; Agboola Taiwo; Ogechukwu Taiwo

2015-01-01

Background: The proportion of unintended pregnancy remains high in developing regions due to unmet need for contraception and inconsistent use of modern contraceptives. Practice of emergency contraception is particularly important because of the high rates of unintended pregnancy. The aim was to assess the practice of emergency contraception among female students. Methods: A cross-sectional study was conducted among 5,233 female university students in Nigeria. Results: About 25.4% of th...

Emergency contraception - potential for women's health.

Science.gov (United States)

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.

EMERGENCY CONTRACEPTION

Directory of Open Access Journals (Sweden)

Dragana Pantić

2007-10-01

Full Text Available Emergency contraception refers to any device or drug that is used as an emergency procedure to prevent pregnancy after unprotected sexual intercourse.The first method of emergency contraception was high dose of estrogen. Concern about side effects led to subsequent development of the so-called Yuzpe regimen which combined ethinil estradiol with levonorgestrel and levonorgestrel alone. Less convenient to use is the copper intauterine contraceptive device.It is known that in some women sexual steroids may inhibit or delay ovulation and may interfere with ovum and sperm transport and implantation. Copper intrauterine device causes a foreign-body effect on the endometrium and a direct toxic effect to sperm and blastocyst.The Yuzpe regimen reduces the risk of pregnancy after a single act of sexual intercourse by about 75% and the levonorgestrel alone by about 85%. The copper intrauterine device is an extremely effective method for selected patients.Nausea and vomiting are common among women using the Yuzpe regimen and considerably less common among women using levonorgestrel alone regimen.Emergency contraception is relatively safe with no contraindications except pregnancy. It is ineffective if a woman is pregnant. There is no need for a medical hystory or a phisical examination before providing emergency contraceptive pills. They are taken long before organogenesis starts, so they should not have a teratogenic effect.Counseling should include information about correct use of the method, possible side effects and her preferences for regular contraception.Unintended pregnancy is a great problem. Several safe, effective and inexpensive methods of emergency contraception are available including Yuzpe regimen, levonorges-trel-only regimen and copper intrauterine device.

The underutilization of emergency contraception.

Science.gov (United States)

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.

Prevalence of pregnancy experiences and contraceptive knowledge among single adults in a low socio-economic suburban community in Kuala Lumpur, Malaysia

Science.gov (United States)

2014-01-01

Background This study aimed to investigate the prevalence of pregnancy experience and its association with contraceptive knowledge among single adults in a low socio-economic suburban community in Kuala Lumpur, Malaysia. Methods A cross-sectional survey was conducted in 2012 among the Kerinchi suburban community. Of the total 3,716 individuals surveyed, young single adults between 18 and 35 years old were questioned with regard to their experience with unplanned pregnancy before marriage. Contraceptive knowledge was assessed by a series of questions on identification of method types and the affectivity of condoms for the prevention of sexually transmitted diseases. Results A total of 226 female and 257 male participants completed the survey. In total, eight female (3.5%) participants reported experience with an unplanned pregnancy before marriage, and five male (1.9 %) participants had the experience of impregnating their partners. The participants had a mean total score of 3.15 (SD = 1.55) for contraceptive knowledge out of a possible maximum score of five. Female participants who had experienced an unplanned pregnancy had a significantly lower contraceptive knowledge score (2.10 ± 1.48) than who had never experienced pregnancy (3.30 ± 1.35), pknowledge score (1.60 ± 1.50) than those who did not have such experience (3.02 ± 1.59), pknowledge found in this study indicates the need for educational strategies designed to improve contraceptive knowledge. PMID:25438066

Contraception matters: indicators of poor usage of contraception in sexually active women attending family planning clinics in Victoria, Australia

Directory of Open Access Journals (Sweden)

Ong Jason

2012-12-01

Full Text Available Abstract Background Unintended pregnancy (mistimed or unwanted remains an important health issue for women. The purpose of this study was to determine the prevalence of and factors associated with risk of unintended pregnancy in a sample of Victorian women attending family planning clinics. Methods This cross-sectional survey of three Family Planning Victoria Clinics from April to July 2011 recruited women aged 16-50 years with a male sexual partner in the last 3 months, and not intending to conceive. The questionnaire asked about contraceptive behaviours and important factors that influence contraception use (identified from a systematic literature review. Univariate analysis was calculated for the variables of interest for associations with contraceptive use. An overall multivariate model for being at risk for unintended pregnancy (due to inconsistent or ineffective contraceptive use or non-use was calculated through backward elimination with statistical significance set at Results 1006 surveys were analyzed with 96% of women reporting contraception use in the last 3 months. 37% of women were at risk for unintended pregnancy due to imperfect use (61% inconsistent users; 31% ineffective methods or never using contraception (8%. On multivariate analysis, women at risk for unintended pregnancy compared with women not at risk were 1 partner in the last 3 months (OR 3.2, 95% CI 2.3-4.6. These women were dissatisfied with current contraception (OR 2.5, 95% 1.8-3.5; felt “vulnerable” to pregnancy (OR 2.1, 95% CI 1.6-3.0; were not confident in contraceptive knowledge (OR 2.6, 95% CI 1.5-4.8; were unable to stop to use contraception when aroused (OR 2.1, 95% CI 1.5-2.9 but were comfortable in speaking to a doctor about contraception (OR 2.3, 95% CI 1.1-4.1. Conclusion Despite reported high contraceptive usage, nearly 40% of women were at risk for unintended pregnancy primarily due to inconsistent contraceptive use and use of ineffective

Adverse mood symptoms with oral contraceptives.

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Poromaa, Inger Sundström; Segebladh, Birgitta

2012-04-01

In spite of combined oral contraceptives (COCs) having been available for more than 50 years, surprisingly little is known about the prevalence of truly COC-related adverse mood symptoms and about the underlying biological mechanisms of proposed changes in mood and affect. Precise estimates of COC-related adverse mood symptoms are not available due to the lack of placebo-controlled trials. In prospective trials the frequency of women who report deteriorated mood or deteriorated emotional well-being varies between 4 and 10%, but it can be assumed that the causal relation in these prevalence rates is overestimated. Adverse mood symptoms and somatic symptoms are most pronounced during the pill-free interval of the treatment cycles, but whether extended COC regimens would be more favorable in this respect is not known. COCs with anti-androgenic progestagens, such as drospirenone and desogestrel, appear more favorable in terms of mood symptoms than progestagens with a more androgenic profile. Available data suggest that lower doses of ethinylestradiol could be beneficial. © 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.

Ulipristal acetate in emergency contraception.

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Goldstajn, Marina Sprem; Baldani, Dinka Pavicić; Skrgatić, Lana; Radaković, Branko; Vrbić, Hrvoje; Canić, Tomislav

2014-03-01

Despite the widespread availability of highly effective methods of contraception, unintended pregnancy is common. Unplanned pregnancies have been linked to a range of health, social and economic consequences. Emergency contraception reduces risk of pregnancy after unprotected intercourse, and represents an opportunity to decrease number of unplanned pregnancies and abortions. Emergency contraception pills (ECP) prevent pregnancy by delaying or inhibiting ovulation, without interfering with post fertilization events. If pregnancy has already occurred, ECPs will not be effective, therefore ECPs are not abortificants. Ulipristal acetate (17alpha-acetoxy-11beta-(4N-N,N-dymethilaminophenyl)-19-norpregna--4,9-diene-3,20-dione) is the first drug that was specifically developed and licensed for use as an emergency contraceptive. It is an orally active, synthetic, selective progesterone modulator that acts by binding with high affinity to the human progesterone receptor where it has both antagonist and partial agonist effects. It is a new molecular entity and the first compound in a new pharmacological class defined by the pristal stem. Up on the superior clinical efficacy evidence, UPA has been quickly recognized as the most effective emergency contraceptive pill, and recently recommended as the first prescription choice for all women regardless of the age and timing after intercourse. This article provides literature review of UPA and its role in emergency contraception.

[The difficulties of contraception: conflicts and paradoxes].

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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

Emergency contraception - Potential for women′s health

Directory of Open Access Journals (Sweden)

Suneeta Mittal

2014-01-01

Full Text Available 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.

Pregnancy, contraceptive use, and HIV acquisition in HPTN 039: relevance for HIV prevention trials among African women.

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Reid, Stewart E; Dai, James Y; Wang, Jing; Sichalwe, Bupe N; Akpomiemie, Godspower; Cowan, Frances M; Delany-Moretlwe, Sinead; Baeten, Jared M; Hughes, James P; Wald, Anna; Celum, Connie

2010-04-01

Biomedical HIV prevention trials enroll sexually active women at risk of HIV and often discontinue study product during pregnancy. We assessed risk factors for pregnancy and HIV acquisition, and the effect of pregnancy on time off study drug in HIV Prevention Trials Network 039. A total of 1358 HIV negative, herpes simplex virus type 2-seropositive women from South Africa, Zambia, and Zimbabwe were enrolled and followed for up to 18 months. A total of 228 pregnancies occurred; time off study drug due to pregnancy accounted for 4% of woman-years of follow-up among women. Being pregnant was not associated with increased HIV risk (hazard ratio 0.64, 95% confidence interval 0.23-1.80, P = 0.40). However, younger age was associated with increased risk for both pregnancy and HIV. There was no association between condom use as a sole contraceptive and reduced pregnancy incidence; hormonal contraception was not associated with increased HIV risk. Bacterial vaginosis at study entry was associated with increased HIV risk (hazard ratio 2.03, P = 0.02). Pregnancy resulted in only a small amount of woman-time off study drug. Young women are at high risk for HIV and are an appropriate population for HIV prevention trials but also have higher risk of pregnancy. Condom use was not associated with reduced incidence of pregnancy.

Knowledge, Attitude and Practice of Emergency Contraception ...

African Journals Online (AJOL)

BACKGROUND: Emergency contraception refers to methods that women can use to prevent pregnancy after unprotected sexual intercourse, method failure or incorrect use. Unwanted pregnancy followed by unsafe abortion can be avoided by using different contraceptive methods including emergency contraceptives.

Contraception use and unplanned pregnancies among injection drug-using women in St Petersburg, Russia.

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Abdala, Nadia; Kershaw, Trace; Krasnoselskikh, Tatiana V; Kozlov, Andrei P

2011-07-01

This cross-sectional study estimated the prevalence of contraceptive methods and investigated whether abortion rates influence contraceptive behaviour among injection drug-using (IDU) women in St Petersburg, Russia. A self-administered questionnaire of behaviour in the last 3 months was applied to a convenient sample of IDU women. Of 80 sexually active participants, 67% had had an abortion. No participant reported using hormonal contraceptives or intrauterine devices (IUDs). The only valid method of contraception used was condoms, which was reported by half of the participants. Consistent condom use was reported by 22% of participants and was no more likely among those who had an abortion. Condom use was significantly associated with having multiple or casual sex partners [prevalence ratio (PR) 1.75, 95% (confidence interval) CI 1.11-2.78, p = 0.01], having an IDU sex partner (PR 0.55, 95% CI 0.36-0.85, p = 0.029) and with a negative attitude toward condoms (PR 0.53, 95% CI 0.33-0.84, p = 0.01). Abortions were less likely among those who had multiple or casual sex partners (PR 0.69, 95% CI 0.49-0.97, p = 0.03). Despite the high prevalence of abortions among IDU women, none reported the use of hormonal contraception or IUDs. Having had an abortion was not associated with greater likelihood of using condoms. Participants mostly used condoms with casual or multiple sex partners, suggesting that condoms were used mainly to prevent HIV/sexually transmitted infection transmission and not to prevent pregnancy. Programmes to prevent unwanted pregnancies and reduce abortion-related health risks among this understudied vulnerable group are needed.

Pregnancy-related anxiety and depressive symptoms are associated with visuospatial working memory errors during pregnancy.

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Kataja, E-L; Karlsson, L; Huizink, A C; Tolvanen, M; Parsons, C; Nolvi, S; Karlsson, H

2017-08-15

Cognitive deficits, especially in memory and concentration, are often reported during pregnancy. Similar cognitive dysfunctions can also occur in depression and anxiety. To date, few studies have investigated the associations between cognitive deficits and psychiatric symptoms during pregnancy. This field is of interest because maternal cognitive functioning, and particularly its higher-order aspects are related to maternal well-being and caregiving behavior, as well as later child development. Pregnant women (N =230), reporting low (n =87), moderate (n =97), or high (n =46) levels of depressive, general anxiety and/or pregnancy-related anxiety symptoms (assessed repeatedly with EPDS, SCL-90/anxiety subscale, PRAQ-R2, respectively) were tested in mid-pregnancy for their cognitive functions. A computerized neuropsychological test battery was used. Pregnant women with high or moderate level of psychiatric symptoms had significantly more errors in visuospatial working memory/executive functioning task than mothers with low symptom level. Depressive symptoms throughout pregnancy and concurrent pregnancy-related anxiety symptoms were significant predictors of the performance in the task. General anxiety symptoms were not related to visuospatial working memory. Cognitive functions were evaluated only at one time-point during pregnancy precluding causal conclusions. Maternal depressive symptoms and pregnancy-related anxiety symptoms were both associated with decrements in visuospatial working memory/executive functioning. Depressive symptoms seem to present more stable relationship with cognitive deficits, while pregnancy-related anxiety was associated only concurrently. Future studies could investigate, how stable these cognitive differences are, and whether they affect maternal ability to deal with demands of pregnancy and later parenting. Copyright © 2017 Elsevier B.V. All rights reserved.

Emergency contraception: clinical outcomes.

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Glasier, Anna

2013-03-01

Emergency contraception (EC) is widely used to prevent unwanted pregnancy. This review considers the safety and efficacy of three commonly used methods -- levonorgestrel (LNG-EC), ulipristal acetate (UPA) and the copper intrauterine device. All are extremely safe, and side effects are minimal. Concerns about increased risks of ectopic pregnancy after EC use have proved unfounded, and possible teratogenic effects seem unlikely. Although the true effectiveness of EC is impossible to estimate, recent research suggests that LNG-EC prevents around 50% of expected pregnancies in women using the method within 72 h of intercourse, whereas UPA appeared to prevent almost two thirds of pregnancies. Emergency intrauterine device insertion probably prevents over 95% of pregnancies. However, although improved accessibility of EC has clearly led to increased use, it does not appear to have had any public health benefit in reducing unintended pregnancy rates. Most of the data on sexual behavior following improved access to EC do not show any detrimental effect on subsequent use of other more effective methods of contraception or on the incidence of unintended pregnancy or sexually transmitted infection. However, unless these other methods of contraception are also made easily available from pharmacies, improved access to EC risks unlinking its use with use of subsequent ongoing contraception. Copyright © 2013 Elsevier Inc. All rights reserved.

First intercourse, contraception and first pregnancy in Flanders: changes during the past 30 years.

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Lodewijckx, E

1987-10-01

The investigation of women in Flanders born between 1931 and 1962 shows that premarital sexual intercourse has become almost general and that the age at the onset of sexual intercourse is steadily declining. Until the 1970s in spite of the improving contraceptive behavior of youngsters, the number of women experiencing premarital pregnancy increased and 1st conceptions occurred at an increasingly younger age. The 1970s marked a turning point: fewer women became pregnant before marriage or in adolescnece. From that time, the contraceptive revolution kept pace with the sexual revolution.

[The efficiency of oral contraception containing drospirenone in treating symptoms of premenstrual syndrome or premenstrual dysphoric disorder in gyneacology practice].

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Svojanovská, K

2010-10-01

The efficiency of oral contraception containing drospirenone in treating symptoms of premenstrual dysphoric disorder (PMDD) was demonstrated in a number of studies. The objective of this observation was to use the "Premenstrual Symptoms Screening Tool" (PSST) to identify women who suffer from severe premenstrual syndrome (PMS) or PMDD and evaluate the benefits of their treatment through using the oral contraceptive containing drospirenone in regime 24/4 in gyneacology practice. The retrospective study was conducted from September 2008 to August 2009. Fifty-one women met by the PSST (Premenstrual Symptoms Screening Tool, Steiner et. al., 2003) the criteria of severe PMS/PMDD. Twenty-eight women took no contraception at the start of the evaluation and twenty-three already took oral contraceptives before changing to the oral contraceptive with drospirenone. The women completed the PSST and in the case of severe PMS/PMDD started treatment with the oral contraceptive containing 20 microg ethinylestradiol /EE/ + 3 mg drospirenone /drsp/ in regime 24/4. The next evaluation was conducted by the same PSST after 3 or 4 months of treatment with this oral contraceptive. The study involved 51 women between the ages of 15 and 44 years (average 25.7 years), who completed the PSST before and after 3 or 4 months of treatment with the oral contraceptive containing drospirenone. The summary score of all subjects significantly decreased from 24.6 before they started using the oral contraceptive with drospirenone to 7,2 after 3 or 4 months of treatment with this oral contraceptive. Significant declines in summary scores have been shown in both groups (in the group without oral contraception from 24.9 at the start of the observation to 8.2 after 3 or 4 months of using this oral contraceptive with drospirenone; and from 24.3 to 6.0 in the group with the change from using various oral contraceptives to using the contraceptive containing drospirenone). The application of PSST for detection

Mechanisms of action of hormonal emergency contraceptives.

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Leung, Vivian W Y; Levine, Marc; Soon, Judith A

2010-02-01

Hormonal emergency contraceptives have been used to prevent unwanted pregnancy for more than 3 decades. The mechanisms of action of the regimen containing a combination of estrogen and progestin, known as the Yuzpe regimen, and those of the levonorgestrel regimen continue to be controversial, especially over the possibility that these regimens might act by interfering with implantation of the fertilized ovum. We performed a search of the PubMed (1949-July 2009) and EMBASE (1980-July 2009) databases to identify literature on the mechanisms of action of these contraceptive regimens, and data were extracted from pertinent English-language studies. We classified studies according to the approach taken by the investigators to study the actions of emergency contraceptives on pregnancy: an indirect method that uses statistical models to determine whether emergency contraceptives would be as effective as reported if they act only by disrupting ovulation; direct observation of the effects of emergency contraceptives on surrogate outcomes, including ovulation, sperm activity, hormonal levels, and endometrial receptivity to implantation; and analysis of directly observed pregnancy outcomes against statistical data. Acceptability of emergency contraceptives by women and clinicians may depend on personal opinions about when life or pregnancy begins. The evidence strongly supports disruption of ovulation as a mechanism of action. The data suggest that emergency contraceptives are unlikely to act by interfering with implantation, although the possibility has not been completely excluded. The data also suggest that emergency contraceptives are ineffective after ovulation. Women and clinicians who consider implantation or later events to be the beginning of pregnancy should be aware that emergency contraceptives are likely nonabortive by this definition of pregnancy.

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

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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

Impact of emergency contraception status on unintended pregnancy: observational data from a women’s health practice

Directory of Open Access Journals (Sweden)

Payakachat N

2010-09-01

Full Text Available Objective: This study aimed to determine if non-prescription emergency contraception (EC availability impacted self-reported unintended pregnancy rates and to assess women’s knowledge and awareness of EC prior to and after non-prescription availability.Methods: A survey regarding contraception use and knowledge was verbally administered to a cross-sectional, convenience sample of 272 pregnant women receiving prenatal care at a large urban community women’s clinic between August 2003 and October 2008. Statistical analyses determined the differences between two groups (before [BA] and after, [AA] non-prescription EC availability in the U.S. drug market in terms of self-reported unintended pregnancy rates, knowledge and awareness of EC.Results: The AA group reported higher incidence of unintended pregnancy when compared to the BA group (90.7% vs. 72.7%, P = 0.0172. The majority of both groups reported that they were not using any contraception at the time of conception (BA-84.4%; AA-83.3%. There was no significant difference in the participants’ awareness of EC between the two groups (BA-46.8% vs. AA-43.0% nor was there a significant difference between the two groups in the self-reported willingness to use EC in the future (BA-53.1% vs. AA-63.4%. However, among participants who were unaware of EC, 61% reported they would consider using it in the future after receiving brief EC counseling from a pharmacist or student pharmacist. Neither age nor pregnancy intention was associated with self-reported EC awareness but there was an association with income (P = 0.0410 and education (P = 0.0021.Conclusion: The change from prescription-only to non-prescription status of EC in the U.S. drug market did not impact the unintended pregnancy rate in this patient population. Lack of knowledge and awareness is still a major barrier to widespread EC use.

Hormonal emergency contraception: a clinical primer.

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Ziebarth, Angela; Hansen, Keith A

2007-03-01

Unintended and teenage pregnancies are major public health concerns in the United States. Emergency contraception is used to prevent pregnancy after failure of a contraceptive method or after unprotected intercourse. Expanded use of emergency contraception has the potential to reduce unintended pregnancy and induced abortions, while reducing state and federal healthcare expenditures. The recent approval of Plan B as an over-the-counter medication for individuals over 18 years of age should improve access to this medication. However, there are still widespread misconceptions about the mechanisms and implications of emergency contraception. Expanded access to emergency contraception is associated with increased use, but not associated with decreased efficacy, increased sexual risk-taking behavior, or less consistent use of traditional birth control methods. This review is designed to provide clinicians with information regarding the use of emergency contraception for reproductive age patients. It includes a brief description of methods of use, mechanisms of action, and side effect profiles of the most commonly used methods of emergency contraception, levonorgestrel and the Yuzpe method.

Postpartum Teenagers' Views on Providing Contraception in School-Based Health Clinics.

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Patel, Pooja R; Huynh, Michaela T; Alvarez, Crystal A; Jones, DaJonitta; Jennings, Kristofer; Snyder, Russell R

2016-01-01

To determine characteristics of teen pregnancies in southeast Texas and the opinions of postpartum teenagers with regard to having contraceptive services available in high school clinics. A cross-sectional study of postpartum teenagers interviewed during their hospital stay. Of 404 postpartum teenagers interviewed, 86% had unplanned pregnancies. Approximately 53% of respondents first had intercourse at less than 16 years of age. Of the 130 teenagers who had used contraception prior to pregnancy, 85% became pregnant because they were unable to visit the clinic to obtain a contraceptive refill or replacement. In multivariate modeling, factors associated with using contraceptives prior to pregnancy included black race (p teenagers surveyed, 223 (82%) were in favor of having contraceptive services offered in high school clinics. Contraceptive education is not sufficient to prevent teenage pregnancy. Increase in access is critical as teenagers with previous pregnancies were more likely to use contraception, likely due to their interaction with the medical community during the antecedent pregnancy. One possible solution is to bring contraceptive services to the teenagers, by offering them at school based health systems. A majority of teenagers surveyed in this study supported this proposal.

Update on emergency contraception.

Science.gov (United States)

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.

Cost-effectiveness of emergency contraception options over 1 year.

Science.gov (United States)

Bellows, Brandon K; Tak, Casey R; Sanders, Jessica N; Turok, David K; Schwarz, Eleanor B

2018-05-01

The copper intrauterine device is the most effective form of emergency contraception and can also provide long-term contraception. The levonorgestrel intrauterine device has also been studied in combination with oral levonorgestrel for women seeking emergency contraception. However, intrauterine devices have higher up-front costs than oral methods, such as ulipristal acetate and levonorgestrel. Health care payers and decision makers (eg, health care insurers, government programs) with financial constraints must determine if the increased effectiveness of intrauterine device emergency contraception methods are worth the additional costs. We sought to compare the cost-effectiveness of 4 emergency contraception strategies-ulipristal acetate, oral levonorgestrel, copper intrauterine device, and oral levonorgestrel plus same-day levonorgestrel intrauterine device-over 1 year from a US payer perspective. Costs (2017 US dollars) and pregnancies were estimated over 1 year using a Markov model of 1000 women seeking emergency contraception. Every 28-day cycle, the model estimated the predicted number of pregnancy outcomes (ie, live birth, ectopic pregnancy, spontaneous abortion, or induced abortion) resulting from emergency contraception failure and subsequent contraception use. Model inputs were derived from published literature and national sources. An emergency contraception strategy was considered cost-effective if the incremental cost-effectiveness ratio (ie, the cost to prevent 1 additional pregnancy) was less than the weighted average cost of pregnancy outcomes in the United States ($5167). The incremental cost-effectiveness ratios and probability of being the most cost-effective emergency contraception strategy were calculated from 1000 probabilistic model iterations. One-way sensitivity analyses were used to examine uncertainty in the cost of emergency contraception, subsequent contraception, and pregnancy outcomes as well as the model probabilities. In 1000 women

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

Science.gov (United States)

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

Contraceptive challenges experienced by women who requested ...

African Journals Online (AJOL)

... of contraceptives over weekends and during lunch breaks could enable more women to prevent unwanted pregnancies, reducing the number of requests for TOP services. Keywords: abortions; accessibility of contraceptives; contraceptive challenges; contraceptives' side-effects; emergency contraceptives; termination of ...

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

Directory of Open Access Journals (Sweden)

Anthony Idowu Ajayi

2016-10-01

Full Text Available Abstract Background 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. Methods 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. Results 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. Conclusions 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.

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

Science.gov (United States)

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.

Contraception for the older woman.

Science.gov (United States)

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.

Association between knowledge about levonorgestrel emergency contraception and the risk of ectopic pregnancy following levonorgestrel emergency contraception failure: a comparative survey.

Science.gov (United States)

Zhang, Duo; Yan, Ming-Xing; Ma, Jue; Xia, Wei; Xue, Rui-Hong; Sun, Jing; Zhang, Jian

2016-08-01

To study the association between knowledge about levonorgestrel emergency contraception (LNG-EC) and the risk of ectopic pregnancy (EP) following LNG-EC failure. This study included 600 women who had visited the hospital with LNG-EC failure. Of these, 300 with EP and 300 with intrauterine pregnancy (IUP) were recruited to the EP group and IUP group respectively. The participants were interviewed face-to-face using a standardized questionnaire. Pearson's chi-square tests and t-test were used to compare the sociodemographic characteristics, reproductive and gynecological history, surgical history, previous contraceptive experience, and answers to 10 questions concerning the knowledge about LNG-EC. Those who gave incorrect answers to the question regarding the basic mechanism and specific method of levonorgestrel emergency contraceptive pills (LNG-ECPs) were at a higher risk of EP after LNG-EC failure. Women who did not strictly follow instructions or advice from healthcare professionals were more likely to subsequently experience EP (p < 10(-4) ). Women with LNG-EC failure reported friends/peers, TV, and Internet as the main sources of information. No difference was observed with regard to the sources of knowledge on LNG-EC (p = 0.07). The results illustrate the importance of strictly following the doctor's guidance or drug instructions when using LNG-ECPs. The media should be used to disseminate information about responsible EC, and pharmacy staff should receive regular educational training sessions in this regard. © 2016 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd. © 2016 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd.

Parent and Peer Influence on Sexual Behavior, Contraceptive Use, and Pregnancy Experience of Young Women.

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Shah, Farida; Zelnik, Melvin

1981-01-01

Analyzed data from a national probability sample of 15 through 19-year-old women to determine the influence of parents and peers on premarital sexual behavior, contraceptive use, and premarital pregnancy. Results show women with views resembling those of parents have low levels of premarital experience. (Author)

Contraception.

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Bourne, G L

1967-01-01

Contraception is discussed in this article. Abstinence is the only certain method of contraception. The normal pregnancy rate in the normal unprotected population would be somewhere between 60 to 80 pregnancies per 100 woman-years. Contraceptive methods vary in effectiveness. The failure rate of the safe period method is between 10-50 per 100 woman-years while the failure rate of spermicidal pessaries and creams is somewhere between 20 and 80 per 100 woman-years. Occlusive diaphragms fit over the anterior vaginal wall, such as the Dutch cap, or over the cervix itself, such as the cervical or Dumas cap. The failure rate of the Dumas cap is about 4 per 100 woman-years and the Dutch cap 6 per 100 woman-years. Perhaps the ideal female contraceptive is just around the corner in the alteration of cervical mucus by changing its pH or other constituents so that it becomes a spermicidal barrier or causes either sperm agglutination or a reduction of sperm motility. Between 8% and 15% of plastic IUDs are extruded spontaneously and a further 10% may be removed because of pain, intermenstrual bleeding, or menorrhagia. They are well tolerated in about 80% of patients, in whom the failure rate is about 2 per 100 woman years. The douche and sponge are unacceptable and unreliable methods of contraception. The main advance in contraceptive technique over the past 10 years has been the introduction of the oral contraceptives. The combined type of pill was developed first, followed by the sequential type. It has been estimated that between half a million and 1 million women in this country now take oral contraceptive pills and nothing detrimental has so far been proved about the method in spite of persistent and widely published doubts about its possible dangers. The failure rate of the oral contraceptives is less than 1 per 100 woman years.

Maternal use of oral contraceptives and risk of fetal death

DEFF Research Database (Denmark)

Jellesen, R.; Strandberg-Larsen, Katrine; Jørgensen, Torben

2008-01-01

Intrauterine exposure to artificial sex hormones such as oral contraceptives may be associated with an increased risk of fetal death. Between 1996 and 2002, a total of 92 719 women were recruited to The Danish National Birth Cohort and interviewed about exposures during pregnancy. Outcome.......2%) women took oral contraceptives during pregnancy. Use of combined oestrogen and progesterone oral contraceptives (COC) or progesterone-only oral contraceptives (POC) during pregnancy was not associated with increased hazard ratios of fetal death compared with non-users, HR 1.01 [95% CI 0.71, 1.45] and HR...... 1.37 [95% CI 0.65, 2.89] respectively. Neither use of COC nor POC prior to pregnancy was associated with fetal death. Stratification by maternal age and smoking showed elevated risks of fetal death for women contraception during pregnancy, but the interactions were...

Unwanted pregnancies and Contraception in Chronic Renal Failure: A Case Report and Review of the Literature

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Batuhan Özmen

2006-06-01

Full Text Available Pregnancy is a rare condition in patients requiring dialysis with end-stage chronic renal disease (CRD. However successful pregnancies were reported in CRD, patients are encountering with great number of complications and aggressive acceleration\tof CRD by achieving pregnancy. The most crucial topic is unwanted pregnancies of these patients due to high complication rates described in the literature. Thus many authors were discussing safety of contraception in CRD patients requiring dialysis (hemodialysis, peritoneal dialysis and in patients with renal transplant. In this report medical termination of a twenty-two weeks gestational age unwanted pregnancy that was complicated with aggressive hypertension and severe renal insufficiency under\tdialysis in a 38 years-old end-stage CRD patient was reported.

Contraceptive use before first pregnancy by women in India (2005-2006): determinants and differentials.

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Pandey, Anjali; Singh, K K

2015-12-29

There exist ample of research literature investigating the various facet of contraceptive use behaviors in India but the use of contraception by married Indian women, prior to having their first pregnancy has been neglected so far. This study attempts to identify the socio demographic determinants and differentials of contraceptive use or non use by a woman in India, before she proceeds to have her first child. The analysis was done using data from the third National Family Health Survey (2005-2006), India. This study utilized information from 54,918 women who ever have been married and whose current age at the time of NFHS-3 survey was 15-34 years. To identify the crucial socio-demographic determinants governing this pioneering behavior, logistic regression technique has been used. Hosmer Lemeshow test and ROC curve analysis was also performed in order to check the fitting of logistic regression model to the data under consideration. Of all the considered explanatory variables religion, caste, education, current age, age at marriage, media exposure and zonal classifications were found to be significantly affecting the study behavior. Place of residence i.e. urban--rural locality came to be insignificant in multivariable logistic regression. In the light of sufficient evidences confirming the presence of early marriages and child bearing practices in India, conjunct efforts are required to address the socio demographic differentials in contraceptive use by the young married women prior to their first pregnancy. Encouraging women to opt for higher education, ensuring marriages only after legal minimum age at marriage and promoting the family planning programs via print and electronic media may address the existing socio economic barriers. Also, the family planning programs should be oriented to take care of the geographical variations in the study behavior.

