Demographic analysis of post-abortive and interval-administered hormonal contraceptive methods.

OBJECTIVE: To compare, using method type and application time, the demographic characteristics of women using hormonal contraceptive methods administered after abortion or during the interval period with those of intrauterine device (IUD) users. METHODS: The demographic characteristics of women to whom oral contraception (OC), monthly injection, depot medroxyprogesterone acetate (DMPA), or IUD were administered in the post-abortive and interval periods between January 1998 and September 2001 in our clinic, were evaluated with the help of a registration system based on the Microsoft Access software used in our clinic. Demographic characteristics recorded were: age, reproductive expectation, previous contraceptive method, education level, number of live children, number of induced and spontaneous abortuses. RESULTS: A total of 10 500 women were included in the study. Of these, 6601 women had taken a contraceptive method during the interval period, and 3899 women had taken a contraceptive method post-abortion. Only 4.6% of the cases were younger than 20 years, 48.3% were between 21 and 30 years, 37.2% were between 31 and 40 years and 9.9% were 41 years old or over. The DMPA-administered group contained the highest number of women > or = 41 years when compared to other groups (22.8%). In reproductive expectations, 65.8% of the cases wanted no more children; 1.3% wanted to have a baby within a 2-year period whereas 23.7% wanted a child after 2 years. The proportion of women wanting no more children was greatest in the DMPA-administered group (77.3%). No previous use of contraceptive methods was reported by 20.7% of women; 27% were using coitus interruptus. The education level of the women was as follows: 10% had no education, 58.3% had education to primary school level, 23.2% to secondary-high-school level and 2.1% to university level. The group of women who chose OC as their contraceptive method contained the highest proportion of university graduates (6.5%). Only 6.26% of the women had no children. The proportion of women in the DMPA-use group with three or more children was higher compared to that in other groups (33.2%). CONCLUSION: The evaluation of demographic characteristics plays an important role in counseling, and in the efficacy and continued use of contraceptive methods.     

Clinical experience with the combined contraceptive vaginal ring in Switzerland,including a subgroup analysis of previous hormonal contraceptive use

Objective?To collect data on cycle and cycle-related symptoms during a second clinical experience programme with the contraceptive vaginal ring (NuvaRing®) in Switzerland.

Methods?Women requiring contraception were recruited by gynaecologists. Questionnaires were used to collect data on cycle and related symptoms, weight, satisfaction and adverse events at baseline and follow-up (typically four cycles).

Results?Of the 1053 women included, 36.9% were starters, 22.4% starters anew, and 40.6% switchers. At follow-up, improvement in cycle regularity was significantly better for starters compared with switchers (18.5% versus 11%; p?<?0.001). Starters showed the greatest improvement in bleeding duration and severity. Improvement in the severity of premenstrual symptoms (PMS) and dysmenorrhoea was significantly (p <?0.001) greater in starters compared with switchers (18.5% vs. 9.1% and 26.5% vs. 9.8%, respectively). Menstrual headache improved in all subgroups. Women were satisfied with changes in weight (92%), cycle control (93.6%) and PMS (86%). Adverse events were reported for 17.5% of women and were most frequently ring-related (such as feeling the ring in situ, vaginal discomfort, ring expulsion).

Conclusions?The data support previous findings that the vaginal ring improves cycle-related symptoms (moderate or severe PMS, dysmenorrhoea, and menstrual headache). Not only starters experienced improvements in symptoms; switchers also benefited.     

Long-term use of hormonal contraceptive DMPA not linked to breast cancer

A study conducted by the World Health Organization (WHO) Special Programme of Research, Development and Research Training in Human Reproduction with the collaboration with the University of Otago Medical School in Dunedin, New Zealand, and the Fred Hutchinson Cancer Research Center in Seattle, Washington, reveals that the injectable contraceptive DMPA (depot-medroxyprogesterone acetate) does not increase the overall risk of developing breast cancer, especially in women who have used DMPA for long periods in the past. Women who began using DMPA within the last 5 years may face a 2-fold increased risk of developing breast cancer, however. Enhanced detection of breast tumors or an acceleration of the growth of pre-existing tumors may explain this increased risk in recent or current users of DMPA. The researchers concluded that providers should not restrict DMPA on the grounds of breast cancer risk. The study reaffirmed the known link of increased risk of breast cancer with early menarche, being single, late age at birth of first child, nulliparity, family history of breast cancer, and history of benign breast disease. The study data originated from New Zealand, the US, Kenya, Mexico, and Thailand. Disadvantages of DMPA include: irregular bleeding, that it is provider-dependent, and slow return to fertility after DMPA use ceases. Advantages include high contraceptive effectiveness, no effect on blood clotting factors, and a protective effect against endometrial cancer.     

