Internal or Infernal Devices: Experiences of Contraception Among Australian Women Living With Hepatitis C

In this article we seek to delineate the experiences of contraceptive use by Australian women living with hepatitis C. Using semi-structured, in-depth interviews, 109 women with hepatitis C from two cities in Australia, Melbourne (Victoria) and Canberra (the Australian Capital Territory), were interviewed about their alcohol and other drug use, their contraceptive history, and their experiences of hepatitis C. We aimed to understand why such a high proportion of women living with hepatitis C (66%) had previously reported that they were not currently using contraception.

Many women had used contraception at some stage of their lives but were no longer using it because they had experienced contraceptive failure or uncomfortable side effects. Others were concerned about the impact of contraception on their fertility, were planning to get pregnant or considered themselves to be celibate. Hepatitis C appeared to have little impact on their contraceptive practices, but some women's illicit drug use had an important influence. Illicit drug use was, for some, an encouragement to seek long-term forms of contraception that reduced their chances of pregnancy while for others drug taking hampered their contraceptive use. In compliance with health promotion campaigns of the last two decades, women were generally more concerned about preventing sexually transmissible infections than pregnancies, particularly with new or casual partners.     

Practice and methods of contraception among Saudi women in Riyadh

The use of contraceptives can have an impact on better spacingbetween children, better child care, improvement of children'shealth and preservation of the mother's health. In this study2675 Saudi women attending a gynaecology out-patient clinicwere interviewed about their contraceptive practices. The majorityof the women (56.0%) were using or had used some form of contraceptive.Oral con traceptives were the most common method; 94.8% of the1497 women who practised contraception were using or had usedthis form of contraception. Sterilization accounted for 0.9%of contraceptive practices, while the intrauterine device wasa more common form of contraceptive among the more educatedwomen.     

城乡哺乳期妇女避孕现状比较分析

目的分析比较城乡哺乳期妇女避孕方法的使用情况、获得渠道和选择决定者，以及未避孕原因等。方法利用国家人口和计划生育委员会2001年全国计划生育／生殖健康调查的原始数据，对城乡哺乳期妇女避孕方法的使用现状进行描述性统计分析。结果我国哺乳期妇女的避孕率为78％，城乡哺乳期妇女的避孕率、未避孕原因虽然没有较大差异，但在选择避孕方法、避孕工具获得渠道和选择决定者等方面差异有统计学意义。结论我国妇女对哺乳期避孕的必要性缺乏足够认识，需从多方面加强干预。     

Genital infections in developing countries: experience in a family planning clinic

A study was undertaken to determine the incidence of 3 common genital infections in women seen at 1 urban and 1 rural family planning clinic in Kenya. 100 married and 100 unmarried women, 50 in each group making their 1st visit and not using contraception and the other 50 using contraception, were studied in Nairobi. 50 randomly-selected patients in a rural clinic were also studied. Laboratory procedures were carried out to identify gonorrhea, candidiasis, and trichomoniasis. Although these women represented largely the better educated and more professionally active strata of Kenyan society, more than 1/2 exhibited signs of at least 1 of these diseases; some had all 3 infections. These results are particularly noteworthy because most of the women had presented for contraceptive and not medical treatment. Gonorrhea occurred more often among unmarried than among married women, but there were no differences according to use or nonuse of contraceptives. The unmarried and the contraceptive users had more yeast infections. Family planning programs in Kenya and other areas of the developing world have a role to play in treating and controlling venereal diseases and genital infections. They must also combat the commonly-held notion that the use of contraception actually leads to such maladies, either through the contraceptive itself or through increased promiscuity.     

Contraceptive practice before and after termination of pregnancy: a prospective study

This study is part of a larger prospective research program focusing on termination of pregnancy (TOP). One hundred and three women requesting TOP were interviewed before the intervention and 6 months later using open and closed questions and psychological tests. This paper focuses on contraceptive practices before and after abortion. The analysis took into account specific aspects of contraceptive practices and patients' behaviors. The aims were to assess: the level of women's knowledge and practice of contraception at the time of request for a TOP; the behavioral modifications following professional counseling 6 months after TOP; the influence of psychological and sexual factors, and those linked to the women's use of contraception. Most women (n = 101) had already used recommended contraception. During the cycle that had resulted in pregnancy, more than half (n = 58) had used recommended contraception and one third had not used any contraception. Six months later, 86 women used recommended contraception, and 17 did not. The majority of women reported changes in their contraceptive methods (n = 82). Most changes were within recommended methods. The women (n = 10) who continued to practice unprotected intercourse post-TOP were slightly older, satisfied with their sexual relations with their partner, often involved in a long-term and good relationship. During post-TOP period, it is essential to take into account the psychological dynamics involved in the choice of contraceptive methods. Counseling should emphasize not only protection against an unwanted pregnancy but also protection against sexually transmitted diseases, which is often perceived as a less important issue following TOP.     