Identification of risk factors and perspectives of adolescents regarding pregnancy, sexuality and contraception

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Janette Carrillo Soto

2018-04-01

Full Text Available Aims: Describe the risk factors and perspectives of adolescents regarding pregnancy, sexuality and contraception at the Hospital General de Jerez, Zacatecas. Material and methods. Transversal, observational and descriptive study. The population consisted of 137 teenagers or young mothers with a history of pregnancy who attended a consultation in the General Hospital of Jerez and who were between 14 and 22 years old. Results. The average age of the 137 adolescents surveyed was 19.8 ± 1.9 years. 56.2% were single, 68.5% have primary and/or secondary, 75.9% of them depended economically on their father before getting pregnant and currently only 34.3% of them Conclusion. The information regarding the risks of pregnancy in adolescents presented in this document is insufficient. It is necessary to reinforce in schools, community health centers, hospitals, neighborhoods and homes, preventive education to avoid pregnancy at an early age and that this brings consequences for the adolescent mother, the child and her family.

Budget impact analysis of 8 hormonal contraceptive options.

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Crespi, Simone; Kerrigan, Matthew; Sood, Vipan

2013-07-01

To develop a model comparing costs of 8 hormonal contraceptives and determine whether acquisition costs for implants and intrauterine devices (IUDs) were offset by decreased pregnancy-related costs over a 3-year time horizon from a managed care perspective. A model was developed to assess the budget impact of branded or generic oral contraceptives (OCs), quarterly intramuscular depot medroxyprogesterone, etonogestrel/ethinyl estradiol vaginal ring, etonogestrel implant, levonorgestrel IUD, norelgestromin/ethinyl estradiol transdermal contraceptive, and ethinyl estradiol/levonorgestrel extended-cycle OC. Major variables included drug costs, typical use failure rates, discontinuation rates, and pregnancy costs. The base case assessed costs for 1000 women initiating each of the hormonal contraceptives. The etonogestrel implant and levonorgestrel IUD resulted in the fewest pregnancies, 63 and 85, respectively, and the least cost, $1.75 million and $2.0 million, respectively. In comparison, generic OC users accounted for a total of 243 pregnancies and $3.4 million in costs. At the end of year 1, costs for the etonogestrel implant ($800,471) and levonorgestrel IUD ($949,721) were already lower than those for generic OCs ($1,146,890). Sensitivity analysis showed that the cost of pregnancies, not product acquisition cost, was the primary cost driver. Higher initial acquisition costs for the etonogestrel implant and levonorgestrel IUD were offset within 1 year by lower contraceptive failure rates and consequent pregnancy costs. Thus, after accounting for typical use failure rates of contraceptive products, the etonogestrel implant and levonorgestrel IUD emerged as the least expensive hormonal contraceptives.

Protective Factors, Risk Indicators, and Contraceptive Consistency Among College Women.

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Morrison, Leslie F; Sieving, Renee E; Pettingell, Sandra L; Hellerstedt, Wendy L; McMorris, Barbara J; Bearinger, Linda H

2016-01-01

To explore risk and protective factors associated with consistent contraceptive use among emerging adult female college students and whether effects of risk indicators were moderated by protective factors. Secondary analysis of National Longitudinal Study of Adolescent to Adult Health Wave III data. Data collected through in-home interviews in 2001 and 2002. National sample of 18- to 25-year-old women (N = 842) attending 4-year colleges. We examined relationships between protective factors, risk indicators, and consistent contraceptive use. Consistent contraceptive use was defined as use all of the time during intercourse in the past 12 months. Protective factors included external supports of parental closeness and relationship with caring nonparental adult and internal assets of self-esteem, confidence, independence, and life satisfaction. Risk indicators included heavy episodic drinking, marijuana use, and depression symptoms. Multivariable logistic regression models were used to evaluate relationships between protective factors and consistent contraceptive use and between risk indicators and contraceptive use. Self-esteem, confidence, independence, and life satisfaction were significantly associated with more consistent contraceptive use. In a final model including all internal assets, life satisfaction was significantly related to consistent contraceptive use. Marijuana use and depression symptoms were significantly associated with less consistent use. With one exception, protective factors did not moderate relationships between risk indicators and consistent use. Based on our findings, we suggest that risk and protective factors may have largely independent influences on consistent contraceptive use among college women. A focus on risk and protective factors may improve contraceptive use rates and thereby reduce unintended pregnancy among college students. Copyright © 2016 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published

The Role of Patient Activation in Contraceptive Use.

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Bello, Jennifer K; Lapin, Brittany; Poston, Lindsay; Hirshfeld, Meredith; Hosack, Allison

2016-01-01

Many unintended pregnancies occur due to to contraceptive misuse and nonuse, which is partly due to to lack of knowledge and low self-efficacy related to contraception. We conducted an exploratory, cross-sectional study among low-income women to examine the relationship between knowledge, skills, and confidence in managing one's health, measured using the Patient Activation Measure (PAM) and factors that influence contraceptive use. A survey and chart review were conducted among 18- to 45-year-old women from a community health center in Chicago, Illinois, to measure the relationship between activation, self-confidence in avoiding pregnancy, contraception use, and contraceptive counseling. Associations between PAM and outcomes were evaluated using the χ(2) test and adjusted logistic regression models. Among 112 participants (61% Latina, 15% Black, 14% White), we found no differences in PAM by age, race/ethnicity, or parity. Women with higher PAM were more likely to be confident they could avoid pregnancy compared with women with lower PAM (50% vs. 7%; p = .02). Higher PAM remained a significant predictor for self-confidence after risk adjustment (odds ratio, 3.13; 95% CI, 1.11-8.78; p = .031). Greater confidence in avoiding pregnancy was associated with using a moderately or highly effective contraceptive method (43% vs. 14%; p = .047). Women with lower PAM were less likely to receive contraceptive counseling in the prior month (0% vs. 57%; p influence women's contraceptive use, including self-confidence in avoiding pregnancy until it is desired and receiving contraceptive services in primary care. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Sexual and Contraceptive Behaviors among Adolescents Requesting Emergency Contraception.

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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 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.

Factors associated with unintended pregnancy, poor birth outcomes and post-partum contraceptive use among HIV-positive female adolescents in Kenya.

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Obare, Francis; van der Kwaak, Anke; Birungi, Harriet

2012-10-06

Although the experiences of unintended pregnancies and poor birth outcomes among adolescents aged 15-19 years in the general population are well documented, there is limited understanding of the same among those who are living with HIV. This paper examines the factors associated with experiencing unintended pregnancies, poor birth outcomes, and post-partum contraceptive use among HIV-positive female adolescents in Kenya. Data are from a cross-sectional study that captured information on pregnancy histories of HIV-positive female adolescents in four regions of Kenya: Coast, Nairobi, Nyanza and Rift Valley provinces. Study participants were identified through HIV and AIDS programs in the four regions. Out of a total of 797 female participants, 394 had ever been pregnant with 24% of them experiencing multiple pregnancies. Analysis entails the estimation of random-effects logit models. Higher order pregnancies were just as likely to be unintended as lower order ones (odds ratios [OR]: 1.2; 95% confidence interval [CI]: 0.8-2.0) while pregnancies occurring within marital unions were significantly less likely to be unintended compared to those occurring outside such unions (OR: 0.1; 95% CI: 0.1-0.2). Higher order pregnancies were significantly more likely to result in poor outcomes compared to lower order ones (OR: 2.5; 95% CI: 1.6-4.0). In addition, pregnancies occurring within marital unions were significantly less likely to result in poor outcomes compared to those occurring outside such unions (OR: 0.3; 95% CI: 0.1-0.9). However, experiencing unintended pregnancy was not significantly associated with adverse birth outcomes (OR: 1.3; 95% CI: 0.5-3.3). There was also no significant difference in the likelihood of post-partum contraceptive use by whether the pregnancy was unintended (OR: 0.9; 95% CI: 0.5-1.5). The experience of repeat unintended pregnancies among HIV-positive female adolescents in the sample is partly due to inconsistent use of contraception to prevent

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

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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.

Knowledge, attitude, and practice of emergency contraception ...

African Journals Online (AJOL)

Background: The contraceptive prevalence in our environment is very low with attendant increase in unwanted pregnancy and unsafe abortion. The use of emergency contraception (EC) in women with unprotected intercourse could be the only option that can avoid the unwanted pregnancy and unsafe abortion. Objective: ...

Advance Provision of Emergency Contraception for Adolescents

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Adamji, Jehan-Marie; Swartwout, Kathryn

2010-01-01

Emergency contraception is most effective at preventing unintended pregnancy when taken as early as possible following unprotected sexual intercourse. Advance provision of this medication supports more timely and effective use. In the midst of rising teen pregnancy rates, current policies often limit access to emergency contraception for…

Association between long-acting reversible contraceptive use, teenage pregnancy, and abortion rates in England

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Connolly A

2014-11-01

Full Text Available Anne Connolly,1 Guilhem Pietri,2 Jingbo Yu,3 Samantha Humphreys4 1The Ridge Medical Practice, Cousen Road, Bradford, UK; 2HERON – A PAREXEL® Company, London, UK; 3Merck & Co, Inc., Whitehouse Station, NJ, USA; 4Merck Sharp & Dohme Limited, Hertfordshire, UK Background: Since the late 1990s, the British government has launched major strategies to address high teenage pregnancy and abortion rates in England. These have focused in part on improving access to contraception through national campaigns. This study assessed teenage pregnancy and abortion rate trends since 1998 and possible associations with usage of long-acting reversible contraceptives (LARCs. Methods: Teenage conception rates and age-specific abortion rates were obtained from the Office for National Statistics and the Department of Health. LARC usage data was obtained for Depo-Provera, Implanon/Nexplanon, intrauterine devices, Mirena, and Noristerat from the IMS British Pharmaceutical Index, IMS Hospital Pharmacy Audit, IMS Disease Analyzer, and KT-31 reports. Through linear regression methods, changes in conception and abortion-related outcomes during 1998–2011 and the associations with LARC usage were assessed. Results: Conception rates for girls younger than 18 years of age decreased significantly between 1998–2011, from 46.6 to 30.7 per 1,000 girls. A statistically significant association was observed between this decrease and increased LARC usage (P=0.0024 in this population. Abortion rates among females aged <18 years or aged 18–19 years decreased between 1998–2011, and their associations with increased LARC usage were statistically significant (P=0.0029 and P=0.0479, respectively. The pattern in older women was complex; abortion rates in women aged 20–24 years or 25–34 years increased slightly from 1998 to 2011, with stabilization during 2007–2011. Conclusion: Increased LARC usage in England was significantly associated with decreased teenage pregnancy rates

Emergency contraception – a neglected option for birth control

Directory of Open Access Journals (Sweden)

Eka R. Gunardi

2013-12-01

Full Text Available Emergency contraception (EC is any method of contraception which is used after intercourse and before the potential time of implantation, in order to prevent pregnancy after an unprotected or inadequately protected sexual intercourse, or cases of rape. Use of emergency contraception could halve the number of unintended pregnancies and the consequent need for abortion, but unfortunately many medical professionals and the public are not aware of it. Two methods are available for emergency contraception, namely emergency contraception pills (ECPs and copper-bearing intrauterine devices (Cu-IUDs. There are two regimens of ECP, the levonorgestrel regimen and combined regimen. The levonorgestrel regimen is preferred as it is more effective and causes less side effects. ECPs should be administered as soon as possible after unprotected or inadequately protected sex, being most effective if initiated within 24 hours. Cu-IUDs can be inserted up to 5 days after unprotected sexual intercourse. Emergency contraception mainly works by preventing fertilization, and does not interrupt and established pregnancy. Emergency contraception is very safe, therefore can be offered to women who have had unprotected intercourse and wish to prevent pregnancy. It must only be used as a backup method of birth control. (Med J Indones. 2013;22:248-52. doi: 10.13181/mji.v22i4.609Keywords: Birth control, copper-IUD, emergency contraception, emergency contraceptive pills, levonorgestrel

Sleep disturbances and binge eating disorder symptoms during and after pregnancy.

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Ulman, T Frances; Von Holle, Ann; Torgersen, Leila; Stoltenberg, Camilla; Reichborn-Kjennerud, Ted; Bulik, Cynthia M

2012-10-01

We compared sleep problems during pregnancy and sleep dissatisfaction 18 months after pregnancy in pregnant women with binge eating disorder (BED) symptoms and pregnant women without an eating disorder. Norwegian Mother and Child Cohort Study (MoBa). Data were gathered from 72,435 women. A total of 1,495 (2.1%) women reported having BED symptoms both before and during pregnancy; 921 (1.3%) reported pre-pregnancy BED symptoms that remitted during pregnancy; 1,235 (1.7%) reported incident BED symptoms during pregnancy; and 68,784 (95.0%) reported no eating disorder symptoms before or during pregnancy (referent). Questionnaires were collected at 3 time points, with a median completion time of 17.1 weeks gestation, 30.1 weeks gestation, and 18.7 months after childbirth. We collected information on demographics, eating disorder status before and during pregnancy, sleep problems during the first 18 weeks of pregnancy, hours of sleep during the third trimester, and sleep satisfaction 18 months after childbirth. All BED symptom groups were significantly more likely to report sleep problems during the first 18 weeks of pregnancy than the referent (adjusted odds ratio [OR] = 1.26-1.42, false discovery rate [FDR] P sleep than the referent (adjusted OR = 1.49, FDR P sleep 18 months after childbirth (adjusted ORs = 1.28-1.47, FDR P sleeping problems during pregnancy and dissatisfaction with sleep 18 months after childbirth. Health care professionals should inquire about BED during pregnancy as it may be associated with sleep disturbances, in addition to the hallmark eating concerns.

Strategies for communicating contraceptive effectiveness.

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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

Noncontraceptive use of contraceptive agents.

Science.gov (United States)

Nickles, Monique Collier; Alderman, Elizabeth

2014-06-01

• On the basis of strong research evidence, there are many noncontraceptive advantages to use of hormonal contraceptive agents in adolescent girls. (3) (4)(5)(7)(10)(11)(12)(13)(14). • On the basis of research evidence and consensus, most of these agents are safe with minor adverse effects. (2)(3)(4)(5)(7)(10)(11)(12)(13)(14). • On the basis of research evidence and consensus, through application of evidence-based approaches and proper counseling, pediatricians can use various contraceptive agents to treat several medical conditions and to help alleviate many of the undesired symptoms and complications associated with menstrual periods. (2)(3)(4)(5)(7)(10)(11)(12)(13) (14). • On the basis of research evidence and consensus, these agents may be used in sexually active adolescents to simultaneously help prevent unintended adolescent pregnancies. (2)(3)(4)(5)(7)(10)(11)(12)(13)(14).

Oral contraceptives induced hepatotoxicity

OpenAIRE

B. Akshaya Srikanth; V. Manisree

2013-01-01

Oral Contraceptives are the pharmacological agents used to prevent pregnancy. These are divided as the combined and progestogen methods and are administered orally, transdermally, systemically and via vaginal route. All these methods contain both oestrogen and progestogen. Vigorous usage of oral contraceptives and anabolic steroids as associated with cholestasis, vascular lesions and hepatic neoplasm. Benign hepatic neoplasms are clearly associated with oral contraceptives. In this article we...

Long-acting reversible contraceptives: intrauterine devices and the contraceptive implant.

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Espey, Eve; Ogburn, Tony

2011-03-01

The provision of effective contraception is fundamental to the practice of women's health care. The most effective methods of reversible contraception are the so-called long-acting reversible contraceptives, intrauterine devices and implants. These methods have multiple advantages over other reversible methods. Most importantly, once in place, they do not require maintenance and their duration of action is long, ranging from 3 to 10 years. Despite the advantages of long-acting reversible contraceptive methods, they are infrequently used in the United States. Short-acting methods, specifically oral contraceptives and condoms, are by far the most commonly used reversible methods. A shift from the use of short-acting methods to long-acting reversible contraceptive methods could help reduce the high rate of unintended pregnancy in the United States. In this review of long-acting reversible contraceptive methods, we discuss the intrauterine devices and the contraceptive implant available in the United States, and we describe candidates for each method, noncontraceptive benefits, and management of complications.

Missed Opportunities: Emergency Contraception Utilisation by ...

African Journals Online (AJOL)

Although contraceptives, including emergency contraceptives, are widely available free at public health facilities in South Africa, rates of teenage and unintended pregnancy are high. This paper analyses awareness and utilisation of emergency contraception amongst 193 young women (aged 15-24 years) attending public ...

Unmet need for contraception among sex workers in Madagascar☆,☆☆

Science.gov (United States)

Khan, Maria R.; Turner, Abigail Norris; Pettifor, Audrey; Van Damme, Kathleen; Rabenja, Ny Lovaniaina; Ravelomanana, Noro; Swezey, Teresa; Williams, D’Nyce; Jamieson, Denise; Behets, Frieda

2018-01-01

Background The study was conducted to investigate past and future pregnancy preferences and contraceptive need among Malagasy sex workers. Study Design We analyzed data on pregnancy and contraceptive use collected during the baseline visit of a randomized, prospective formative trial which assessed diaphragm and microbicide acceptability among sex workers. To be eligible, women could not be pregnant or planning pregnancy for the next 2 months. Results Women (N=192) from four cities (Antananarivo, Antsiranana, Mahajanga and Toamasina) reported a median of 10 sex acts per week. Fifty-two percent reported a prior unwanted pregnancy, 45% at least one induced abortion and 86% that preventing future pregnancy was moderately to very important. During the last sex act, 24% used a hormonal method, 36% used a male condom, 2% used a traditional method and 38% used no method. Nearly 30% of participants reported that pregnancy prevention was moderately or very important but used no contraception at last sex; these women were categorized as having “unmet need” for contraception. In multivariable binomial regression analyses, factors associated with unmet need included low knowledge of contraceptive effectiveness [age- and site-adjusted prevalence ratio (PR): 2.1; 95% confidence interval (CI): 1.4–3.0] and low self-efficacy to negotiate condom use (age- and site-adjusted PR: 2.0; 95% CI: 1.4–3.0). Conclusions Among these women, prior unwanted pregnancy and induced abortion were common and preventing future pregnancy was important, yet gaps in contraceptive use were substantial. Contraceptive knowledge and self-efficacy should be improved to promote contraceptive use by sex workers. PMID:19185677

Impact of Hypnosis Intervention in Alleviating Psychological and Physical Symptoms During Pregnancy.

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Beevi, Zuhrah; Low, Wah Yun; Hassan, Jamiyah

2016-04-01

Physical symptoms (e.g., vomiting) and psychological symptoms (stress, anxiety, and depression) during pregnancy are common. Various strategies such as hypnosis are available to reduce these symptoms. The objective of the authors in this study is to investigate the impact of a hypnosis intervention in reducing physical and psychological symptoms during pregnancy. A pre-test/post-test quasi-experimental design was employed in this study. The hypnosis intervention was given to the experimental group participants at weeks 16 (baseline), 20 (time point 1), 28 (time point 2), and 36 (time point 3) of their pregnancy. Participants in the control group received only the traditional antenatal care. Participants from both groups completed the Depression Anxiety Stress Scale-21 (DASS-21) and a Pregnancy Symptoms Checklist at weeks 16, 20, 28 and 36 of pregnancy. Results indicated that stress and anxiety symptoms were significantly reduced for the experimental group, but not for the control group. Although mean differences for the depressive symptoms were not significant, the experimental group had lower symptoms at time point 3. The physical symptoms' results showed significant group differences at time point 3, indicating a reduction in the experience of physical symptoms for the experimental group participants. Our study showed that hypnosis intervention during pregnancy aided in reducing physical and psychological symptoms during pregnancy.

Contraceptive practices of women in Northern Tshwane, Gauteng ...

African Journals Online (AJOL)

Although most participants knew about legalised termination of pregnancy services in the RSA, they didnot know how to access these services. The recommendations address ways in which contraceptive services could be improved. Keywords: adolescents\\' contraceptive use; emergency contraception; contraception; ...

Maternal adiposity prior to pregnancy is associated with ADHD symptoms in offspring: evidence from three prospective pregnancy cohorts

DEFF Research Database (Denmark)

Rodriguez, A; Miettunen, J.; Henriksen, Tine Brink

2007-01-01

Objectives:We examine whether pregnancy weight (pre-pregnancy body mass index (BMI) and/or weight gain) is related to core symptoms of attention deficit hyperactivity disorder (ADHD) in school-age offspring.Design:Follow-up of prospective pregnancy cohorts from Sweden, Denmark and Finland within...... in this range). Logistic regression and latent class analyses were used to examine maternal pregnancy weight in relation to children's ADHD core symptoms.Results:Teacher rated 12 556 school-aged children. Gestational weight gain outside of the Institute of Medicine guidelines was not related to ADHD symptoms...... the Nordic Network on ADHD.Methods:Maternal pregnancy and delivery data were collected prospectively. Teachers rated inattention and hyperactivity symptoms in offspring. High scores were defined as at least one core symptom rated as 'severe' and two as 'present' (approximately 10% of children scored...

Swedish teenager perceptions of teenage pregnancy, abortion, sexual behavior, and contraceptive habits--a focus group study among 17-year-old female high-school students.

Science.gov (United States)

Ekstrand, Maria; Larsson, Margareta; Von Essen, Louise; Tydén, Tanja

2005-10-01

Sweden has the highest abortion numbers among the Nordic countries. Since 1995, the abortion rate among teenagers has increased by nearly 50%. We therefore undertook a study where the overall aim was to gain a deeper understanding on which factors female teenagers believe may explain the increasing numbers of teenage abortions. Teenagers' perceptions of teenage pregnancy, abortion, sexual behavior, and contraceptive habits were investigated. Six focus group interviews with 17-year-old Swedish girls were conducted. The interviews were tape-recorded, transcribed verbatim, and analyzed by manifest content analysis. Negative attitudes toward teenage pregnancy and supportive attitudes toward abortion were expressed. Risk-taking behaviors such as negligence in contraceptive use and intercourse under the influence of alcohol were suggested as main reasons behind the increasing numbers of abortions among Swedish teenagers. The contemporary, sexualized, media picture was believed to influence adolescents' sexual behavior, and liberal attitudes toward casual sex were expressed. Girls were perceived as more obliged than boys in taking responsibility for contraceptive compliance and avoidance of pregnancy. The apprehension that hormonal contraceptives cause negative side-effects was widely spread, and the participants were found to have a somewhat limited knowledge of abortion. The majority were unsatisfied with the quality of sexual education provided by the schools. Possible reasons for increased abortion numbers among teenagers in Sweden could be liberal attitudes toward casual sex in combination with negligence in contraceptive use, use of alcohol followed by sexual risk-taking, fear of hormonal contraceptives, and a deterioration of sexual education in the schools.

Falling short of universal access to reproductive health: unintended pregnancy and contraceptive use among Mexican women with HIV.

Science.gov (United States)

Kendall, Tamil

2013-01-01

A favourable context for women with HIV to prevent unintended pregnancy is a cornerstone of reproductive rights and will contribute to achieving universal access to reproductive health, a Millennium Development Goal target. This analysis explores the reproductive trajectories of Mexican women with HIV post-diagnosis and their access to reproductive counselling and use of contraceptives. In-depth interviews and short surveys were conducted with women of reproductive age living with HIV. Results indicate that sexual and reproductive health counselling in HIV care focuses on the male condom and does not routinely address reproductive desires or provide information about or access to other contraceptive methods. Unintended pregnancies result from inconsistent condom use and condom breakage. Women experienced discriminatory denial of and pressure to accept particular contraceptive methods because of their HIV status. Mexican women with HIV are not enjoying their constitutionally guaranteed right to freely choose the number and spacing of their children. Mexico's commitment to reproductive rights and the Popular Health Insurance offer policy and financial frameworks for providing family planning services in public HIV clinics. To ensure respectful implementation, rights-based training for HIV healthcare providers and careful monitoring and evaluation will be needed.

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

Science.gov (United States)

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.

Pregnancy Intention and Contraceptive Use among Women by Class of Obesity: Results from the 2006-2010 and 2011-2013 National Survey of Family Growth.

Science.gov (United States)

Nguyen, Brian T; Elia, Jennifer L; Ha, Cathrine Y; Kaneshiro, Bliss E

Conflicting research findings on the association of obesity and pregnancy intention may be due to their collective definition of obesity at a body mass index of 30 kg/m 2 or greater. However, obese women with a BMI of 40 kg/m 2 or greater may be both behaviorally and clinically different from obese women with a lower BMI. This study reexamines this relationship, stratifying by class of obesity; the study also explores variations in contraceptive use by class of obesity given their potential contribution to the incidence of unintended or unwanted pregnancy. This study combined data from the 2006 through 2010 and 2011 through 2013 US National Survey of Family Growth. Pregnancy intention (intended, mistimed, unwanted) and current contraceptive use (no method, barrier, pill/patch/ring/injection, long-acting reversible contraceptive, sterilization) were compared across body mass index categories: normal (18.5-24.9 kg/m kg/m 2 ), overweight (25.0-29.9), obese class 1 (30.0-34.9 kg/m 2 ), class 2 (35.0-39.9 kg/m 2 ), and class 3 (≥40 kg/m 2 , severe obesity). Weighted multinomial logistic regressions were refined to determine independent associations of body mass index class and pregnancy intention, as well as contraceptive method, controlling for demographic, socioeconomic, and reproductive factors. Body mass index data were available for 9,848 nonpregnant, sexually active women who reported not wanting to become pregnant. Women with class 3 obesity had significantly greater odds of mistimed (adjusted odd ratio [aOR], 1.67; 95% confidence interval [CI], 1.02-2.75) or unwanted (aOR, 1.96; 95% CI, 1.15-3.32) pregnancy compared with normal weight women. Women with class 2 or 3 obesity were more likely to not be using contraception (aOR, 1.53-1.62; 95% CI, 1.04-2.29). Although women with class 2 obesity were more likely to be using long-acting reversible contraceptive methods and sterilization over short-acting hormonal methods (aOR, 1.67; 95% CI, 1.08-2.57; aOR, 2

Contraception and cardiovascular disease

NARCIS (Netherlands)

Roos-Hesselink, JolienW.; Cornette, Jerome; Sliwa, Karen; Pieper, Petronella G.; Veldtman, Gruschen R.; Johnson, Mark R.

2015-01-01

Contraceptive counselling should begin early in females with heart disease, preferably directly after the start of menstruation. In coming to a decision about the method of contraception, the following issues should be considered: (i) the risk of pregnancy for the mother and the consequences of an

Factors associated with unintended pregnancy, poor birth outcomes and post-partum contraceptive use among HIV-positive female adolescents in Kenya

Directory of Open Access Journals (Sweden)

Obare Francis

2012-10-01

Full Text Available Abstract Background Although the experiences of unintended pregnancies and poor birth outcomes among adolescents aged 15–19 years in the general population are well documented, there is limited understanding of the same among those who are living with HIV. This paper examines the factors associated with experiencing unintended pregnancies, poor birth outcomes, and post-partum contraceptive use among HIV-positive female adolescents in Kenya. Methods Data are from a cross-sectional study that captured information on pregnancy histories of HIV-positive female adolescents in four regions of Kenya: Coast, Nairobi, Nyanza and Rift Valley provinces. Study participants were identified through HIV and AIDS programs in the four regions. Out of a total of 797 female participants, 394 had ever been pregnant with 24% of them experiencing multiple pregnancies. Analysis entails the estimation of random-effects logit models. Results Higher order pregnancies were just as likely to be unintended as lower order ones (odds ratios [OR]: 1.2; 95% confidence interval [CI]: 0.8–2.0 while pregnancies occurring within marital unions were significantly less likely to be unintended compared to those occurring outside such unions (OR: 0.1; 95% CI: 0.1–0.2. Higher order pregnancies were significantly more likely to result in poor outcomes compared to lower order ones (OR: 2.5; 95% CI: 1.6–4.0. In addition, pregnancies occurring within marital unions were significantly less likely to result in poor outcomes compared to those occurring outside such unions (OR: 0.3; 95% CI: 0.1–0.9. However, experiencing unintended pregnancy was not significantly associated with adverse birth outcomes (OR: 1.3; 95% CI: 0.5–3.3. There was also no significant difference in the likelihood of post-partum contraceptive use by whether the pregnancy was unintended (OR: 0.9; 95% CI: 0.5–1.5. Conclusions The experience of repeat unintended pregnancies among HIV-positive female adolescents

Unmarried Mother's Knowledge and Attitudes toward Emergency Contraceptive Pills

Directory of Open Access Journals (Sweden)

Gyeong Mi Lee

2013-06-01

Full Text Available PurposeThis study was conducted to identify relationships among knowledge and attitudes of unmarried mothers toward emergency contraceptive pills.MethodsData were collected through structured questionnaires from 135 unmarried mothers enrolled in 7 single mothers' facilities nationwide. Data were analyzed using the SPSS/WIN 17.0 program for descriptive statistics, t-test, ANOVA, Scheffe-test, and Pearson correlation coefficients.ResultsFor knowledge about emergency contraceptive pills, there were significant differences among who live with her before pregnancy, experience of past pregnancies, state of present pregnancy and preparation in using contraceptives. For attitude toward emergency contraceptive pills, there were significant differences according to age, education level and religion. There were significant positive relationships between knowledge and attitudes toward emergency contraceptive pills.ConclusionThe results of this study suggest that unmarried women should be better informed about emergency contraceptive pills, and reassured about their safety. Efforts are needed to disseminate up-to-date information to experts in sex education including nurses.

Knowledge, attitude, and practice on emergency contraceptives ...

African Journals Online (AJOL)

Background: Unwanted pregnancy followed by unsafe abortion can be avoided by using different contraceptive methods, including emergency contraceptives. Information on knowledge, attitude and practice of emergency contraceptives among women is particularly important because of high rates of teenage and ...

Pipeline for Contraceptive Development

Science.gov (United States)

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

Female contraception over 40

DEFF Research Database (Denmark)

2009-01-01

BACKGROUND: The majority of women 40-49 years of age need an effective method of contraception because the decline in fertility with age is an insufficient protection against unwanted pregnancy. Although pregnancy is less likely after the age of 40 years, the clinical and social consequences...... is insufficient for contraceptive purposes. Thus a family planning method is needed. Sterilization is by far the most common method in several countries. Copper intrauterine devices and hormone intrauterine systems have similar effectiveness, with fewer than 1% failures in the first year of typical use. Special...

Stability of the Pregnancy Obsessive-Compulsive Personality Disorder Symptoms Checklist.