Unwanted pregnancies: Understanding contraceptive use and benefits in adolescents and older women

The highest percentages of unintended pregnancies and the largest increases in births reported in the United States in recent years were in adolescents and in women more than 35 years of age. Increasing numbers of these women will require contraception to avoid unintended pregnancy. In adolescents the combined oral contraceptive agents protect fertility indirectly and exert favorable actions on menstrual dysfunction and certain hormone-related disorders such as acne and hirsutism. To avoid sexually transmitted disease, barrier protection should be used along with oral contraceptives until mutually monogamous, stable relationships are established. Healthy older women who are nonsmokers may also safely use currently available contraceptives. These agents have little impact on metabolic parameters linked to the development of cardiovascular disease. In addition to providing reliable contraception, oral contraceptives offer noncontraceptive benefits to older reproductive-age women, including control of abnormal bleeding and a reduction in the incidence of ovarian and endometrial cancers and other gynecologic pathology. Intrauterine devices and progestin implants are safe, effective, and underused in the United States. Progestin implants may have an additional role in patients for whom estrogen preparations are contraindicated. Counseling is very important before insertion because of the high rate of nuisance side effects. The contraception selection process must consider the efficacy and acceptability of the specific,method to avoid the probability of unintended pregnancy and the risk of sexually transmitted diseases. (Ann J OBSTEr GYNECOL 1993;168:2042-8.)     

Qualitative analysis of African-American adolescent females' beliefs about emergency contraceptive pills

STUDY OBJECTIVE: This project was initiated to better understand why some African-American adolescent females do not use emergency contraceptive pills (ECP), despite their widespread availability. Adolescents are considered likely candidates for ECP because they are more likely to inconsistently use birth control and have sporadic sexual behavior patterns. These factors increase the risk of unprotected intercourse and unplanned pregnancy. DESIGN: A qualitative study design was employed to assess the knowledge of African-American adolescent females regarding ECP and their beliefs affecting use and nonuse of ECP. SETTING: An adolescent clinic at a large, urban, academic children's hospital. PARTICIPANTS: Twenty-nine African-American adolescent (age 13-18) females.Interventions. Semi-structured, qualitative interviews lasting 15-20 minutes. MAIN OUTCOME MEASURES: Interviews yielded qualitative data that was coded and categorized into themes.RESULTS: Through the interviews, eight themes emerged: Taking Care of Self, Lack of Knowledge of ECP, Inaccurate Information, Sources of Information, Acceptability of Adolescent Pregnancy, Partner's Influence on Adolescent Choices, Discomfort Talking About Sex, and Concern About Sexually Transmitted Infections (STIs). CONCLUSIONS: The results from this qualitative study will contribute to future quantitative research efforts by providing insight into the decision-making process regarding ECP among this population. The themes provide a foundation for clinical implications and educational interventions. Although a large proportion of the sample (24%) had used ECP, misinformation about ECP and basic reproductive health issues was prevalent. Most of the adolescents report they obtain reproductive health information from a complex network of information sharing, in which their primary sources tend to be peers.     

A comparative analysis of the modification of sexual desire of users of oral hormonal contraceptives and intrauterine contraceptive devices.

OBJECTIVE: To compare the influence of oral hormonal contraceptives (OCs) and the use of intrauterine contraceptive devices (IUDs) on the modification of sexual desire. MATERIALS AND METHODS: A prospective observational study of 1073 women using OCs or an IUD at the Family Planning Center 'Marina Alta' in Alicante, Spain. In order to evaluate the relative risk regarding the decrease in libido attributed to each contraceptive method, a logistic regression analysis was undertaken which considered the factors of age adjustment, level of studies, family planning information, relationship with partner, age when sexual relationships were initiated, parity, contraceptive method previously used and the duration of use of the contraceptive method. RESULTS: No differences in the decrease of sexual desire were observed between the use of the OC and IUD (odds ratio (OR) 1.32; 95% confidence interval (CI) 0.70-2.49), yet differences were noted, however, in relation to age (OR 1.05; 95% CI 1.01-1.10). Although these differences were not statistically significant, a high level of awareness regarding family planning was shown to increase sexual desire when compared to a lower level of information on this subject (OR 0.64; 95% CI 0.41-1.01). Sexual desire was seen to decrease if the quality of the relationship with the partner was average (OR 2.24; 95% CI 1.36-3.69) or poor (OR 4.69; 95% CI 1.93-11.4). Nulliparous women showed a greater decrease in sexual desire in relation to women who had already given birth (OR 1.57; 95% CI 1.00-2.47). Sexual desire was greater if the contraceptive method had already been in use for 6-12 months (OR 0.41; 95% CI 0.17-0.98). CONCLUSIONS: Sexual desire does not vary in relation to the use of OCs or IUDs, yet it does decrease with age, in nulliparous women and in those with an average or poor relationship with their partner. Furthermore, sexual desire shows an increase between the first 6 and 12 months of contraceptive treatment.     