农村地区已婚育龄妇女人工流产原因分析

目的:了解农村已婚育龄妇女的人工流产原因。方法:采用结构式问卷调查方法对农村已婚育龄妇女进行问卷调查,分析人工流产情况及原因。结果:农村已婚育龄妇女的人工流产率为29.98％;人工流产原因中有35.15％是由于未避孕造成的,有超过一半(52.85％)的人工流产为避孕失败情况下采取的补救措施;避孕失败的原因中有65.09％为宫内节育器失败;婚前及婚后初产前的人工流产超过70％是未采取避孕措施造成的,而产后的人工流产主要是避孕失败造成的;多次人工流产妇女的避孕措施趋向多样化;而人工流产原因中避孕失败的比例增加。结论:应加强避孕方法知识的宣传以及避孕方法使用的指导,提高农村育龄妇女的避孕使用率及正确使用率,特别是对有人工流产(一次或多次)史的对象应加强避孕使用指导;对采用宫内节育器的妇女应进行定期检查,保证官内节育器的有效性。     

'Without a plan' but 'keeping on track': views on contraception, pregnancy and abortion in Mexico City

Despite increased use of modern contraception among Mexican women, there has been a significant increase in abortions. Little is known about the experiences behind these trends. This study examines decision-making around contraception, pregnancy, childbearing and abortion. We carried out 26 in-depth interviews with 23- to 35-year-old females and males in Mexico City. Interviewees described reproductive planning 'without a plan' and sporadic contraceptive use. Linking of reproductive preferences and contraceptive use occurred only after raising a child for a few years or after experiencing an abortion. Interviewees described side effects of hormonal contraceptives and the intrauterine device (IUD) and problems with condoms. Only 8% of participants disagreed with abortion completely. Those with mixed views opposed abortion for pregnancies resulting from lack of responsibility or due to personal problems or concerns about one's future. However, these more controversial reasons were the primary motivations for terminating pregnancies. Females and males expressed that females made most decisions related to contraception, pregnancy and abortion. Further research could explore the reasons behind reproductive planning 'without a plan', 'on and off' contraceptive use and abortion beliefs and experiences that are somewhat contradictory.     

Bridge over troubled waters: considerations in transitioning emergency contraceptive users to hormonal methods

BackgroundAs emergency contraceptive pills (ECPs) become increasingly available through pharmacies, concerns about potential overuse of this product have emerged. In response, bridging women from ECPs to ongoing contraception was advanced as a solution.Study DesignWe collected information in Ghanaian pharmacies on ECP users' sexual activity, use of contraceptive methods and reasons for buying ECPs. Further, two behavioral indicators were examined to determine whether a woman should consider using an ongoing contraceptive method: how often she has sex and how she uses ECPs.ResultsOf the four types of ECP users, stratified by those two indicators, only women who have sex frequently and use ECPs as their main contraceptive method would be appropriate for, but not necessarily amenable to, bridging.ConclusionsThe challenges of bridging to meet the contraceptive needs of women are discussed in light of the characteristics of emergency contraceptive users and suggest that bridging is not as straightforward as initially conceived.     

Teenage women's use of contraceptives in two populations

BACKGROUND: Adolescent patterns of contraceptive use might be different in various populations and might have changed in the last 30 years. More appropriate use of contraception could prevent unplanned pregnancy. METHODS: We interviewed 378 women in rural East Tennessee and 396 women in suburban-urban Baltimore, all of whom were aged 18 to 50 years, in a convenience sampling about their memories of sexual experiences and early contraceptive use. RESULTS: First sexual experiences began at a younger age in women from Tennessee than in women from Baltimore. Sexual experiences occurred at an earlier age during the last 15 years in Baltimore women. Contraceptive use at first sexual experience has approximately doubled in both locations, from 7% to 15% in Tennessee and from 42% to 75% in Baltimore during the last 15 years. The primary reason in Baltimore is increased use of condoms. Condom use in Tennessee is very low. CONCLUSIONS: These two populations are using contraception and condoms differently. Although the two populations are diverse, it could help physicians to learn about the particular contraceptive practices of their patient population to help their patients more appropriately with their contraceptive needs.     