Science.gov (United States)

van Broekhoven, Kiki E M; Karreman, Annemiek; Hartman, Esther E; Pop, Victor J M

2018-02-01

Because stability over time is central to the definition of personality disorder, aim of the current study was to determine the stability of the Pregnancy Obsessive-Compulsive Personality Disorder (OCPD) Symptoms Checklist (N = 199 women). Strong positive correlations between assessments at 32 weeks of pregnancy and 2 and 3-3.5 years after childbirth were found (r between .62-.72), and the group mean score did not change over time. The Pregnancy OCPD Symptoms Checklist assesses stable, trait-like symptoms of OCPD.

Sexually transmitted diseases, human immunodeficiency virus, and pregnancy prevention. Combined contraceptive practices among urban African-American early adolescents.

Science.gov (United States)

Stanton, B F; Li, X; Galbraith, J; Feigelman, S; Kaljee, L

1996-01-01

To evaluate the success of efforts to educate youth not only to use prescription contraceptives to avoid pregnancy, but also to use condoms to avoid sexually transmitted diseases, including infection with the human immunodeficiency virus. Longitudinal study of 383 African-American youth aged 9 to 15 years enrolled in a randomized, controlled trial of an acquired immunodeficiency syndrome (AIDS) risk reduction intervention. Data about contraceptive practices were obtained at baseline and 6, 12, and 18 months later using a culturally and developmentally appropriate risk assessment tool administered with "talking" computers (Macintosh, Apple Computer Inc, Cupertino, Calif). Approximately three fourths of sexually active youth used some form of contraception in each 6-month round, with almost half of the youth using combinations of contraceptives. Among all youth at baseline and among control youth throughout the study, more than half used condoms and more than two thirds who used oral contraceptives also used condoms. Receipt of an AIDS education intervention was associated with use of more effective contraceptive practices (eg, condoms and another prescription or nonprescription method of birth control). After receiving the intervention, more than 80% of the youth who used oral contraceptives also used condoms. Contraceptive practices showed considerable stability. Knowledge about AIDS was positively associated with use of more effective contraceptive methods. Many youth are using condoms and prescription birth control simultaneously, and these use rates can be increased through AIDS education interventions.

Adolescents and oral contraceptives.

Science.gov (United States)

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

Choice of Postpartum Contraception: Factors Predisposing Pregnant Adolescents to Choose Less Effective Methods Over Long-Acting Reversible Contraception.

Science.gov (United States)

Chacko, Mariam R; Wiemann, Constance M; Buzi, Ruth S; Kozinetz, Claudia A; Peskin, Melissa; Smith, Peggy B

2016-06-01

The purposes were to determine contraceptive methods pregnant adolescents intend to use postpartum and to understand factors that predispose intention to use less effective birth control than long-acting reversible contraception (LARC). Participants were 247 pregnant minority adolescents in a prenatal program. Intention was assessed by asking "Which of the following methods of preventing pregnancy do you intend to use after you deliver?" Multinomial logistic regression analysis was used to determine factors associated with intent to use nonhormonal (NH) contraception (male/female condoms, abstinence, withdrawal and no method) or short-/medium-acting hormonal (SMH) contraception (birth control pill, patch, vaginal ring, injectable medroxyprogesterone acetate) compared with LARC (implant and intrauterine device) postpartum. Twenty-three percent intended to use LARC, 53% an SMH method, and 24% an NH method. Participants who intended to use NH or SMH contraceptive methods over LARC were significantly more likely to believe that LARC is not effective at preventing pregnancy, to report that they do not make decisions to help reach their goals and that partners are not important when making contraceptive decisions. Other important factors were having a mother who was aged >19 years at first birth and had not graduated from high school, not having experienced a prior pregnancy or talked with parents about birth control options, and the perception of having limited financial resources. Distinct profiles of factors associated with intending to use NH or SMH contraceptive methods over LARC postpartum were identified and may inform future interventions to promote the use of LARC to prevent repeat pregnancy. Copyright © 2015 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Teen pregnancy: an update.

Science.gov (United States)

McCracken, Katherine A; Loveless, Meredith

2014-10-01

To provide clinicians with a review of recent research and clinically applicable tools regarding teen pregnancy. Teen pregnancy rates have declined but still remain a significant problem in the USA. Teen pregnancy prevention was identified by Centers for Disease Control and Prevention as one of its top six priorities, which is increasing research and intervention data. Long-acting contraceptive methods are acceptable to teens and have been shown to reduce teen birth rates. Pregnant teens need special attention to counseling on pregnancy options and reducing risk during pregnancy with regular prenatal care. Postpartum teens should be encouraged and supported to breastfeed, monitored for depression, and have access to reliable contraception to avoid repeat undesired pregnancy. This review highlights important issues for all providers caring for female adolescents and those who may encounter teen pregnancy. Foremost prevention of teen pregnancy by comprehensive sexual education and access to contraception is the priority. Educating patients and healthcare providers about safety and efficacy of long-acting reversible contraception is a good step to reducing undesired teen pregnancies. Rates of postpartum depression are greater in adolescents than in adults, and adolescent mothers need to be screened and monitored for depression. Strategies to avoid another undesired pregnancy shortly after delivery should be implemented.

Bulimia symptoms and other risk behaviors during pregnancy in women with bulimia nervosa.

Science.gov (United States)

Crow, Scott J; Keel, Pamela K; Thuras, Paul; Mitchell, James E

2004-09-01

The current study examined the change in bulimic symptoms as well as alcohol, drug, and tobacco use during pregnancy in subjects with bulimia nervosa. A self-report questionnaire was used to collect retrospective data on eating disorder symptoms and substance use during pregnancy from 129 participants in a long-term study of bulimia nervosa. Follow-up data were collected for a total of 322 pregnancies occurring over a 10-15-year period. Overall, subjects reported that body dissatisfaction worsened, but binge eating and purging improved during pregnancy. However, the number of women completely abstinent from bulimic symptoms did not change significantly with pregnancy. Body esteem often worsened with pregnancy, particularly for women with active bulimia symptoms. Self-reported alcohol use significantly declined with pregnancy. In general, bulimia nervosa symptoms decreased during pregnancy, although the number of women completely abstinent did not change significantly.

Preconception counseling and contraception after gestational diabetes

DEFF Research Database (Denmark)

Mølsted-Pedersen, L; Skouby, S O; Damm, P

1991-01-01

-contraceptive compounds appear to be safe for women with previous GDM when administered for limited periods. At the follow-up examination, we found no increased risk of developing diabetes in women with previous GDM who used oral contraception. We consider the intrauterine contraceptives (IUD) a safe and effective......Women with gestational diabetes mellitus (GDM) diagnosed in the period 1978-1984 were followed for on average 6 yr after the index pregnancy. Thirty percent had diabetes mellitus at the follow-up examination, and preliminary results indicate that at least another third will develop diabetes during...... a subsequent pregnancy. Therefore, family planning and contraceptive guidance should follow the lines for women with pregestational diabetes. When low-dose hormonal contraceptives containing ethinyl estradiol and levonorgestrel were given to women with previous GDM, glucose tolerance and lipoprotein levels...

Prevalence of gestrointestinal symptoms in pregnancy | Audu ...

African Journals Online (AJOL)

Prevalence of gestrointestinal symptoms in pregnancy. BM Audu, SK Mustapha. Abstract. Objectives: This study is aimed at determining the prevalence of gastrointestinal symptoms among healthy pregnant women attending antenatal clinic at the University of Maiduguri Teaching Hospital. Methods: Questionnaires were ...

Measuring and reporting of the treatment effect of hormonal emergency contraceptives.

Science.gov (United States)

Leung, Vivian W Y; Soon, Judith A; Levine, Marc

2012-03-01

To derive summary estimates of observed pregnancy rates in women who used the Yuzpe or levonorgestrel emergency contraceptive regimen and identify the various ways in which data related to regimen effectiveness were reported, to discuss the limitations of the effectiveness estimates as they are currently reported, and to propose alternative reporting methods that are less susceptible to misinterpretation. Analysis of pooled data from 34 experimental or observational studies that had an explicit method of follow-up to systematically evaluate pregnancy outcome after a single course of emergency contraception treatment within a given menstrual cycle. Women who took either the Yuzpe or levonorgestrel emergency contraceptive regimen to prevent pregnancy. We searched the MEDLINE and EMBASE databases for clinical studies that systematically evaluated pregnancy outcomes of women who used the Yuzpe or levonorgestrel regimen for emergency contraception. The effectiveness of these regimens is typically reported in relative terms as the reduction of pregnancy risk from a theoretical baseline risk. We reported the effectiveness using absolute risk reductions and numbers needed to treat. We pooled relevant data by using the β-binomial method to derive observed pregnancy rates. The pooled observed pregnancy rates for studies of the Yuzpe and levonorgestrel regimens were 2.0% (95% confidence interval [CI] 1.5-2.5%) and 1.7% (95% CI 1.2-2.2%), respectively. Against expected pregnancy rates of 4-8%, relative emergency contraceptive effectiveness ranges were 50.0-75.0% and 57.5-78.8% for the Yuzpe and levonorgestrel regimens, respectively. Absolute risk reductions were 2.0-6.0% and 2.3-6.3%, respectively. This means that 17-50 women would need to have received the Yuzpe regimen and 16-43 women the levonorgestrel regimen to prevent one pregnancy. Emergency contraception effectiveness data are susceptible to misinterpretation when data are reported in relative terms without the

EMERGENCY CONTRACEPTION: AN OVERVIEW AMONG USERS.

Science.gov (United States)

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.

Benefits and risks of hormonal contraception for women

OpenAIRE

Gorenoi, Vitali; Schönermark, Matthias P.; Hagen, Anja

2007-01-01

Scientific background: A large proportion of women of reproductive age in Germany use various methods of pregnancy prevention (contraception), among them various hormone-based methods. Hormonal contraceptives may be divided into combined estrogen-progestogen contraceptives (pills, skin patches, vaginal rings), progestogen-only contraceptives (pills, injections, implants, hormone spirals) and emergency contraceptives. Research questions: The evaluation addressed the question of benefits and ri...

Missed hormonal contraceptives: new recommendations.

Science.gov (United States)

Guilbert, Edith; Black, Amanda; Dunn, Sheila; Senikas, Vyta

2008-11-01

To provide evidence-based guidance for women and their health care providers on the management of missed or delayed hormonal contraceptive doses in order to prevent unintended pregnancy. Medline, PubMed, and the Cochrane Database were searched for articles published in English, from 1974 to 2007, about hormonal contraceptive methods that are available in Canada and that may be missed or delayed. Relevant publications and position papers from appropriate reproductive health and family planning organizations were also reviewed. The quality of evidence is rated using the criteria developed by the Canadian Task Force on Preventive Health Care. This committee opinion will help health care providers offer clear information to women who have not been adherent in using hormonal contraception with the purpose of preventing unintended pregnancy. The Society of Obstetricians and Gynaecologists of Canada. SUMMARY STATEMENTS: 1. Instructions for what women should do when they miss hormonal contraception have been complex and women do not understand them correctly. (I) 2. The highest risk of ovulation occurs when the hormone-free interval is prolonged for more than seven days, either by delaying the start of combined hormonal contraceptives or by missing active hormone doses during the first or third weeks of combined oral contraceptives. (II) Ovulation rarely occurs after seven consecutive days of combined oral contraceptive use. (II) RECOMMENDATIONS: 1. Health care providers should give clear, simple instructions, both written and oral, on missed hormonal contraceptive pills as part of contraceptive counselling. (III-A) 2. Health care providers should provide women with telephone/electronic resources for reference in the event of missed or delayed hormonal contraceptives. (III-A) 3. In order to avoid an increased risk of unintended pregnancy, the hormone-free interval should not exceed seven days in combined hormonal contraceptive users. (II-A) 4. Back-up contraception should

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

Science.gov (United States)

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.

Emergency contraception: which is the best?

Science.gov (United States)

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

Use of IUDs for emergency contraception: current perspectives

Directory of Open Access Journals (Sweden)

McKay R

2014-08-01

Full Text Available Rebecca McKay,1 Lynne Gilbert2 1Department of Obstetrics and Gynaecology, Peterborough City Hospital, Peterborough, Cambridgeshire, United Kingdom; 2Department of Contraception and Sexual Health, Cambridgeshire Community Services NHS Trust, Cambridge, Cambridgeshire, United Kingdom Abstract: Emergency contraception is an essential intervention for the prevention of unplanned pregnancy worldwide. The copper intrauterine device (IUD is highly effective at preventing pregnancy after unprotected sex or contraceptive failure. Unfortunately, its usage in this context is low and far exceeded by hormonal forms of emergency contraception. These have higher failure rates and, unlike the IUD, are not effective post-fertilization. This review aims to summarize the literature surrounding IUD use as emergency contraception, contrast it with the hormonal options, and provide suggestions for increased usage. Keywords: levonorgestrel, ulipristal acetate, copper intrauterine device

Committee Opinion No 707: Access to Emergency Contraception.

Science.gov (United States)

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.

Effective factors contraceptive use by logistic regression model in Tehran, 1996

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Ramezani F

1999-07-01

Full Text Available Despite unwillingness to fertility, about 30% of couples do not use any kind of contraception and this will lead to unwanted pregnancy. In this clinical trial study, 4177 subjects who had at least one alive child, and delivered in one of the 12 university hospitals in Tehran were recruited. This study was conducted in 1996. The questionnaire included some questions about contraceptive use, their attitudes about unwantedness or wantedness of their current pregnancies. Data were analysed using a Logistic Regrassion Model. Results showed that 20.3% of those who had no fertility intention, did not use any kind of contraception methods, 41.1% of the subjects who were using a contraception method before pregnancy, had got pregnant unwantedly. Based on Logistic Regression Model; age, education, previous familiarity of women with contraception methods and husband's education were the most significant factors in contraceptive use. Subjects who were 20 years old and less or 35 years old and more and illeterate subjects were at higher risk for unuse of contraception methods. This risk was not related to the gender of their children that suggests a positive change in their perspectives towards sex and the number of children. It is suggested that health politicians choose an appropriate model to enhance the literacy, education and counseling for the correct usage of contraceptives and prevention of unwanted pregnancy.

Adolescents: Contraceptive Knowledge and Use, a Brazilian Study

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Correia, Divanise S.; Pontes, Ana C. P.; Cavalcante, Jairo C.; Egito, E. Sócrates T.; Maia, Eulália M.C.

2009-01-01

The purpose of this study was to identify the knowledge and use of contraceptive methods by female adolescent students. The study was cross-sectional and quantitative, using a semi-structured questionnaire that was administered to 12- to 19-year-old female students in Maceió, Brazil. A representative and randomized sample was calculated, taking into account the number of hospital admissions for curettage. This study was approved by the Human Research Ethics Committee, and Epi InfoTM software was used for data and result evaluation using the mean and chi-square statistical test. Our results show that the majority of students know of some contraceptive methods (95.5%), with the barrier/hormonal methods being the most mentioned (72.4%). Abortion and aborting drugs were inaccurately described as contraceptives, and 37.9% of the sexually active girls did not make use of any method. The barrier methods were the most used (35.85%). A significant association was found in the total sample (2,592) between pregnancy and the use of any contraceptive method. This association was not found, however, in the group having an active sexual life (559). The study points to a knowledge of contraceptive methods, especially by teenagers who have already been pregnant, but contraceptives were not adequately used. The low use of chemical methods of contraception brings the risk of pregnancy. Since abortion and aborting drugs were incorrectly cited as contraceptive methods, this implies a nonpreventive attitude towards pregnancy. PMID:19151897

Is there an association between depressive and urinary symptoms during and after pregnancy?

NARCIS (Netherlands)

Pol, G. van de; Brummen, H.J. van; Bruinse, H.W.; Heintz, A.P.M.; Vaart, C.H. van der

2007-01-01

Depressive symptoms and urinary symptoms are both highly prevalent in pregnancy. In the general population, an association is reported between urinary symptoms and depressive symptoms. The association of depressive and urinary symptoms has not yet been assessed in pregnancy. In this study, we

Contraceptive efficacy of emergency contraception with levonorgestrel given before or after ovulation.

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Noé, Gabriela; Croxatto, Horacio B; Salvatierra, Ana María; Reyes, Verónica; Villarroel, Claudio; Muñoz, Carla; Morales, Gabriela; Retamales, Anita

2011-11-01

The contraceptive efficacy of emergency contraceptive pills containing levonorgestrel (LNG-EC) has been estimated in most previous studies by judging the day of ovulation from presumptive menstrual cycle data, thus providing poorly reliable estimates. In the present study, the efficacy of LNG-EC was determined in 393 cycles by dating ovulation on the basis of reliable hormonal and ovarian parameters validated by a database constructed in a separate study. In addition, the efficacy was determined separately for cycles in which LNG-EC was given before or after ovulation. For the 148 women who had sexual intercourse during the fertile days, the overall accumulated probability of pregnancy was 24.7, while altogether 8 pregnancies were observed. Thus, the overall contraceptive efficacy of LNG-EC was 68%. Among the 103 women who took LNG-EC before ovulation (days -5 to -1), 16 pregnancies were expected and no pregnancy occurred (p<.0001). Among the 45 women who took LNG-EC on the day of ovulation (day 0) or thereafter, 8 pregnancies occurred and 8.7 were expected (p=1.00). These findings are incompatible with the inhibition of implantation by LNG-EC in women. The same cases were also analyzed using the presumptive menstrual cycle data, and important discrepancies were detected between the two methods. The efficacy of LNG-EC has been overestimated in studies using presumptive menstrual cycle data. Our results confirm previous similar studies and demonstrate that LNG-EC does not prevent embryo implantation and therefore cannot be labeled as abortifacient. Copyright © 2011 Elsevier Inc. All rights reserved.

Documentation of Pregnancy Status, Gynaecological History, Date of Last Menstrual Period and Contraception Use in Emergency Surgical Admissions: Time for a Change in Practice?

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Powell-Bowns, M; Wilson, M S J; Mustafa, A

2015-12-01

To determine whether pregnancy status, gynaecological history, date of last menstrual period and contraceptive use are documented in emergency female admissions of reproductive age admitted to general surgery. This is a retrospective study. This study was conducted in the United Kingdom. Females of reproductive age (12-50 years) admitted as an emergency to general surgery with abdominal pain were considered in this study. Retrospective analysis of medical notes of emergency female admissions with abdominal pain between January and September 2012. We recorded whether a pregnancy test result was documented (cycle 1). Results were analysed and a prompt added to the medical clerk-in document. We re-audited (cycle 2) between January and June 2013 looking for improvement. Documented pregnancy status within 24 h of admission and prior to any surgical intervention. 100 case notes were reviewed in stage 1. 30 patients (30 %) had a documented pregnancy status. 32 (32 %), 25 (25 %) and 29 (29 %) had a documented gynaecology history, contraceptive use and date of last menstrual period (LMP), respectively. 24 patients underwent emergency surgery, 6 (25 %) had a documented pregnancy status prior to surgery. Of 50 patients reviewed in stage 2, 37 (75.0 %) had a documented pregnancy status (p contraceptive use (p < 0.0001) documented. 40 patients (80 % had a documented LMP (p < 0.0001). 7 patients required surgery, of whom 6 (85.7 %) had a documented pregnancy test prior to surgery (p = 0.001). All pregnancy tests were negative. A simple prompt in the surgical admission document has significantly improved the documentation of pregnancy status and gynaecological history in our female patients, particularly in those who require surgical intervention. A number of patient safety concerns were addressed locally, but require a coordinated, interdisciplinary discussion and a national guideline. A minimum standard of care, in females of reproductive age, should include mandatory objective

Brief Report: Dapivirine Vaginal Ring Use Does Not Diminish the Effectiveness of Hormonal Contraception.

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Balkus, Jennifer E; Palanee-Phillips, Thesla; Reddy, Krishnaveni; Siva, Samantha; Harkoo, Ishana; Nakabiito, Clemensia; Kintu, Kenneth; Nair, Gonasangrie; Chappell, Catherine; Kiweewa, Flavia Matovu; Kabwigu, Samuel; Naidoo, Logashvari; Jeenarain, Nitesha; Marzinke, Mark; Soto-Torres, Lydia; Brown, Elizabeth R; Baeten, Jared M

2017-10-01

To evaluate the potential for a clinically relevant drug-drug interaction with concomitant use of a dapivirine vaginal ring, a novel antiretroviral-based HIV-1 prevention strategy, and hormonal contraception by examining contraceptive efficacies with and without dapivirine ring use. A secondary analysis of women participating in MTN-020/ASPIRE, a randomized, double-blind, placebo-controlled trial of the dapivirine vaginal ring for HIV-1 prevention. Use of a highly effective method of contraception was an eligibility criterion for study participation. Urine pregnancy tests were performed monthly. Pregnancy incidence by arm was calculated separately for each hormonal contraceptive method and compared using an Andersen-Gill proportional hazards model stratified by site and censored at HIV-1 infection. Of 2629 women enrolled, 2310 women returned for follow-up and reported using a hormonal contraceptive method at any point during study participation (1139 in the dapivirine arm and 1171 in the placebo arm). Pregnancy incidence in the dapivirine arm versus placebo among women using injectable depot medroxyprogesterone acetate was 0.43% vs. 0.54%, among women using injectable norethisterone enanthate was 1.15% vs. 0%, among women using hormonal implants was 0.22% vs. 0.69%, and among women using oral contraceptive pills was 32.26% vs. 28.01%. Pregnancy incidence did not differ by study arm for any of the hormonal contraceptive methods. Use of the dapivirine ring does not reduce the effectiveness of hormonal contraceptives for pregnancy prevention. Oral contraceptive pill use was associated with high pregnancy incidence, potentially because of poor pill adherence. Injectable and implantable methods were highly effective in preventing pregnancy.

Emergency contraception: an overview among users

International Nuclear Information System (INIS)

Khan, S.; Hafiz, H.; Akbar, R.

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. Methods: 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. Results: 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. Conclusion: 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. (author)

The impact of combined oral contraceptives on ocular tissues: a review of ocular effects

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Marilita M. Moschos

2017-10-01

Full Text Available The aim of this manuscript is to review the action and adverse effects of combined oral contraceptives (COCs on ocular tissues. The percentage of unwanted pregnancies and the subsequent abortions make contraception crucial worldwide. Over 100 million women around the world use common contraceptive methods, including intrauterine devices, combined estrogen and progestin oral contraceptives, as well as progestin only preparations (oral contraceptives, implants or injections. COCs are widely used for contraception, but they are also indicated in menorrhagia, endometriosis, acne and hirsutism, fibroid uterus and premenstrual syndrome. However, they have been associated with high rates of cardiovascular events, venous thromboembolic disease, ischemic strokes and breast cancer. The incidence of COCs-related ocular complications is estimated to be 1 in 230 000, including dry eye symptoms, corneal edema, lens opacities and retinal neuro-ophthalmologic or vascular complications. We may infer that the serious ocular complications of COCs can be prevented by eliminating the estrogen dosage and choosing third-generation progestins. In any case, doctors should take into consideration the systemic and ocular history of the patients before selecting any method of contraception.

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.

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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.

Effect of BMI and body weight on pregnancy rates with LNG as emergency contraception: analysis of four WHO HRP studies.

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Festin, Mario Philip R; Peregoudov, Alexandre; Seuc, Armando; Kiarie, James; Temmerman, Marleen

2017-01-01

To estimate the effect of increased body weight and body mass index (BMI) on pregnancy rates with levonorgestrel (LNG) 1.5mg used as emergency contraception (EC). The study reviewed data from 6873 women in four WHO-HRP randomized trials on EC conducted between 1993 and 2010. Participants took either 1.5mg of LNG as a single dose or in two doses 12h apart, up to 120h of unprotected intercourse. Contraceptive efficacy (pregnancy rates) at different weight and BMI categories was evaluated. Overall pregnancy rate was low at 1.2%. Pregnancy rates were also low in women weighing over 80kg (0.7%) and who were obese (BMI over 30kg/m 2 ) (2.0%). The pooled analyses for pregnancy demonstrated that BMI over 30kg/m 2 decreased efficacy significantly (odds ratio 8.27, 95% confidence interval = 2.70-25.37) when compared to women in lower BMI categories, mainly influenced by pregnancies in obese women from one study site. Sensitivity analyses excluding that site showed that obesity was no longer a risk factor; however, the other studies included too few obese women in the sample to exclude a substantial decrease in efficacy. Pregnancy rates with use of LNG 1.5mg for EC were low at less than 3% across different weight and BMI categories. Pooled analyses showed an increase in pregnancy rates among obese women (BMI more than 30kg/m 2 ) compared to women with normal BMI levels, influenced by pregnancies all coming from one study site. Access to LNG as EC should still be promoted to women who need them, and not be restricted in any weight or BMI category, with additional attention for counselling and advice for obese women. Copyright © 2016. Published by Elsevier Inc.

Non-Heterosexuality, Relationships, and Young Women's Contraceptive Behavior.

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Ela, Elizabeth J; Budnick, Jamie

2017-06-01

Non-heterosexual young women have a higher rate of unintended pregnancy than their heterosexual peers, but their fertility behaviors are understudied. We use longitudinal data from the Relationship Dynamics and Social Life study to investigate mechanisms contributing to non-heterosexual women's higher pregnancy risk. These data include weekly reports of relationships, sex, and contraceptive use over 30 months. We compare the relationships and fertility behaviors of three groups: exclusively heterosexual (consistent heterosexual behavior, identity, and attraction); mostly heterosexual (heterosexual identity with same-sex behavior and/or same-sex attraction); and LGBTQ (any non-heterosexual identity). We find that mostly heterosexual and LGBTQ women behave differently from exclusively heterosexual women in ways likely to elevate their risk of unintended pregnancy: more distinct partners during the study period, more sexual intercourse with men, less frequent contraceptive use, less use of a dual method (condom plus hormonal method), and more gaps in contraceptive coverage. Mostly heterosexual women resemble LGBTQ women in their contraceptive behavior but have significantly more intercourse with men, which may increase their pregnancy risk relative to both LGBTQ and exclusively heterosexual women. We conclude by considering implications for LGBTQ health and the measurement of sexual minority populations.

Progestogen-only injectable contraceptive: Experience of women in ...

African Journals Online (AJOL)

Background: Progestogen-only injectable contraceptive is a long-acting contraceptive given intramuscularly to give protection against unwanted pregnancy for a period of 2 or 3 months, depending on the type. Alterations in menstrual pattern are a well known side effect of this effective contraceptive method. Objectives: To ...

An update on emergency contraception.

Science.gov (United States)

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.

Contraceptive methods and use by women aged 35 and over: A qualitative study of perspectives

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Fiscella Kevin

2011-02-01

Full Text Available Abstract Background More than 30% of the pregnancies in women aged 35 and over are unintended. This paper compares perceptions about contraceptive methods and use among women with and without an unintended pregnancy after turning age 35. Methods Semi-structured, in-depth interviews were conducted with 17 women. They were all 35 to 49 years old, regularly menstruating, sexually active, not sterilized, not desiring a pregnancy in the near future, and at least 3 months postpartum. We purposely sampled for women who had had at least one unintended pregnancy after age 35 (n = 9 and women who did not (n = 8. We assessed partnership, views of pregnancy and motherhood, desired lifestyle, perceived advantages and disadvantages of using and obtaining currently available well-known reversible contraceptives in the U.S. ''We also assessed contraceptive methods used at any time during their reproductive years, including current method use and, if appropriate, circumstances surrounding an unintended pregnancy after age 35.'' Each interview was taped and transcribed verbatim. Data were analyzed using Grounded Theory. Analysis focused on partnership, views of pregnancy, motherhood, desired lifestyle and perceived advantages and disadvantages of various reversible contraceptive methods. Results The women without an unintended pregnancy after age 35 were more likely to (1 use contraceptive methods that helped treat a medical condition, (2 consider pregnancy as dangerous, or (3 express concerns about the responsibilities of motherhood. The women who experienced an unintended pregnancy after age 35 were more likely to (1 report unstable partnerships, (2 perceive themselves at lower risk of pregnancy, or (3 report past experiences with unwanted contraceptive side effects. There was a greater likelihood a woman would choose a contraceptive method if it was perceived as easy to use, accessible, affordable and had minimal side effects. Conclusions Women's perspective

Contraceptive methods and use by women aged 35 and over: A qualitative study of perspectives.

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Godfrey, Emily M; Chin, Nancy P; Fielding, Stephen L; Fiscella, Kevin; Dozier, Ann

2011-02-16

More than 30% of the pregnancies in women aged 35 and over are unintended. This paper compares perceptions about contraceptive methods and use among women with and without an unintended pregnancy after turning age 35. Semi-structured, in-depth interviews were conducted with 17 women. They were all 35 to 49 years old, regularly menstruating, sexually active, not sterilized, not desiring a pregnancy in the near future, and at least 3 months postpartum. We purposely sampled for women who had had at least one unintended pregnancy after age 35 (n = 9) and women who did not (n = 8). We assessed partnership, views of pregnancy and motherhood, desired lifestyle, perceived advantages and disadvantages of using and obtaining currently available well-known reversible contraceptives in the U.S. ''We also assessed contraceptive methods used at any time during their reproductive years, including current method use and, if appropriate, circumstances surrounding an unintended pregnancy after age 35.'' Each interview was taped and transcribed verbatim. Data were analyzed using Grounded Theory. Analysis focused on partnership, views of pregnancy, motherhood, desired lifestyle and perceived advantages and disadvantages of various reversible contraceptive methods. The women without an unintended pregnancy after age 35 were more likely to (1) use contraceptive methods that helped treat a medical condition, (2) consider pregnancy as dangerous, or (3) express concerns about the responsibilities of motherhood. The women who experienced an unintended pregnancy after age 35 were more likely to (1) report unstable partnerships, (2) perceive themselves at lower risk of pregnancy, or (3) report past experiences with unwanted contraceptive side effects. There was a greater likelihood a woman would choose a contraceptive method if it was perceived as easy to use, accessible, affordable and had minimal side effects. Women's perspective on contraceptive use after age 35 varies. Public health

ACOG Committee Opinion Number 542: Access to emergency contraception.

Science.gov (United States)

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.

Cost Savings From the Provision of Specific Methods of Contraception in a Publicly Funded Program

Science.gov (United States)

Rostovtseva, Daria P.; Brindis, Claire D.; Biggs, M. Antonia; Hulett, Denis; Darney, Philip D.

2009-01-01

Objectives. We examined the cost-effectiveness of contraceptive methods dispensed in 2003 to 955 000 women in Family PACT (Planning, Access, Care and Treatment), California's publicly funded family planning program. Methods. We estimated the number of pregnancies averted by each contraceptive method and compared the cost of providing each method with the savings from averted pregnancies. Results. More than half of the 178 000 averted pregnancies were attributable to oral contraceptives, one fifth to injectable methods, and one tenth each to the patch and barrier methods. The implant and intrauterine contraceptives were the most cost-effective, with cost savings of more than $7.00 for every $1.00 spent in services and supplies. Per $1.00 spent, injectable contraceptives yielded savings of $5.60; oral contraceptives, $4.07; the patch, $2.99; the vaginal ring, $2.55; barrier methods, $1.34; and emergency contraceptives, $1.43. Conclusions. All contraceptive methods were cost-effective—they saved more in public expenditures for unintended pregnancies than they cost to provide. Because no single method is clinically recommended to every woman, it is medically and fiscally advisable for public health programs to offer all contraceptive methods. PMID:18703437

Committee Opinion No. 707 Summary: Access to Emergency Contraception.

