A closer look at traditional contraceptive use in Turkey

Withdrawal is the main method used amongst couples in Turkey to prevent pregnancy. Discontinuation of use is most likely to be due to the desire to become pregnant or failure of the method. Withdrawal users are less likely to switch to another contraceptive method; however, among users who do switch, they will most likely switch to a modern method. The strongest three determinants that predict withdrawal use are using withdrawal as one's first method, the woman's age, and the husband's education. The woman's work status and the couple's ethnicity are also important predictors of withdrawal use. Family planning programs should target different segments of the population and focus on correct knowledge of all methods. Results indicate that men and women need to learn about family planning options earlier in their lives or prior to marriage.     

Why withdrawal? Why not withdrawal? Men's perspectives

Withdrawal is an ancient and prevalent form of male contraception which has largely been ignored by family planning programme managers all over the world. The objective of this study was to understand men's perspectives on withdrawal use, both users and non-users. In-depth interviews with 62 male factory workers in western Turkey are reported, on use of withdrawal, attitudes to family planning, information on contraception, marital and sexual experience, and gender values and attitudes. Advantages reported both by users and non-users of withdrawal were being free from side effects, ease of access and having no cost. While current users said withdrawal was easy to use and practical, non-users complained about the difficulties of using withdrawal, that it was coitus-dependent, caused anxiety and decreased pleasure during sexual intercourse. Current users emphasised taking responsibility as husbands for family planning and protecting their wives from possible adverse effects of contraceptives. Withdrawal should be seen as a valuable choice in a world where increasing method choice, male participation and responsibility taking in reproductive health are all desirable. With its cited advantages withdrawal is likely to fill an important niche among current contraceptive practices and deserves more attention and support.     

State-of-the-art of non-hormonal methods of contraception: IV. Natural family planning

Despite the popularity of ‘modern’ contraceptives, natural family planning (NFP), including fertility awareness-based (FAB) methods and withdrawal, are practised in most countries. Worldwide FAB methods and withdrawal are used, respectively, by about 3.6% and 2.9% of all couples of reproductive age. This article describes the underpinnings of the different NFP methods, their rationales, histories, rules for use, efficacy and in broad categories their prevalence. Pregnancy rates of FAB methods with perfect use have ranged between 0.3 and 5.0 per 100 users per year, but typical use rates rises into the teens or higher. Withdrawal requires the male partner to be aware of his impending climax and to pull out of the vagina before ejaculation. Perfect use and typical pregnancy rates for withdrawal are estimated to be 4 and 27 per 100 per year, respectively. Many couples find NFP in accord with their own beliefs, satisfactory in its effectiveness and useful in planning a desired pregnancy. Many prize their self-control in practising NFP or withdrawal. In our research we used Medline, Popline and the Cochrane Library search engines in English, local institutional libraries, our own files in our native languages, the literature references contained therein, and source recommendations from colleagues.     

The dynamics of contraceptive use in developing countries. Pt. 1

The dynamics of contraceptive use in developing countries are described in an abbreviated discussion and are based on a prospective study of the determinants of contraceptive use in India. It is acknowledged use varies among different populations. Contraceptive use behavior is complex and affected by more than just desired family size. The pattern of usage may vary throughout the childbearing years. There is a complex interplay of various sociocultural and behavioral factors associated with the process of choice, continuation or cessation of use of a method, or switching to another method. Not only behavioral factors that operate at the individual level, but national factors such as the national family planning and health services are involved. Information on the social, cultural, and service related determinants of choice and use of different methods is important for policy makers. It affords them the information to plant what methods to offer, the supply of methods, and significance of offering new methods. Policy makers concerned with family planning to reduce fertility need to know to what extent the desire to become pregnant is a reason for discontinuation vs. method failure, opposition by spouse, or health concerns about side effects. Those desiring 2 children were twice as likely to have used other methods prior to sterilization than those desiring 4. Fertility intention was related to choice of method. The distance to the health clinic from home was also related to the prior use of methods before sterilization. Those 1 km from a clinic had a 1.8 times greater chance of having used another method prior to sterilization. IUD and pill users had high discontinuation rates. IUD users shifted to sterilization (34%) or natural methods (20%). while pill users changed to the IUD (49%), sterilization (29%), and the condom (23%). Fertility intentions, the nature and extent of health services, and woman's education affected the pattern. The number of living sons, the inaccessibility of services, and poor knowledge of spacing methods lead to more women accepting sterilization. Overall fertility rates have not had the desired impact from the current contraceptive use patterns (sterilization and little birth spacing). Lack of education affects the use of the pill and IUD knowledge of methods other than sterilization. Mothers desiring 4 or more children are less likely to space and exceed the desired size. Women's education and the quality and extent of health services are the 2 most important intervention efforts.     

