Injectable contraceptive discontinuation and subsequent unintended pregnancy among low-income women.

OBJECTIVES: This study investigated rates of discontinuation of the recently introduced injectable contraceptive depot medroxyprogesterone acetate (DMPA) and postdiscontinuation rates of unprotected intercourse and unintended pregnancy. METHODS: A sample of 402 low-income, urban, minority women were interviewed when they initiated DMPA use and 12 months later. RESULTS: The 12-month life-table discontinuation rate was 58%, with half of the discontinuers stopping after only one injection. Menstrual changes and other side effects were the most frequently cited reasons for discontinuation. Approximately half of the discontinuers at risk for unintended pregnancy either did not make the transition to another contraceptive or used contraception only sporadically. The cumulative unintended pregnancy rate by 9 months postdiscontinuation was 20%. CONCLUSIONS: DMPA initiators were at substantial risk for unintended pregnancy because most quickly discontinued use and did not make the transition to consistent use of another contraceptive.     

Clinic discontinuation and contraceptive need

The results of a follow-up study of dropouts from the Orleans Parish Family Planning Program in New Orleans, Louisiana were provided. During 1969, 4516 patients accepted contraceptives from the program and as of March 1972, 1635 of these patients discontinued their participation in the program. A sample of 527 of these dropouts was randomly selected for inclusion in the study. Of these 527 patients, 158 were lost to follow-up, 2 refused to participate, and 50 returned to the program prior to interview. The remaining 317 were interviewed and classified as either currently in need of contraception, temporarily not in need, or permanently not in need. 153 patients or 48.3% of the dropouts, were classified as currently in need of contraception, and among these patients, 50 were practicing effective contraception, 41 were using less effective methods, and 62 were using no method. Many of the respondents who were practicing less effective methods or no methods indicated that they were dissatisfied with the method provided by the clinic. Clinic strategies should be revised to provide more information on alternative methods. 107 patients, or 33.7% of the dropouts were classed as temporarily not in need of contraception, 16 were currently pregnant with planned conceptions, 25 were currently pregnant with unplanned conception, 13 were less than 6 months postpartum, 12 wanted to become pregnant, 47 were sexually inactive, and 4 were subfecund. Efforts should be made to reestablish contact with the sexually inactive patients on a periodical basis. 57 patients or 18.0% of the dropouts were permanently not in need of contraception because of sterilization, postmenopause, or death.     

Access as a factor in differential contraceptive use between Mayans and ladinos in Guatemala

Previous studies have demonstrated consistently that the Mayan women of Guatemala have a far lower level of contraceptive use than their ladino counterparts (e.g. 50% versus 13% in the 1998 Demographic and Health Survey - DHS). Most researchers and practitioners have attributed this to social, economic and cultural differences between the two groups that result in Mayans having a far lower demand for family planning than ladinos. This paper tests an alternative hypothesis: that the contraceptive supply environment may be more limited for Mayans than ladinos. This analysis uses an innovative approach of linking household level data from the 1995/6 Guatemala DHS and with facility-level data from the 1997 Providers Census for four highland departments in which the latter was conducted. On average, married women of reproductive age in the four departments lived 2 km from a facility that provided some type of contraception. Mayans and ladinos did not differ significantly in terms of (1) mean distance to the closest facility offering family planning services, or (2) mean distance to a facility providing each specific method (except injectables). Mayans were more likely to live closer to an APROFAM clinic, whereas ladinos were closer to a facility that offered access to injectables. Otherwise, the family planning supply environment differed little for the two groups. However, access may not be the determining factor in contraceptive use, given that less than 8% of users got their (last) contraceptive from the nearest facility. Moreover, APROFAM - which was the nearest facility for only 7% of the respondents in this study - was the source of supply for 48% of users. Although this study does not directly measure quality, the characteristics that differentiate APROFAM from other service providers point to quality as more important than physical access or cost in source of contraception among this group of users.     

Medical aspects of oral contraceptive discontinuation

Carbohydrate metabolism was prospectively evaluated in twenty-one normal women prior to and during their use for three months of a monophasic oral contraceptive containing the progestin gestodene plus ethinyl estradiol. The women had a three-hour oral glucose tolerance test using a 75 gram glucose load, measuring serum glucose and insulin levels. The results demonstrate no significant changes in either of the carbohydrate metabolic indices between the two tests. These data support the safety of this new progestin-containing contraceptive.

