Use-effectiveness of the diaphragm in a selected family planning clinic population in the United Kingdom

4052 established users of the diaphragm aged 25–39 years attending family planning clinics in the United Kingdom have been followed during 5909 woman-years of exposure to the risk of pregnancy. 139 accidental pregnancies have been observed, representing a use-effectiveness pregnancy rate of 2.4 per 100 woman-years. Of the factors related to the risk of accidental pregnancy, the age of the user and the duration of use of the diaphragm appear to be the most important.It is concluded that women attending family planning clinics who are already established users of the diaphragm need not be encouraged to change to a more modern method of birth control with its attendant risks.     

Sexual behavior and condom use among urban women attending a family planning clinic in the United States

In this paper I present data on risky sexual behavior and condom use among a sample of 100 adult women who attended a family planning clinic in an urban area of the United States. Although the women in this study protected themselves from pregnancy by using contraception, they engaged in sexual behaviors that put them at risk for sexually transmitted human immunodeficiency virus (HIV), including unprotected oral, anal, and vaginal intercourse, and sex with risky partners. Alcohol and drug use were also common among the women in this sample. Almost half of the participants reported a history of sexually transmitted infections. Health assessment for women using contraception should include assessment of risk factors for sexually transmitted HIV infection. All women should be counseled regarding methods of reducing their risk for HIV.     

Partner-specific condom use among adolescent women clients of a family planning clinic.

Because inconsistent condom use could put adolescent women at an increased risk for sexually transmitted diseases, it is important to understand when and with whom they use condoms. This study examined partner-specific condom use over time among adolescent women. The data were from a clinic-based, prospective study of 308 adolescent women who had at least one sex partner during a 6-month follow-up. Their condom use was examined with three types of partners: exclusive, nonexclusive primary, and nonexclusive secondary. Predictors of consistent condom use (using condoms 100% of the time with a specific partner) were explored in a multiple logistic regression analysis. Consistent condom use was more likely to occur in shorter relationships (less than 3 months) and with partners who preferred condoms for contraception. It was no more likely to occur with nonexclusive partners than with exclusive partners, and it was somewhat less likely to occur among consistent oral contraceptive users. These findings emphasize the importance of educating adolescent women to introduce and maintain condom use with all partners.     

Quality of condom use as reported by female clients of a family planning clinic.

OBJECTIVES. This study analyzed the prevalence and determinants of the quality of condom use after a woman's first visit to a family planning clinic. METHODS. This report presents data from 360 female family planning clients who reported using condoms as their primary method of contraception for at least 1 sexually active month during the study's follow-up period after their first clinic visit. RESULTS. Only 1% always engaged in all five use behaviors studied: using a condom for each sexual intercourse, putting the condom on before first entry, withdrawal after intercourse while there is still an erection, holding on to the condom's rim during withdrawal, and using foam. Multiple linear regression indicated that more effective condom use was reported by women who had not had an induced abortion, were not using condoms just because they were starting oral contraceptive pill regimens, had more knowledge about birth control in general, had received a nursing intervention, and had more communication with their partner. CONCLUSIONS. Increasing attention needs to be devoted to understanding determinants of the specific actions that differentiate between more and less effective contraceptive use.     

Cultural differences in a family planning clinic

An analysis of the use of contraception in a multi-racial family planning clinic in relation to age, parity and ethnicity (Asian or non-Asian) was carried out in the London Borough of Newham. Whether follow-up appointments were given and kept and the taking of cervical smears were noted. Asian patients favoured the sheath (44%) and the IUD (31%); the Pill was less used at 20% with the cap little used at 3%. Non-Asian patients favoured the Pill (50%), and IUD (22%) with the sheath being used by 15% and the cap by 13%. Parity increased with age in both groups. The 16-20-year-old Asian patients chose the Pill (54%) in preference to the sheath (27%) whereas the older Asian patients chose the sheath in preference to all other methods. When follow-up appointments were given the failure rate was equal in both groups. 29% of the Asian patients had a cervical smear taken as against 45% of the non-Asian patients.     

Infertility services in a family planning clinic

The Family Planning Association (FPA) of Ceylon was regarded with much scepticism when it was first established. The first clinic which was opened in August 1953 was called the Mother's Welfare Clinic. Its aims included assisting and possibly treating infertile couples in order to show that is did not simply wish to control births, but rather to help plan families. The FPA continues to combine the two services.     

Early abortion in a family planning clinic

The successful integration of sessions for very early abortion in the Planned Parenthood Clinic of San Francisco is described. Abortion sessions replaced 2 one- half days of contraceptive clinics per week. Flexible Karman cannulas and foot, or electrically-operated vacuum pumps were used. Routine testing for RhD antibody and gonorrhea were done at each abortion. 560 women were aborted during the year and 4 had repeat abortion. Problems encountered were 1.8% failed abortion requiring repeat suction, 1.6% bleeding heavier than a menstrual period, 3% infection in the uterus or surrounding tissues, and 1 ecotopic pregnancy. The abortion service in the Clinic was well accepted by patients, staff, the medical community, and the community at large.     