Emergency contraception: an anomalous position in the family planning repertoire?

Emergency contraception (EC) can be used up to 72 h after sex to prevent pregnancy. Internationally there is wide variation in the availability of EC. In the USA it has only recently (1997) won approval from the FDA, while the UK and New Zealand have seen calls for over the counter availability. In recent years surveys, editorials and opinion pieces in medical journals have pointed out that increased access to EC could help to tackle the unwanted pregnancy rate, especially among teenagers, and concluded that lack of knowledge of EC is the major barrier to use. However, women in a UK study have expressed concerns that it is not safe to use the method repeatedly and cited general practitioners (GPs) as one of the sources of this belief, which contradicts the professional guidelines and the rationale for de-regulation. A subsequent study sought to seek the views of GPs about prescribing EC and explored reasons for the gap between the views of women using UK family planning services, GPs and professionals at the public policy level. Data from two studies are presented. In the first study, 53 women seeking emergency contraception were interviewed at two family planning clinics. In the second, semi-structured telephone interviews were completed with a random sample of 76 GPs from three English health authorities. Interviews were recorded, transcribed and thematic analysis was conducted using the constant comparative method. EC was rarely described, by users or GPs, as an acceptable contraceptive option. Consultations for emergency contraception were viewed by GPs as an important opportunity to discuss the woman's future contraceptive needs. Repeated use of EC was not encouraged and a discussion of contraceptive needs could range from a mild enquiry to quite forceful messages contrasting EC to 'regular' and 'proper' methods. The medical literature suggests that EC is underused because of a lack of awareness. Commentators have recommended educating health professionals and women about EC and increasing availability through de-regulation. The data presented in this paper show that British GPs are not enthusiastic about the de-regulation of EC, but the reasons are complex and related to concerns about planned contraception and sexual behaviour. It is suggested that it may be because EC is used after sex that it seems to occupy an uncomfortable place within the contraceptive repertoire.     

广东省城市流动人口年轻女性避孕现况调查

目的 :调查广东省城市流动人口年轻女性避孕现况及需求 ,探讨加强该人群避孕意识、降低人工流产率的有效措施。方法 :采用个人问卷调查和小组访谈方式调查了 2 0 0 6名 15～ 35岁流动人口女性。结果 :有婚前性行为者占 2 3 4 % ,其中有人工流产史者占 6 6 8% ,75 7%是由于未采用避孕措施造成的。未婚人工流产者性行为中无避孕措施的高达 93.9%。 2 0 0 6人中避孕知识答卷得分≥6 0分占 35 9% ,<6 0分占 6 4 1% ,其中 0分占 7 6 % ;有人工流产史者避孕知识得分≥ 6 0分占18 7% ,<6 0分占 81 3%。能说出 3种以上避孕药具及正确使用方法的仅占 8 0 %。能正确描述紧急避孕方法者占 12 % ;听说过紧急避孕但不能正确描述者占 34 0 % ;不知道紧急避孕者占 5 3 9%。结论 :流动人口年轻女性避孕生殖健康知识贫乏 ,婚前性行为普遍 ,无防护性行为率高。     

北京市未婚人工流产女青年避孕知识、态度、行为的调查研究

目的：研究未婚人工流产（人流）女青年的避孕知识,态度、行为以及影响避孕行为的因素。方法：以Lawrence的PROCEDE-pROCEED健康促进计划模式为基础的调查问卷,对306例自愿要求人工流产,年龄在18－24岁的未婚女青年进行断面的调查。结果：近12个月以来,仅有13％和女青地持每次性行为都使用避孕方法,偶尔使用和从未使用者的比例分别为26％和275,在224例曾经用过避孕方法的女青年中,最常用的方法分别是避孕套（495）、体外排精（285）、安全期（165）,在从未使用任何避孕方法的女青年中,735认为没想到会怀孕是最主要的不避孕的原因。logistic 逐步回归分析显示,女青年对避孕知识的了解,对意外妊娠风险的认识,男友对避孕方法使用的态度。与男友讨论避孕方法,对占孕服务可及性的感受是影响女 年既往避孕行为的主要因素,结论亟需对未婚青年开展有关避孕知识的性教育,提高对意外妊娠风险和人工并发症的认识促进男性积极参与避孕,加强性伴侣之间有关避孕方法的交流。     