Compliance considerations with estrogen replacement: Withdrawal bleeding and other factors

Withdrawal bleeding and other side effects such as edema, bloating, premenstrual irritability, lower abdominal cramps, dysmenorrhea, and breast tenderness limit compliance with hormonal replacement therapy. Although many of these troublesome side effects can be managed by adjusting the dose or changing the source of the estrogen or progestin components, postmenopausal women view withdrawal bleeding as the most negative factor influencing their decision to use hormonal replacement therapy. Additionally, the potential link between postmenopausal estrogen use and subsequent endometrial hyperplasia and cancer concerns potential users. Cyclic progestins protect the endometrium from hyperplastic changes but may not prevent withdrawal bleeding. Both patient and physician education, including the nature of menopause and the protective role of estrogens in osteoporosis and cardiovascular disease, are critical to improving compliance with hormonal replacement therapy.     

Couple communication and sexual satisfaction among withdrawal users in Pakistan

Withdrawal is a popular method of family planning in Pakistan, associated with relatively high continuation and modest failure rates. In 1997, a small, qualitative study was conducted on the circumstances of withdrawal use among 25 married men and 24 married women (not in the same couple) who had ever used withdrawal, with two to three in-depth interviews per respondent. This paper presents findings on couple communication and unsolicited information on sexuality from the study. Withdrawal use was typically initiated by mutual agreement, with neither sex dominating the decision-making. Control over fertility without having to use a modern method (due to fear of side effects) was a primary aim of the women, and supported by their husbands. Information on sexuality was forthcoming from many of the men, though much less from the women. Men and women presented very different perspectives on achieving sexual satisfaction in the context of withdrawal use. While men freely discussed their own sexual satisfaction and that of their wives, and emphasised the importance of their wives'sexual satisfaction, women barely mentioned their own sexual needs. Slightly more mentioned their husbands'needs. Even so, the respondents in this study used withdrawal in a context ofpositive communication and mutual regard, which clearly arises from and enhances their satisfaction with the method.     

Attitudes towards contraception and some reasons for discontinuation

3101 women aged 20-44 were surveyed in Flanders in 1982-83 concerning their perceptions of the contraceptive methods they used. The survey was part of a larger longitudinal study of changes in family formation in Belgium. Traditional and modern contraceptive methods were perceived very differently. Withdrawal/periodic abstinence and the condom were regarded as effective by 61% and 79% of respondents, while the IUD, pill, and female sterilization were believed by 99% of respondents to be effective. Traditional and intermediate contraceptive methods were believed to be less convenient to use, to be more frustrating sexually, but to be more natural. The IUD and pills were associated with higher risks of secondary effects, but oral contraceptive (OC) users believed their method to be much more harmful to their health than did IUD users. IUD users complained of physical secondary effects, while OC users complained of physical, psychic, and sexual secondary effects. Fewer IUD users than OC users believed their method to be highly effective. Considerable proportions of withdrawal, periodic abstinence, and condom users appeared to overestimate the efficacy of their method. Sterilization users believed the accessibility of their method to be significantly lower than did users of other methods, perhaps because sterilization has become accepted and widely available in Flanders only in the past few years. The most frequently cited advantages of withdrawal/periodic abstinence and the condom were naturalness, innocuity, and lack of secondary effects, while the most frequently cited advantage of OCs and sterilization was their efficacy. Ease of use and efficacy were both cited as advantages by IUD users. A large number of women, especially those using modern methods, stated their method had no major disadvantages. The principle disadvantages cited by withdrawal, abstinence, and condom users were low efficacy and inconvenience for sex life, while the principle disadvantages for the pill and IUD were health worries and secondary effects. Perception of the attributes of the contraceptive method used was influenced more by prior contraceptive use than by age, educational level, ideology or completeness of the family. As in other countries, users of modern methods seem to be more satisfied with their choice. Reasons for terminating use of different methods used in the past were directly related to their perceived disadvantages. Secondary effects and health worries were the major reasons for terminating OC and IUD use. A nonnegligible proportion who terminated IUD use cited its lack of efficacy.     