Nutrition education in a family planning clinic

Nutrition and reproductive health are closely connected and therefore nutrition should be a part of the family planning clinic. Research has established that oral contraceptive users undergo changes in the metabolism of certain nutrients; however such long-term effects as nutrient deficiencies have not been widely documented. Nevertheless, users of the pill should be encouraged to maintain a proper diet. IUD users have a greater chance of developing iron deficiency anemia due to longer periods and heavier bleeding. Teenagers should be the focus of the nutrition counselor as they often have poor eating habits. Nutritional status can also seriously affect the outcome of future pregnancies and thus pregnant women should also be a focus. Those doing nutrition counseling should: inform oral users that they may be at nutritional risk; inform IUD users about the importance of high-iron foods in their diets; use laboratory data and physical findings (weight for height, hematocrit/hemoglobin level, blood pressure) as a screening device for nutritional problems; provide written materials concerning proper foods; and compile a referral list of various associations which may be helpful in nutrition education.     

Issues in family planning clinic management

Describes the use of a patient flow analysis (PFA) technique for improving the efficiency of family planning clinic sessions. Using the PFA technique, 883 clinic sessions were studied. The most common problems identified were long patient waits and inefficient use of staff. The causes of these problems were identified, and included inadequate patient scheduling, failed appointment rates and inadequate sequencing of clients through the clinic. Solutions to the problems are discussed.     

Oral sex and condom use among young people in the United Kingdom

CONTEXT: The development of UK national targets to reduce the transmission of HIV and other STDs has focused health promotion efforts on advocating the use of condoms during penetrative vaginal and anal sex. However, other behaviors that can facilitate STD transmission-such as oral sex and, in particular, fellatio-have received limited attention. METHODS: Between 2003 and 2005, a sample of 1,373 full- and part-time students, primarily aged 16-18, completed questionnaires about their knowledge, attitudes and experiences related to sexual behavior and health. Chi-square tests were used to assess differences by sexual experience and gender. Supplementary data were obtained from sexual event diaries completed by 108 young people. RESULTS: Fifty-six percent of survey respondents had experienced fellatio or cunnilingus, including 22% of those who had not yet engaged in penetrative intercourse. Of young people who had had vaginal intercourse, 70% had previously had oral sex. Among those who had experienced fellatio once, 17% had used a condom, but only 2% of respondents who had engaged in fellatio more than once reported consistent use. Reduced pleasure and lack of motivation, desire and forethought were reasons given for not using condoms during fellatio; hygiene, avoidance of the dilemma of whether to spit or swallow ejaculate, and taste were commonly cited as triggers for use. CONCLUSION: Greater efforts are needed to publicize the risk of exposure to STDs that many young people face because of unprotected noncoital sexual activities before, as well as after, they enter into relationships involving intercourse.     

Female-condom use in a gender-specific family planning clinic trial

Objectives. We evaluated female-condom use among women participating in an HIV/STD intervention designed to reduce unprotected sex and expand prevention strategies.

Methods. Women (n = 360) were recruited from a family-planning clinic and were randomized into an 8- or 4-session intervention group or a control group. We conducted follow-up interviews at 1, 6, and 12 months.

Results. At 1 month, the odds ratios of first-time female-condom use were 9.49 (95% confidence interval [CI] = 4.01, 22.20) in the 8-session group and 4.39 (95% CI = 1.84, 10.49) in the 4-session group relative to controls. Repeated use (n = 21) was predicted by perceived ability to use, by self and partner satisfaction, by dislike of male condoms, and by previous diaphragm use.

Conclusions. Gender sensitive cognitive-behavioral interventions can influence women to try the female condom. To increase long-term use, interventions may need to include self-insertion practice and involvement of male partners.

     

Vaginal douching in teenagers attending a family planning clinic

This study assessed the knowledge and usage patterns of vaginal douching in sexually active teenagers attending a family pluming clinic. A questionnaire was administered consecutively to 94 black, 36 Hispanic, and 12 Anglo females ranging in age from 13 to 19 years. The survey showed that vaginal douching is a common practice, with almost two thirds learning about douching from their mother. The technique is primarily used for hygienic reasons with few using it to prevent pregnancy or infection. Age of first douche correlated with age of first intercourse (p < 0.001). Almost 23% had douched within 2 days of the clinic visit, and 56% reported douching one or more times a week.     

The United States commitment to international family planning and population programs

The U.S. government's policy towards birth control has changed from Eisenhower's opinion in 1959 that birth control was not the government's business to the present broad federal support allotted of family planning. The legistature was the main vehicle for mounting support of family planning with the approval of Presidents Kennedy, Johnson and Nixon. The Agency for International Development's budget for population activities in 1973 was $1,982,000,000 or 6.3% of its total foreign appropriations. Since family planning is an integral part of development, continued U.S. assistance in the field of population and family planning is necessary.