Science.gov (United States)

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.

Post-ovulatory contraception.

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Glasier, A; Baird, D T

1990-06-01

It is possible to prevent pregnancy after unprotected intercourse by suppressing ovulation, inhibiting fertilization or interfering with tubal transport and/or implantation of the early embryo. IUCDs probably prevent implantation by stimulating the release of prostaglandins from the endometrium but are not acceptable to many women. Post-coital contraceptive steroids, e.g. high-dose oestrogens, are associated with a relatively high incidence of side-effects and must be taken within 72 hours of coitus. As these agents are effective by creating a uterine environment unfavourable for implantation, it may be possible to use antigestagens or antioestrogens in this way. It is already known that an antigestagen in combination with a prostaglandin is a highly effective method of inducing abortion in very early pregnancy. The corpus luteum is essential for the maintenance of pregnancy and its destruction by a luteolytic agent should dislodge the implanting embryo. If an effective method of preventing implantation could be developed which was relatively free from side-effects, it should be possible to use it as a regular form of contraception to be taken only when the risk of pregnancy had occurred.

Maternal depressive symptoms during and after pregnancy are associated with attention-deficit/hyperactivity disorder symptoms in their 3- to 6-year-old children.

Science.gov (United States)

Wolford, Elina; Lahti, Marius; Tuovinen, Soile; Lahti, Jari; Lipsanen, Jari; Savolainen, Katri; Heinonen, Kati; Hämäläinen, Esa; Kajantie, Eero; Pesonen, Anu-Katriina; Villa, Pia M; Laivuori, Hannele; Reynolds, Rebecca M; Räikkönen, Katri

2017-01-01

Maternal depressive symptoms during pregnancy have been associated with child behavioural symptoms of attention-deficit/hyperactivity disorder (ADHD) in early childhood. However, it remains unclear if depressive symptoms throughout pregnancy are more harmful to the child than depressive symptoms only during certain times, and if maternal depressive symptoms after pregnancy add to or mediate any prenatal effects. 1,779 mother-child dyads participated in the Prediction and Prevention of Pre-eclampsia and Intrauterine Growth Restriction (PREDO) study. Mothers filled in the Center of Epidemiological Studies Depression Scale biweekly from 12+0-13+6 to 38+0-39+6 weeks+days of gestation or delivery, and the Beck Depression Inventory-II and the Conners' Hyperactivity Index at the child's age of 3 to 6 years (mean 3.8 years, standard deviation [SD] 0.5). Maternal depressive symptoms were highly stable throughout pregnancy, and children of mothers with consistently high depressive symptoms showed higher average levels (mean difference = 0.46 SD units, 95% Confidence Interval [CI] 0.36, 0.56, p maternal depressive symptoms after pregnancy, which both added to and partially mediated the prenatal effects. Maternal depressive symptoms throughout pregnancy are associated with increased ADHD symptomatology in young children. Maternal depressive symptoms after pregnancy add to, but only partially mediate, the prenatal effects. Preventive interventions suited for the pregnancy period may benefit both maternal and offspring mental health.

Attitude toward contraception and abortion among Curaçao women. Ineffective contraception due to limited sexual education?

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Meyboom-de Jong Betty

2011-06-01

Full Text Available Abstract Background In Curaçao is a high incidence of unintended pregnancies and induced abortions. Most of the induced abortions in Curaçao are on request of the woman and performed by general practitioners. In Curaçao, induced abortion is strictly prohibited, but since 1999 there has been a policy of connivance. We present data on the relevance of economic and socio-cultural factors for the high abortion-rates and the ineffective use of contraception. Methods Structured interviews to investigate knowledge and attitudes toward sexuality, contraception and abortion and reasons for ineffective use of contraceptives among women, visiting general practitioners. Results Of 158 women, 146 (92% participated and 82% reported that their education on sexuality and about contraception was of good quality. However 'knowledge of reliable contraceptive methods' appeared to be - in almost 50% of the cases - false information, misjudgements or erroneous views on the chance of getting pregnant using coitus interruptus and about the reliability and health effects of oral contraceptive pills. Almost half of the interviewed women had incorrect or no knowledge about reliability of condom use and IUD. 42% of the respondents risked by their behavior an unplanned pregnancy. Most respondents considered abortion as an emergency procedure, not as contraception. Almost two third experienced emotional, physical or social problems after the abortion. Conclusions Respondents had a negative attitude toward reliable contraceptives due to socio-cultural determined ideas about health consequences and limited sexual education. Main economic factors were costs of contraceptive methods, because most health insurances in Curaçao do not cover contraceptives. To improve the effective use of reliable contraceptives, more adequate information should be given, targeting the wrong beliefs and false information. The government should encourage health insurance companies to reimburse

Women's perceptions of contraceptive efficacy and safety.

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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.

Male Hormonal Contraception: Looking Back and Moving Forward

OpenAIRE

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 contrace...

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

Science.gov (United States)

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.

Pregnancy and protection: perceptions, attitudes and experiences of Australian female adolescents.

Science.gov (United States)

Skinner, S Rachel; Smith, Jennifer; Fenwick, Jennifer; Hendriks, Jacqueline; Fyfe, Sue; Kendall, Garth

2009-06-01

Despite decades of research, development and evaluation of educational and promotional strategies to prevent teenage pregnancy, we have only a limited understanding of the strategies that are effective and why. This study sought to explore female teenagers' attitudes, perceptions and experiences of contraceptive use, and describe the influence of this on pregnancy risk. A qualitative approach was used to explore the contraceptive behaviour in a purposive sample of sexually active Australian females aged 14-19 years. Teenagers were drawn from three sub-groups: antenatal and postnatal services (pregnant-continuing); termination services (pregnant-terminating); and sexual health clinics (never-pregnant). Sixty-eight individual, semi-structured interviews were conducted. Thematic analysis was employed to analyse the data and generate a rich, description of contraceptive behaviour. Whilst participants were familiar with contraception, many used it inconsistently. Commitment to pregnancy prevention was firmly located within participants' attitudes toward teenage pregnancy and parenthood, perceptions of pregnancy risk and perceptions of the costs and benefits of using contraception. Further, motivation to use contraception fluctuated in different contexts, such as romantic relationships. Our research highlights the importance of attitudes toward contraception, pregnancy and parenthood in shaping teenagers' motivation to use contraception. Educational and prevention programs must address the spectrum of attitudes underlying teenagers' contraceptive and reproductive decisions in order to alter pathways to teenage pregnancy and early parenting.

Contraception with combined oral contraceptive pills in Port ...

African Journals Online (AJOL)

Mass media was the commonest source of information, and one accidental pregnancy occurred (Pearl index 0.03 per 100 woman years). Conclusion: This study shows that combined oral contraceptives pills appear to be acceptable, safe and effective in Port Harcourt. This compares to world wide experience. Concerted ...

Contraception with Intrauterine Contraceptive Device (IUCD) in Port ...

African Journals Online (AJOL)

One accidental pregnancy occurred (pearl index of 0.007 per 100 woman years). IUCD is an effective method of contraception in Port Harcourt ; comparable to worldwide experience. The low uptake rate calls for concerted effort to create more awareness about it especially in the rural areas/ non literate population.

Unprotected intercourse in the 2 weeks prior to requesting emergency intrauterine contraception.

Science.gov (United States)

Sanders, Jessica N; Howell, Laura; Saltzman, Hanna M; Schwarz, E Bimla; Thompson, Ivana S; Turok, David K

2016-11-01

Previous emergency contraception studies have excluded women who report >1 episode of unprotected or underprotected intercourse. Thus, clinical recommendations are based on exposure to a single episode of underprotected intercourse. We sought to assess the prevalence and timing of underprotected intercourse episodes among women requesting emergency contraception and to examine the probability of pregnancy following an emergency contraception regimen including placement of either a copper intrauterine device or a levonorgestrel intrauterine device with simultaneous administration of an oral levonorgestrel pill in women reporting multiple underprotected intercourse episodes, including episodes beyond the Food and Drug Administration-approved emergency contraception time frame (6-14 days). Women seeking emergency contraception who had a negative pregnancy test and desired either a copper intrauterine device or levonorgestrel emergency contraception regimen enrolled in this prospective observational study. At enrollment, participants reported the number and timing of underprotected intercourse episodes in the previous 14 days. Two weeks later, participants reported the results of a self-administered home pregnancy test. Of the 176 women who presented for emergency contraception and received a same-day intrauterine device, 43% (n = 76) reported multiple underprotected intercourse episodes in the 14 days prior to presenting for emergency contraception. Women with multiple underprotected intercourse episodes reported a median of 3 events (range 2-20). Two-week pregnancy data were available for 172 (98%) participants. Only 1 participant had a positive pregnancy test. Pregnancy occurred in 0 of 97 (0%; 95% confidence interval, 0-3.7%) women with a single underprotected intercourse episode and 1 of 75 (1.3%; 95% confidence interval, 0-7.2%) women reporting multiple underprotected intercourse episodes; this includes 1 of 40 (2.5%; 95% confidence interval, 0-13.2%) women

Sexual Behavior and Contraceptive Use at Brown University: 1975-2011.

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Peipert, Benjamin J; Scott, Dana Marie; Matteson, Kristen A; Clark, Melissa A; Zhao, Qiuhong; Peipert, Jeffrey F

2016-01-01

To assess sexual behaviors and contraceptive use in a sample of Brown University students. A total of 255 undergraduate students responded to an anonymous online survey in May 2011. The survey addressed level of sexual activity, behaviors, and contraceptive use. Female responders were compared to results from surveys conducted in 1975, 1986, 1989, and 1995. Of the surveyed undergraduates 62% were sexually active. Sexual activity among women was similar to that of previous survey years. Contraceptive pills were the most common primary contraceptive method, reported by 59% of students, and 32% used dual method contraceptive use for sexually transmitted disease (STD) and pregnancy prevention. We observed a plateau in condom use among women in 2011 after an increase from 1975-1995. Use of long-acting reversible contraception (LARC) was uncommon (3%). Educational efforts should emphasize the effectiveness of LARC and dual method contraceptive use to reduce the risk of STDs and unintended pregnancies.

Contraceptive availability during an emergency response in the United States.

Science.gov (United States)

Ellington, Sascha R; Kourtis, Athena P; Curtis, Kathryn M; Tepper, Naomi; Gorman, Susan; Jamieson, Denise J; Zotti, Marianne; Barfield, Wanda

2013-03-01

This article provides the evidence for contraceptive need to prevent unintended pregnancy during an emergency response, discusses the most appropriate types of contraceptives for disaster situations, and details the current provisions in place to provide contraceptives during an emergency response.

Safety and Efficacy of Contraceptive Methods for Obese and Overweight Women.

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Lotke, Pamela S; Kaneshiro, Bliss

2015-12-01

Increasing rates of obesity have become a major public health challenge. Given the added health risks that obese women have during pregnancy, preventing unwanted pregnancy is imperative. Clinicians who provide contraception must understand the efficacy, risks, and the weight changes associated with various contraceptive methods. Despite differences in the pharmacokinetics and pharmacodynamics of hormonal contraceptives in overweight and obese women, efficacy does not appear to be severely impacted. Both estrogen-containing contraceptives and obesity increase the risk of venous thromboembolism, but the absolute risk remains acceptably low in reproductive age women. Copyright © 2015 Elsevier Inc. All rights reserved.

Informative content of clinical symptoms of acute appendicitis in different terms of pregnancy

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Kutovoy A.B.

2015-09-01

Full Text Available With the purpose to evaluate diagnostic efficacy of some clinical symptoms of acute appendicitis 75 women in different terms of pregnancy were examined. Informative content of such symptoms as Kocher- Volkovich, Rovsing, Bartomje - Michelson, Sitkovsky, Gabay, Brendo, Michelson, Ivanov was studied. Pain syndrome was fixed in all examined women. Pain localization was various and depended on the pregnancy term. During the I trimester of pregnancy the most often pain was manifestated in epigastrium and right lower quadrant, rarely in other abdomen regions. In the II trimester in majority of cases pain occurred in right lower quadrant. During III trimester pain prevailed in right upper quadrant of abdomen. Analyzing informative component of researching symptoms there was noted significant decrease (р<0,05; р<0,01; р<0,001 of their diagnostic value with growth of pregnancy term. Therefore Kocher – Volkovich and Rovsing symptoms were the most informative in the I trimester of pregnancy. Diagnostic efficacy of Brendo(67,3%, Michelson(55,7%, Ivanov(59,6% symptoms was higher than that of Kocher – Volkovich (36,5%, Rovsing (28,8%, Sitkovsky (51,9%, Bartomje – Michelson (55,7% symptoms, their value was diminishing together with increase of pregnancy terms.

Emergency contraceptives bring a little peace of mind.

Science.gov (United States)

Setty, V

1999-04-01

Although emergency contraceptive pills have been prescribed to US women since the discovery of the birth control pill, this regimen has been termed "America's best-kept secret." For fear of legal liability, many providers have been unwilling to prescribe oral contraceptive pills for a purpose other than that for which they are labeled on the packaging. There are indications, however, that access to emergency contraception in the US is improving. PREVEN, the first product to be approved by the US Food and Drug Administration specifically for emergency contraception, was released in 1998. The kit includes a step-by-step information booklet, a pregnancy test, and four birth control pills. In Washington State, collaborative drug agreements between volunteer pharmacists and licensed prescribers enable pharmacists to prescribe emergency contraception pills directly--a move that is estimated to have prevented 207 unintended pregnancies and 103 abortions in less than one year. Planned Parenthood has developed two programs to increase the use of emergency contraception. The first allows clinicians to discuss emergency contraception over the phone with clients (even new ones) and to call in prescriptions to local pharmacies; the second provides women with emergency contraceptive kits to keep on hand in advance of a need for the regimen.

Oral contraceptives, pregnancy and the risk of cerebral thromboembolism: the influence of diabetes, hypertension, migraine and previous thrombotic disease

DEFF Research Database (Denmark)

Lidegaard, O

1995-01-01

OBJECTIVE: To assess the risk of developing cerebral thromboembolism among pregnant women and among fertile women with hypertension, migraine, diabetes, and previous thrombotic disease, and to investigate the interaction of these risk factors with the use of oral contraceptives. DESIGN...... multivariate analysis, pregnancy implied an odds ratio (OR) for a cerebral thromboembolic attack of 1.3 (nonsignificant), diabetes an OR of 5.4 (P hypertension an OR of 3.1 (P ... thromboembolism whereas diabetes, hypertension, migraine and past thromboembolic events increased the risk of cerebral thromboembolism significantly. Women with these increased thrombotic risks should use oestrogen-containing oral contraceptives only after careful considerations of the risks, if at all....

Adolescent males' orientation toward paternity and contraception.

Science.gov (United States)

Marsiglio, W

1993-01-01

Data from a nationally representative sample of 1,880 young men aged 15-19 reveal that neighborhood quality, parental education, race or ethnicity, and attitudes about male gender roles are related to young men's attitudes toward an unplanned pregnancy and to their contraceptive experiences. Young men who live in poor neighborhoods are more likely to be pleased about an unplanned pregnancy than those who have better living conditions (12% vs. 2%) and are also more likely to view impregnating a woman as enhancing their masculinity (8% vs. 3%). Among men with average living conditions, 12% of black adolescents view fathering a child as enhancing their masculinity, compared with 6% of white adolescents; among those with very good living conditions, these proportions were 10% and 2%, respectively. Young men whose parents had less education and those who held traditional male gender role attitudes were also more likely than their counterparts to view fathering a child as enhancing their masculinity. Regarding contraceptive behavior, sexually active black men and Hispanic men were more likely than white men to have discussed contraception with their last partner; black men were more likely to have used an effective contraceptive method the last time they had intercourse; and black men were more likely to have used a condom at last intercourse. However, young men who were aware that they had been responsible for a previous pregnancy were less likely than those who reported no pregnancies to have used an effective contraceptive the last time they had intercourse. These same young men were also more likely to report that fathering a child would please them and enhance their masculinity.

Male hormonal contraception: looking back and moving forward.

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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.

High pregnancy incidence and low contraceptive use among a prospective cohort of female entertainment and sex workers in Phnom Penh, Cambodia.

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Duff, Putu; Evans, Jennifer L; Stein, Ellen S; Page, Kimberly; Maher, Lisa

2018-05-03

While HIV and unintended pregnancies are both occupational risks faced by female sex workers, the epidemiology of pregnancy and its drivers in this population remains understudied. This includes Cambodia, where the drivers of pregnancy among female entertainment and sex workers (FESW) remain unknown. The current study aimed to examine factors associated with incident pregnancy, as well as describe contraceptive use among FESW in Phnom Penh, Cambodia. This analysis drew from the Young Women's Health Study (YWHS)-2, a 12-month observational cohort of 220 FESW aged 15-29 years, conducted between August 2009 and August 2010. Interviewer-administered questionnaires were conducted at baseline and quarterly thereafter, alongside HIV and pregnancy testing. Bivariate and multivariable extended Cox regression analysis was used to examine correlates of incident pregnancy. At baseline, 6.8% of participants were pregnant, and only 10.8% reported using hormonal contraceptives, with 11.3% reporting an abortion in the past 3 months. Pregnancy incidence was high, at 22/100 person-years (95% CI: 16.3-30.1). In multivariable analysis, younger age (19-24 years versus 25-29 years) (Adjusted Hazards Ratio (AHR): 2.28; 95% Confidence Interval (CI) 1.22-4.27), lower income (400,000-600,000 Riel (≤150$USD) versus > 600,000 Riel (> 150$USD)) (AHR 2.63; 95% CI 1.02-6.77) positively predicted pregnancy, while higher self-reported condom self-efficacy were associated with reduced pregnancy incidence (AHR 0.89; 95% CI 0.81-0.98). Results document high incidence of pregnancy and unmet reproductive health needs among FESWs in Cambodia. Findings point to an urgent need for multi-level interventions, including venue-based HIV/STI and violence prevention interventions, in the context of legal and policy reform. High pregnancy incidence in this population may also undermine recruitment and retention into HIV prevention intervention trials. The exploration of innovative and comprehensive sex

Teen Pregnancy and Childbearing

Science.gov (United States)

... Pregnancy has sub items, Reproductive Health & Teen Pregnancy Contraceptive Use STDs Teen Pregnancy & Childbearing Teen Pregnancy Prevention Program Trends Negative Impacts Strategies & Approaches for Prevention Engaging Adolescent Males in Prevention Tips for Parents of Teens ...

Maternal depressive symptoms during and after pregnancy are associated with attention-deficit/hyperactivity disorder symptoms in their 3- to 6-year-old children.

Directory of Open Access Journals (Sweden)

Elina Wolford

Full Text Available Maternal depressive symptoms during pregnancy have been associated with child behavioural symptoms of attention-deficit/hyperactivity disorder (ADHD in early childhood. However, it remains unclear if depressive symptoms throughout pregnancy are more harmful to the child than depressive symptoms only during certain times, and if maternal depressive symptoms after pregnancy add to or mediate any prenatal effects. 1,779 mother-child dyads participated in the Prediction and Prevention of Pre-eclampsia and Intrauterine Growth Restriction (PREDO study. Mothers filled in the Center of Epidemiological Studies Depression Scale biweekly from 12+0-13+6 to 38+0-39+6 weeks+days of gestation or delivery, and the Beck Depression Inventory-II and the Conners' Hyperactivity Index at the child's age of 3 to 6 years (mean 3.8 years, standard deviation [SD] 0.5. Maternal depressive symptoms were highly stable throughout pregnancy, and children of mothers with consistently high depressive symptoms showed higher average levels (mean difference = 0.46 SD units, 95% Confidence Interval [CI] 0.36, 0.56, p < 0.001 compared to the low group, and proportion (32.1% vs. 14.7% and odds (odds ratio = 2.80, 95% CI 2.20, 3.57, p < 0.001 of clinically significant ADHD symptoms. These associations were not explained by the effects of maternal depressive symptoms after pregnancy, which both added to and partially mediated the prenatal effects. Maternal depressive symptoms throughout pregnancy are associated with increased ADHD symptomatology in young children. Maternal depressive symptoms after pregnancy add to, but only partially mediate, the prenatal effects. Preventive interventions suited for the pregnancy period may benefit both maternal and offspring mental health.

Contraceptive choice and acceptability: the future for STI risk in Kelantan, Malaysia.

Science.gov (United States)

Shiely, Frances; Saifuddin, Mohammed Syafiek

2014-03-01

More than 150 million women become pregnant in developing countries annually and an estimated 287,000 die from pregnancy-related causes. Contraception is vital to prevent unnecessary maternal deaths, as well as sexually transmitted infections. The objective of this study was to investigate preferred contraceptive methods and the factors that influence contraceptive choice among women in Kelantan, Malaysia. A cross-sectional study using interview-based questionnaires was conducted, during July and August 2009, in local family planning clinics in Kelantan. The questionnaire was administered to adult women (age 20-50). Prevalence of unplanned pregnancies was high (48%). Contraceptive preference was Depo contraceptive injection (32%), oral contraceptive pills (27%), intrauterine devices (15%) and contraceptive implants (12%); 9% used condoms. Only 2% used contraception to protect against sexually transmitted infections or HIV/AIDS. Younger women (OR 0.90; 95% CI 0.807-0.993) were more likely to use contraception. In conclusion, non-interrupted contraceptive methods were preferred. More than 60% would stop using contraception if it interrupted intercourse. From both a public health and infectious disease perspective, this is extremely worrying.

Influence of gender, anxiety and depression symptoms, and use of oral contraceptive in color perception.

Science.gov (United States)

Silva, Maria Aparecida da; Anfe, Taciana Emília de Almeida; Matos, Adriana Bona; Vieira, Glauco Fioranelli

2015-01-01

The color is a psychophysical phenomenon, and much has been studied about its physical components. However, the psychological part is poorly investigated, except for the difference between genders in the literature shows that more men are color deficient than women. Dental students are trained to better understand the differences in color, so we became interested in studying whether psychological variables such as anxiety and depression and use of hormonal contraceptives may interfere with this ability. The aim of this in vitro study was to investigate if factors, such as, hormonal contraceptive use, depressive symptoms, anxiety and quality of life, influence on the ability of color discrimination of dental school students. Sixty-one subjects participated and the following instruments apply: (1) test that consists in the observation of a set of 25 labels (Pantones) with values of known colors, (2) scales of depression, anxiety, and quality of life assessments, and (3) Ishihara test. No difference was observed between genders as color perception (p = 0.868). Symptoms of anxiety and depression were significantly more frequent in the female population that showed worse quality of life (p color perception. Women using hormonal contraceptives had lower color perception than men (p = 0.04). No difference between the genders in the perception of colors was observed, contrary to common sense that women discriminate more colors than men, but women using hormonal contraceptives showed more difficulty in color perception. The ability to understand and distinguish color differences is extremely important in clinical dentistry. There could be differences in color perception between men and women that would influence clinical performance. © 2014 Wiley Periodicals, Inc.

Practice Bulletin No. 152: Emergency Contraception.

Science.gov (United States)

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.

Adolescent mothers' knowledge and perceptions of contraceptives ...

African Journals Online (AJOL)

This descriptive quantitative survey attempted to identify reasons why adolescent mothers (aged 19 or younger at the birth of their babies) failed to utilise contraceptive, emergency contraceptive and / or termination of pregnancy (TOP) services. The research population comprised all adolescent mothers in the region, the ...

Emergency Contraception: A Global Overview of Knowledge ...

African Journals Online (AJOL)

Context: Recent concerns over teenage pregnancy, abortion and sexuality have pushed emergency contraceptive methods to the fore once again. The studies on knowledge and attitudes of providers are of particular importance, as they will have direct effects on potential users of emergency contraception. Aim/Method: ...

Vaginal contraception--an update.

Science.gov (United States)

Edelman, D A; Thompson, S

1982-04-01

A number of new and innovative methods of vaginal contraceptive have been developed in recent years and are currently being evaluated. Some of these methods are described briefly and the available data on their safety and efficacy are presented. 3 types of contraceptive sponges have been developed--collagen sponge, intravaginal insert, and Secure sponge--and are now being evaluated. The collagen sponge, a cylindrical-shaped disk, exerts its contraceptive effect by acting as a physical barrier to the sperm and through its ability to absorb semen much in excess of its own weight. Preliminary data confirm the effectiveness of the sponge obtained from post-coital tests. The intravaginal insert (IVI) is made of a polyester material incorporating the spermicide nonoxynol-9. In a small clinical evaluation of the IVI, 49 women were followed up for 1 month. No pregnancies or unexpected adverse reactions were reported. The Secure sponge is made of polyurethane and incorporates 1 g of the spermicide nonoxynol-9. Its primary mode of action in preventing pregnancy is through the release of nonoxynol-9. In a multiclinic phase 2 evaluation of the Secure, which included 382 women, the 6-month gross life-table pregnancy rate was 3.8 +or- 1.3/100 women; the 6-month gross discontinuation rate for all reasons was 26.2 +or- 3.4/100 women. Sufficient data from the comparative trials of the Secure and Neo Sampoon foaming suppository studies conducted in Yugoslavia, Taiwan, and Bangladesh have been reported to the International Fertility Research Program (IFRP). The 12-month life-table rates for reasons leading to discontinuation of the contraceptive methods were not significantly different except for the category of "other personal reasons." The advantages Secure provides over other vaginal contraceptives are identified. Foaming vaginal suppositories similar to Neo Sampoon but containing 100 mg nonoxynol-9 are being developed and evaluated in the U.S. Clinical data on these products are

Factors Associated With Interest in Same-Day Contraception Initiation Among Females in the Pediatric Emergency Department.

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Miller, Melissa K; Randell, Kimberly A; Barral, Romina; Sherman, Ashley K; Miller, Elizabeth

2016-02-01

The purposes were to describe interest in hormonal contraception initiation among female adolescent in the emergency department (ED) and to assess for associations with factors known to increase pregnancy risk such as violence victimization. We used a computerized survey to assess sexual and dating practices, pregnancy history/likelihood, contraception use (including long-acting reversible contraception [LARC]) and concerns, contraception initiation interest, violence victimization, medical utilization, and demographics among sexually experienced females aged 14-19 years in our ED. The primary outcome was interest in contraception initiation. We compared responses between subgroups using the chi-square test. A total of 168 adolescents participated (82% of approached; mean age 16.6 years; 41% white; 48% black; 21% commercial insurance). Interest in contraception initiation was high: 60% overall and 70% among those not using hormonal contraception (n = 96). Among those using non-LARC contraception (n = 59), 29% were interested in LARC initiation. Contraception/LARC interest was positively associated with lack of recent well care (p contraception (p contraception at last intercourse. One third (36%) reported violence victimization. Most (70%) reported ≥1 concern about contraception (most commonly cost). Many reported behaviors and exposures, including violence victimization, that increase their risk for pregnancy and most expressed interest in same-day initiation of hormonal contraception, including LARC. These findings may inform novel strategies for increased adolescent access to contraception and pregnancy prevention through use of nontraditional sites such as EDs. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Contraception among bankers in an urban community in Lagos State, Nigeria.

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Meka, Ijeoma Angela; Okwara, Emmanuel Chidiebere; Meka, Anthony Obiamaka

2013-01-01

Contraception means procedures employed to interfere at one stage or the other with the normal sequence of events in the process of reproduction leading to a failure in conception. It means voluntary techniques adopted to achieve birth control. Its use remains sensitive worldwide. Within the same society, contraception varies amongst people of different socio-cultural, educational, religious, or occupational affiliations. It also varies between urban and rural settlements. Some contraceptive techniques also prevent sexually transmitted infections (STIs). The prevalence of STIs also varies with these same factors. There is very limited literature on contraception exclusively amongst bankers. We sought to investigate the level of awareness and practice of contraception amongst bankers in an urban society in Lagos State, Nigeria. In this descriptive cross-sectional study, 200 self-administered structured questionnaires were retrieved from bankers from 5 banks selected by simple random sampling in Surulere Local Government Area of Lagos State, Nigeria. Data was subsequently statistically analyzed using SPSS. The age range was 21-45 years, mean 28.8±1.4 years, 51.7% were males (72% single, 27% married, 1% separated) and 48.3% were females (52.4% single, 47.6% married). All (100%) respondents were aware of contraception, 93.3% males and 91.7% females were sexually active, 88.9% males and 84.5% females believe contraception is useful. Most (71.4%) respondents practice contraception, males (81%) being more than females (61.1%), p males believe that contraception prevents pregnancy but not STIs, 28.6% of females and 46.6% of males believe it prevents both pregnancy and STIs, whereas 14% of males and no female believe contraception prevents STIs but not pregnancy. The awareness of and practice of contraception was very high among the bankers but more male bankers practice contraception whereas more female bankers perceive contraceptives to be for the married only.

Risk factors and the choice of long-acting reversible contraception following medical abortion: effect on subsequent induced abortion and unwanted pregnancy.

Science.gov (United States)

Korjamo, Riina; Heikinheimo, Oskari; Mentula, Maarit

2018-04-01

To analyse the post-abortion effect of long-acting reversible contraception (LARC) plans and initiation on the risk of subsequent unwanted pregnancy and abortion. retrospective cohort study of 666 women who underwent medical abortion between January-May 2013 at Helsinki University Hospital, Finland. Altogether 159 (23.8%) women planning post-abortion use of levonorgestrel-releasing intrauterine system (LNG-IUS) participated in a randomized study and had an opportunity to receive the LNG-IUS free-of-charge from the hospital. The other 507 (76.2%) women planned and obtained their contraception according to clinical routine. Demographics, planned contraception, and LARC initiation at the time of the index abortion were collected. Data on subsequent abortions were retrieved from the Finnish Abortion Register and electronic patient files until the end of 2014. During the 21 months ([median], IQR 20-22) follow-up, 54(8.1%) women requested subsequent abortions. When adjusted for age, previous pregnancies, deliveries, induced abortions and gestational-age, planning LARC for post-abortion contraception failed to prevent subsequent abortion (33 abortions/360 women, 9.2%) compared to other contraceptive plans (21/306, 6.9%) (HR 1.22, 95% CI 0.68-2.17). However, verified LARC initiation decreased the abortion rate (4 abortions/177 women, 2.3%) compared to women with uncertain LARC initiation status (50/489, 10.2%) (HR 0.17, 95% CI 0.06-0.48). When adjusted for LARC initiation status, age abortion (27 abortions/283 women, 9.5%) compared to women ≥25 years (27/383, 7.0%, HR1.95, 95% CI 1.04-3.67). Initiation of LARC as part of abortion service at the time of medical abortion is an important means to prevent subsequent abortion, especially among young women.