Advantages and disadvantages of each contraceptive method

A 1978 French study of 3000 women aged 20--44 conducted by the National Institute of Demographic Studies included questions on satisfaction or dissatisfaction with currently used contraceptive methods and reasons for changing methods. Up to 2 reasons could be cited by a respondent for each method. 79.4% of the 855 pill users cited their efficacy as a reason for satisfaction and 45.5% cited their ease of use. Only 7.4% of pill users were "resigned", or unable to cite any motive for satisfaction with their method. 52.3% of the 267 IUD users stated as a reason for satisfaction their inability to use a more modern method, 44.4% cited ease of use, and 41.0% cited efficacy as advantages. 34.8% of IUD users were "resigned". Among the 153 condom users, 521 withdrawal users, and 173 periodic abstinence users respectively, 46.3%, 48.8%, and 51.6% cited health advantages or the naturalness of the method as reasons for satisfaction; 26.6%, 26.0%, and 28.3% cited a vague reason that no better method existed; 31.1%, 15.8%, and 17.6% stated they were unable to use a more modern method; and 54.5%, 46.6%, and 44.4% were in the "resigned" group. 23.6% of pill users cited secondary effects and medical causes, 12.2% cited health worries, and 16.0% cited constraints of use as reasons for dissatisfaction. 17.0% of IUD users cited secondary effects and medical reasons, 8.2% health worries, and 3.6% constraints of use as reasons for dissatisfaction. Among users of condoms, withdrawal, and periodic abstinence respectively, 18.5%, 21.9%, and 22.6% cited lack of efficacy; 13.5%, 13.2%, and 19.0% cited constraints of use; and 24.6%, 18.3%, and 16.1% cited sexual frustrations as reasons for dissatisfaction. The proportions of users citing at least 1 reason for dissatisfaction were 47.3% for pills, 35.7% for IUDs, 53.7% for condoms, 50.8% for withdrawal, and 56.6% for periodic abstinence. Pregnancy was feared by 7.8% of pill users, 21.6% of IUD users, 37.3% of condom users, 45.2% of withdrawal users, and 48.4% of periodic abstinence users. 17.2% of all users were considering a change of method, with proportions ranging from 4.6% of IUD users to 25.4% of condom users. Pill users suffering secondary effects were most likely to consider changing methods, while users of traditional methods who complained of sexual frustrations in use were most likely to consider a change. Nearly 80% of the women felt they were well informed about contraception. 93% of users of modern methods but less than 80% of users of traditional methods felt they had made a good choice.     

Use of Withdrawal (Coitus Interruptus) for Both Pregnancy and HIV Prevention among Young Adults in Rakai,Uganda

IntroductionAlthough understudied in the context of AIDS, use of withdrawal (coitus interruptus) with or in place of other prevention methods affects exposure to both pregnancy and human immunodeficiency virus (HIV).AimWe used mixed methods to assess use of withdrawal among 15–24‐year‐olds in a rural Ugandan setting with considerable HIV prevalence.MethodsWe measured withdrawal reporting among (i) sexually active 15–24‐year‐olds enrolled in a quantitative community survey (n = 6,722) and (ii) in‐depth qualitative interview participants systematically selected from the latest round of the community survey (N = 60). Respondents were asked about family planning and HIV prevention practices, including a direct question about withdrawal in the in‐depth interviews.Main Outcome MeasuresThe main outcome measures were reports of current use of withdrawal on the quantitative survey (general question about family planning methods) and reports of current or recent use withdrawal in qualitative interviews (specific question about withdrawal). Qualitative interviews also probed for factors associated with withdrawal use.ResultsAlthough less than 1% of quantitative survey participants spontaneously named withdrawal as their current family planning method, 48% of qualitative interview respondents reported current or lifetime use of withdrawal. Withdrawal was often used as a pleasurable alternative to condoms, when condoms were not available, and/or as a “placeholder” method before obtaining injectable contraception. A few respondents described using withdrawal to reduce HIV risk.ConclusionQualitative findings revealed widespread withdrawal use among young adults in Rakai, mainly as a condom alternative. Thus, withdrawal may shape exposure to both pregnancy and HIV. Future behavioral surveys should assess withdrawal practices directly—and separately from other contraceptives and HIV prevention methods. Further clinical research should further document withdrawal's association with HIV risk. Higgins JA, Gregor L, Mathur S, Nakyanjo N, Nalugoda F, and Santelli JS. Use of withdrawal (coitus interruptus) for both pregnancy and HIV prevention among young adults in Rakai, Uganda. J Sex Med 2014;11:2421–2427.     

