Non-availability of the IUD and contraceptive choice

The Copper 7 and Lippes Loop IUD are no longer distributed in the United States, and the cost of the Progestasert precludes usage in many family planning clinics. The impact of the loss of this widely used contraceptive method was assessed in a pilot study at the UCLA Family Planning Clinic. The clients who would have selected an IUD at the time of their clinic visit between March and December of 1986 instead chose oral contraceptive pills (55%) or barrier methods (45%) but their level of dissatisfaction with the methods they received was significantly greater than that of all other contraceptors, and this led to their subsequent selection of another method which, in the majority (66%), was of lower efficacy than the IUD. There were two unplanned conceptions amongst twenty women who would have chosen an IUD, both due to non-compliance with oral contraceptive pills; and at the time of survey in March 1987, no clients had opted for sterilization. Women who no longer have their choice of the IUD represent a high risk for contraceptive dissatisfaction and failure, but have not made precipitous decisions to undergo permanent sterilization.     

Emotional intelligence and medical specialty choice: findings from three empirical studies

Context  Despite only modest evidence linking personality-type variables to medical specialty choice, stereotypes involving empathy and 'emotional connectedness' persist, especially between primary care providers and surgeons or subspecialists. This paper examines emotional intelligence (EI) and specialty choice among students at three US medical schools.
Methods  Results from three independent studies are presented. Study 1 used the Mayer–Salovey–Caruso Emotional Intelligence Test (MSCEIT ™) administered to a single cohort of 84 Year 4 medical students. Study 2 used the Trait Meta–Mood Scale (TMMS) and Davis' Interpersonal Reactivity Index (IRI) administered to three cohorts ( n  = 250) of Year 3 medical students. Study 3 used the Bar-On Emotional Quotient Inventory (EQ-I^®) administered to two cohorts of Year 1 medical students ( n  = 292). Results were linked to specialty choice data retrieved from the National Residency Match Program (NRMP). Classifications of specialty choice included: (i) primary care (family practice, internal medicine, paediatrics) versus non-primary care (all others), and (ii) primary care, hospital-based specialties (anaesthesiology, emergency medicine, pathology, radiology), and technical and surgical specialties (neurology, obstetrics and gynaecology, ophthalmology, and all surgical fields).
Conclusions  Across all three studies – and using both classifications of specialty choice – no significant differences in EI were found between students entering primary care and non-primary care specialties. Limitations are acknowledged, and future directions for research involving EI are identified.     

Obesity and oral contraceptive failure: findings from the 2002 National Survey of Family Growth

Oral contraceptives are the most popular reversible method of contraception in the United States. Although most women using oral contraceptives are reliably protected against pregnancy, nearly half of the 3 million unintended pregnancies in the United States annually occur among the 90% of women who use contraception. Recent findings suggest that obesity may reduce the biologic effectiveness of oral contraceptives. The purpose of this study was to further investigate the potential obesity-oral contraceptive failure association using 2002 National Survey of Family Growth data. In this retrospective cohort of 1,491 women, body mass index (kg/m2) was derived from self-reported values, and oral contraceptive failure was defined as conceptions that occurred while women used oral contraceptives. Hazard ratios and 95% confidence intervals were obtained from Cox proportional hazards models. Obese women (body mass index > or = 30 vs. 18.5-24.9) had an increased risk of oral contraceptive failure (hazard ratio = 1.59, 95% confidence interval: 0.94, 2.68). Results were largely attenuated after adjustment for age, race/ethnicity, and parity. This population-based study found no association between obesity and oral contraceptive failure. While it is possible that misclassification or uncontrolled confounding obscured a true relation, it may be that there is no association. Large, prospective studies are needed to assess whether obesity plays a biologically relevant role in oral contraceptive effectiveness.     