Knowledge, attitudes and practice of secondary school girls towards contraception in Limpopo Province

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Dorah U. Ramathuba

2012-07-01

Full Text Available Unplanned teenage pregnancy constitutes an important health problem, whilst contraceptive services are free throughout South Africa and the number of Termination of Pregnancy (TOP services is increasing. The purpose of this study was to assess the knowledge, attitudes and practices of secondary school girls towards contraception in Thulamela Municipality of Limpopo Province, South Africa. A quantitative descriptive study design was used and respondents were selected by convenience sampling from a population of secondary school girls, the sample consisting of 273 girls in Grades 10–12. A self-administered questionnaire was used to collect data and analysed by computing frequencies and percentages using the Statistical Package for Social Sciences. Findings showed that respondents were aware of different contraceptive methods that can prevent pregnancy. However, most did not have knowledge of the emergency contraceptive, intra-uterine device and female condom. Pressure from male partners, fear of parental reaction to the use of contraceptives, reluctance to use contraceptives, poor contraceptive education and lack of counselling were seen as the main causes of ineffective contraceptive use and non-utilisation. Possible modalities of intervention deal with providing contraceptive counselling and care to empower these school girls to make informed choices on reproductive health.

Ulipristal acetate for emergency contraception: postmarketing experience after use by more than 1 million women.

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Levy, Delphine P; Jager, Martine; Kapp, Nathalie; Abitbol, Jean-Louis

2014-05-01

To describe the safety of ulipristal acetate in emergency contraception. Postmarketing pharmacovigilance data collection. A total of 553 women experienced 1049 adverse drug reactions. The most frequent (n,%) were pregnancies (282, 6.8%); nausea, abdominal pain and vomiting (139, 13.3%); headache, dizziness (67, 6.4%); and metrorrhagia, menses delay and breast symptoms (84, 8.0%). Including data from clinical trials, 376 pregnancies have been reported in total, 232 (62%) with a known outcome: 28 live births (29 newborns), 34 miscarriages, 151 induced abortions, 4 ectopics and 15 which are ongoing. No safety concern emerges from a sizable database of reported adverse reactions following ulipristal acetate exposure among varying ethnicities and regions. Postapproval data confirm the safety profile described during the clinical trials. Use of ulipristal acetate for emergency contraception in a variety of settings and among diverse populations indicate that it is safe and without unexpected or serious adverse events. Copyright © 2014 Elsevier Inc. All rights reserved.

A prospective longitudinal cohort study: evolution of GERD symptoms during the course of pregnancy

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Fill Malfertheiner Sara

2012-09-01

Full Text Available Abstract Background Symptoms of gastro-esophageal reflux disease (GERD in pregnancy are reported with a prevalence of 30–80%. The aim of this study was to assess the prevalence and severity of GERD symptoms during the course of pregnancy. Furthermore current practice in medical care for GERD during pregnancy was assessed. Methods We performed a prospective longitudinal cohort study on 510 pregnant women (mean age 28.12, SD 5.3. Investigations for reflux symptoms where based on the use of validated reflux-disease questionnaire (RDQ. Additional information was collected about the therapy. A group of non-pregnant women (mean age 24.56, SD 5.7 was included as controls. Frequency and severity of reflux symptoms were recorded in each trimester of pregnancy. Results The prevalence of GERD symptoms in pregnant women increased from the first trimester with 26.1 to 36.1% in the second trimester and to 51.2% in the third trimester of pregnancy. The prevalence of GERD symptoms in the control group was 9.3%. Pregnant women received medication for their GERD symptoms in 12.8% during the first, 9.1% during the second and 15.7% during the third trimester. Medications used >90% antacids, 0% PPI. Conclusion GERD symptoms occur more often in pregnant women than in non-pregnant and the frequency rises in the course of pregnancy. Medical therapy is used in a minority of cases and often with no adequate symptom relief.

Use of contraceptives among adolescents in Kintampo, Ghana: a cross-sectional study

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Boamah EA

2014-05-01

Full Text Available Ellen Abrafi Boamah, Kwaku Poku Asante, Emmanuel Mahama, Grace Manu, Emmanuel Kwesi Ayipah, Elisha Adeniji, Seth Owusu-Agyei Kintampo Health Research Center, Ghana Health Service, Kintampo, Ghana Introduction: The use of contraceptives is essential in preventing unwanted pregnancies, unsafe abortions, and abortion-related complications that expose adolescents to health-related risks such as infertility and sometimes death. Objective: To assess contraceptive use among adolescents as evidence to develop appropriate interventions for adolescent sexual health programs. Methods: A cross-sectional survey using both quantitative and qualitative methods was conducted among 793 male and female adolescents (aged 15–19 years in the Kintampo area of Ghana from October 2010–May 2011. Results: Knowledge of at least one contraceptive method was high (88.9% among adolescents of both sexes (males 92.1% and females 86.6%. Knowledge of male condoms was highest (84.0%, and it was the most common contraceptive method used (82.0%. The use of other methods such as pills (7.9%, injection (0.9%, and foam (0.3%, amongst others, was low. About 22.9% of adolescents used contraceptives consistently. Among adolescents, consistent contraceptive use was significantly associated with discussions of contraceptive use between partners (P<0.01. Adolescents who discussed contraceptive use before their first sexual encounter were more likely to use contraceptives consistently when compared to those who had never discussed contraceptive use (odds ratio =0.06; 95% confidence interval: 0.02–0.17; P<0.01. Among sexually active adolescents, 30.0% had experienced pregnancy, with 34.0% of pregnancies resulting in abortions. Pregnancy was high among adolescents who did not use contraceptives consistently, as compared to those who did (6.4% versus 93.6%; P<0.01. The most common source of contraceptives was the chemical seller's/pharmacy shop (62.1%. Conclusion: Though a high number of

Current and future contraceptive options for women living with HIV.

Science.gov (United States)

Patel, Rena C; Bukusi, Elizabeth A; Baeten, Jared M

2018-01-01

Among women living with HIV, half of the pregnancies are unintended. Effective contraception can prevent unintended pregnancies and consequently reduce maternal mortality and perinatal transmission of HIV. While contraceptive options available for all women also apply to women living with HIV, specific considerations exist to the use of contraception by women living with HIV. Areas covered: First, general principles guiding the use of contraception among women living with HIV are discussed, such as choice, method mix, relative effectiveness, and drug-drug interactions. Second, a detailed discussion of each contraceptive method and issues surrounding the use of that method, such as drug-drug interactions, follows. Third, future contraceptive options in advanced development for use by women or men are briefly discussed. Expert opinion: Contraceptive methods available to all women should also be accessible to women living with HIV. When the relative effectiveness of a contraceptive method is reduced, for example due to drug-drug interactions with antiretrovirals, the method should still be made available to women living with HIV with the appropriate information sharing and counseling. Greater research on various aspects of contraceptive use by women living with HIV and more comprehensive testing of co-administration of hormonal contraceptives and common medications used by these women are warranted.

Attitudes towards and knowledge about intrauterine contraceptive ...

African Journals Online (AJOL)

In terms of attitudes, 40.0% (n=60) expressed concern about the pain during insertion, 33.3% (n=50) believed the IUCD can ... women are at risk of unintended pregnancy. ... pregnancies requires long periods of effective contraceptive use.

Are oral emergency contraceptives a safe and effective form of long-term birth control?

Science.gov (United States)

Kraus, Connie; Hooper-Lane, Christopher

2017-10-01

Yes, but not as effective as some other methods. Annual pregnancy rates in women using pericoital levonorgestrel 150 mcg to 1 mg range from 4.9% to 8.9%; menstrual irregularity is the most common adverse effect (strength of recommendation [SOR]: B, Cochrane review of lower-quality trials). In women younger than 35 years who have sexual intercourse 6 or fewer times per month, correct and consistent use of pericoital levonorgestrel 1.5 mg results in an annual pregnancy rate of 11% (SOR: B, one large prospective, open-label trial). Pericoital contraception is less effective than long-acting reversible contraceptives (annual pregnancy rates of 0.05%-0.8%) or perfect use of combined oral contraceptives (0.3% annual pregnancy rate), but similar to, or better than, typical use of combined oral contraception (9%) and condoms (18%).

Intra-uterine contraceptive devices.

Science.gov (United States)

Elias, J

1985-05-01

Among the advantages of IUDs are the device's high continuation rate, the lack of systemic side effects, and the absence of a need for continual motivation to practice contraception. The effectiveness of plastic IUDs is directly proportional to their surface area, but the degree of excessive bleeding experienced is inversely related to device size. Thus, devices represent a compromise between large size for effectiveness and small size for acceptability. The optimum time to fit an IUD is during the 1st hald of the menstrual cycle. Absolute contraindications to IUD use include the presence of active pelvic inflammatory disease, undiagnosed irregular bleeding, a history of ectopic pregnancy or tubal surgery, and a distorted uteine cavity. Failure rates associated with IUD use range from 2-3% in the 1st year and then decrease. Since the main mechanism of action appears to be production of a sterile inflammatory reaction in the uterine cavity, the IUD prevents intrauterine pregnancy more effectively than ectopic pregnancy. Nonetheless, there is little evidence to suggest that IUD use actually increases the incidence of ectopic pregnancy. Resumption of fertility after IUD removal is not delayed. There is not need to change inert plastic IUDs in women who remain symptom free. The copper devices should be changed every 3-4 years. A search is under way for antifertility agents that can be incorporated into the device to reduce side effects. In general, the IUD is most suitable for older, parous women.

Contraceptive Coverage and the Affordable Care Act.

Science.gov (United States)

Tschann, Mary; Soon, Reni

2015-12-01

A major goal of the Patient Protection and Affordable Care Act is reducing healthcare spending by shifting the focus of healthcare toward preventive care. Preventive services, including all FDA-approved contraception, must be provided to patients without cost-sharing under the ACA. No-cost contraception has been shown to increase uptake of highly effective birth control methods and reduce unintended pregnancy and abortion; however, some institutions and corporations argue that providing contraceptive coverage infringes on their religious beliefs. The contraceptive coverage mandate is evolving due to legal challenges, but it has already demonstrated success in reducing costs and improving access to contraception. Copyright © 2015 Elsevier Inc. All rights reserved.

Influence of women health care adoption on contraceptive use

International Nuclear Information System (INIS)

Abbasi, S.U.R.S.; Zafar, M.I.; Batool, Z.

2008-01-01

The effect of woman heath seeking behaviour during pregnancy and post delivery period on contraceptive use and family size are important dimensions of female fertility. These determinants of female fertility have rarely been explored, particularly in developing countries confronting problems of rising population growth. A study was conducted in district Faisalabad, Pakistan to explore the influence of pre and postnatal care on contraceptive use. A random sample of 1051 married women was studied from the urban and rural areas of the district through formal survey. It was found that contraceptive use is associated with pre. and postnatal care. Minimum of 5-7 prenatal and at least 2 postnatal visits have been identified as effective to promote contraceptive use. Involvement of health professionals, motivation through mass media and improved access to health care services during the period of pregnancy and after childbirth are the measures suggested to enhance contraceptive use in the society to curtail family size. (author)

Long acting reversible contraception | Kluge | Obstetrics and ...

African Journals Online (AJOL)

Long acting reversible contraception (LARC) has great potential in reducing these pregnancies as they are highly effective and do not rely a great deal on compliance and correct use. They have better continuation rates than short term hormonal contraception and as per definition require administration less than once per ...

Effect of body weight and BMI on the efficacy of levonorgestrel emergency contraception.

Science.gov (United States)

Kapp, Nathalie; Abitbol, Jean Louis; Mathé, Henri; Scherrer, Bruno; Guillard, Hélène; Gainer, Erin; Ulmann, André

2015-02-01

To further evaluate the effect of weight and body mass index (BMI) on the efficacy of levonorgestrel emergency contraception. Data from two large, multicenter, randomized controlled trials designed to assess emergency contraceptive efficacy were pooled to evaluate the effect of weight and BMI on pregnancy rates among women who received levonorgestrel. Descriptive methods (comparison of means and distributions according to pregnancy status and pregnancy rates across weight and BMI categories) as well as cubic spline modeling were used to describe the relationship between pregnancy risk and weight/BMI. The analysis population comprised 1731 women, among whom 38 pregnancies were reported. Women for whom levonorgestrel was not effective in preventing pregnancy had a significantly higher mean body weight and BMI than women who did not become pregnant (76.7 vs. 66.4 kg, p85 kg groups, respectively. Statistical modeling demonstrated a steep increase in pregnancy risk starting from a weight near 70-75 kg to reach a risk of pregnancy of 6% or greater around 80 kg. Similar results were obtained for statistical modeling of BMI as well as when the two studies were analyzed individually. All analyses showed a significant drop in the efficacy of levonorgestrel emergency contraception with increasing body weight, with pregnancy risk in the higher weight categories similar to expected rates in the absence of contraception. Like body weight, increasing BMI was highly correlated with increased pregnancy risk. Copyright © 2015 Elsevier Inc. All rights reserved.

Antibiotics and oral contraceptives.

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DeRossi, Scott S; Hersh, Elliot V

2002-10-01

With the exception of rifampin-like drugs, there is a lack of scientific evidence supporting the ability of commonly prescribed antibiotics, including all those routinely employed in outpatient dentistry, to either reduce blood levels and/or the effectiveness of oral contraceptives. To date, all clinical trials studying the effects of concomitant antibiotic therapy (with the exception of rifampin and rifabutin) have failed to demonstrate an interaction. Like all drugs, oral contraceptives are not 100% effective with the failure rate in the typical United States population reported to be as high as 3%. It is thus possible that the case reports of unintended pregnancies during antibiotic therapy may simply represent the normal failure rate of these drugs. Considering that both drug classes are prescribed frequently to women of childbearing potential, one would expect a much higher rate of oral contraceptive failure in this group of patients if a true drug:drug interaction existed. On the other hand, if the interaction does exist but is a relatively rare event, occurring in, say, 1 in 5000 women, clinical studies such as those described in this article would not detect the interaction. The pharmacokinetic studies of simultaneous antibiotic and oral contraceptive ingestion, and the retrospective studies of pregnancy rates among oral contraceptive users exposed to antibiotics, all suffer from one potential common weakness, i.e., their relatively small sample size. Sample sizes in the pharmacokinetic trials ranged from 7 to 24 participants, whereas the largest retrospective study of pregnancy rates still evaluated less than 800 total contraceptive users. Still, the incidence of such a rare interaction would not differ from the accepted normal failure rate of oral contraceptive therapy. The medico-legal ramifications of what looks like at best a rare interaction remains somewhat "murky." On one hand, we have medico-legal experts advising the profession to exercise caution

Emergency contraception: different bioethical perspectives

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Marco Bo

2007-10-01

Full Text Available Emergency contraceptives, in this case post-morning pills, are contraceptive methods used to avoid an unwanted pregnancy after an unprotected sexual intercourse. Their use is feeding a strong ethical debate between subjects for and against their prescription and leading some health professionals to conscientious objection. Among people contrary to prescription some oppose to it because of a general refuse of all contraceptive methods, others considering post-morning pills as abortive. Among people supporting prescription, some consider emergency contraception necessary to assure fundamental women’s rights, in particular the right to sexual auto-determination, while others prescribe emergency contraception only to avoid a greater demand for abortion. It is up to the Italian National Health Service warranting a correct balance between the two opposite positions, that can protect women’s right of access to health services.

Emergency contraceptive pills as a backup for lactational amenorrhea method (LAM) of contraception: a randomized controlled trial.

Science.gov (United States)

Shaaban, Omar M; Hassen, Shaimaa G; Nour, Sanna A; Kames, Mervat A; Yones, Entsar M

2013-03-01

The use of breastfeeding as a method of birth spacing occasionally ends in "unplanned pregnancy." This is due to unexpected expiration of one or more of the lactation amenorrhea method (LAM) prerequisites. The current study tests a new concept that the in-advance provision of single packet of progestogen emergency contraception (EC) pills during the postpartum LAM counseling may decrease the incidence of unplanned pregnancy during breastfeeding. This was a registered two-armed randomized controlled trial (NCT 01111929). Women intending to breastfeed and to postpone pregnancy for 1 year or more were approached. They received adequate postpartum contraceptive counseling. Women intending to use LAM were randomly assigned to one of two groups. The LAM-only group received the proper LAM counseling and did not receive counseling about EC. The LAM-EC group received counseling for both LAM and EC with in-advance provision of one packet of EC pills. They were advised to use these pills if one of the prerequisites of LAM expires and sexual relation has occurred before the initiation of another regular contraceptive protection. All the participants were advised that they need to use another regular method upon expiration of any of the LAM prerequisites. Eligible women were 1158 parturients randomized into two equal groups. Forty-four percent of the women provided with EC used them. Significantly more women in the LAM-EC group initiated regular contraception within or shortly after the first 6 months postpartum when compared with those in the LAM-only group (30.5% vs. 7.3%, respectively; p=.0004). Pregnancy occurred in 5% of the LAM-only group as compared with 0.8% in the LAM-EC group (p=.005). Minimal side effects were reported after EC use. In-advance provision of EC pills can increase the rate of initiation of regular contraception once one or more of the prerequisites of LAM expire. Consequently, the use of EC pills as a temporary backup of LAM can decrease the incidence

Fertility awareness-based mobile application for contraception

Science.gov (United States)

Berglund Scherwitzl, Elina; Gemzell Danielsson, Kristina; Sellberg, Jonas A.; Scherwitzl, Raoul

2016-01-01

Abstract Objectives: The aim of the study was to retrospectively evaluate the effectiveness of a fertility awareness-based method supported by a mobile-based application to prevent unwanted pregnancies as a method of natural birth control. Methods: In a retrospective analysis, the application’s efficiency as a contraceptive method was examined on data from 4054 women who used the application as contraception for a total of 2085 woman-years. Results: The number of identified unplanned pregnancies was 143 during 2053 woman-years, giving a Pearl Index of 7.0 for typical use. Ten of the pregnancies were due to the application falsely attributing a safe day within the fertile window, producing a perfect-use Pearl Index of 0.5. Calculating the cumulative pregnancy probability by life-table analysis resulted in a pregnancy rate of 7.5% per year (95% confidence interval 5.9%, 9.1% per year). Conclusions: The application appears to improve the effectiveness of fertility awareness-based methods and can be used to prevent pregnancies if couples consistently protect themselves on fertile days. PMID:27003381

Knowledge, attitude and practice of emergency contraceptive among women who seek abortion care at Jimma University specialized hospital, southwest Ethiopia

Directory of Open Access Journals (Sweden)

Tesfaye Tatek

2012-03-01

Full Text Available Abstract Background In Ethiopia maternal mortality rate is very high more than one in five women die from pregnancy or pregnancy related causes. The use of contraceptives to prevent unwanted pregnancies and unsafe abortion is an important strategy to minimize maternal mortality rate. Among various forms of contraception, emergency contraceptives are the only one that can be used after sexual intercourse offering chance to prevent unwanted pregnancy. The aim of this study was to assess the knowledge, attitude and practice of emergency contraceptive among women who seek abortion care at Jimma University specialized hospital (JUSH. Methods Institution base cross-sectional study on knowledge, attitude and practice of emergency contraceptive was conducted at JUSH from April to June, 2011Data was collected using structured questionnaire and analyzed using SPSS version 17.0. Results In this study 89 women were interviewed. More than half of them (48 were from urban area and 41 were from rural area.46 (51.7% of them were single. Of all the respondents only nine women had awareness about emergency contraceptive. Seven of the women mentioned pills as emergency contraception and only two of them mentioned both pills and injectable as emergency contraception. All of them have positive attitude towards emergency contraception but none of them have ever used emergency contraceptives. Conclusion and recommendation The finding revealed pregnancy among women of 15-19 years was very common. The knowledge and practice of emergency contraception is very low. But there is high positive attitude towards emergency contraceptives. Since there is much deficit on knowledge of women on emergency contraceptives, in addition to making them accessible; programs targeted at promotion and education of emergency contraceptives is helpful to prevent unwanted pregnancy.

Experience with oral emergency contraception since the OTC switch in Germany.

Science.gov (United States)

Kiechle, Marion; Neuenfeldt, Miriam

2017-03-01

In March 2015, the oral emergency contraceptives levonorgestrel (LNG) and ulipristal acetate (UPA) were released from prescription-only status in Germany. The main research question is to analyse whether the OTC status of oral emergency contraceptives has an influence on the patterns of use. All information is based on searches for public domain sources on emergency contraception. Searches were made for scientific publications, statistics, and surveys. Due to additional active ingredient properties, UPA is superior to LNG in terms of ovulation-inhibiting effect. Since the OTC switch, demand for oral emergency contraceptives has risen by almost 50%, especially at weekends when sexual encounters and thus contraceptive failures are most frequent. However, the age distribution of the users has not changed as a result of the OTC switch. Doctors still play an important role in advising on emergency contraception after the removal of the prescription-only requirement. Pregnancies despite emergency contraception are terminated in more than half of the cases. In federal states with higher rates of use of the morning-after pill, fewer terminations of pregnancy were performed. As a result of the OTC switch, more women and girls use the morning-after pill after unprotected intercourse and the time between unprotected intercourse and taking the oral emergency contraceptive decreases. This is of great advantage in terms of the mechanism of action. UPA is used more frequently than LNG. Only half of all people aged between 16 and 39 years in Germany are aware of the morning-after pill and 94% of women who had a pregnancy terminated in 2015 did not use any emergency contraception after the unprotected intercourse. In the population, there is still a great need for information and education on contraception and emergency contraception.

Beyond the Condom: Frontiers in Male Contraception.

Science.gov (United States)

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.

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

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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.

Knowledge and use of emergency contraception among educated ...

African Journals Online (AJOL)

Background: One of the effective ways to reduce unwanted pregnancy and its consequences is the knowledge and effective use of emergency contraception among the population. Aim: To evaluate the knowledge of emergency contraception among educated men and women and how often they use it. Methodology: ...

Psychosocial Correlates of Contraceptive Practices during Late Adolescence.

Science.gov (United States)

Lagana, Luciana

1999-01-01

Reviews the literature on psychosocial correlates of contraceptive practices among sexually active late adolescents. Helps 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. Promotes further research on those variables…

Differences between users and non-users of emergency contraception after a recognized unprotected intercourse

DEFF Research Database (Denmark)

Sørensen, M B; Pedersen, B L; Nyrnberg, L E

2000-01-01

Knowledge of emergency contraception is crucial but might not transform into use. Factors influencing decision-making related to use of emergency contraception after an unprotected intercourse and the characteristics of users of emergency contraception (EC) were assessed. In an abortion clinic...... setting, 217 women referred for termination of pregnancy were asked to fill in a questionnaire. Of the 217 women, 139 (64%) were aware of pregnancy risk but only 9 (4%) had used EC after the unprotected intercourse. 42% were estimated to have sufficient knowledge to use hormonal emergency contraception...

Students' perceptions of contraceptives in university of ghana.

Directory of Open Access Journals (Sweden)

Nana Nimo Appiah-Agyekum

2013-03-01

Full Text Available 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.Data was conducted with three sets of focus group discussions. Participants were systematically sampled from accounting and public administration departments.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.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.

Practice Bulletin Summary No. 152: Emergency Contraception.

Science.gov (United States)

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.

Emergency contraception amongst female college students – knowledge, attitude and practice

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Wendwosen T. Nibabe

2014-03-01

Full Text Available Background: Unwanted teenage pregnancies have a notable detrimental impact on the learners’ trajectory and have been associated with jeopardising the students’ educational progress and future career prospects. These pregnancies are mostly unplanned and unintended and many are terminated, either legally or illegally. Aim: The aim of this study was to explore the contributory role played by the knowledge, attitude and practices of female college students with respect to the utilisation of emergency contraceptives. Setting: Three tertiary institutions in Dessie, Ethiopia. Methods: Quantitative self-administered questionnaires were used to collect descriptive data from 352 female college students. Results: The study revealed that there was a high percentage (78.3% of unwanted pregnancies amongst those engaging in sex. Significantly, nearly half (43.3% of these unwanted pregnancies resulted in abortion. Only 10% of the students sampled admitted to ever having used emergency contraception. Even though more than half (69.9% of the students knew about emergency contraception, only 27% of them felt confident that they understood when it was most effective. Conclusion: These and other observed findings confirm the need for improvement of female college students’ knowledge and timely utilisation of emergency contraception.

Emergency contraception amongst female college students – knowledge, attitude and practice

Science.gov (United States)

Nibabe, Wendwosen T.

2014-01-01

Background Unwanted teenage pregnancies have a notable detrimental impact on the learners’ trajectory and have been associated with jeopardising the students’ educational progress and future career prospects. These pregnancies are mostly unplanned and unintended and many are terminated, either legally or illegally. Aim The aim of this study was to explore the contributory role played by the knowledge, attitude and practices of female college students with respect to the utilisation of emergency contraceptives. Setting Three tertiary institutions in Dessie, Ethiopia. Methods Quantitative self-administered questionnaires were used to collect descriptive data from 352 female college students. Results The study revealed that there was a high percentage (78.3%) of unwanted pregnancies amongst those engaging in sex. Significantly, nearly half (43.3%) of these unwanted pregnancies resulted in abortion. Only 10% of the students sampled admitted to ever having used emergency contraception. Even though more than half (69.9%) of the students knew about emergency contraception, only 27% of them felt confident that they understood when it was most effective. Conclusion These and other observed findings confirm the need for improvement of female college students’ knowledge and timely utilisation of emergency contraception. PMID:26245395

Teenage Pregnancy.

Science.gov (United States)

McClellan, Mary C.

1987-01-01

Reviews the problems of teenage pregnancy, including the costs to society, the challenge to educators, and the types of preventive programs developing across the country. Programs dealing strictly with reproduction and contraception are the least effective deterrents to teenage pregnancy. (MD)

Obesity and contraception: metabolic changes, risk of thromboembolism, use of emergency contraceptives, and role of bariatric surgery.

Science.gov (United States)

Gurney, E P; Murthy, A S

2013-06-01

Rates of obesity are increasing worldwide. Due to the medical consequences of obesity, routine health care like family planning becomes complicated. Conflicting data exists regarding efficacy of hormonal contraceptives in obese women, while little data on efficacy of emergency contraception in obese women exists. Much of what is available suggests lower serum hormonal levels in obese women with little effect on ovulation inhibition. Contraceptive steroids can cause a number of deteriorating metabolic changes, particularly in obese women; whether these changes are clinically significant is unknown. Venous thromboembolic risk is increased with both obesity and use of hormonal contraceptives; however the question remains if the risk is additive or multiplicative. Bariatric surgery can lead to digestive changes which may affect absorption of contraceptive hormones. While long acting reversible contraceptives may be the best option in the post operative obese patient, little data, beyond a simple recommendation to avoid pregnancy for at least one year, exists to help guide appropriate contraceptive choice.

Contraceptive Provision to Adolescent Females Prescribed Teratogenic Medications.

Science.gov (United States)

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.

Common symptoms during pregnancy to predict depression and health status 14 years post partum.

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Khatun, Mohsina; Clavarino, Alexandra M; Callaway, Leonie; Alati, Rosa; Najman, Jake M; Williams, Gail; Al Mamun, Abdullah

2009-03-01

To examine the prospective association between symptoms commonly experienced during pregnancy and the mental and general health status of women 14 years post partum. Data used were from the Mater-University of Queensland Study of Pregnancy, a community-based prospective birth cohort study begun in Brisbane, Australia, in 1981. Logistic regression analyses were conducted. Data were available for 5118 women. Women who experienced a higher burden of symptoms during pregnancy were at greater risk of becoming depressed and reporting poorer health status 14 years post partum. Women who experienced major problems during pregnancy were 4 times more likely to be depressed and nearly 8 times more likely to report poorer health status 14 years after the index pregnancy compared with women who experienced few problems. Findings suggest that pregnant women who experience common symptoms during pregnancy are likely to experience poorer mental and self-reported general health 14 years after the pregnancy.

Barriers to and Enablers of Contraceptive Use among Adolescent Females and their Interest in an Emergency Department-based Intervention

Science.gov (United States)

Chernick, Lauren S; Schnall, Rebecca; Higgins, Tracy; Stockwell, Melissa; Castaño, Paula; Santelli, John; Dayan, Peter S

2015-01-01

Objective Over 15 million adolescents, many at high risk for pregnancy, use emergency departments (ED) in the United States annually, but little is known regarding reasons for failure to use contraceptives in this population. The purpose of this study was to identify the barriers to and enablers of contraceptive use among adolescent females using the ED and determine their interest in an ED-based pregnancy prevention intervention. Study Design We conducted semi-structured, open-ended interviews with females in an urban ED. Eligible females were 14-19 years old, sexually active, presenting for reproductive health complaints, and at risk for pregnancy, defined as non-use of effective (per the World Health Organization) contraception. Interviews were recorded, transcribed, and coded based on thematic analysis. Enrollment continued until no new themes emerged. A modified Health Belief Model guided the organization of the data. Results Participants (n=14) were predominantly Hispanic (93%), insured (93%), and in a sexual relationship (86%). The primary barrier to contraceptive use was perceived health risk, including effects on menstruation, weight, and future fertility. Other barriers consisted of mistrust in contraceptives, ambivalent pregnancy intentions, uncertainty about the future, partner's desire for pregnancy, and limited access to contraceptives. Enablers of past contraceptive use included the presence of a school-based health clinic and clear plans for the future. All participants were receptive to ED-based pregnancy prevention interventions. Conclusions The identified barriers and enablers influencing hormonal contraceptive use can be used to inform the design of future ED-based adolescent pregnancy prevention interventions. PMID:25499588

HIV/ AIDS and Contraception | Steyn | Obstetrics and Gynaecology ...

African Journals Online (AJOL)

Prevention of unintended pregnancies in HIV infected women is a high priority. With the exception of male and female condoms contraceptive options provide no protection for STI and HIV transmission. Consistent and correct condom use needs to be encouraged in addition to the use of an effective contraceptive method.

Contraceptive Promotion And Utilization: Solution To Problem Of ...

African Journals Online (AJOL)

This study examined the contraceptive utilisation among patients treated in a University Teaching Hospital for complications of illegal abortion aimed at utilizing such information to proffer solution to the problems of unwanted pregnancy and induced abortion. In this study, 93.3% of patients had never used contraceptive and ...

Contraceptives and minors: The Emperor Has No Clothes.

Science.gov (United States)

Radosh, A

1991-01-01

The rate of teenage pregnancy in the US is significantly higher than in any other industrialized nation. Studies have shown the teenagers in other countries are not more sexually active. The biggest difference between US and the rest of the industrialized world is the US failure to make contraceptives easily available to teenagers. There are only 2 ways to prevent teenage pregnancy: 1) get them to shop having sex, or 2) get them to use contraceptives. When forming policy it is important to know which method will be more successful. Policymakers, educators, and health professionals are all guilty of rationalizing why option 1 will work better than option 2, even though their is little or no research or anecdotal evidence to support their claim. The facts are clear: in other industrialized countries the more freely available contraceptives are to teenagers, the lower the pregnancy rate. In New York City, 840 condoms were distributed in just 4 months upon request to participants in a male responsibility discussion group. Nationwide 2000 teenage boys were sent a coupon for free condoms by mail and 6% returned their coupons (the normal rate of return would be 3%). A 1988 study revealed that condom usage between 1979-88 among 17-19 year old males in metropolitan areas doubled. A 1987 Harris poll found that 60% of all adults favored condom advertising on television. A 1989 follow-up study revealed that 89% of parents of adolescents favored condom advertising on television. The most common reason given for not increasing access to contraceptives is that teenagers will receive the wrong message. Another fear is that parents will complain, yet in the 2000 condom coupon example, less than 1/3 of 1% of the parents complained. Is the rest of the industrialized world giving their teenagers the wrong message by making contraceptives easily available? Clearly, US policy against contraceptive access for teenagers is giving the worst message and the high teenage pregnancy rate is

Sexual Attitudes and Contraceptive Practices.