Factors influencing women's satisfaction with birth control methods.

OBJECTIVES: To study the extent to which variation in satisfaction with a birth control method is explained by variation in perceived physical and psychological effects. METHODS: A population survey among 1466 German women was carried out. Within the overall sample, 1303 women had ever used oral contraceptives, 996 had relied on condoms, 342 had ever used intrauterine devices (IUD), 428 had used natural family planning and 139 women were sterilized. For each method a woman had ever used, she answered questions about satisfaction with the method, concerns about getting pregnant or suffering health risks during use, ease of use, changes in sexual relationship, relationship with the partner and mood. Past and current users of oral contraceptives and IUDs and sterilized women additionally reported changes in menstrual bleeding. RESULTS: Variation in satisfaction was, for a large part, explained by variation in health concerns among oral contraceptive users, by variation in perceived changes in the quality of the sexual relationship among condom users, by perceived ease of use among IUD users and sterilized women, and by variation in pregnancy concern among natural family planning users. CONCLUSION: Counselling about these perceived experiences is most likely to result in greater satisfaction and therefore improved compliance.     

Considerations in the Measurement and Reporting of Withdrawal: Findings from the 2018 National Survey of Sexual Health and Behavior

IntroductionAlthough withdrawal use is routinely measured as part of contraceptive surveillance in the United States, its assessment may be prone to underreporting and measurement errors. Additionally, at the population level, little is known about subjective experiences of withdrawal.AimTo measure respondents’ frequency of and reasons for engaging in extra-vaginal ejaculation in the past year, and to compare contraceptive withdrawal vs extra-vaginal/anal ejaculation during the most recent sexual event.MethodsThe 2018 National Survey of Sexual Health and Behavior is a U.S. nationally representative probability survey of adolescents and adults. This study was administered in February–March 2018 via GfK Research’s KnowledgePanel. Respondents who reported consensual penile-vaginal intercourse in the past year were included in the analysis. Logistic regression was used to assess factors associated with finding extra-vaginal ejaculation sexy/arousing.Main Outcome MeasuresMain outcomes were the frequency of and reasons for extra-vaginal ejaculation in the past year, as well as reported contraceptive withdrawal use and the location of ejaculation at the most recent penile-vaginal intercourse.ResultsIn the past year, approximately 60% of respondents reported engaging in any extra-vaginal ejaculation; pregnancy prevention and sexual pleasure were given as common reasons. Those who were men, white, or aged 25–29 were more likely to find extra-vaginal ejaculation sexy or arousing; no gender differences were observed in their partner’s perception of this act. Prevalence of selecting withdrawal on the contraceptive inventory was 12.2% (95% CI 10.6–14.0) at last sexual event, whereas extra-vaginal/anal ejaculation was reported by 20.8% (95% CI 18.7–23.0). This lack of concordance in differing measures was observed consistently across all age groups, and approximately 12% to 14% of individuals reported an ejaculation location that did not correspond to their withdrawal use.Clinical ImplicationsThe results of this study have implications for how healthcare providers discuss withdrawal with their patients and counsel them on using extra-vaginal ejaculation as part of their contraceptive use or part of their sexual repertoire.Strengths & LimitationsThis is the first nationally representative study to directly compare contraceptive withdrawal to extra-vaginal ejaculation. Limited data were collected at event level regarding motivations for extra-vaginal ejaculation, pregnancy attitudes, perceptions of condoms and sexually transmitted infection prevention, or exposure to erotic media, thus limiting further assessment of relationships between various factors and extra-vaginal/anal ejaculation.ConclusionWe found that reporting of withdrawal as a contraceptive method vs extra-vaginal/anal ejaculation was inconsistent and that extra-vaginal/anal ejaculation was commonly used for reasons other than pregnancy prevention; future research should use more precise measures of “withdrawal.”Fu TC, Hensel DJ, Beckmeyer JJ, et al. Considerations in the Measurement and Reporting of Withdrawal: Findings from the 2018 National Survey of Sexual Health and Behavior. J Sex Med 2019;16:1170–1177.     