Locus of control and choice of contraceptive method

The purpose was to assess the relationship between locus of control and the contraceptive method chosen. It was used the Levenson's Multidimensional Locus of Control Scale and 191 women was interviewed. Users of male condoms presented greater Internality than the monthly contraceptive injection users. Regarding the External locus of control (Powerful Others), the implant users presented less Externality than those who used condoms, tubal ligation, three-monthly injections and the IUD. Regarding the External locus of control (Chance), the implant users presented smaller scores than those who opted for tubal ligation, three-monthly injections and the IUD. It was observed also that monthly injections users presented smaller scores of External locus of control (Chance) than the women who were three-monthly injections users.     

青少年人工流产现状及避孕方式的选择

目的了解目前年龄≤25岁青少年人工流产现状和PAC服务前后对避孕方式的选择,分析LARC在该人群中的应用状况。方法对2018年四川省妇幼保健院行非意愿妊娠人工流产的年龄≤25岁青少年实施术前问卷调查和术后流产后关爱(post-abortion care,PAC)服务,统计分析该人群对避孕方式的选择。结果年龄≤25岁青少年占非意愿妊娠人工流产总人数的38.43%。实施PAC服务后避孕意识增强,未采取避孕措施的比例较PAC服务前明显降低,差异有统计学意义(P<0.05);且选择高效避孕措施的比例明显增高,如复方口服避孕药(76.46%vs 1.03%),LARC(12.13%vs 0),差异均有统计学意义(P<0.05)。结论年龄≤25岁青少年人工流产率高;PAC服务后青少年能更好地选择高效的避孕措施,但目前LARC在该人群中并不受青睐。     

One-year continuation of postpartum intrauterine contraceptive device: findings from a retrospective cohort study in India

Objective

To evaluate outcomes of a national postpartum (within 48?h of delivery) copper intrauterine device placement (PPCuIUD) program in six “high-focus states” with high unmet family planning need in India.

Does choice make a difference to contraceptive use? Evidence from east Java.

This study investigates sustained use of contraceptives among women in East Java, Indonesia. Interest is focused on the effect of whether the client's choice of contraceptive method was granted or denied, and the interaction between whether choice was granted or denied and husband-wife concurrence concerning method choice. Data were collected twice in a panel survey. The first round was conducted in family planning clinics among women initiating contraceptive use; the second was a follow-up household survey carried out 12 months later. Whether the user was granted her choice of method was found to be a very important determinant of sustained use of contraceptives. The interaction between whether choice was granted and whether there was husband-wife concurrence on method choice was also important. The highest rate of discontinuation occurred when method choice was denied in the presence of husband-wife agreement on method choice, and the lowest rate occurred when method choice was granted in the presence of such concurrence. The results imply that contraceptive continuation can be enhanced either when family planning workers pay more attention to the stated desires of their clients, or when policy is instituted allowing clients to use their method of choice.     

Implanon as a contraceptive choice for teenage mothers: a comparison of contraceptive choices, acceptability and repeat pregnancy

Background

This study was conducted to compare the incidence of repeat teenage pregnancy over a 24-month period postpartum among users of Implanon, the combined oral contraceptive pill (COCP) or depot medroxyprogesterone acetate (DMPA) and barrier methods or nothing (barrier/none). Contraceptive continuation rates 24 months postpartum for Implanon and COCP/DMPA were also compared.

Study Design

A prospective cohort study was conducted. Comparison groups were postpartum teenagers (12-18 years old) who self-selected Implanon (n=73), COCP/DMPA (n=40) and barrier/none (n=24). Questionnaires were used to gather data at recruitment and postpartum at 6 weeks and then 3 monthly intervals for 2 years.

Results

At 24 months postpartum, 48 (35%) teenagers had conceived. Implanon users became pregnant later than other contraceptive groups (p=.022), with mean time to first repeat pregnancy of 23.8 months [95% confidence interval (CI), 22.2-25.5], compared to 18.1 months (95% CI, 15.1-20.7) for COCP/DMPA and 17.6 months (95% CI, 14.0-21.3) for barrier/none. Implanon users were more likely to continue their use at 24 months than COCP/DMPA (p<.001) users. The mean duration for Implanon users was 18.7 months (95% CI, 17.0-20.3) compared to 11.9 months (95% CI, 9.5-14.3) for COCP/DMPA.