Science.gov (United States)

Byrne, Donn

1978-01-01

Discusses barriers to effective contraception, such as informational, emotional, and imaginative factors, and what might be done to avoid unwanted pregnancies by using these factors in positive programs and behaviors. (Author/RK)

Contraception in women with medical problems

Science.gov (United States)

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

[A new contraceptive method: breast feeding].

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Townsend, S

1993-08-01

Even though women have known for centuries that breast feeding has a contraceptive effect, family planning agents have only recently promoted it. Family planning specialists at a meeting in Bellagio, Italy, on breast feeding developed directives referred to as the Lactational Amenorrhea Method (LAM). Adherence to these directives assure effective protection against pregnancy until resumption of menstruation, expansion of infant feeding to foods other than breast milk, or until 6 months postpartum. Nipple stimulation during suckling is sufficient to suppress ovulation. Frequent suckling or more intense suckling maintains the contraceptive effect, so the directives insist that mothers exclusively or almost exclusively breast feed their infants. LAM provides 98% effective protection against pregnancy for 6 months if women observe it as directed. After 6 months, they should use another family planning method. Scientists are trying to see whether they can make the directives more simple. They will discuss this possibility at their next international meeting in 1993 or 1994. Research indicates that the most crucial rule is amenorrhea and use of this rule will make LAM more easy to learn and use, thereby increasing its use. It is difficult to motivate hospital and family planning clinic staff to promote LAM. Information and education are needed to support LAM. for example, a project in Honduras is using peer counseling to promote LAM. Family Health International is following 1000 women for 1 year postpartum in Pakistan and the Philippines. This study's 6-month LAM efficacy rate was around 95%. Little research has looked at the cost effectiveness of LAM. Optimally, LAM is a temporary contraceptive method which must be followed immediately by another contraceptive method. Indeed, LAM counseling should often pregnancy. LAM supporters do not intend for LAM to be a substitute for family planning, but want LAM to be another method in the contraceptive method mix.

Emergency Contraception: Do Your Patients Have a Plan B?

Science.gov (United States)

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.

Emerging Options for Emergency Contraception

Science.gov (United States)

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

Benefits and risks of hormonal contraception for women

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Hagen, Anja

2007-08-01

Full Text Available Scientific background: A large proportion of women of reproductive age in Germany use various methods of pregnancy prevention (contraception, among them various hormone-based methods. Hormonal contraceptives may be divided into combined estrogen-progestogen contraceptives (pills, skin patches, vaginal rings, progestogen-only contraceptives (pills, injections, implants, hormone spirals and emergency contraceptives. Research questions: The evaluation addressed the question of benefits and risks of hormonal contraceptives, their economic effects as well as their ethical-social and legal implications.MethodsA systematic literature search was conducted in April 2006 starting from 2000. The evaluation is primarily based on systematic reviews. Results: In perfect use, all hormonal contraceptives excluding emergency contraceptives proved to be the most effective reversible contraceptive methods (rate of unintended pregnancies 0.05% to 0.3%. However, the typical use of oral contraceptives, injections, skin patches, and vaginal rings, which also considers possible application errors, showed a lower contraceptive efficacy (rate of unintended pregnancies 3% to 8%. It was lower than that of copper spirals. The risk of venous thromboembolism increased three to six times in users of hormonal contraceptives, the risks of stroke and myocardial infarction two to three times. The risk declined after discontinuation of use. The effects were estrogen-dose and progestogen-type dependent. The use of hormonal contraceptives showed a relative risk of ovarian and endometrial carcinomas of approximately 0.5 or 0.7, of breast and cervical cancer of approximately 1.2 or 1.6. The effect remained several years after discontinuation of use. The results concerning hepatocellular carcinoma suggested a carcinogenic effect. In women with acne, an improvement due to use of hormonal contraceptives was proven. Cervical chlamydial infections were more frequent in users of hormonal

Recruiting online: lessons from a longitudinal survey of contraception and pregnancy intentions of young Australian women.

Science.gov (United States)

Harris, Melissa L; Loxton, Deborah; Wigginton, Britta; Lucke, Jayne C

2015-05-15

Recruitment of young people for epidemiologic research remains challenging, with marked decreases in the effectiveness of face-to-face, mail, and telephone recruitment methods. We report on the implementation and feasibility of an innovative and flexible approach used to recruit participants for a longitudinal cohort study about contraceptive use and pregnancy (the Contraceptive Use, Pregnancy Intention, and Decisions (CUPID) Study). Australian women aged 18-23 years were recruited using a range of online, networking, and offline methods, including social media (primarily Facebook (Facebook Inc., Menlo Park, California; http://www.facebook.com)), face-to-face events, distribution of promotional material, and media releases. Over the course of the 1-year recruitment period (beginning in September 2012), a total of 3,795 eligible women were recruited to complete the online survey, at a cost of approximately A$11 per participant. This sample was found to be broadly representative of the Australian population of women aged 18-23 years in terms of demographic characteristics, with the exception of an overrepresentation of tertiary-educated women (88.7% compared with 72.6%). This study demonstrated that although current recruitment strategies are required to be innovative and flexible in order to engage young people in epidemiologic research, representative samples can be achieved online at reasonable cost. © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Postpartum education for contraception: a systematic review.

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Lopez, Laureen M; Hiller, Janet E; Grimes, David A

2010-05-01

Contraceptive education is generally considered a standard component of postpartum care, but the effectiveness is seldom examined. Two-thirds of postpartum women may have unmet needs for contraception, and many adolescents become pregnant again within a year of giving birth. Women may prefer to discuss contraception prenatally or after hospital discharge. The objective of this systematic review was to assess the effects of educational interventions for postpartum mothers about contraceptive use. We searched computerized databases for randomized controlled trials that evaluated the effectiveness of postpartum contraceptive education. The intervention must have started within 1 month after delivery. The Mantel-Haenszel odds ratio was calculated with 95% confidence interval for the dichotomous outcomes. Eight trials met the inclusion criteria. Of 4 short-term interventions, 1 did not have sufficient data and 1 was statistically underpowered. The remaining 2 showed a positive effect on contraceptive use. Of 4 multifaceted programs, 2 showed fewer pregnancies or births among adolescents in the experimental group that had enhanced services, and 1 structured home-visiting program showed more contraceptive use. The effective interventions were conducted in Australia, Nepal, Pakistan, and the United States. Postpartum education about contraception led to more contraception use and fewer unplanned pregnancies. Short-term interventions were limited by self-reported outcomes or showing no effect for many comparisons. The longer-term programs were promising and not necessarily more costly than usual care. Health care providers can determine if 1 of these interventions suits their setting and level of resources. Obstetricians & Gynecologist, Family Physicians. After completing this educational activity, the participant should be better able to assess the importance of assessing delivery methods when examining intervention quality, evaluate the evidence from randomized trials on

Adolescent contraception: review and guidance for pediatric clinicians.

Science.gov (United States)

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.

Association between contraceptive discontinuation and pregnancy intentions in Guatemala Asociación entre la suspensión en el uso de anticonceptivos y las intenciones de embarazo en Guatemala

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Janine L. Barden-O’Fallon

2008-06-01

Full Text Available OBJECTIVES: To determine whether contraceptive discontinuation is associated with pregnancies that are conceived earlier than desired (mistimed or are not wanted at the time of conception (unwanted. METHODS: Data were obtained from the 2002 Guatemala National Maternal and Child Health Survey. Pregnancies within the three years prior to and at the time of the survey (April 1999-November 2002 were classified as either "intended," "mistimed," or "unwanted." The key independent variable was whether the woman had used contraception within 12 months of the pregnancy and, for those who had used it, the reason for discontinuation (either to get pregnant or for another reason. A multinomial logistic analysis was used to determine the degree of association of discontinuation with pregnancy intentions. RESULTS: One of every five mistimed pregnancies and one of every six unwanted pregnancies followed discontinuations that were for reasons other than to become pregnant (e.g., contraceptive failure, side effects, and health concerns. Discontinuations for reasons other than to become pregnant were shown to be positively and significantly associated with a reported mistimed pregnancy (coefficient = 2.15; standard error = 0.27 or unwanted pregnancy (2.68; 0.37 compared to an intended pregnancy. Pregnancies preceded by discontinuations for reasons other than to become pregnant were also more likely to be reported as mistimed or unwanted than pregnancies of women who were not using contraception during the year prior to pregnancy. CONCLUSIONS: There is a need to increase contraceptive continuation. Any program should include an increased effort to reduce contraceptive failure and better address the side effects and the health concerns that women have that can lead to discontinuation. Non-users who want to delay or limit births should also be identified and targeted for outreach in order to reduce unintended pregnancies.OBJETIVOS: Determinar si la suspensión del

Emergency contraception. Widely available and effective but disappointing as a public health intervention: a review.

Science.gov (United States)

2015-04-01

Emergency contraception (EC) prevents pregnancy after unprotected sex or contraceptive failure. Use of EC has increased markedly in countries where a product is available over the counter, yet barriers to availability and use remain. Although effective in clinical trials, it has not yet been possible to show a public health benefit of EC in terms of reduction of unintended pregnancy rates. Selective progesterone receptor modulators developed as emergency contraceptives offer better effectiveness than levonorgestrel, but still EC is less effective than use of ongoing regular contraception. Methods which inhibit ovulation whenever they are taken or which act after ovulation to prevent implantation and strategies to increase the uptake of effective ongoing contraception after EC use would prevent more pregnancies. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Contraception coverage and methods used among women in South Africa: A national household survey

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M F Chersich

2017-04-01

Full Text Available Background. Globally, family planning services are being strengthened and the range of contraceptive choices expanded. Data on contraceptive coverage and service gaps could help to shape these initiatives. Objective. To assess contraception coverage in South Africa (SA and identify underserved populations and aspects of programming that require strengthening. Methods. Data from a 2012 SA household survey assessed contraception coverage among 6 296 women aged 15 - 49 years and identified underserved populations. Results. Two-thirds had an unintended pregnancy in the past 5 years, a quarter of which were contraceptive failures. Most knew of injectable (92.0% and oral contraception (89.9%, but fewer of intrauterine devices (56.1% and emergency contraception (47.3%. Contraceptive prevalence was 49.1%, and 41.8% women used modern non-barrier methods. About half had ever used injectable contraception. Contraception was lower in black Africans and younger women, who used a limited range of methods. Conclusion. Contraception coverage is higher than many previous estimates. Rates of unintended pregnancy, contraceptive failure and knowledge gaps, however, demonstrate high levels of unmet need, especially among black Africans and young women.

Contraception for Women with Diabetes Mellitus

DEFF Research Database (Denmark)

Damm, P.; Mathiesen, E.; Clausen, T.D.

2005-01-01

Planned pregnancy is mandatory in women with diabetes, and their need for contraception is essential. Basically, the same methods can be used as in women without diabetes, but a number of specific conditions have to be considered when guiding these women, as we discuss in this review. Unfortunately......, the field is limited in studies in certain areas, especially considering contraception for women with type 1 diabetes and late diabetic complications and women with type 2 diabetes. Thus, in the real clinical world, the choice of contraceptive often will be a kind of compromise, balancing pro and cons...

Contraception for women with diabetes mellitus

DEFF Research Database (Denmark)

Damm, Peter; Mathiesen, Elisabeth; Clausen, Tine Dalsgaard

2005-01-01

Planned pregnancy is mandatory in women with diabetes, and their need for contraception is essential. Basically, the same methods can be used as in women without diabetes, but a number of specific conditions have to be considered when guiding these women, as we discuss in this review. Unfortunately......, the field is limited in studies in certain areas, especially considering contraception for women with type 1 diabetes and late diabetic complications and women with type 2 diabetes. Thus, in the real clinical world, the choice of contraceptive often will be a kind of compromise, balancing pro and cons...

Contraceptive options for women living with HIV.

Science.gov (United States)

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.

Analysis of tubal pregnancy

International Nuclear Information System (INIS)

Malik, N.; Iqbal, F.; Tayyeb, R.

2001-01-01

Objective: This study was carried out to determine the frequency, etiological factors, modes of presentation, accuracy of diagnostic modalities, operative findings and surgical treatment of tubal pregnancies. Design: Observational study. Place and duration of study: This study was conducted in gynae unit iii, Sir Ganga Ram Hospital, Lahore from January 1995 to December 1996. Subject and Methods: All the patients diagnosed as a case of tubal pregnancy in two years period were included in the study. Detailed history regarding the symptoms and risk factors of tubal pregnancy was taken followed by clinical examination. The diagnostic and treatment modality used and operative findings were also recorded. All the data was recorded on a proforma and finally the results were analysed. Results: Incidence of tubal pregnancy was found out to be 1:305 deliveries. Out of these, 70% of the cases occurred in the age group of 21-30 years and in patients with low parity (in para 0-2) 65% of the patients had high risk factor e.g previous abdominopelvic surgery PID or history of infertility. Pain was the commonest symptom (90% of cases) followed by vaginal bleeding (80%) adnexal masses (70%) and amenorrhea (65%). Acute tubal pregnancy was found in 85% of the cases while 15% of cases had chronic tubal pregnancy. Tubal pregnancy in the ampullary region was detected in 65% patients. Conclusion: Previous abdominopelvic surgery, PID or history of infertility and use of intra-uterine contraceptive device are the main etiologic factors. Most of the patients present at a very late stage with ruptured tubal pregnancy followed by salpingostomy in 95% of cases. Only 5% of cases had conservative surgical treatment i.e salpingostomy. Culdocentesis ultrasonography and laparoscopy were good diagnostic modalities. (author)

Reproductive knowledge and use of contraception among women ...

African Journals Online (AJOL)

prevent maternal deaths is to prevent pregnancy'.[5] One of its recommendations was to promote contraceptive use through education and service provision. This also promotes reproductive health. Women with unplanned pregnancies, especially those with an underlying medical condition such as pregestational diabetes, ...

Associations of life events during pregnancy with longitudinal change in symptoms of antenatal anxiety and depression

NARCIS (Netherlands)

Meijer, J. L.; Bockting, C. L. H.; Stolk, R. P.; Kotov, R.; Ormel, J.; Burger, H.

2014-01-01

OBJECTIVE: to investigate the association of life events during pregnancy with change in antenatal anxiety and depression symptoms. We distinguished pregnancy related and non-pregnancy related events and assessed specificity of these associations for depressive or anxious symptoms. In addition, we

Can the delivery method influence lower urinary tract symptoms triggered by the first pregnancy?

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Simone Botelho

2012-04-01

Full Text Available INTRODUCTION AND OBJECTIVES: The increase of the intensity of urinary symptoms in late pregnancy and postpartum has been well documented by several authors, but their causes remain uncertain, partly because of its probable multifactor origin. There are also controversies whether the etiology of lower urinary tract symptoms during pregnancy is the same as postpartum and whether the method of delivery could influence the risk of onset of urinary symptoms. This study aimed to evaluate the urinary symptoms triggered during pregnancy and its evolution in the late puerperium, correlating them with the delivery method. MATERIALS AND METHODS: A longitudinal study was conducted, which included 75 primigravidae women, classified according to method of delivery as: (VD vaginal delivery with right mediolateral episiotomy (n = 28; (CS elective caesarean section (n = 26; and (EC emergency caesarean section (n = 21. Urinary symptoms were assessed in the last trimester of pregnancy and at 45 days (± 10 of puerperium with validated versions for Portuguese language of the following questionnaires: International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF and the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB. RESULTS: It was observed that frequency, urgency, nocturia and urge incontinence, triggered during pregnancy, decreased significantly in the postpartum period, regardless of the delivery method (p = 0.0001. However, symptoms related to urinary loss due to stress persisted after vaginal delivery (p = 0.0001. CONCLUSIONS: Urgency, frequency and nocturia triggered during pregnancy tend to disappear in the late postpartum period, regardless of the delivery method, but the symptoms related to urinary loss due to stress tend to persist in late postpartum period after vaginal delivery.

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

Science.gov (United States)

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.

Emerging Options for Emergency Contraception

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Atsuko Koyama

2013-01-01

Full Text Available 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.

Emergency contraception: ¿how, when and with what?

Directory of Open Access Journals (Sweden)

Álvaro Monterrosa Castro

2006-04-01

Full Text Available Emergency contraception is a valid birth-control strategy that articulated and immers d in its real dimension makes a good influenceover the negative social-demographic, biological and economicreverberations that unwanted pregnancy and abortions in riskconditions generate. Due to all the implications that this has, it isimportant that professionals that attend sexual and reproductivehealth, have a clear level of theoretical knowledge based on scientific concepts, be convinced of its advantages and have a serious compromise with the society. Because the abortion is not legal in Colombia, even in rape cases, incest, life risk and woman health, and because the provoked abortion and its complications is the third cause of maternal death, all the actions, including emergency contraception, that prevent unwanted pregnancy and abortion have great importance. Every health professional must know when, with what tools and how administrate emergency contraception.

Restless Legs Symptoms and Pregnancy and Neonatal Outcomes.

Science.gov (United States)

Oyieng'o, D Onentia; Kirwa, Kipruto; Tong, Iris; Martin, Susan; Antonio Rojas-Suarez, José; Bourjeily, Ghada

2016-02-01

Restless legs syndrome (RLS) is a commonly occurring neurologic disorder that affects up to one third of women during pregnancy. RLS has been associated with increased sympathetic tone in the nonpregnant population. We examined whether a RLS surrogate is associated with a higher prevalence of pregnancy and neonatal outcomes. Data were analyzed from a cross-sectional survey of 1000 women interviewed soon after delivery by using an RLS surrogate question. Women were asked how frequently (0 = none, 1 = rarely [pregnancy. Clinical charts were reviewed to obtain relevant demographic and clinical data, including the presence of gestational hypertensive disorders and neonatal outcomes at birth. Subjects who "always" experienced RLS were compared with subjects experiencing symptoms less frequently or not at all with respect to prevalence of gestational hypertensive disorder. The mean ([SD]) age, prepregnancy body mass index (BMI), and BMI at delivery were 29.0 (6.1) years, 26.1 (6.2) kg/m(2), and 32.0 (6.3) kg/m(2), respectively. The overall prevalence of the RLS surrogate (jumpy or jerky leg movements) was 35.5% with the following distribution on a Likert scale: score 1 = 6.4%; score 2 = 10.2%; score 3 = 8.1%; and score 4 = 10.8%. Chronic hypertension was present in 2.1%, pregnancy-induced hypertension in 9.5%, and preeclampsia in 4.5% of respondents. Subjects who reported "always" having sensations of jumpy or jerky legs were more likely to have gestational hypertensive disorders compared with those who reported less frequent occurrence of the symptoms. Adjusted odds ratios were 3.74 (95% CI, 1.31-10.72; P = 0.014) for chronic hypertension; 1.26 (95% CI, 0.65-2.46; P = 0.487) for pregnancy-induced hypertension; and 2.15 (95% CI, 0.97-4.75; P = 0.060) for preeclampsia. There was a significant association between leg movement score and neonatal birth weight (coefficient, -149.5 g [95% CI, -276.9 to -22.5]; P = 0.005) and gestational age at birth (-0.7 week [95% CI, -1.1 to

Symptoms associated with the DSM IV diagnosis of depression in pregnancy and post partum.

Science.gov (United States)

Kammerer, Martin; Marks, Maureen N; Pinard, Claudia; Taylor, Alyx; von Castelberg, Brida; Künzli, Hansjörg; Glover, Vivette

2009-06-01

Pregnancy and the postpartum may affect symptoms of depression. However it has not yet been tested how the symptoms used for the DSM IV diagnosis of depression discriminate depressed from non depressed women perinatally. A modified version of the Structured Clinical Interview for DSM IV (SCID interview) was used that allowed assessment of all associated DSM IV symptoms of depression with depressed and non depressed women in pregnancy and the postpartum period. Loss of appetite was not associated with depression either ante or postnatally. The antenatal symptom pattern was different from the postnatal. The sensitivity of the symptoms ranged from 0.7% to 51.6%, and specificity from 61.3% to 99.1%. The best discriminating symptoms were motor retardation/agitation and concentration antenatally, and motor retardation/agitation, concentration and fatigue postnatally. Depression in pregnancy and postpartum depression show significantly different symptom profiles. Appetite is not suitable for the diagnosis of depression in the perinatal period.

Contraception Initiation in the Emergency Department: A Pilot Study on Providers' Knowledge, Attitudes, and Practices.

Science.gov (United States)

Liles, Iyanna; Haddad, Lisa B; Lathrop, Eva; Hankin, Abigail

2016-05-01

Almost half of all pregnancies in the United States are unintended; these pregnancies are associated with adverse outcomes. Many reproductive-age females seek care in the emergency department (ED), are at risk of pregnancy, and are amenable to contraceptive services in this setting. Through a pilot study, we sought to assess ED providers' current practices; attitudes; and knowledge of emergency contraception (EC) and nonemergency contraception (non-EC), as well as barriers with respect to contraception initiation. ED physicians and associate providers in Georgia were e-mailed a link to an anonymous Internet questionnaire using state professional databases and contacts. The questionnaire included Likert scales with multiple-choice questions to assess study objectives. Descriptive statistics were generated as well as univariate analyses using χ(2) and Fisher exact tests. A total of 1232 providers were e-mailed, with 119 questionnaires completed. Participants were predominantly physicians (80%), men (59%), and individuals younger than 45 years (59%). Common practices were referrals (96%), EC prescriptions (77%), and non-EC prescriptions (40%). Common barriers were perceived as low likelihood for follow-up (63%), risk of complications (58%), and adverse effects (51%). More than 70% of participants correctly identified the highly effective contraceptive methods, 3% identified the correct maximum EC initiation time, and 42% correctly recognized pregnancy as a higher risk than hormonal contraception use for pulmonary embolism. Most ED providers in this pilot study referred patients for contraception; however, there was no universal contraceptive counseling and management. Many ED providers in this study had an incorrect understanding of the efficacy, risks, and eligibility associated with contraceptive methods. This lack of understanding may affect patient access and be a barrier to patient care.

Knowledge and use of emergency contraception among students of public secondary schools in Ilorin, Nigeria.

Science.gov (United States)

Babatunde, Oluwole Adeyemi; Ibirongbe, Demilade Olusola; Omede, Owen; Babatunde, Olubukola Oluwakemi; Durowade, Kabir Adekunle; Salaudeen, Adekunle Ganiyu; Akande, Tanimola Makanjuola

2016-01-01

Unintended pregnancy and unsafe abortion pose a major reproductive health challenge to adolescents. Emergency contraception is safe and effective in preventing unplanned pregnancy. The objective of this study was to assess the student's knowledge and use of emergency contraception. This cross-sectional study was carried out in Ilorin, Nigeria, using multi-stage sampling method. Data was collected using pre-tested semi-structured self-administered questionnaire. Knowledge was scored and analysed. SPSS version 21.0 was used for data analysis. A p-value emergency contraception. Majority of respondents (87.2%) had never used emergency contraception. Majority of those who had ever used emergency contraception (85.7%) used it incorrectly, using it more than 72 hours after sexual intercourse (p=0.928). Knowledge about Emergency contraception and prevalence of use were low. Contraceptive education should be introduced early in the school curriculum for adolescents.

Knowledge, attitude and practice of emergency contraceptives among adama university female students.

Science.gov (United States)

Tilahun, Dejene; Assefa, Tsion; Belachew, Tefera

2010-11-01

Unwanted pregnancy followed by unsafe abortion is one of the major worldwide health problems, which has many negative consequences on the health and well-being of women. Information about women's knowledge, attitude and practice of emergency contraceptives plays a major role in the reduction of unwanted pregnancy; however, there are no studies about this issue in the study area. This study assessed Adama University female students' knowledge, attitude and practice of emergency contraceptives. A cross-sectional study design was employed from February 1 to 30/2009, on 660 regular undergraduate female students of Adama University. Data were entered and analyzed using SPSS for windows version 16.0. Logistic regression was used to identify the association between variables and emergency contraceptive knowledge, attitude and practice. P-value less than 0.05 at 95% CI was taken for statistical significance. Of the total, 660 respondents, 194(29.4%) were sexually active, 63(9.4%) had history of pregnancy and 49(7.4%) had history of abortion. About 309 (46.8%) of the students had heard about emergency contraceptives and from those who heard emergency contraceptives, 27.2% had good knowledge. Majority, four hundred fifteen (62.9%) of the students had positive attitude towards it. However, only 31(4.7%) had used emergency contraceptive methods. This study demonstrated lack of awareness, knowledge and utilization of emergency contraceptives among Adama University female students. Hence behavioral change strategies should be considered by responsible bodies to improve knowledge and bring attitudinal change on use of emergency contraception.

A clinical study of transdermal contraceptive patch in Thai adolescence women.

Science.gov (United States)

Piyasirisilp, Rachatapon; Taneepanichskul, Surasak

2008-02-01

To study cycle control, compliance and safety of a transdermal contraceptive patch in adolescent Thai women. Fifty-eight healthy women were assigned to receive 3 cycles of contraceptive patch (ethinyl estradiol 20 microg and norelgestromin 150 microg/day). All participants aged 16-20 years were invited to participate from the family planning clinic at King Chulalongkorn Memorial Hospital. Data were collected on adverse effects, perceived advantages and disadvantages, body weight, blood pressure, patch detachments and compliance. Data were analyzed using mean, percentage and student's t-test. The participants' average age was 19.4 years, height 158.8 cm, weight 51.8 kg, BMI 20.8 Kg/m2. The most location of patch application was the abdomen and the most adverse event was breast tenderness (31.0%) followed by application site reaction, nausea vomiting and headache respectively. The breast symptom was mild in severity. The participants reported decrease in dysmenorrhea and shorter duration of bleeding. There were no significant changes in body weight and blood pressure. The improvement of their facial acne was reported. There were no pregnancies during use and the adhesion of the contraceptive patch is excellent. Partial patch detachment was reported in only 6.9%. No completed patch detachment was found. The present study found an overall positive impression of a new transdermal contraceptive patch. The good compliance and few side effects were demonstrated. The adhesive patch contraceptive was excellent.

Postpartum Visit Attendance Increases the Use of Modern Contraceptives.

Science.gov (United States)

Masho, Saba W; Cha, Susan; Charles, RaShel; McGee, Elizabeth; Karjane, Nicole; Hines, Linda; Kornstein, Susan G

2016-01-01

Background. Delays in postpartum contraceptive use may increase risk for unintended or rapid repeat pregnancies. The postpartum care visit (PPCV) is a good opportunity for women to discuss family planning options with their health care providers. This study examined the association between PPCV attendance and modern contraceptive use using data from a managed care organization. Methods. Claims and demographic and administrative data came from a nonprofit managed care organization in Virginia (2008-2012). Information on the most recent delivery for mothers with singleton births was analyzed ( N = 24,619). Routine PPCV (yes, no) and modern contraceptive use were both dichotomized. Descriptive analyses provided percentages, frequencies, and means. Multiple logistic regression was conducted and ORs and 95% CIs were calculated. Results. More than half of the women did not attend their PPCV (50.8%) and 86.9% had no modern contraceptive use. After controlling for the effects of confounders, women with PPCV were 50% more likely to use modern contraceptive methods than women with no PPCV (OR = 1.50, 95% CI = 1.31, 1.72). Conclusions. These findings highlight the importance of PPCV in improving modern contraceptive use and guide health care policy in the effort of reducing unintended pregnancy rates.

Postpartum Visit Attendance Increases the Use of Modern Contraceptives

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Saba W. Masho

2016-01-01

Full Text Available Background. Delays in postpartum contraceptive use may increase risk for unintended or rapid repeat pregnancies. The postpartum care visit (PPCV is a good opportunity for women to discuss family planning options with their health care providers. This study examined the association between PPCV attendance and modern contraceptive use using data from a managed care organization. Methods. Claims and demographic and administrative data came from a nonprofit managed care organization in Virginia (2008–2012. Information on the most recent delivery for mothers with singleton births was analyzed (N = 24,619. Routine PPCV (yes, no and modern contraceptive use were both dichotomized. Descriptive analyses provided percentages, frequencies, and means. Multiple logistic regression was conducted and ORs and 95% CIs were calculated. Results. More than half of the women did not attend their PPCV (50.8% and 86.9% had no modern contraceptive use. After controlling for the effects of confounders, women with PPCV were 50% more likely to use modern contraceptive methods than women with no PPCV (OR = 1.50, 95% CI = 1.31, 1.72. Conclusions. These findings highlight the importance of PPCV in improving modern contraceptive use and guide health care policy in the effort of reducing unintended pregnancy rates.

The conscientious objection: debate on emergency contraception.

Science.gov (United States)

Montanari Vergallo, G; Zaami, S; Di Luca, N M; Marinelli, E

2017-01-01

The authors discuss the emergency contraception (EC) topic, assessing scientific and ethical aspects. The almost totality of the studies carried out tends to report on the use of drugs as an emergency measure to prevent pregnancy. However, it is not yet completely excluded that emergency contraceptives can induce medical abortion. The debate on side effects of EC continues to be a highly emotional and controversial issue both for advocates who believe they will lower considerably the number of unintended pregnancies and abortions, and for opponents who believe that using emergency contraception amounts to an abortion. This latter hypothesis highlights the conflicting aspect of the conscientious objection to abortion of physicians and pharmacists. This research work is aimed at investigating the emergency contraception issue, paying particular attention to the medico-legal and regulatory aspects of this subject. Particularly, the authors focus on the conscientious objection in order to assess, if any, legal protection for physicians and pharmacists who claim a right to conscientious objection. Inappropriate use of EC could be resolved through a registry of user. This registry, of course, would not have the intention of persecution, but would only serve to detect possible cases of subjugation, exploitation and harassment.

Use of various contraceptive methods and time of conception in a community-based population.

Science.gov (United States)

Kaplan, Boris; Nahum, Ravit; Yairi, Yael; Hirsch, Michael; Pardo, Josef; Yogev, Yariv; Orvieto, Raoul

2005-11-01

To investigate the association between method of contraception and time to conception in a normal community-based population. Prospective, cross-sectional, survey. Large comprehensive ambulatory women's health center. One thousand pregnant women at their first prenatal obstetrics visit were asked to complete a self-report questionnaire. The return to fertility was analyzed by type of contraceptive method, duration of use, and other sociodemographic variables. Response rate was 80% (n=798). Mean age of the patients was 29.9+/-5 years. Seventy-five percent had used a contraceptive before trying to conceive: 80% oral contraceptives, 8% intrauterine device, and 7% barrier methods. Eighty-six percent conceived spontaneously. Contraceptive users had a significantly higher conception rate than nonusers in the first 3 months from their first attempt at pregnancy. Type of contraception was significantly correlated with time to conception. Pregnancy rates within 6 months of the first attempt was 60% for oral contraceptive users compared to 70 and 81% for the intrauterine device and barrier method groups, respectively. There was no correlation between time to conception and parity or duration of contraceptive use. Other factors found to be significantly related to time to conception were older age of both partners and higher body mass index. Contraception use before a planned pregnancy does not appear to affect ease of conception. Type of method used, although not duration of use, may influence the time required to conceive.