Contraceptive failure in the United States: the impact of social economic and demographic factors (author's transl)

With the use of a relatively new multivariate life table technique, 1st year contraceptive use failure rates are calculated for currently married U.S. women, based on data from the 1973 and 1976 National Surveys of Family Growth, conducted by the National Center for Health Statistics. When, in order to delay or prevent a subsequent pregnancy, age and family income are controlled for simultaneously, the pill is considered the most effective method with a 1 year standardized failure rate of 2.4%, next is the IUD with 4.6%, the condom (9.6%), spermicides (17.9%), diaphragm (18.6%), and natural family planning (NFP) or rhythm (23.7%). Including other variables, such as parity, education, age at marriage, religion, and race, does not result in any significant improvement in the ability to predict contraceptive use effectiveness beyond that obtained by using method, intention, age, and income. Previous studies, which did not employ multivariate techniques found that women who sought to prevent another pregnancy were less likely to experience contraceptive failure than were those who sought only to delay conception, presumably because preventers are more highly motivated to avoid conception. This analysis, however, shows that among those 25 and younger, preventers have higher failure rates for each method than delayers. The most likely explanation for this phenomenon is that women who had all the children they wanted at an early age have probaly already had previous contraceptive failures, while those who are still spacing at older ages are more likely to have been successful in postponing pregnancy until the desired time. Among preventers, failures for all methods decline with increasing age. By contrast, among delayers, failure rates (except for those among condom users) are lowest for women ages 22-25 and differ little among older and younger women. It is notable that failure rates among pill users are generally very low for women in all age, income, and intention groups. The highest failure rate for pill users (8% for women under age 22 seeking to prevent an unwanted pregnancy and who have annual family incomes of under $10,000) is the same as the lowest failure rate for women who depend on NFP methods (those seeking to avoid an unwanted pregnancy who have incomes of over $15,000 and are age 30 or older). For women under age 22, the diaphragm is associated with extremely high failure rates, but diaphragm use improves at older ages. Among women age 30 and older, the condom is associated with lower failure rates than any method except the pill. Failure rates shown are based on those experienced in actual use and reflect failures due to the method itself as well as to incorrect use. If theoretical method effectiveness is measured as the lowest failure rate seen by any subgroup of women under age 30, rates for each method are: pill--1.2%, IUD--2.3%, condom--5.7%, spermicides--9.4%, diaphragm--9.7%, and rhythm--12.6%. For each method, the lowest rates are obtained by preventers with annual family incomes of over $15,000 and ages 26-29. (author's modified)     

Progress report on a study of the cervical cap

This study was conducted for the purpose of gathering more information on the effectiveness and convenience of the cervical cap as a contraceptive method; currently, women's groups can only obtain and prescribe caps in the US if they secure an investigational device exemption from the FDA and subsequently carry out a study such as this one. This study focuses mainly on user satisfaction, the propensity of study participants to continue using the cap over a long period of time and the incidence of cap failure, or pregnancy. 8 clinical centers in 2 states fitted 872 women with the cap. There was, however, a high rate of attrition; only 580 of them returned for the 1-month checkups, 307 for the 6-month and 113 for the 12-month. The strongest predictors for satisfaction with the cap were confidence in the cap and ease of insertion. More sexually active women were marginally more satisfied with the cap, as were younger women and previous users of the diaphragm. Experiences of dislodgement, trouble inserting the cap, and cramps lowered women's satisfaction. The most influential factor affecting length of cap use was the woman's use of spermicide with the cap: spermicide use substantially decreased the likelihood of continuing cap use. Prior use of the diaphragm increased continuity. Higher satisfaction with the cap was related, of course, to longer use. The analysis of failure pregnancies reveals that cap dislodgement (reported by 31% of the women) more than tripled the risk of pregnancy. Prior births also increased the likelihood of pregnancy. Women who reported difficulties inserting or removing the cap were about 2.5 times less likely to become pregnant than those who reported no such trouble. Prior diaphragm users who wre not using spermicide with the cap showed the lowest pregnancy rates; the highest pregnancy rates were observed for current spermicide users who had never used a diaphragm. It appears that 1st-time users of a spermicide require special attention and instruction in its proper use with the cervical cap.     