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Resumen Se realizó un estudio prospectivo a los efectos de evaluar el metabolismo de los hidratos de carbono en veintiún mujeres normales antes de y durante un tratamiento de tres meses con un anticonceptivo oral monofásico que contenía gestodén-progesterona además de etinil estradiol. Las mujeres fueron sometidas a un análisis de tres horas para medir la tolerancia a la glucosa administrada por vía oral a razón de 75 gramos. En el curso de este análisis se midieron los niveles de seroglucosa y de insulina. Los resultados no revelaron cambios significativos de los índice metabólicos de los hidratos de carbono entre los dos análisis. Estos datos corroboran la seguridad de este nuevo anticonceptivo con progesterona.

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Resumé Une étude prospective a été effectuée pour évaluer le métabolisme des hydrates de carbone chez vingt et une femmes normales avant de pendant un traitement de trois mois avec un contraceptif oral monophasique contenant du gestodène-progestérone, plus de l'éthinyl oestradiol. Ces femmes ont été soumises à un test de trois heures orale à raison de 75 grammes. Au cours de ce test, on a mesuré les niveaux de glucose sérique et d'insuline. Les résultats n'ont pas révélé de changements significatifs des indices métaboliques des hydrates de carbone entre les deux tests, ce qui vient confirmer la sécurité de ce nouveau contraceptif aux hormones progestatives.

     

The association between vaginal bleeding patterns and reasons for discontinuation of contraceptive use

This paper describes the relationship between menstrual bleeding patterns recorded and reasons for discontinuing method use given by women using one of four types of hormonal contraception: combined oral pills, progestogen-only oral pills, a vaginal ring or depot-medroxyprogesterone acetate (DMPA). The women were recruited to five clinical trials, each of which lasted at least 48 weeks. The subject's reason for discontinuation was recorded if she stopped contraceptive use before the scheduled time. Overall, the reason expressed for discontinuing method use was a close reflection of the subject's experience. Among women using either type of oral contraceptive or a vaginal ring, subjects who discontinued for a non-menstrual reason or were lost to follow-up had bleeding patterns which did not differ markedly from those of women who continued method use. Only in the DMPA group was there any evidence that women who complained of non-menstrual side effects or were lost to follow-up might have ceased method use because they were unwilling or unable to tolerate their bleeding patterns. Subjects who discontinued because of amenorrhea had few bleeding/spotting days and at least one prolonged bleeding-free interval; women who complained of longer bleeding had long episodes and short intervals. Women who reported heavier bleeding had patterns which were similar to, but less extreme, than those of subjects who reported longer bleeding. The complaint of irregular bleeding, however, did not concur with the bleeding patterns recorded, regardless of contraceptive method. The predominant menstrual disturbance in this group of women was frequency of bleeding. They had no special difficulty in predicting either the time of onset or the length of their bleeding episodes. There were marked differences between individuals in terms of their acceptance of bleeding disturbances. Nevertheless, the results of this study confirm the importance of counselling. Women using DMPA tolerated far greater menstrual disruption than subjects using any other method. Subjects using an oral contraceptive were unlikely to have been warned of potential bleeding problems; when they encountered any, they tended to cease method use. In contrast, subjects using DMPA would have been advised to expect irregular patterns and possibly amenorrhea; prepared for such disturbances, their perseverance was remarkable.     

Fertility and contraceptive adoption and discontinuation in rural Kenya.

After a long period of slow progress, the recent uptake of contraceptive use in Kenya has been dramatic. This report describes adoption of a method and method switching and discontinuation among a cohort of married women aged 25-34 in two contrasting rural areas. A retrospective "fertility diary" completed by each woman provided information on spousal separation, reproductive status, and contraceptive use over a period of 46-48 months. Contraceptive prevalence rose rapidly over the period in both areas, with significant net adoption of injectables in both areas and of IUDs in one only. Method discontinuation was concentrated among users of pills, barrier methods, and "natural" methods, and only one-third of all discontinuations were voluntary. The wide differences between the two rural areas in contraceptive prevalence were not totally reflected in recent fertility levels, and the contribution of other proximate determinants of fertility, particularly postpartum amenorrhea and spousal separation, are discussed.     