A Snapshot of Urban Adolescent Women's Contraceptive Knowledge at the Onset of a Community Long-Acting Reversible Contraceptive Promotion Initiative.

Science.gov (United States)

Greenberg, Katherine Blumoff; Jenks, Sara Catherine; Piazza, Nina; Malibiran, Beatriz Ramos; Aligne, C Andrew

2017-08-01

To contextualize young women's knowledge and attitudes regarding contraception at the outset of an intervention promoting long-acting reversible contraceptive (LARC) use for teen pregnancy prevention. Our intervention was on the basis of diffusion of innovation theory, and at the outset we were interested in likely early adopters' existing knowledge and attitudes toward contraception. This mixed methods study consisted of focus groups within positive youth development programs in Rochester, New York; we discussed young women's knowledge and sources of information for all US Food and Drug Administration-approved contraceptive methods. Seven focus groups and 24 female adolescent participants aged 15-19 years. Quantitative ranking of all contraceptive methods; qualitative themes from focus group discussions. Our findings showed a high level of knowledge about a select group of methods, which included LARC methods, and that participants received contraceptive information from peers and family. Participants had more concerns than positive impressions regarding the effectiveness, safety, practicality, and partner reception of the contraceptive methods, with the exception of the condom. Quantitatively, the condom received the highest average rating. The importance of personal anecdotes in our findings supports the use of outreach and information campaigns; providing medically accurate information and spreading positive personal anecdotes will be key to improving young women's impressions of the safety and acceptability of LARC use. This snapshot of contraceptive knowledge indicates that young women can be mature, informed consumers of sexual and reproductive health care, and through diffusion of innovation could be key players in promoting the most effective means of pregnancy prevention. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

POSTPARTUM CONTRACEPTIVE USE IN RURAL BAREILLY

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Syed Esam Mahmood

2011-12-01

Full Text Available Background: Contraception is an important intervention to reduce burden of unwanted pregnancy and promote healthy living among women. Objectives: To find out the postpartum contraceptive usage and identify the different variables which affect the postpartum contraception among the rural females of Bareilly district. Methods: The cross sectional study was carried out in randomly selected villages of Bhojipura Block of Bareilly district, Uttar Pradesh. All women who had delivered within last one year were interviewed by house to house survey to collect data regarding socio-demographic characteristics and contraceptive use by structured questionnaire. A total of 123 women participated in the study. Chi- square test was used to analyze data. Results: Only 13.8% mothers adopted postpartum contraception. Lack of knowledge (32.5% and young infant being breastfed (28.5% were the common reasons of not using any contraceptive method. Contraceptive use was higher amongst females aged less than 30 years and those belonging to middle socioeconomic class and nuclear families. The significant influence of the women’ educational status on utilization of family planning methods was observed (p<0.05. Conclusions: Low percent of postpartum contraceptive use indicates the need for improving awareness among the study population.

Uptake of post‑abortion contraception among women who had ...

African Journals Online (AJOL)

Background: Unexpected or unplanned pregnancy poses a major public health ... therefore, reinforcing the importance of contraception from time to time among this age ... or inconsistent use of contraception contributed to most ... and build upon the work non-commercially, as long as the author is credited and the new.

[Contraception in the future].

Science.gov (United States)

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.

Contraception and Induced Abortion in the West Indies: A Review

NARCIS (Netherlands)

Boersma, A.A.; de Bruijn, J.G.M.

2011-01-01

Abstract BACKGROUND: Most islands in the West Indies do not have liberal laws on abortion, nor laws on pregnancy prevention programmes (contraception). We present results of a literature review about the attitude of healthcare providers and women toward (emergency) contraception and induced

The Symptoms Get Worse after Pregnancy in Sheehan's Syndrome: A Case Report

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Jingwen Hao

2012-01-01

Full Text Available Sheehan’s syndrome, which is pituitary necrosis after severe postpartum hemorrhage and hypovolemia, may cause hypopituitarism immediately or several years later, depending on the degree of tissue destruction. We report an unusual case, in which a 55-year-old woman with Sheehan's syndrome got worse symptoms after spontaneous labor. In 1998, she had severe postpartum hemorrhage and pituitary necrosis during the third delivery, thus it was diagnosed as Sheehan’s syndrome by clinical manifestations, laboratory tests, and magnetic resonance imaging. She was treated by replacement therapy including hydrocortisone and levothyroxine sodium. However, she had the fourth spontaneous pregnancy in 2000 and got worse symptoms after delivery. We carefully concluded that pregnancy provided no evidence against the diagnosis of Sheehan’s syndrome because pregnancy might improve hypopituitarism by stimulating the pituitary remnant to undergo hyperplasia and irritating the placenta to secrete hormone. However, pregnancy might aggravate the symptoms by inducing autoimmunity as well. All in all, early diagnosis and adequate medical treatment are important to provide a good prognosis of Sheehan’s syndrome.

Routine counseling about intrauterine contraception for women seeking emergency contraception.

Science.gov (United States)

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, pcontraceptives with the option of same-day contraceptive placement. Copyright © 2014 Elsevier Inc. All rights reserved.

Adherence to oral contraception in women on Category X medications.

Science.gov (United States)

Steinkellner, Amy; Chen, William; Denison, Shannon E

2010-10-01

Over 6% of women become pregnant when taking teratogenic medications, and contraceptive counseling appears to occur at suboptimal rates. Adherence to contraception is an important component in preventing unwanted pregnancy and has not been evaluated in this population. We undertook a pharmacy claims-based analysis to evaluate the degree to which women of childbearing age who receive Category X medications adhere to their oral contraception. We evaluated the prescription medication claims for over 6 million women, age 18-44 years, with prescription benefits administered by a pharmacy benefits manager. Women with 2 or more claims for a Category X medication and 2 or more claims for oral contraception were evaluated in further detail. Adherence to oral contraception was measured by analyzing pharmacy claims. Multivariable logistic regression was performed to identify factors associated with adherence. There were 146,758 women of childbearing age who received Category X medications, of which 26,136 also took oral contraceptive medication. Women who received Category X medications were prescribed oral contraception (18%) at rates similar to others of childbearing age (17%). Women prescribed both Category X and oral contraception demonstrated adherence similar to the overall population. Age, class of Category X medication, number of medications, prescriber's specialty, and ethnicity correlated with lower adherence rates. Despite added risk associated with unintended pregnancy, many women who receive Category X medications have refill patterns suggesting nonadherence to oral contraception. Compared with all women age 18-44 years, women receiving teratogenic medications do not have better adherence to oral contraception. Copyright © 2010 Elsevier Inc. All rights reserved.

Contraceptive use in women enrolled into preventive HIV vaccine trials: experience from a phase I/II trial in East Africa.

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Hannah Kibuuka

Full Text Available HIV vaccine trials generally require that pregnant women are excluded from participation, and contraceptive methods must be used to prevent pregnancy during the trial. However, access to quality services and misconceptions associated with contraceptive methods may impact on their effective use in developing countries. We describe the pattern of contraceptive use in a multi-site phase I/IIa HIV Vaccine trial in East Africa (Uganda, Kenya and Tanzania and factors that may have influenced their use during the trial.Pregnancy prevention counseling was provided to female participants during informed consent process and at each study visit. Participants' methods of contraception used were documented. Methods of contraceptives were provided on site. Pregnancy testing was done at designated visits during the trial. Obstacles to contraceptive use were identified and addressed at each visit.Overall, 103 (31.8% of a total of 324 enrolled volunteers were females. Female participants were generally young with a mean age of 29(+/-7.2, married (49.5% and had less than high school education (62.1%. Hormonal contraceptives were the most common method of contraception (58.3% followed by condom use (22.3%. The distribution of methods of contraception among the three sites was similar except for more condom use and less abstinence in Uganda. The majority of women (85.4% reported to contraceptive use prior to screening. The reasons for not using contraception included access to quality services, insufficient knowledge of certain methods, and misconceptions.Although hormonal contraceptives were frequently used by females participating in the vaccine trial, misconceptions and their incorrect use might have led to inconsistent use resulting in undesired pregnancies. The study underscores the need for an integrated approach to pregnancy prevention counseling during HIV vaccine trials.ClinicalTrials.gov NCT00123968.

Young women's consistency of contraceptive use--does depression or stress matter?

Science.gov (United States)

Stidham Hall, Kelli; Moreau, Caroline; Trussell, James; Barber, Jennifer

2013-11-01

We prospectively examined the influence of young women's depression and stress symptoms on their weekly consistency of contraceptive method use. Women ages 18-20 years (n = 689) participating in a longitudinal cohort study completed weekly journals assessing reproductive, relationship and health characteristics. We used data through 12 months of follow-up (n = 8877 journals) to examine relationships between baseline depression (CES-D) and stress (PSS-10) symptoms and consistency of contraceptive methods use with sexual activity each week. We analyzed data with random effects multivarible logistic regression. Consistent contraceptive use (72% of weeks) was 10-15 percentage points lower among women with moderate/severe baseline depression and stress symptoms than those without symptoms (p contraceptive consistency each week than those without symptoms, respectively (OR 0.53, CI 0.31-0.91 and OR 0.31, CI 0.18-0.52). Stress predicted inconsistent use of oral contraceptives (OR 0.27, CI 0.12-0.58), condoms (OR 0.40, CI 0.23-0.69) and withdrawal (OR 0.12, CI 0.03-0.50). Women with depression and stress symptoms appear to be at increased risk for user-related contraceptive failures, especially for the most commonly used methods. Our study has shown that young women with elevated depression and stress symptoms appear to be at risk for inconsistent contraceptive use patterns, especially for the most common methods that require greater user effort and diligence. Based upon these findings, clinicians should consider women's psychological and emotional status when helping patients with contraceptive decision-making and management. User-dependent contraceptive method efficacy is important to address in education and counseling sessions, and women with stress or depression may be ideal candidates for long-acting reversible methods, which offer highly effective options with less user-related burden. Ongoing research will provide a greater understanding of how young women

Lower Urinary Tract Symptoms and Urinary Incontinence During Pregnancy.

Science.gov (United States)

Balik, Gülşah; Güven, Emine Seda G; Tekin, Yeşim B; Şentürk, Şenol; Kağitci, Mehmet; Üstüner, Işık; Mete Ural, Ülkü; Şahin, Figen K

2016-05-01

Lower urinary tract symptoms (LUTS) can frequently be seen in pregnant women. Pregnancy and delivery have been considered as risk factors in the occurrence of pelvic floor dysfunction and determinants of LUTS. The main associated risk factor is parity. In the present study, we aim to determine the frequency of LUTS and urinary incontinence (UI) during pregnancy and the associated risk factors. This prospective study was carried out in a total of 250 women during their 28- and 40-gestational week checks. The Urinary Distress Inventory-6, the Incontinence Impact Questionnaire-7, and International Consultation on Incontinence Questionnaire-Short Form were used to determine LUTS and its effect on quality of life. The mean age and gestational age of the participants were 29.41 ± 5.70 year (range 18-44) and 35.45 ± 2.98 weeks (range 28-40), respectively. The prevalence of LUTS was 81.6%. The prevalence of UI during pregnancy was 37.2%. Stress urinary incontinence, urge urinary incontinence and mixed urinary incontinence were diagnosed as 15.6, 4.8 and 16.8%, respectively. We found that advanced age, smoking and multiparity were risk factors associated with incontinence. Incontinence reduced pregnant women's quality of life. Lower urinary tract symptoms are commonly seen among pregnant women and these symptoms negatively affect the quality of life of pregnant women. Advanced age, smoking and multiparity were risk factors associated with urinary incontinence and LUTS. Obstetricians should be on the lookout for individual urological problems in pregnancy. Resolving any urological issues and cessation of smoking for the affected individuals will help alleviate the problem. © 2014 Wiley Publishing Asia Pty Ltd.

Canadian Contraception Consensus (Part 1 of 4).

Science.gov (United States)

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

To provide guidelines for health care providers on the use of contraceptive methods to prevent pregnancy and on the promotion of healthy sexuality. Guidance for Canadian practitioners on overall effectiveness, mechanism of action, indications, contraindications, non-contraceptive benefits, side effects and risks, and initiation of cited contraceptive methods; family planning in the context of sexual health and general well-being; contraceptive counselling methods; and access to, and availability of, cited contraceptive methods in Canada. Published literature was retrieved through searches of Medline and The Cochrane Database from January 1994 to January 2015 using appropriate controlled vocabulary (e.g., contraception, sexuality, sexual health) and key words (e.g., contraception, family planning, hormonal contraception, emergency contraception). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies published in English from January 1994 to January 2015. Searches were updated on a regular basis and incorporated in the guideline to June 2015. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The quality of the evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table). Chapter 1: Contraception in Canada Summary Statements 1. Canadian women spend a significant portion of their lives at risk of an unintended pregnancy. (II-2) 2. Effective contraceptive methods are underutilized in Canada, particularly among vulnerable populations. (II-2) 3. Long-acting reversible contraceptive methods, including contraceptive implants and intrauterine contraception (copper-releasing and levonorgestrel

Canadian Contraception Consensus (Part 2 of 4).

Science.gov (United States)

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

To provide guidelines for health care providers on the use of contraceptive methods to prevent pregnancy and on the promotion of healthy sexuality. Guidance for Canadian practitioners on overall effectiveness, mechanism of action, indications, contraindications, non-contraceptive benefits, side effects and risks, and initiation of cited contraceptive methods; family planning in the context of sexual health and general well-being; contraceptive counselling methods; and access to, and availability of, cited contraceptive methods in Canada. Published literature was retrieved through searches of Medline and The Cochrane Database from January 1994 to January 2015 using appropriate controlled vocabulary (e.g., contraception, sexuality, sexual health) and key words (e.g., contraception, family planning, hormonal contraception, emergency contraception). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies published in English from January 1994 to January 2015. Searches were updated on a regular basis and incorporated in the guideline to June 2015. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The quality of the evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table). Chapter 1: Contraception in Canada Summary Statements  1. Canadian women spend a significant portion of their lives at risk of an unintended pregnancy. (II-2)  2. Effective contraceptive methods are underutilized in Canada, particularly among vulnerable populations. (II-2)  3. Long-acting reversible contraceptive methods, including contraceptive implants and intrauterine contraception (copper-releasing and levonorgestrel

Barriers and Misperceptions Limiting Widespread Use of Intrauterine Contraception Among Canadian Women.

Science.gov (United States)

Hauck, Brian; Costescu, Dustin

2015-07-01

Unintended pregnancy is a major social and public health problem with adverse effects on neonatal and developmental outcomes, as well as maternal health and wellbeing. Traditionally, family planning policies have focused on increasing contraceptive uptake in non-users; however, rates of non-use are low in many developed nations. A high proportion of unintended pregnancies are attributable to contraceptive failure, particularly when using barrier and short-acting hormonal contraceptives. Intrauterine contraceptive devices (IUCDs) are highly effective and have been shown to reduce unintended pregnancy rates. Despite this, global utilization rates are low, and IUCD uptake in Canada has been particularly low. In this review we explore why IUCDs are not more widely used, and specifically focus on barriers and misperceptions that may influence IUCD uptake, particularly in Canada. We reviewed relevant articles published in English between 1990 and 2014, through searches of PubMed and Medline, including primary studies of any design containing information on the knowledge and attitudes of health care providers and women. Providing education to care providers, women, and policy makers may help overcome misperceptions about the use of IUCDs, and may facilitate greater use. Increased support from federal and provincial health programs may also encourage the use of IUCDs in Canadian women, and help to reduce unintended pregnancy rates.

KNOWLEDGE OF EMERGENCY CONTRACEPTIVES AMONG WOMEN OF REPRODUCTIVE AGE GROUP

OpenAIRE

Singh; Himabindu; Shrivastava

2016-01-01

BACKGROUND As per data from WHO, 21.6 million unsafe abortions occurred globally in 2008, out of which 47,000 women died from abortionrelated complications, contributing to 13% of global maternal mortality. (1) Emergency contraceptive can be used after intercourse to prevent pregnancy in case of unprotected intercourse, contraceptive failure or sexual assault. A considerable proportion of these abortions can be prevented by the timely use of emergency contraception. OBJECTIVE...

Stagnant contraceptive sales after the Zika epidemic in Brazil.

Science.gov (United States)

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.

'Failed' contraception in a rural South African population

African Journals Online (AJOL)

Although access (preferably free) to termination of pregnancy. (TOP) is an integral component of women's reproductive health and rights, it is surely more desirable to avoid unwanted pregnancies. According to Benagiano and Pera/ the best ways to reduce the need for abortion are education and contraception. Putting ...

21 CFR 310.501 - Patient package inserts for oral contraceptives.

Science.gov (United States)

2010-04-01

... dispenser may provide the insert to the parent or legal guardian of a legally incompetent patient (or to the... the effectiveness of oral contraceptives in preventing pregnancy, the contraindications to the drug's... concerning the increased risks associated with cigarette smoking and oral contraceptive use. (5) A discussion...

Contraception in HIV-positive female adolescents

Directory of Open Access Journals (Sweden)

Ananworanich Jintanat

2011-06-01

Full Text Available Abstract Sexual behavior of HIV-positive youths, whether infected perinatally, through risky behavior or other ways, is not substantially different from that of HIV-uninfected peers. Because of highly active antiretroviral therapy, increasing number of children, infected perinatally, are surviving into adolescence and are becoming sexually active and need reproductive health services. The objective of this article is to review the methods of contraception appropriate for HIV-positive adolescents with a special focus on hormonal contraceptives. Delaying the start of sexual life and the use of two methods thereafter, one of which is the male condom and the other a highly effective contraceptive method such as hormonal contraception or an intrauterine device, is currently the most effective option for those who desire simultaneous protection from both pregnancy and sexually transmitted diseases. Health care providers should be aware of the possible pharmacokinetic interactions between hormonal contraception and antiretrovirals. There is an urgent need for more information regarding metabolic outcomes of hormonal contraceptives, especially the effect of injectable progestins on bone metabolism, in HIV-positive adolescent girls.

Contraceptive Uptake among Women of Reproductive Age in a ...

African Journals Online (AJOL)

TNHJOURNALPH

ABSTRACT. BACKGROUND. Family planning reduces the number of unintended and unwanted pregnancies and thereby saving women from high risk pregnancies and unsafe abortions. Despite the persistent advocacy urging the use of modern contraceptive methods for family planning, the fertility rates in most sub-.

Motivating factors for dual-method contraceptive use among adolescents and young women: a qualitative investigation.

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Lemoine, Julie; Teal, Stephanie B; Peters, Marissa; Guiahi, Maryam

2017-11-01

This qualitative study explores how adolescents and young women perceive the need for and describe the use of dual method contraception. We interviewed 20 sexually active women aged 16-24 who attended an adolescent-focused Title X family-planning clinic and were using a non-barrier contraceptive method. We used a semi-structured interview guide that included domains related to sexual activity, knowledge of and use of contraceptives and condoms, and relationship factors. We coded transcripts using grounded theory techniques and used an iterative process to develop overarching themes. Dual method contraceptive users primarily discussed pregnancy prevention as their motivating factor. Many expressed anxieties over an unplanned pregnancy and reported condom use as "back-up" contraception. Risk perception for pregnancy or STI acquisition did not necessarily change as relationship trust increased, but rather, their anxiety regarding the negativity of such outcomes decreased. Dual-method contraception use decreased when participants reported that condoms were not readily available, or when they self-described immaturity. Less frequently, participants reported dual method use for sexually transmitted infection (STI) prevention, and many substituted STI testing for condom use. Contraceptive type (short-acting vs. long-acting) did not influence reported attitudes towards dual method use. Health educators and clinicians encourage condom use in young women due to the significant morbidity associated with STI acquisition. Most participants in our study view condoms as a way to improve pregnancy prevention. Acknowledging and addressing this divergence in motivation will allow caregivers to improve strategies for communicating the importance of dual method use. Young women primarily describe pregnancy prevention as the reason for dual method use, STI protection is less salient. Consideration of this viewpoint by health educators and clinicians will allow us to communicate more

Hormonal contraception and female pain, orgasm and sexual pleasure.

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Smith, Nicole K; Jozkowski, Kristen N; Sanders, Stephanie A

2014-02-01

Almost half of all pregnancies in the United States are unintentional, unplanned, or mistimed. Most unplanned pregnancies result from inconsistent, incorrect, or nonuse of a contraceptive method. Diminished sexual function and pleasure may be a barrier to using hormonal contraception. This study explores sexual function and behaviors of women in relation to the use of hormonal vs. nonhormonal methods of contraception. Data were collected as part of an online health and sexuality study of women. Main outcomes variables assess frequencies in two domains: (i) sexual function (proportion of sexual events with experiences of pain or discomfort, arousal, contentment and satisfaction, pleasure and enjoyment, lubrication difficulty, and orgasm) and (ii) sexual behavior (number of times engaged in sexual activity, proportion of sexual events initiated by the woman, and proportion of sexual events for which a lubricant was used). Sociodemographic variables and contraceptive use were used as sample descriptors and correlates. The recall period was the past 4 weeks. The sample included 1,101 women with approximately half (n = 535) using a hormonal contraceptive method exclusively or a combination of a hormonal and nonhormonal method, and about half (n = 566) using a nonhormonal method of contraception exclusively. Hierarchical regression analyses were conducted to examine the relation of hormonal contraceptive use to each of the dependent variables. Women using a hormonal contraceptive method experienced less frequent sexual activity, arousal, pleasure, and orgasm and more difficulty with lubrication even when controlling for sociodemographic variables. This study adds to the literature on the potential negative sexual side effects experienced by many women using hormonal contraception. Prospective research with diverse women is needed to enhance the understanding of potential negative sexual side effects of hormonal contraceptives, their prevalence, and possible mechanisms

Health Care Factors Influencing Teen Mothers' Use Of Contraceptives in Malawi.

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Machira, Kennedy; Palamuleni, Martin E

2017-06-01

The study seeks to examine factors associated with teen mothers' use of modern contraceptives after giving birth. The 2010 Malawi Demographic and Health Survey data was used to test the study objective. A sample of 12, 911 teen mothers aged between 10 and 18 years were extracted from 23, 020 women and were asked of contraceptive usage after first birth experiences, in which, a logistic regression model was employed to estimate correlates of contraceptive usage. The study found that 54.8% of the teen mothers are still at a risk of having a repeat teenage pregnancy due to their non-use of contraceptives. This implies that less than 50% of teen mothers use contraceptives after experiencing teen birth. It is noted that health care factors such as use of antenatal care, awareness of pregnancy complications, attainment of primary education and exposure to media predict teen mothers' use of modern contraceptives. Despite endeavours made by government to improve access to family planning, health care challenges still exist affecting women's use of contraceptives in Malawi. Ameliorating these health encounters call for wide-range approaches aimed at addressing teen birth comprehensively in order to prevent early motherhood and subsequently high fertility. None declared.

Contraception and fertility awareness among women with solid organ transplants.

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French, Valerie A; Davis, John S; Sayles, Harlan S; Wu, Serena S

2013-10-01

To assess the contraception and fertility counseling provided to women with solid organ transplants. A telephone survey of 309 women aged 19-49 years who had received a solid organ transplant at the University of Nebraska Medical Center was performed. Of the 309 eligible women, 183 responded. Patients were asked 19 questions regarding pretransplant and posttransplant fertility awareness and contraception counseling. Data were summarized using descriptive statistics. Patients had undergone a variety of solid organ transplantations: 40% kidney (n=73); 32% liver (n=59); 6% pancreas (n=11); 5% heart (n=9); 3% intestine (n=5); and 14% multiple organs (n=26). Before their transplantations, 79 women (44%) reported they were not aware that a woman could become pregnant after transplantation. Only 66 women aged 13 and older at the time of transplantation reported that a health care provider discussed contraception before transplantation. Approximately half of women surveyed were using a method of contraception. Oral contraceptive pills were the most commonly recommended method. Twenty-two of the 31 pregnancies after organ transplantation were planned, which is higher than that of the general population. Few women with transplants are educated regarding the effect of organ transplantation on fertility and are not routinely counseled about contraception or the potential for posttransplant pregnancy. Health care providers should incorporate contraceptive and fertility counseling as part of routine care for women with solid organ transplants. : II.

Contraceptive choices among grand multiparous women at Murtala Mohammed Specialist Hospital, Kano.

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Rabiu, Ayyuba; Abubakar, Idris Sulaiman; Garba, Ibrahim; Haruna, Iman Usman

2016-01-01

Grand multiparity is known to be associated with pregnancy complications. Nigeria with a contraceptive prevalence of women get to grand multiparity early in their obstetric carriers. These women contribute significantly to the bad obstetric performance indices in the country. The present study was to explore the contraceptive choices among grand multiparous women. This study was a descriptive cross-sectional study among grand multiparous women attending an antenatal clinic. Data were collected on sociodemographic characteristics, contraceptive choices, and factors that influence such choices. The data were analyzed using Statistical Package for the Social Sciences version 18. There were 219 respondents. The mean age was 33.05 ± 3.17, and the mean parity was 6.48 ± 1.83. Most of the respondents (208, 95.50%) were aware of modern contraceptive methods, and oral contraceptive was the method of most of the respondents (197, 90.00%). Only 92 (42.00%) were currently using a modern contraceptive method. Being convenient for the lifestyle was the reason for the choice of a contraceptive method by many of the respondents (42, 19.10%). There was high awareness of modern contraceptive methods; however, there was low use prevalence among respondents, and the desire for more pregnancy was the reason for the nonuse.

Relationship between inflammatory biomarkers and depressive symptoms during late pregnancy and the early postpartum period: a longitudinal study.

Science.gov (United States)

Simpson, William; Steiner, Meir; Coote, Marg; Frey, Benicio N

2016-01-01

Perinatal depressive symptoms often co-occur with other inflammatory morbidities of pregnancy. The goals of our study were 1) to examine whether changes in inflammatory markers from the third trimester of pregnancy to 12 weeks postpartum were associated with changes in depressive symptoms; 2) to examine whether third trimester inflammatory markers alone were predictive of postpartum depressive symptoms; and 3) to examine the relationship between inflammatory markers and depressive symptoms during the third trimester of pregnancy and at 12 weeks postpartum. Thirty-three healthy pregnant women were recruited from the Women's Health Concerns Clinic at St. Joseph's Healthcare in Hamilton, Canada. The impact of depressive symptoms on the levels of interleukin (IL)-6, IL-10, tumor necrosis factor alpha (TNF-α), and C-reactive protein (CRP) at the third trimester of pregnancy, at 12 weeks postpartum, and across time was assessed using linear and mixed-model regression. Regression analysis revealed no significant association between depressive symptoms and any of the candidate biomarkers during pregnancy, at 12 weeks postpartum, or over time. Pregnancy depressive symptoms (p > 0.001), IL-6 (p = 0.025), and IL-10 (p = 0.006) were significant predictors of postpartum Edinburgh Perinatal Depression Scale (EPDS) score. Our study supports previous reports from the literature showing no relationship between inflammatory biomarkers and depressive symptoms during late pregnancy, early postpartum, or across time. Our study is the first to observe an association between late pregnancy levels of IL-6 and IL-10 and postpartum depressive symptoms. Further studies with larger samples are required to confirm these findings.

Evaluation of an integrated services program to prevent subsequent pregnancy and birth among urban teen mothers.

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Patchen, Loral; Letourneau, Kathryn; Berggren, Erica

2013-01-01

This article details the evaluation of a clinical services program for teen mothers in the District of Columbia. The program's primary objectives are to prevent unintended subsequent pregnancy and to promote contraceptive utilization. We calculated contraceptive utilization at 6, 12, 18, and 24 months after delivery, as well as occurrence of subsequent pregnancy and birth. Nearly seven in ten (69.5%) teen mothers used contraception at 24 months after delivery, and 57.1% of contraceptive users elected long-acting reversible contraception. In the 24-month follow-up period, 19.3% experienced at least one subsequent pregnancy and 8.0% experienced a subsequent birth. These results suggest that an integrated clinical services model may contribute to sustained contraceptive use and may prove beneficial in preventing subsequent teen pregnancy and birth.

Behavioral interventions for improving dual-method contraceptive use.

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Lopez, Laureen M; Stockton, Laurie L; Chen, Mario; Steiner, Markus J; Gallo, Maria F

2014-03-30

Dual-method contraception refers to using condoms as well as another modern method of contraception. The latter (usually non-barrier) method is commonly hormonal (e.g., oral contraceptives) or a non-hormonal intrauterine device. Use of two methods can better prevent pregnancy and the transmission of HIV and other sexually transmitted infections (STIs) compared to single-method use. Unprotected sex increases risk for disease, disability, and mortality in many areas due to the prevalence and incidence of HIV/STI. Millions of women, especially in lower-resource areas, also have an unmet need for protection against unintended pregnancy. We examined comparative studies of behavioral interventions for improving use of dual methods of contraception. Dual-method use refers to using condoms as well as another modern contraceptive method. Our intent was to identify effective interventions for preventing pregnancy as well as HIV/STI transmission. Through January 2014, we searched MEDLINE, CENTRAL, POPLINE, EMBASE, COPAC, and Open Grey. In addition, we searched ClinicalTrials.gov and ICTRP for current trials and trials with relevant data or reports. We examined reference lists of pertinent papers, including review articles, for additional reports. Studies could be either randomized or non-randomized. They examined a behavioral intervention with an educational or counseling component to encourage or improve the use of dual methods, i.e., condoms and another modern contraceptive. The intervention had to address preventing pregnancy as well as the transmission of HIV/STI. The program or service could be targeted to individuals, couples, or communities. The comparison condition could be another behavioral intervention to improve contraceptive use, usual care, other health education, or no intervention.Studies had to report use of dual methods, i.e., condoms plus another modern contraceptive method. We focused on the investigator's assessment of consistent dual-method use or use at

Contraceptive sales in the setting of the Zika virus epidemic

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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

Contraceptive sales in the setting of the Zika virus epidemic.

Science.gov (United States)

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 efficacy, compliance and beyond: factors related to satisfaction with once-weekly transdermal compared with oral contraception.

Science.gov (United States)

Urdl, Wolfgang; Apter, Dan; Alperstein, Alan; Koll, Peter; Schönian, Siegfried; Bringer, Jacques; Fisher, Alan C; Preik, Michael

2005-08-01

To investigate contraceptive efficacy, compliance and user's satisfaction with transdermal versus oral contraception (OC). Randomized, open-label, parallel-group trial conducted at 65 centers in Europe and South Africa. One thousand four hundred and eighty-nine women received a contraceptive patch (n = 846) or an OC (n = 643) for 6 or 13 cycles. Overall/method-failure Pearl Indices were 0.88/0.66 with the patch and 0.56/0.28 with the OC (p = n.s.). Compliance was higher at all age groups with the patch compared to the OC. Significantly more users were very satisfied with the contraceptive patch than with the OC. The percentage of patch users being very satisfied increased with age whereas it did not in the OC group. Likewise, improvements of premenstrual symptoms as well as emotional and physical well-being increased with age in the patch-group in contrast to the OC group. Ratings of satisfaction with the study medication correlated weakly with emotional (r = 0.33) and physical well-being (r = 0.39) as well as premenstrual symptoms (r = 0.30; p Contraceptive efficacy of the patch is comparable to OC, but compliance is consistently better at all age groups. Higher satisfaction with the patch at increasing age may be attributed to improvements in emotional and physical well-being as well as reduction of premenstrual symptoms.