Contraception boom points to break-through in reproductive health

The mean fertility rate in developing countries has fallen from 6.1 to 3.9 between the early 1970s and 1992. Increases in contraceptive use contributed to this decline. In 1965-1970, just 9% of married couples used contraception, but by 1985-1990, 50% did. During the same period, the number of contraceptive users increased from 18 to 217 million. Yet, vast regional differences in the decline in fertility exist. The greatest decline occurred in East Asia, while the smallest took place in sub-saharan Africa. Availability of family planning services contributes to this disparity (95% in East Asia and 9% in sub-Saharan Africa). Contraceptive availability in southeastern Asia and Latin America is 57%, and 54% in southern Asia. Just 60% of the population in developing countries can easily obtain at least one safe, effective, and acceptable family planning method. Couples in East Asian countries, especially China, are more likely to use contraception than couples in developed countries. Further, 71% of people who use contraceptives in China use modern contraceptive methods compared to just 47% in developed countries. Just 1% of Chinese contraceptive users depend on traditional methods, while 24% of developed world contraceptive users depend on them. Nevertheless, about 300 million couples worldwide who want to stop having children do not use any contraception. Almost 50% of the 910,000 daily conceptions are not planned and 25% are unwanted. 150,000 induced abortions occur daily, 33% of which are done in an unsafe manner resulting in 500 deaths. Further, many people do not realize that most women who have an abortion are either married or part of a stable union and are mothers to several children.     

Opinions of imams about family planning and their use of methods in Kayseri,Turkey

Objectives: Imams are religious leaders who have significant influence on the social attitudes and behavior of a society. This study examined the views of imams on family planning and their personal preference of birth control methods. Materials and methods: Using a pre-prepared questionnaire, an on-site individual interview was conducted face-to-face with each of 164 imams at Kayseri, a city in Central Anatolia. Results: All of the imams included in the study knew of at least one family planning method. Withdrawal was the most widely known method of family planning (84.2%). Among imams, 88.4% approved the use of birth control. While only 61.8% of the imams used at least one method of family planning, 20.1% used none at all. Of the family planning methods used, we considered 43.1% efficient (modern) and 18.7% inefficient (traditional). The most important factor affecting preference of traditional methods was religious suitability. Conclusion: Contrary to common belief, imams viewed family planning positively and used family planning methods at a rate similar to that of the general public. If provided with accurate information, we believe that imams may have a positive contribution to make in the development of family planning programs.     

After pregnancy complicated by diabetes: postpartum care and education

The postpartum period in women with pregestational or gestational diabetes allows the physician and mother to switch from intensive medical and obstetric management into a proactive and preventive mode, and to jointly develop a reproductive health plan. The woman's individual needs regarding contraception and breastfeeding, an appropriate diet to achieve healthy weight goals, the medical management of diabetes, daily exercise, and future pregnancy planning must be considered. Essential is the active participation of the woman, who, through education, gains an understanding of the far-reaching effects her active participation will have on her subsequent health, her newborn child's health, and possibly that of her future children.     