Factors associated with short-term oral contraceptive discontinuation

An investigation was devised to study factors associated with short-term oral contraceptive discontinuation. Of 405 women in New Orleans who accepted oral contraceptives in the clinics of the Orleans Parish Family Planning Program during January 1974, 365 (90.1%) were located and interviewed. 5.2% of the women did not start the method as scheduled, and 6.1% of those who started quit before the second cycle. 53% ofthose who did not start the pill gave as their major reason for not starting their inability to determine when to begin the pill because of menstrual irregularity. The second major reason (26%) was personal reasons such as sexual inactivity, fear that the pill causes cancer, and unrelated health problems. 63% of the women who discontinued the pill during or immediately after the first cycle cited side effects, principally breakthrough bleeding, as the reasons for discontinuing. A multiple regression analysis was computed with short-term continuation/discontinuation as the dependent variable. The independent variables were age, parity, education, presence or absence of a male sexual partner, employment status, postpartum status, severity of spotting or bleeding as a side effect, attitude toward conception, and frequency of sexual intercourse. Only 7.3% of the variance in oral contraceptive continuation/discontinuation was accounted for by the variables included in the model, and bleeding and spotting accounted for 88% of this total. It is recommended that 1) oral contraception begin immediately postabortion or postpartum, 2) medical attention be given to postpartum or postabortal bleeding and spotting problems of amenorrhea, and 3) bleeding and spotting problems be checked carefully after pill initiation to see if another pill or another method might be used or if medical intervention is required.     

Oral contraceptive discontinuation and its aftermath in 19 developing countries

Background

The purpose of the article was to document oral contraceptive (OC) discontinuation and switching in a large number of low- and middle-income countries, and to assess the effects of women's education and reason for use (spacing vs. limitation). An attempt was made to explain intercountry variations.

Study Design

Calendar data from 19 Demographic and Health Surveys conducted between 1999 and 2005 were used. Data were analyzed by single- and multiple-decrement life tables and by Cox proportional hazard model.

Results

The probability of stopping OC use within 12 months for reasons that implied dissatisfaction with the method ranged from 15% in Indonesia to over 40% in Bolivia and Peru with a median value of 28%. On average, 35% switched to a modern method within 3 months and 16% to a less effective ‘traditional’ method. Both education and reason for use were strongly related to the probability of switching to a modern method. Discontinuation was lower and switching higher in countries judged to have strong family planning programs.

Conclusions

Both discontinuation of use and inadequate switching to alternative methods are major but neglected problems in the family planning services of many developing countries.     

Side effects and oral contraceptive discontinuation in rural Bangladesh.

Using data from a survey on oral contraceptive (OC) compliance in rural Bangladesh, this study examines the role of side effects on OC discontinuation along with other potential predictors. A total of 1403 currently married women aged 15-49 years were interviewed; of these 43% discontinued OCs. Of the women who discontinued, 53% did so because of side effects, which was the main self-reported reason for OC discontinuation. Multivariate analysis revealed that after adjusting for duration of OC use, women who experienced side effects were 1.4 times more likely to discontinue OC use than their counterparts without such experience. Discontinued OC use was also associated with being Muslim, not being visited by field-workers, OC use as first method of contraception, lack of husband's support, and was inversely associated with duration of OC use. Adequate counseling about OC use, emphasizing the possibility of side effects, and better management of them, coupled with improved client-provider interaction and husband's supportive role could help in reducing OC discontinuation in rural Bangladesh.     