Symptoms of an Intrauterine Hematoma Associated with Pregnancy Complications: A Systematic Review

Science.gov (United States)

Xiang, Lan; Wei, Zhaolian; Cao, Yunxia

2014-01-01

Objective To evaluate the predictive value of the symptoms of an intrauterine hematoma (IUH) for adverse pregnancy outcomes. Methods A literature review was performed with the search terms, including intrauterine/subchorionic/retroplacental/subplacental hematoma/hemorrhage/bleeding/collection/fluid, covering the period from January, 1981 to January, 2014. We just focused on the pregnancy outcomes associated with different symptoms of an IUH. Results It is generally agreed that a retroplacental, posterior or subchorionic in the fundus of uterus, and/or persistent IUH is associated with adverse outcomes in the ongoing pregnancy. However, the prognosis value of both volume and gestational age at diagnosis of IUH still remains controversial. Some researchers argue that a large IUH is associated with an increased risk of adverse events during pregnancy while others refuted. It is believed by some that the earlier an IUH was detected, the higher the risk for adverse outcomes would be, while no or weak association were reported by other studies. The prognostic value of the simultaneous presence of vaginal bleeding on pregnancy outcome is also controversial. Conclusions Both the position relative to the placenta or uterus and duration of IUH have strong predictive value on the prognosis in the ongoing pregnancy. However, the prognostic values of the IUH volume, gestational age at diagnosis and the simultaneous presence of vaginal bleeding remain controversial up to now. Moreover, most of previous reports are small, uncontrolled studies with incomplete information. Prospective, large sample, cohorts studies which take all detailed symptoms of an IUH into consideration are needed when we evaluate its clinical significance in the prognosis of pregnancy. PMID:25369062

[Intrauterine contraception].

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Tauber, P F

1984-09-01

Approximately 60 million women worldwide use IUDs. Despite worldwide distribution, the total number of IUD carriers has barely increased since 1970. Due to its risks and side effects there is a retrograding tendency both in West Germany and the US. To generate positive development, 3 basic trends have emerged: 1) Restrictive usage of the pharmacologically inactive, 1st generation IUDs such as the Lippes Loop or the Saf-T-Coil, 2) the increasing usage of small plastic IUDs with bioactive alloys to decrease failure rates such as the copper (2nd generation) or hormone-releasing IUDs, and 3) improvements made by changing its design to reduce side effects without loss of contraceptive effectiveness. Almost all IUDs increase monthly blood loss by 50-100%. The risk of illness for women with IUDs is 2-3 times higher than for a woman without or with other contraceptive methods. About 20% of all expulsions occur unnoticed. There are 2 kinds of perforations: primary (iatrogenic), at time of insertion, and secondary, some time after insertion. The IUD failure rate is about 1-3 pregnancies/100 woman years. In case of pregnancy, the IUD must be removed immediately. IUD insertion requires consent of the woman and can be made to women from 16 years on, presupposing moral maturity. IUD insertion after a miscarriage or abortion does not lead to risks or complications. Due to its corrosive quality, the copper IUD can only remain inside the uterus for a limited time. IUDs could become an excellent contraceptive method if it were possible to decrease bleeding, design easily-removeable IUDs, and prolong their potential for duration in the body.

Correlates of oral contraception continuation.

Science.gov (United States)

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.

A qualitative assessment of decisions affecting contraceptive utilization and fertility intentions among HIV-positive women in Soweto, South Africa.

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Laher, Fatima; Todd, Catherine S; Stibich, Mark A; Phofa, Rebecca; Behane, Xoliswa; Mohapi, Lerato; Gray, Glenda

2009-06-01

The HIV epidemic in sub-Saharan Africa disproportionately affects women of reproductive age. The increasing provision of Highly Active Anti-Retroviral Therapy (HAART) with improved prognosis and maternal-fetal outcomes calls for an understanding of fertility planning for HIV-positive women. We describe the effect of HIV and HAART on pregnancy desires and contraceptive use among HIV-positive women in Soweto, South Africa. Focus group discussions and in-depth interviews were conducted with 42 HIV-positive women of reproductive age. Analysis was performed using ATLAS-ti (ATLAS-ti Center, Berlin). Emergent themes were impact of HIV diagnosis on pregnancy intentions; factors affecting contraceptive uptake including real and normative side effects, body image, and perceived vaginal wetness; and the mitigating influence of partnership on both pregnancy intentions and contraceptive use. Routine counseling about pregnancy desires and contraception should be offered to HIV-positive women.

THE KNOWLEDGE OF THE NIŠ UNIVERSITY STUDENTS ABOUT EMERGENCY CONTRACEPTION

Directory of Open Access Journals (Sweden)

Milena Veljković

2014-03-01

Full Text Available Emergency contraception is a treatment that used as an emergency procedure to prevent unwanted pregnancy after an unprotected sexual intercourse or contraception failure regardless of the point in the menstrual cycle. The most common method is the treatment with sexual steroids and the second-line form is the copper intrauterine device. A considerable number of female students of Nis were informed about the existence of emergency contraception. Younger generations (I/II years of sudy were better informed than older generations (III/IV years of study: 81.6% vs. 57.5%. The difference was statistically significant (χ2 =7.91;p<0.005. The students of medicine were better informed than the students of art and science: 87.9% vs. 78.2% vs. 70.0% but there was not statistical difference. It is expected that adequate usage of emergency contraception will significantly reduce the number of unwanted pregnancies. It is only emergency treatment and is not a substitution for regular contraception. Students are very important in the population of youth and it is expected that they could be optimally informed about this method of fertility control.

Pharmacy Access to Emergency Contraception in Rural and Frontier Communities

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Bigbee, Jeri L.; Abood, Richard; Landau, Sharon Cohen; Maderas, Nicole Monastersky; Foster, Diana Greene; Ravnan, Susan

2007-01-01

Context: Timely access to emergency contraception (EC) has emerged as a major public health effort in the prevention of unintended pregnancies. The recent FDA decision to allow over-the-counter availability of emergency contraception for adult women presents important rural health implications. American women, especially those living in rural and…

Relationship between inflammatory biomarkers and depressive symptoms during late pregnancy and the early postpartum period: a longitudinal study

Directory of Open Access Journals (Sweden)

William Simpson

Full Text Available Objective: Perinatal depressive symptoms often co-occur with other inflammatory morbidities of pregnancy. The goals of our study were 1 to examine whether changes in inflammatory markers from the third trimester of pregnancy to 12 weeks postpartum were associated with changes in depressive symptoms; 2 to examine whether third trimester inflammatory markers alone were predictive of postpartum depressive symptoms; and 3 to examine the relationship between inflammatory markers and depressive symptoms during the third trimester of pregnancy and at 12 weeks postpartum. Methods: Thirty-three healthy pregnant women were recruited from the Women’s Health Concerns Clinic at St. Joseph’s Healthcare in Hamilton, Canada. The impact of depressive symptoms on the levels of interleukin (IL-6, IL-10, tumor necrosis factor alpha (TNF-α, and C-reactive protein (CRP at the third trimester of pregnancy, at 12 weeks postpartum, and across time was assessed using linear and mixed-model regression. Results: Regression analysis revealed no significant association between depressive symptoms and any of the candidate biomarkers during pregnancy, at 12 weeks postpartum, or over time. Pregnancy depressive symptoms (p > 0.001, IL-6 (p = 0.025, and IL-10 (p = 0.006 were significant predictors of postpartum Edinburgh Perinatal Depression Scale (EPDS score. Conclusions: Our study supports previous reports from the literature showing no relationship between inflammatory biomarkers and depressive symptoms during late pregnancy, early postpartum, or across time. Our study is the first to observe an association between late pregnancy levels of IL-6 and IL-10 and postpartum depressive symptoms. Further studies with larger samples are required to confirm these findings.

Preventing Teenage Pregnancy: A Team Approach

OpenAIRE

Anderson, Cheryl

1986-01-01

By age 16 one in three adolescents have experienced sexual intercourse. Because one-third of these sexually active teens never use contraception, they have a five-times greater risk of pregnancy than teenagers who take contraceptive measures. In 1982, one in 23 Canadian teenage girls became pregnant. Teenagers' reasons for not using contraceptives include fear of parents learning about their sexual activity, lack of knowledge about contraception, and lack of self-esteem. Parents, educators an...

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

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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

A systematic review of effectiveness and safety of different regimens of levonorgestrel oral tablets for emergency contraception.

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Shohel, Mohammad; Rahman, Mohammad Mahfuzur; Zaman, Asif; Uddin, Mir Muhammad Nasir; Al-Amin, Md Mamun; Reza, Hasan Mahmud

2014-04-04

Unintended pregnancy is a complex phenomenon which raise to take an emergency decision. Low contraceptive prevalence and high user failure rates are the leading causes of this unexpected situation. High user failure rates suggest the vital role of emergency contraception to prevent unplanned pregnancy. Levonorgestrel - a commonly used progestin for emergency contraception. However, little is known about its pharmacokinetics and optimal dose for use. Hence, there is a need to conduct a systematic review of the available evidences. Randomized, double-blind trials were sought, evaluating healthy women with regular menstrual cycles, who requested emergency contraception within 72 h of unprotected coitus, to one of three regimens: 1.5 mg single dose levonorgestrel, two doses of 0.75 mg levonorgestrel given 12 h apart or two doses of 0.75 mg levonorgestrel given 24 h apart. The primary outcome was unintended pregnancy; other outcomes were side-effects and timing of next menstruation. Every trial under consideration successfully established the contraceptive effectiveness of levonorgestrel for preventing unintended pregnancy. Moreover, a single dose of levonorgestrel 1.5 mg for emergency contraception supports its safety and efficacy profile. If two doses of levonorgestrel 0.75 mg are intended for administration, the second dose can positively be taken 12-24 h after the first dose without compromising its contraceptive efficacy. The main side effect was frequent menstrual irregularities. No serious adverse events were reported. The review shows that, emergency contraceptive regimen of single-dose levonorgestrel is not inferior in efficacy to the two-dose regimen. All the regimens studied were very efficacious for emergency contraception and prevented a high proportion of pregnancies if taken within 72 h of unprotected coitus. Single levonorgestrel dose (1.5 mg) can substitute two 0.75 mg doses 12 or 24 h apart. With either regimen, the earlier the treatment is given

Keep Calm and Contracept! Addressing Young Women's Pleasure in Sexual Health and Contraception Consultations

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Hanbury, Ali; Eastham, Rachael

2016-01-01

Clinical sexual health consultations with young women often focus on avoiding "risks;" namely pregnancy and sexually transmitted infection transmission. They also typically fail to explore how contraception use can impact on the capacity to enjoy sexual relationships. In contrast, this paper argues that sexual pleasure should be a…

Conduct Disorder Symptoms and Subsequent Pregnancy, Child-Birth and Abortion: A Population-Based Longitudinal Study of Adolescents

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Pedersen, Willy; Mastekaasa, Arne

2011-01-01

Research on teenage pregnancy and abortion has primarily focused on socio-economic disadvantage. However, a few studies suggest that risk of unwanted pregnancy is related to conduct disorder symptoms. We examined the relationship between level of conduct disorder symptoms at age 15 and subsequent pregnancy, child-birth and abortion. A…

Combined oral contraceptives versus levonorgestrel for emergency contraception.

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Strayer, S M; Couchenour, R L

1998-12-01

A study supported by the World Health Organization's Task Force on Postovulatory Methods of Fertility Control compared the efficacy of the Yuzpe and levonorgestrel-only methods of emergency contraception (EC). Enrolled in this double-blind, randomized trial were 1998 women from 21 centers around the world who requested EC within 72 hours of unprotected intercourse. The pregnancy rate was 1.1% for levonorgestrel alone and 3.2% for the combined ethinyl estradiol-levonorgestrel regimen. The crude relative risk of pregnancy was 0.36 (95% confidence interval, 0.18-0.70) for levonorgestrel compared with the Yuzpe regimen. The former method prevented 85% of expected pregnancies, while the latter prevented only 57%. Finally, side effects such as nausea, vomiting, dizziness, and fatigue were significantly less common in the levonorgestrel group. Although these findings document the superiority of the levonorgestrel regimen for EC, the 0.75 mg tablets are not currently manufactured in the US.

Depressive Symptoms in Pregnancy: The Influence of Social, Psychological and Obstetric Aspects.

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Moraes, Eleomar Vilela de; Campos, Rodolfo Nunes; Avelino, Mariza Martins

2016-06-01

Purpose To assess the prevalence of depressive symptoms and their association with social, psychological, behavioral and obstetric characteristics in pregnant women. Methods This is a cross-sectional study. The sample consisted of 375 pregnant women who attended prenatal clinics in two public maternity hospitals located in the city of Goiania, Brazil. To testify the depressive symptoms, we used the Hospital Anxiety and Depression Scale (HADS). A descriptive statistical analysis was performed using programs such as CDC EPI-INFO™, version 7.1.5, and Statistical Package for Social Sciences (IBM SPSS), version 21.0. Results the patients had probable depressive symptoms (15.47%) and possible depressive symptoms (25.33%). The bivariate analysis showed a significant association among "depressive symptoms" and the following variables: "single or divorced" (prevalence ratio, PR = 2.08; 95% confidence interval, CI = 1.26 to 3.44); "physical activity during pregnancy" (PR = 3.96; 95%CI = 1.28 to 12.31); exposure to "psychological/emotional" violence (PR = 4.74; 95%CI = 2.94 to 7.64); "prior mental problem" (PR = 2.66; 95%CI =1.49 to 4.73) and "obstetric complications during pregnancy" (PR = 2.53; 95%CI = 1.55 to 4.13). The multivariate analysis confirmed the association of these depressive symptoms with the variables "suffered psychological/emotional violence" (odds ratio, OR = 5.821; 95%CI = 2.939 to 11.528); "physical activity during pregnancy" (OR = 3.885; 95%CI = 1.060 to 14.231); "obstetric complications during pregnancy" (OR = 2.442; 95%CI = 1.233 to 4.834) and "single or divorced" (OR = 2.943; 95%CI = 1.326 to 6.533). Conclusions the prevalence of depressive symptoms among pregnant women is of 15.47%, and emotional violence is the main factor associated with gestational depression. Thieme Publicações Ltda Rio de Janeiro, Brazil.

Would male hormonal contraceptives affect cardiovascular risk?

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Michael Zitzmann

2018-01-01

Full Text Available The aim of hormonal male contraception is to prevent unintended pregnancies by suppressing spermatogenesis. Hormonal male contraception is based on the principle that exogenous administration of androgens and other hormones such as progestins suppress circulating gonadotropin concentrations, decreasing testicular Leydig cell and Sertoli cell activity and spermatogenesis. In order to achieve more complete suppression of circulating gonadotropins and spermatogenesis, a progestin has been added testosterone to the most recent efficacy trials of hormonal male contraceptives. This review focusses on the potential effects of male hormonal contraceptives on cardiovascular risk factors, lipids and body composition, mainly in the target group of younger to middle-aged men. Present data suggest that hormonal male contraception can be reasonably regarded as safe in terms of cardiovascular risk. However, as all trials have been relatively short (< 3 years, a final statement regarding the cardiovascular safety of hormonal male contraception, especially in long-term use, cannot be made. Older men with at high risk of cardiovascular event might not be good candidates for hormonal male contraception. The potential adverse effects of hormonal contraceptives on cardiovascular risk appear to depend greatly on the choice of the progestin in regimens for hormonal male contraceptives. In the development of prospective hormonal male contraception, data on longer-term cardiovascular safety will be essential.

Attitudes and practices of pharmacists towards emergency contraception in Durban, South Africa.

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Hariparsad, N

2001-06-01

Emergency contraception, which is used to prevent pregnancy following unprotected intercourse, could prove invaluable to a country like South Africa which has high fertility and pregnancy rates. However, the success of emergency contraception is dependent on the awareness, knowledge, attitudes and practices amongst health-care providers and the public towards it. The aim of this study was to assess the attitudes and practices of community pharmacists towards emergency contraception. The study was conducted in North and South Central Durban, South Africa. This questionnaire-based study sought from pharmacists the frequency of demand and supply of emergency contraception, as well as their attitudes and practices towards it. The sample included all 182 pharmacies located in the study area. A total of 96% of pharmacists had received requests for emergency contraception within the last year. On average, each pharmacist received 177 requests for emergency contraception. Sixty-nine per cent of pharmacists were in favor of making emergency contraceptive pills available without a prescription, 62% were already supplying emergency contraceptive pills without a prescription and 67% felt that it was important to increase public awareness regarding emergency contraception. Ninety-one per cent of pharmacists did not have any literature regarding emergency contraception to hand to clients, 68% had a private area in their pharmacy to counsel patients and 86% of pharmacists indicated that they discussed long-term contraception with clients. This study is the first in South Africa aimed at determining the utilization of emergency contraception. However, further studies are required in order to ascertain information that will assist in changing current health policies to improve those in reproductive health care.

The emotional-behavioural functioning of children exposed to maternal depressive symptoms across pregnancy and early childhood: a prospective Australian pregnancy cohort study.

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Giallo, Rebecca; Woolhouse, Hannah; Gartland, Deirdre; Hiscock, Harriet; Brown, Stephanie

2015-10-01

Children exposed to maternal depression during pregnancy and in the postnatal period are at increased risk of a range of health, wellbeing and development problems. However, few studies have examined the course of maternal depressive symptoms in the perinatal period and beyond on children's wellbeing. The present study aimed to explore the relationship between both the severity and chronicity of maternal depressive symptoms across the early childhood period and children's emotional-behavioural difficulties at 4 years of age. Data from over 1,085 mothers and children participating in a large Australian prospective pregnancy cohort were used. Latent class analysis identified three distinct trajectories of maternal depressive symptoms from pregnancy to 4 years postpartum: (1) no or few symptoms (61%), (2) persistent subclinical symptoms (30%), and (3) increasing and persistently high symptoms (9%). Regression analyses revealed that children of mothers experiencing subclinical and increasing and persistently high symptoms were at least two times more likely to have emotional-behavioural difficulties than children of mothers reporting minimal symptoms, even after accounting for known risk factors for poor outcomes for children. These findings challenge policy makers and health professionals to consider how they can tailor care and support to mothers experiencing a broader spectrum of depressive symptoms across the early childhood period, to maximize opportunities to improve both short-and long-term maternal and child health outcomes.

Teenage pregnancy prevention: the role of young men.

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Vargas, Gabriela; Borus, Joshua; Charlton, Brittany M

2017-08-01

Although teenage pregnancy is declining in many parts of the world, it remains associated with considerable social, health, and economic outcomes. Pregnancy prevention efforts focus primarily on young women, with minimal attention to young men. This review highlights recent literature pertaining to the role of young men in pregnancy prevention. Young men have varying views on contraception as well as which partner(s) should be responsible for its use. Limited contraception knowledge reduces young men's sexual health communication as well as their contraception use. Healthcare providers play a major role as one of the main sources of sexual health information for young men, but there are gaps in young men's sexual health care so new guidelines have emerged. Recent literature highlights young men's range of views on contraception as well as their low sexual health knowledge and sexual health communication. To address teenage pregnancy and improve young men's overall wellness, healthcare providers should routinely address sexual health. Healthcare providers may use our newly proposed acronym, HIS BESTT, (Hello. Initiate. Sexual health assessment. Both condoms and female dependent methods. Examine genitals. STI screening. Talking to partner(s). Talking to parent(s) or guardians), to incorporate current clinical recommendations.

Acculturative stress is associated with trajectory of anxiety symptoms during pregnancy in Mexican-American women.

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Preciado, Andrea; D'Anna-Hernandez, Kimberly

2017-05-01

Over half of pregnant women report anxiety symptoms and these symptoms may be precipitated by stressful experiences. Anxiety rates may be higher in Mexican-American women who experience sociocultural stressors, such as acculturation, acculturative stress and discrimination. However, the role of such stressors on the trajectory of anxiety symptoms across pregnancy is not yet known. Mexican-American women (n=151) completed surveys across pregnancy about acculturation, acculturative stress, perceived discrimination, and state anxiety. Multilevel modeling found that acculturation (Anglo orientation, b=0.050, SE=0.379, t (137.561)=0.134, p=0.894; Mexican orientation, b=0.775, SE=0.692, t (133.424)=1.121, p=0.264) and perceived discrimination (b=-1.259, SE=0.921, t (137.489)=-1.367, p=0.174) were not associated with the trajectory of anxiety symptoms. However, acculturative stress, even while controlling for perceived stress, was associated with high levels of anxiety symptoms that were elevated early in pregnancy (b=-0.045, SE=0.022, t (135.749)=-2, p=0.047). This work highlights the unique role of acculturative stress in risk for prenatal anxiety in early pregnancy. Copyright © 2016. Published by Elsevier Ltd.

Relationship between Maternal General and Specific-Pregnancy Stress, Anxiety, and Depression Symptoms and Pregnancy Outcome.

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Hasanjanzadeh, Parvin; Faramarzi, Mahbobeh

2017-04-01

Despite scientific advances in the field of physical problems during pregnancy, the effect of mental problems on the health of pregnant women is still an important issue that needs further research. To determine the association of symptoms of stress, anxiety and depression during pregnancy and there effect on the pregnancy outcome. This was a descriptive correlational study. The population included 200 pregnant women of the urban and rural health centers affiliated with Babol University of Medical Sciences. There were 100 each in second and third trimester. Convenience multi stage cluster sampling was performed. Data collection was received through the Hospital Anxiety Depression Scale (HADS), Pregnancy Distress Questionnaire (PDQ), and Perceived Stress Scale (PSS-14) questionnaires. The correlation results showed a significant difference between variables of depression, stress, and anxiety with birth weight, birth height and head circumference and infants' APGAR score (prelationships on prediction of infant weight (B=-0.324), anxiety on prediction of infant height (B=-0.197), stress on prediction of head circumference (B=-0.350) and depression on prediction of APGAR score (B=-0.323) are effective (pdepression, anxiety and stress in pregnancy, and scheduling to avoid adverse consequences of the pregnancy outcome.

[Male hormonal contraception: past, present, future].

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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 implants: current perspectives

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Rowlands S

2014-09-01

Full Text Available Sam Rowlands,1,2 Stephen Searle3 1Centre of Postgraduate Medical Research and Education, School of Health and Social Care, Bournemouth University, Bournemouth, United Kingdom; 2Dorset HealthCare, Bournemouth, United Kingdom; 3Sexual Health Services, Chesterfield, United KingdomAbstract: Progestin-only contraceptive implants are a highly cost-effective form of long-acting reversible contraception. They are the most effective reversible contraceptives and are of a similar effectiveness to sterilization. Pregnancies are rare in women using this method of contraception, and those that do occur must be fully investigated, with an ultrasound scan of the arm and serum etonogestrel level if the implant cannot be located. There are very few contraindications to use of implants, and they have an excellent safety profile. Both acceptability and continuation with the method are high. Noncontraceptive benefits include improvements in dysmenorrhea, ovulatory pain, and endometriosis. Problematic bleeding is a relatively common adverse effect that must be covered in preinsertion information-giving and supported adequately if it occurs. Recognized training for both insertion and removal should be undertaken. Care needs to be taken at both insertion and removal to avoid neurovascular injury. Implants should always be palpable; if they are not, noninsertion should be assumed until disproven. Etonogestrel implants are now radiopaque, which aids localization. Anticipated difficult removals should be performed by specially trained experts. Keywords: contraceptive, subdermal implant, etonogestrel, levonorgestrel, progestin-only, long-acting reversible contraception

Utilization and discontinuation of contraceptive methods: the University of Calabar Teaching Hospital (UCTH experience

Directory of Open Access Journals (Sweden)

Njoku CO

2014-09-01

Full Text Available Background: Contraception has an important role to play in reducing the high rate of maternal morbidity and mortality in developing countries. Objective: The objective is to determine the prevalence rate, methods and reasons for discontinuation of contraceptive methods at UCTH, Calabar. Method: This was a retrospective study of all clients that utilised different forms of contraceptives at UCTH, Calabar from 1st January, 2009 to 31st December, 2013. Results: A total of 5,381 clients used various methods of contraception while 13,492 live births were recorded giving the prevalence rate of 39.9% of total live birth. Common methods were intrauterine contraceptive device (IUCD 1,745(32.8% and injectable contraceptives 1,268(23.8%. Most clients 1,876(35.2% were graduates while 81(1.5% had no formal education. A total of 535(10.1% clients discontinued different family planning method commonly due to desire for pregnancy and side effects. IUCD had the highest discontinuation rate. Conclusion: The study revealed low prevalence rate of contraceptive use which was more among teenagers and illiterate women. The main reasons for discontinuation of different methods were desire for pregnancy, side effects and menopause. Creating more contraceptive awareness, improvement in contraceptive counselling and female education will help to improve contraceptive utilisation rate and reduce discontinuation rate.

Young women's consistency of contraceptive use – Does depression or stress matter?

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Moreau, Caroline; Trussell, James; Barber, Jennifer

2013-01-01

Background We prospectively examined the influence of young women's depression and stress symptoms on their weekly consistency of contraceptive method use. Study Design Women ages 18-20 years (n=689) participating in a longitudinal cohort study completed weekly journals assessing reproductive, relationship and health characteristics. We used data through 12 months follow-up (n=8,877 journals) to examine relationships between baseline depression (CES-D) and stress (PSS-10) symptoms and consistency of contraceptive methods use with sexual activity each week. We analyzed data with random effects multinomial logistic regression. Results Consistent contraceptive use (72% of weeks) was 10-15 percentage points lower among women with moderate/severe baseline depression and stress symptoms than those without symptoms (p-valuescontraceptive consistency each week than those without symptoms, respectively (OR 0.53, CI 0.31-0.91 and OR 0.31, CI 0.18-0.52). Stress predicted inconsistent use of oral contraceptives (OR 0.27, CI 0.12-0.58), condoms (OR 0.40, CI 0.23-0.69) and withdrawal (OR 0.12, CI 0.03-0.50). Conclusion Women with depression and stress symptoms appear to be at increased risk for user-related contraceptive failures, especially for the most commonly used methods. Implications Our study has shown that young women with elevated depression and stress symptoms appear to be at risk for inconsistent contraceptive use patterns, especially for the most common methods that require greater user effort and diligence. Based upon these findings, clinicians should consider women's psychological and emotional status when helping patients with contraceptive decision-making and management. User-dependent contraceptive method efficacy is important to address in education and counseling sessions, and women with stress or depression may be ideal candidates for long-acting reversible methods, which offer highly effective options with less user-related burden. Ongoing research will

Teen motherhood and pregnancy prototypes: the role of social context in changing young African American mothers' risk images and contraceptive expectations.

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Barr, Ashley B; Simons, Ronald L; Simons, Leslie Gordon; Gibbons, Frederick X; Gerrard, Meg

2013-12-01

Despite the declining rate of teen pregnancies in the United States, academic and public health experts have expressed concern over the still relatively high rate of rapid repeat pregnancies among adolescents, particularly among minority youth. Using a sample of over 300 African American female adolescents, the current study used insights from the prototype/willingness model of adolescent risk behavior to explore this risk. More specifically, it assessed the relationship between entry into unwed motherhood during mid-to-late adolescence and changes in prototypes of unmarried pregnant teens. Further, it explored the extent to which these changing prototypes accounted for young mothers' later contraceptive expectations. We tested the possibility that social images were affected not only by personal experience (the birth of a child) but also by the family and community context in which this experience took place. The findings show that the early entrance into teen motherhood was associated with a shift toward more favorable prototypes of unwed pregnant teens, but that this was only the case for young mothers in disadvantaged contexts. Given this, prototype changes helped to explain the link between teen motherhood and contraceptive expectations only for those in disadvantaged contexts. We discuss these findings in terms of their practical and theoretical implications.

Considerations for the use of progestin-only contraceptives.

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Freeman, Sarah; Shulman, Lee P

2010-02-01

To highlight the characteristics of progestin-only contraceptives (POCs) currently available in the United States, and to explore the potential of these agents as first-line contraceptive options for women seeking health promotion by prevention of an unwanted pregnancy. The progestin-only pills (Micronor and Ovrette), depot medroxyprogesterone acetate (DMPA) injections (Depo-Provera and depo-subQ provera 104), levonorgestrel intrauterine system (IUS) (Mirena), and etonogestrel implant (Implanon) will be reviewed. The use of levonorgestrel (Plan B) as an emergency contraceptive will also be considered briefly. Worldwide medical literature and the prescribing information for the specified products. A number of POCs are currently available for routine birth control in the United States, ranging from the daily progestin-only pill to nondaily contraceptive options such as injectable DMPA, the levonorgestrel-releasing IUS, and the etonogestrel-releasing contraceptive implant. Each of these methods has specific advantages, but also specific drawbacks that can result in discontinuation of treatment if users are not given adequate information about what to expect in terms of side effects. It is critical that clinicians provide adequate and accurate information along with detailed counseling to women who are considering using POCs, as well as providing periodic reinforcement of the information at regular clinic visits for those already using POCs. Given that a large number of pregnancies are unplanned and create a significant impact on social, economic, and health outcomes, it is important for the clinician to have a vast knowledge of contraceptive options. POCs offer significant choices in contraception. By proactively addressing common concerns (such as potential effects on weight, mood, menstrual bleeding patterns, and bone mineral density), clinicians may improve the likelihood of adherence and continuation with POCs for routine birth control.

Depressive Symptoms Prior to Pregnancy and Infant Low Birth Weight in South Africa.

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Tomita, Andrew; Labys, Charlotte A; Burns, Jonathan K

2015-10-01

Despite improvements in service delivery and patient management, low birth weight among infants has been a persistent challenge in South Africa. The study aimed to explore the relationship between depression before pregnancy and the low birth weight (LBW) of infants in post-apartheid South Africa. This study utilized data from Waves 1 and 2 of the South African National Income Dynamics Study, the main outcome being a dichotomous measure of child LBW (<2500 g) drawn from the Wave 2 child questionnaire. Depressive symptoms of non-pregnant women was the main predictor drawn from the Wave 1 adult questionnaire. Depressive symptoms were screened using the 10-item four-point Likert version of the Center for Epidemiologic Studies Depression Scale (CES-D) instrument. A total score of 10 or greater on the CES-D indicates a positive screen for depressive symptoms. An adjusted logistic regression model was used to examine the relationship between women's depression before pregnancy and infant LBW. A sample size of 651 women in Wave 1 was linked to 672 newborns in Wave 2. The results of the adjusted logistic regression model indicated depressive symptoms (CES-D ≥ 10) prior to pregnancy were associated with infant LBW (adjusted OR 2.84, 95 % CI 1.08-7.46). Another significant covariate in the model was multiple childbirths. Our finding indicates that women's depressive symptoms prior to pregnancy are associated with the low birth weight of newborns and suggests that this association may not be limited to depression present during the ante-natal phase.