Conclusion

Teenagers who choose Implanon are significantly less likely to become pregnant and were found to continue with this method of contraception 24 months postpartum compared to those who choose COCP or DMPA and barrier methods or nothing.     

Trends and determinants of contraceptive method choice in Kenya

This study uses data from the 1989, 1993, and 1998 Kenya Demographic and Health Surveys to examine trends and determinants of contraceptive method choice in Kenya. The analysis, based on two-level multinomial regression models, shows that, over time, the use of modern contraceptive methods, especially long-term methods, is higher in urban than in rural areas, whereas the pattern is reversed for traditional methods. Use of barrier methods among unmarried women is steadily rising, but the levels remain disappointingly low, particularly in view of the HIV/AIDS epidemic in Kenya. One striking result from this analysis is the dramatic rise in the use of injectables. Of particular program relevance is the notably higher levels of use of injectables among rural women, women whose partners disapprove of family planning, uneducated women, and those less frequently exposed to family planning media messages, compared with their counterparts who have better access to services and greater exposure to family planning information.     

Expanding drug access in Brazil: lessons for Latin America and Canada

This paper discusses Brazil's efforts to provide essential medicines for its population while meeting international trade obligations. In the 1950s and 1960s, Brazil's pharmaceutical industry was largely overtaken by foreign companies. To counteract this, Brazil enacted a law in 1971 that allowed the production of patented drugs in order to provide affordable medicines, encourage research and development, and reduce dependency on imports. Eventually, pressure from the United States government (through tariffs and sanctions) drove Brazil to introduce pharmaceutical patent laws. Local interests prevailed, however, through Brazil's liberal interpretation of the TRIPS Agreement, which included a provision that pharmaceutical products must be "worked" or manufactured locally or the government could turn to the use of compulsory licensing. Brazil's willingness to use the threat of compulsory licensing compelled drug companies to lower HIV/AIDS drug prices substantially. Finally, the paper discusses how Canada can facilitate improving drug access in Latin America through helping Brazil expand its role as a manufacturer and providing medicines to countries without manufacturing capabilities.     

Family planning and sexually transmitted diseases: the need to enhance contraceptive choice

Historically, family planning services and sexually transmitted disease (STD) services have not been offered in any integrated fashion. STD control has been the almost exclusive responsibility of poorly funded vertical programs emphasizing prevention efforts in targeted high-risk groups and the treatment of individuals with disease symptoms and their sexual partners. Such interventions are the backbone of STD control and require further strengthening. Increased awareness of the expanding nature of the HIV/AIDS epidemic together with a better understanding of the epidemiology and involvement of STD, however, suggest the need for an expansion of the focus of family planning efforts beyond contraception to reflect a broader concern with reproductive health, including STDs and AIDS. All public health programs, including those which provide services to ostensibly low-risk individuals in the general population, must investigate and claim opportunities to further strengthen the prevention and treatment of STDs. The authors discuss similarities and differences in existing programs, sexual and reproductive health, the technologic dilemma, enhancing contraceptive choice, male involvement, dual method use, the special case of young people, and future prospects.     

Monthly injectable contraceptive use by adolescents in Brazil: evaluation of clinical aspects

PURPOSE: This prospective noncomparative observational study evaluated the clinical symptoms, body weight and blood pressure of 38 adolescents receiving a monthly injectable contraceptive containing estradiol valerate 5 mg and norethisterone 50 mg. METHODS: The volunteers, aged 16-19 years, were examined monthly during 1 year and asked about the following symptoms at baseline: dysmenorrhea, headache, breast tenderness, leg pain and irritability. RESULTS: There was a constant and gradual decline in each of the above symptoms over time, and there was a statistically significant difference between symptoms reported at the first visit and subsequent appointments. Body weight and blood pressure did not change significantly during the 1-year period. No pregnancies were observed. CONCLUSION: These findings suggest that monthly injectable contraception with estradiol valerate 5 mg/norethisterone 50 mg represents a highly effective and well-tolerated contraceptive for teens.     