Factors associated with oral contraceptive discontinuation in rural Bangladesh

Oral contraceptives (OCs) account for half of all modern contraceptive methods used in Bangladesh, however, discontinuation remains fairly high in OC use. This paper identifies factors associated with discontinuation of OC use, where discontinuation refers to cessation of OC use in the 6 months prior to the survey. The data for this study were drawn from a survey on OC compliance in rural Bangladesh. A total of 1600 OC users, current or past, aged 15 to 49 years were interviewed; of these, 36% discontinued OC use. Of the women who discontinued, 47% reported the experience of side-effects as the main reason for OC discontinuation. Multivariate analysis identified lack of fieldworker's visit as the strongest predictor of OC discontinuation; women who were not visited by fieldworkers had a four-fold risk of discontinuing OC use. Discontinuation of OC use decreased with increased duration of use and number of living children. OC discontinuation was associated with side-effect experiences, lack of husband's support in OC use and failure to purchase OCs. Of great concern is that about 70% of the women who were at risk of unintended pregnancy were not using any method of contraception following OC discontinuation. Husband's education was positively associated with the substitution of OCs with another contraceptive method. Effective OC use should be advocated through adequate counselling about how to take it correctly, the possibility of side-effects and their proper management and, more importantly, the possible alternative contraceptive method should OCs prove unsatisfactory or unsuitable. Better provider-client interactions along with improved access to the newly established community clinics could be instrumental in the continued and effective use of OCs.     

Impact of accessibility of contraceptives on contraceptive prevalence in Guatemala

The 1978 National Survey of Fertility, Family Planning, and Communication of Guatemala provided the opportunity to study the effect of accessibility to contraceptive source on contraceptive prevalence. Guatemala's 2 ethnic groups are the Ladinos and the Indians. Demographic characteristics were represented by age of woman, number of living children, and desire for more children. Socioeconomic characteristics were educational status, urban-rural residence, and employment status. The survey found that a substantially lower proportion of Indian couples (4%) than Ladino couples (27%) was using contraception outside the Department of Guatemala, but the 2 groups have similar birth rates, probably due to the pattern of prolonged breastfeeding among Indians. Outside the Department of Guatemala, Indians marry younger than Ladinos; 50% of 15-19 year old Indian women were married (including consensual unions) compared with 32% of Ladino women. For Ladinos the use of reversible modern methods consistently decreased with an increase in average travel time to the source of contraception, but Indians' use of contraception apparently bears little relationship to accessibility. Thus, community-based contraceptive distribution programs may be effective for Ladinos, but different strategies may be required for Indians, including an independent design of information, education, and communications programs for either clinic or community-based programs.     

妇女孕前贫血与孕期贫血间关系的研究

我国妇女妊娠期贫血患病率在20%以上~[1-4],2003年在南方经济发达地区婚前医学检查妇女的贫血患病率仍在25%以上~[5].而农村地区有78.9%～84.1%的妇女在登记结婚后一年内受孕~[6],在北方和经济欠发达地区这一比例可能更高,因此有些妊娠贫血可能是孕前期(孕前)贫血的延续和发展.本研究分析妇女婚前医学检查时血红蛋白(Hb)浓度(g/L)和贫血患病情况与其在孕期Hb浓度和贫血患病率间的关系,明确防治孕前贫血对降低妊娠贫血患病率的作用.     

The contraceptive sponge: factors in initiation and discontinuation of use

This study examined characteristic of the contraceptive sponge that were important in women's decisions to use the contraceptive sponge and reasons why women discontinued sponge use. A sample of 385 current sponge users and 407 former sponge users participated in a national telephone survey on sponge use. Important reasons for trying the sponge were effectiveness, comfort, convenience and ease of use and it "would not interfere with sexual pleasure." The media and physicians were of considerable influence in women's decisions to initiate sponge use, but sexual partners, friends, parents and relatives exerted little influence. The most important reasons for discontinuing use of the sponge were pregnancy, both planned and accidental, and irritation, discomfort or vaginal infection. Women may decide to use the sponge because they have unrealistically positive perceptions of sponge characteristics.     

妊娠期膳食与妊娠期高血压疾病的关系

目的　探讨妊娠期膳食与妊娠期高血压疾病（HDCP）的关系,为妊娠期合理膳食提供理论依据。方法　采用1:2匹配病例对照研究方法,选取2014年1月至12月在合肥市妇幼保健院住院分娩的孕妇进行食物频率问卷调查,分析各类食物摄入频率与HDCP的关系。结果　共纳入研究对象543例,其中病例组181例,对照组362例。Mann Whitney U检验结果显示,病例组和对照组畜禽鱼肉类、蛋类、豆类、干果类、奶类和腌菜泡菜类食物的食用频率不相同,差异均有统计学意义（均P＜0.05）;两组粮谷类、蔬菜类、水果类食物的食用频率比较差异无统计学意义（均P＞0.05）。多元Logistic回归分析结果显示,豆类（OR=0.746, 95% CI: 0.645~0.862）、蛋类（OR=0.789, 95% CI: 0.693~0.898）、奶类（OR=0.822, 95% CI: 0.725~0.931）食物摄入频次越多,发生HDCP的风险越小;腌菜泡菜类（OR=1.190, 95% CI: 1.054~1.344）食物摄入频次越多,发生HDCP的风险越大。结论　豆类、蛋类、奶类食物是HDCP的保护因素,腌菜泡菜类是HDCP的危险因素,妊娠期膳食应科学合理。     