Why do Chinese women practice contraception? The case of rural Jilin Province

This study focuses on the relationship between contraceptive behavior, family size preferences, and perceptions of the one-child policy among young Chinese women in rural areas of Jilin Province. In 1985, about 85 percent of rural married women with one surviving child were practicing contraception, although most of them reported two as their ideal number of children. Most women with one surviving child, including those with one-child certificates, were practicing contraception in response to the government campaign, while more than half of women with two or more children were doing so voluntarily. Most of the women with one child were using the IUD, whereas more than half of women with two or more children were sterilized. Through multivariate analysis of contraceptive behavior and method choice, additional factors were found to be associated with the contraceptive behavior of rural Jilin women; achievement of their ideal family size was a significant factor in the voluntary practice of contraception as well as in contraceptive method choice. Implications of the results are discussed.     

A qualitative study of women's use of emergency contraception

BACKGROUND: While the use of emergency contraception (EC) is becoming more widespread in Australia, little is known about the reasons for, and the social context of, this use. METHODS: In order to explore the use of EC from the perspective of users, a qualitative study was conducted with women presenting to one of three health care settings in Melbourne, Australia for EC. RESULTS: Thirty-two women ranging in age from 18 to 45 years were interviewed. While a number of themes were discussed with the women, this paper reports on four 'types of users' of EC identified from the data. 'Controllers' experienced failure of their contraceptive method and were very uncomfortable needing EC. They changed their contraceptive strategy in an attempt to avoid needing EC in the future. 'Thwarted controllers' were similar to controllers except that they could not improve their contraceptive strategy due to medical or social limitations. 'Risk takers' saw the use of EC as a component of their overall contraceptive strategy. They did not rely on EC regularly, but were comfortable to use it occasionally when the need arose. A final group of women were 'caught short' by a sexual experience that was unplanned and therefore they did not manage to use their chosen contraceptive strategy. CONCLUSIONS: The findings from this study challenge the assumptions that are often made about the users of EC and highlight the need to acknowledge the different ways that women make sense of, and make decisions about, contraception.     

465例人工流产妇女婚育和避孕状况调查

目的了解25岁以下人工流产妇女的婚育和避孕状况,为生殖保健提供依据。方法通过自填和询问方式调查2004年1月-2008年9月在我院行人工流产的465例25岁以下妇女的婚育和避孕状况。结果人工流产妇女中已婚占28．2％,未婚占71．8％;文化程度以初中居多占32．0％;职业以公司职员最多占34．6％;本地户籍占69．5％,本县郊农村妇女占26．4％,外县占4．1％;人流未产妇占84．9％;人流为首次者占58．7％;妊娠原因以未采取避孕措施者居多占63．4％,避孕失败者为36．6％;男性关心避孕者占46．0％,男性主动采取的避孕措施为避孕套,占34．0％,男方建议女方不用避孕措施者占47．6％。结论未婚先孕和避孕率低是人流率高的重要原因;避孕失败率较高及男性参与避孕不够,值得重视;计划生育和生殖保健工作的对象应扩大到整个育龄妇女及男性。     

Contraceptive practices of non-HIV-seropositive injecting drug users

Aims: To study the sociodemographic characteristics and sexual behaviours in contraception choices of injecting drug users (IDUs) and to compare the contraceptive practices of non-HIV-positive IDUs to those of the general population. Design: Two surveys were used: a sample of IDUs attending 10 drug abuse treatment centres in the Paris region (IDU) and the Parisian subsample of the National French Survey of Sexual Behaviour (ACSF). Measurements: Percentages of contraception practices were estimated separately for 81 IDU and 130 ACSF women, and for 175 IDU and 168 ACSF men, aged 25–34, not reporting prostitution or HIV seropositivity. Findings: Most IDU (77%) and ACSF (84%) women, and IDU (73%) and ACSF (75%) men currently used a contraceptive method. Male condoms were more widely used by IDUs than by the general population (64 vs. 10% in women, 75 vs. 14% in men), for all subgroups of educational level, marital status, recent multipartnership status and sexual activity. Conclusions: Contraceptives are used as often by IDUs as by the general population aged 25–34. However, the methods employed differ, with higher condom use by IDUs, which suggest that IDUs take into account the risk of HIV contamination in their contraceptive practices.     