Menopausal vasomotor symptoms: a review of causes, effects and evidence-based treatment options

Vasomotor symptoms are the most common medical complaint of perimenopausal and postmenopausal women. Frequent vasomotor symptoms can be disabling, affecting a woman's social life, psychological health, sense of well-being and ability to work. Women with hot flushes are more likely to experience disturbed sleep, depressive symptoms and significant reductions in quality of life as compared to asymptomatic women. Despite the prevalence and impact of these symptoms, the pathophysiology of hot flushes is unclear; however, estrogen withdrawal clearly plays an important role. It is postulated that declining estrogen concentrations may lead to changes in brain neurotransmitters and instability in the hypothalamic thermoregulatory center. The most effective therapy for relieving vasomotor symptoms and reducing their impact on quality of life is hormone therapy. Other options for women who decline hormone therapy include selective serotonin reuptake inhibitors and related agents. Most herbal therapies that have been evaluated in placebo-controlled trials have shown no clinically significant benefit.     

Condoms: the contraceptive whose time has come -- again

Both the acquired immunodeficiency syndrome (AIDS) epidemic and the removal of the IUD from the marketplace have contributed to renewed interest in the condom as a contraceptive method. These 2 events have further coincided with increased emphasis on the part of family planning programs in male involvement. Today condoms are used by an estimated 40 million couples throughout the world and are the 2nd most widely used form of contraception. Active promotion of condom use by family planning practitioners requires the belief that this is indeed a positive, viable method. The myths that condoms are unnatural, insensitive, and unreliable are widespread even among family planning workers and must be addressed directly. Condom educators must be able to confront clients about the need either to accept that they are sexual beings and plan to be prepared for sexual encounters or to choose not to engage in unprotected sex. The concern that condom use decreases sensitivity is to a certain extent valid, but it is important to note that this decreased sensitivity occurs only after the condom is put on and many enjoyable sexual experiences take place before this point. In terms of reliability, most breakage is due to improper use. Addressing such myths through counseling an education will begin to break down some of the barriers to condom comfort among users.     

Being on the Safe Side: A Qualitative Study of Condom Use Motivations According to Contraceptive Type among Adolescents in Atlanta,Georgia

Study ObjectiveQuantitative data suggest that adolescent users of long-acting reversible contraception (LARC), compared with short-acting methods (pill, patch, ring, depot medroxyprogesterone acetate [DMPA]), might be less likely to use condoms. We qualitatively describe and explain adolescent contraceptive users’ motivations for condom use, including variation according to contraceptive type.DesignIndividual, in-depth qualitative interviews, analyzed thematically.SettingParticipants were recruited from public family planning clinics and an adolescent medicine clinic, as well as university and other community settings in Atlanta, Georgia.ParticipantsSexually active contraceptive users aged 17-19 years old (n = 30), including LARC (n = 10), DMPA (n = 10), and oral contraceptive (n = 10) users.ResultsOf the 30 participants, most (n = 25; 83%) used condoms with their more effective contraceptive method, although 11 of 25 used them inconsistently (44%). Oral contraceptive users were particularly motivated to use condoms for pregnancy prevention, because of concerns about contraceptive method efficacy and a desire to be on “the safe side.” In contrast, LARC users were primarily motivated by sexually transmitted infection (STI) prevention. DMPA users’ motivations were more mixed. Across contraceptive type, factors influencing condom use motivations included sexual health education, personal awareness and/or experience, and perceived consequences and risk.ConclusionBecause all participants were using an effective contraceptive method, it is notable that pregnancy prevention was a prominent motivator for using condoms, although LARC users reported STI prevention to be a more important motivation. Parental and school-based sexual health education that clearly addresses STI prevention in addition to pregnancy prevention has the potential to influence condom use motivations and behavior.     

Screening for substance use in pregnancy: a practical approach for the primary care physician

Our goal was to identify risk factors for substance use during pregnancy for primary care physicians so that we could assess a woman's risk of alcohol or illicit drug use. Participants were 2002 Medicaid-eligible pregnant women with < or =2 visits to prenatal care clinics in South Carolina and Washington State. Structured interviews were used to collect data. Logistic regressions and classification and regression trees identified predictors for pregnant women at high risk for substance use. Approximately 9% of the sample reported current use of either drugs or alcohol or both. Past use of alcohol or cigarettes, including during the month before pregnancy, most differentiated current drug or alcohol users from current nonusers. Our analysis suggests that primary care physicians can ask 3 questions in the context of a prenatal health evaluation to target women for referral to a full clinical assessment for drug and alcohol use.