Migration and the diffusion of modern contraceptive knowledge and use in rural Guatemala

This article uses the concept of social networks as it is employed in the research literature on family planning and migration to explore the impact of out-migration on modern contraceptive knowledge and use in rural Guatemala. Data for this study come from the 1995 Guatemalan Survey of Family Health. Results from multilevel regression models indicate that urban migration experience, having migrant kin in urban or international destinations, and living in a community where urban migration is common are all associated with greater contraceptive knowledge. Social ties to urban or international migrants are also associated with a greater likelihood of modern contraceptive use among married women, but this association works primarily through increased contraceptive knowledge. The findings of significant diffusion effects provide support for recent theories of fertility decline that emphasize the role of social interactions.     

妊娠期三氯乙酸内暴露水平与妊娠结局的关系

目的 调查孕妇妊娠期饮水消毒副产物三氯乙酸(trichloroacetic acid,TCAA))内暴露水平及影响因素,并探讨其与妊娠结局的关系.方法 选择湖北省孝感市某医院2012年11月-2013年3月入院分娩的327名孕妇进行问卷调查,并测定其晨尿中TCAA的含量,采用Logistic回归模型分析探讨妊娠期TCAA内暴露水平和妊娠结局的关系.结果 孕妇尿中TCAA含量的平均值为10.96μg/g cr,P1、P10、P25、P50、P75、P90、P100分别为1.83、3.39、5.20、8.63、12.71、20.19、150.42 μg/g cr.饮水煮沸的孕妇尿TCAA含量明显低于未煮沸者(P＜0.05).经混杂因素校正后,P51～P75的TCAA暴露与胎龄减少有统计学关联(OR=2.947,95％CI:1.504～5.776);未发现TCAA暴露与新生儿出生体重有关.结论 饮水煮沸可能减少TCAA内暴露水平,妊娠期TCAA暴露可能与早产风险增加有关联.     

孕早期不良饮食因素与抑郁的关联性

目的  探究孕早期妇女不良饮食因素与抑郁的关系。 方法  对7 976名参与中国孕产妇队列研究协和项目并在2017年7月25日-2018年7月24日纳入的孕早期妇女进行研究;采用χ²检验描述两组的基线分布差异;在孕早期分别采用定性食物频率测量法和爱丁堡产后抑郁量表测量妇女的饮食摄入频率和抑郁状况;采用Log-binomial回归分析饮食与抑郁的关联性,计算现患比（prevalence ratio,PR）及其95%可信区间（95% confidence interval,95% CI）。 结果  Log-binomial回归结果显示,孕早期饮食规律（PR=0.45,95% CI：0.38~0.54,P < 0.001）、经常吃早餐（PR=0.80,95% CI：0.72~0.90,P < 0.001）的孕妇有较低的抑郁发生风险;而妊娠早期经常食用油炸食品（PR=1.25,95% CI：1.03~1.53,P=0.027）、西式快餐（PR=1.36,95% CI：1.06~1.74,P=0.015）、膨化食品（PR=1.37,95% CI：1.11~1.70,P=0.003）,经常饮用含糖饮料（PR=1.37,95% CI：1.17~1.61,P < 0.001）和葡萄酒（PR=1.60,95% CI：1.26~2.01,P < 0.001）、饮用白酒（PR=1.26,95% CI：1.00~1.59,P=0.047）的孕妇则有较高的抑郁发生风险。 结论  孕早期不良饮食因素与抑郁存在关联性,孕妇应主动了解健康饮食方式,减少不健康饮食的摄入频率,以减少妊娠期间抑郁的发生。