Unmet need for contraception in Kuwait: issues for health care providers

Based on a nationally representive household survey of Kuwaiti women held in 1999 (n = 1502) unmet need for contraception was analyzed in Kuwait, an oil-rich Muslim country. It was found that 9.7% currently married women had an unmet need for contraception. Of those, 6.1% wanted to stop child bearing, while 3.6% wanted to space their children. A bivariate comparison of the women with unmet need and current contraceptors showed that the unmet need group comprised of relatively older women with a significantly higher level of parity and ones where husband or wife disapproved of contraception. Also, larger percentages of the unmet need group belonged to relatively lower socio-economic status and were Bedouins. Among the reasons for current non-use, two-third believed that they had a low risk of pregnancy due to infrequent sexual activity or sub-fecundity, and 22% were not using a method because of health concerns. A significantly larger percentage of the unmet need group disapproved of contraception, and believed that Islam forbids family planning, compared to current users (30% and 15%, respectively). The logistic regression analysis showed that the wife's perception of the husband's disapproval of contraceptive use had the strongest negative association with unmet need. We conclude that the contraceptive needs of about 90% of all non-pregnant currently married women who wanted to delay or limit children were being met adequately despite the absence of a formal family planning program, while about 10% women had an unmet need. Issues for health care providers are discussed and family planning counseling is recommended for higher risk older women with unmet need.     

Provider Practices and Young Women's Experiences with Provider Self-disclosure during Emergency Contraceptive Visits

BackgroundResearch on the impact of providers disclosing personal contraceptive experiences with patients is limited. In this study, we examine patient and provider perspectives about provider self-disclosure (PSD) of personal contraceptive experiences and its effects on contraceptive decision making and the provider–patient relationship.MethodsWe conducted 18 one-on-one telephone interviews with clinicians who provide contraceptive services to young women and 17 patients seeking emergency contraception from three Bay Area community-based, youth-friendly clinics regarding their contraceptive counseling practices and experiences, respectively. After transcribing and coding all interviews, we summarized structural codes related to contraceptive counseling and PSD.ResultsAlthough providers noted that PSD could help to build rapport and increase patient comfort, most did not report self-disclosing their contraceptive experiences, primarily owing to concerns that it might cross professional boundaries or compromise patient autonomy. All patients held positive attitudes toward and welcomed PSD practices, with many noting that it increased their comfort and trust in their provider.ConclusionsThere were notable differences between patient and provider attitudes toward PSD of contraceptive method use, with patients expressing more positive feelings about the practice than providers. Community-based providers should consider that many young women welcome self-disclosure of provider contraceptive experiences and that more research is needed to understand the effects of PSD practices around contraception on the patient–provider relationship and autonomous contraceptive decision making.     

Reproductive history, sexual behavior and use of contraception in women with epilepsy

BACKGROUND: Women with epilepsy experience more pregnancy-related risks than do their healthy peers. Guidelines recommend highly effective contraception. However, their contraceptive practices remain unknown. STUDY DESIGN: We conducted a cross-sectional questionnaire study among reproductive-age women (18-44 years) with epilepsy presenting for routine, outpatient visits to an urban, academic medical center. Our questionnaire, in English or Spanish, included demographic characteristics, reproductive history, antiepileptic drug use, sexual behavior and contraception. RESULTS: Participants had a mean age of 32 years (S.D.=8), 32% spoke Spanish and described themselves as Hispanic. Participants reported a wide range of educational attainment, insurance payor and income.About half of the participants reported at least one pregnancy, and 50% of the 181 pregnancies reported were unplanned. Among the 53% who reported intercourse in the last month, 74% used contraception, 15% were pregnant, 5% did not want to use contraception, 3% sought pregnancy and 3% had hysterectomy. Of those using contraception, 53% used highly effective methods (sterilization, intrauterine device, hormonal pill, patch and injection), and 47% used less effective methods (condom, withdrawal, rhythm and spermicide). Among the 21 participants using hormonal methods, six concomitantly took enzyme-inducing antiepileptic drugs potentially increasing susceptibility to pregnancy. DISCUSSION: In this sample of women with epilepsy about half reported prior pregnancies; 50% were unplanned. Of those using contraception, only 53% used a highly effective method. Future studies should determine generalizability of these findings and explore reasons for inadequate family planning in women with epilepsy.