Exploring informed choice in the context of prenatal testing: findings from a qualitative study

Purpose This study explored whether and how a sample of women made informed choices about prenatal testing for foetal anomalies; its aim was to provide insights for future health policy and service provision. Methods We conducted semi‐structured interviews with 38 mothers in Ottawa, Ontario, all of whom had been offered prenatal tests in at least one pregnancy. Using the Multi‐dimensional Measure of Informed Choice as a general guide to analysis, we explored themes relevant to informed choice, including values and knowledge, and interactions with health professionals. Results Many, but not all, participants seemed to have made informed decisions about prenatal testing. Values and knowledge were interrelated and important components of informed choice, but the way they were discussed differed from the way they have been presented in scientific literature. In particular, ‘values’ related to expressions of women’s moral views or ideas about ‘how life should be lived’ and ‘knowledge’ related to the ways in which women prioritized and interpreted factual information, through their own and others’ experiences and in ‘thinking through’ the personal implications of testing. While some women described non‐directive discussions with health professionals, others perceived testing as routine or felt pressured to accept it. Conclusions Our findings suggest a need for maternity care providers to be vigilant in promoting active decision making about prenatal testing, particularly around the consideration of personal implications. Further development of measures of informed choice may be necessary to fully evaluate decision support tools and to determine whether prenatal testing programmes are meeting their objectives.     

Breast cancer before age 45 and oral contraceptive use: new findings

The relation between the risk of breast cancer before 45 years of age and oral contraceptive use was examined in a case-control study conducted in New York, Philadelphia, Baltimore, and Boston from 1983 to 1986 of 407 patients with breast cancer and 424 controls. With allowance for confounding, for ever use, the multivariate relative risk estimate was 2.0 (95% confidence interval (CI), 1.4-2.9). For less than 10 years of use, the estimate approximated 2.0 in all categories of duration, including less than three months; for 10 or more years of use it was 4.1 (95% CI, 1.8-9.3). The association was apparent in virtually all subgroups examined, including younger and older women, and women at low and high underlying risk of breast cancer. Contrary to some previous reports, the association was not stronger for use before a first term pregnancy or at an early age. The results suggest that oral contraceptive users, particularly those with very long durations of use, may be at increased risk of breast cancer. However, information bias, particularly for short-term use, could not be ruled out. There may also have been selection bias if oral contraceptive users were under more intensive medical surveillance. It has not been possible to reconcile the findings of the various studies to date, including the authors' earlier results showing no association. The latter results were derived from data collected using methods almost identical to those used in the present study.     

Racial and ethnic disparities in contraceptive method choice in California

CONTEXT: Unintended pregnancy, an important public health issue, disproportionately affects minority populations. Yet, the independent associations of race, ethnicity and other characteristics with contraceptive choice have not been well studied. METHODS: Racial and ethnic disparities in contraceptive use among 3,277 women aged 18–44 and at risk for unintended pregnancy were assessed using 2006–2008 data from of the California Women’s Health Survey. Sequential logistic regression analyses were used to examine the independent and cumulative associations of racial, ethnic, demographic and socioeconomic characteristics with method choice. RESULTS: Differences in contraceptive use persisted in analyses controlling for demographic and socioeconomic characteristics. Blacks and foreign‐born Asians were less likely than whites to use high‐efficacy reversible methods—that is, hormonals or IUDs (odds ratio, 0.5 for each). No differences by race or ethnicity were found specifically for IUD use in the full model. Blacks and U.S.‐born Hispanics were more likely than whites to choose female sterilization (1.9 and 1.7, respectively), while foreign‐born Asians had reduced odds of such use (0.4). Finally, blacks and foreign‐born Asians were less likely than whites to rely on male sterilization (0.3 and 0.1, respectively). CONCLUSIONS: Socioeconomic factors did not explain the disparities in method choice among racial and ethnic groups. Intervention programs that focus on improving contraceptive choice among black and, particularly, Asian populations need to be developed, as such programs have the potential to reduce the number of unintended pregnancies that occur among these high‐risk groups.