Women's experiences of gestational diabetes self-management: A qualitative study

Objectiveto explore women's experiences of self-managing their gestational diabetes.Design and participantsthe study design was informed by interpretive phenomenological analysis. Data was collected using semi-structured interviews and one focus group. Participants included 15 women with a diagnosis of gestational diabetes who had experienced self-management of their condition.Resultsincremental adjustment occurred over 4 discrete themes, including: (1) the shock of diagnosis; (2) coming to terms with GDM; (3) working it out/learning new strategies; (4) looking to the future. Each adjustment phase was underpinned by the fifth theme (5) having a supportive environment. Throughout, participants reported that thinking about the baby was a powerful motivator for adherence to gestational diabetes management regimens.Key conclusions and implications for practicethis study has shown that women undergo a process of adjustment following GDM diagnosis as they learn to self-manage their condition. The process is largely facilitated by the women's interest in maximising fetal health which may make them receptive to interventions to improve GDM control and to prevent type 2 diabetes in the future.     

Mass media exposure and modern contraceptive use among married West African adolescents

Purpose: The purpose of this study was to examine whether family planning (FP) messaging is reaching married adolescent women in West Africa, and whether such messaging is associated with increased contraceptive use.

Materials and methods: We utilised data from the 2010 Demographic and Health Surveys (DHS) for Burkina Faso and Senegal (women 15–49; N?=?17,067 and N?=?15,688, respectively). We used chi-square tests to evaluate whether FP messaging exposure (via TV, radio, and/or print) differed according to socio-demographic characteristics. Subsequent analysis focussed on married adolescents (15–19; N?=?961 in Burkina Faso, N?=?996 in Senegal) which utilised propensity score matching and multivariable logistic regression models to test the association between self-reported FP messaging exposure and modern contraceptive use, knowledge of a modern contraceptive method, and future intention to use contraception.

Results: A higher proportion of women 15–49 who reported FP messaging exposure were urban, from higher wealth quintiles, and had higher education levels, compared with unexposed women. A smaller proportion of adolescents reported exposure compared to older age groups. Among married adolescents, there was a positive but non-significant association between FP messaging exposure and use of a modern contraceptive method in Senegal (adjusted odds ratio (aOR)?=?2.3; 95% CI: 0.92, 5.73). No such association was found in Burkina Faso (aOR?=?0.98; 95% CI: 0.43, 2.26).

Conclusions: Mass media campaigns are not reaching the most vulnerable populations in West Africa, such as adolescents and poorer rural women. Adapting mass media campaigns to address these gaps is important for increasing exposure to FP messaging.     

The analysis of negative birth experiences of mothers: a qualitative study

Objective: The aim of this study is to analyse the factors associated with a negative childbirth experience from the perspective of the women who gave birth vaginally.

Background: A negative birth experience can pose a risk for both the maternal/newborn health and the health of the community by disturbing the physical and spiritual health of the woman/family.

Methods: This qualitative study was conducted with 11 mothers who gave birth vaginally assisted by midwives in a state hospital. The data were collected using in-depth interviews and analysed using the thematic analysis technique.

Results: The factors causing the women to have negative birth perceptions were analysed under four main themes: challenges/difficulties encountered, the inadequate communication of health professionals, embarrassment/privacy and inadequate hospital facilities. The mothers indicated that they had experienced their births negatively due to personal reasons such as the inability to cope with labour pain, inability to push, hospital policies such as interventions at birth and hunger. In addition, some of the participants stated that they had difficulty and felt embarrassed during vaginal examinations.

Conclusion: The sociocultural characteristics of mothers, hospital facilities and rules, medical and traditional practices at birth, inadequate empathic communication of health professionals and reproductive health policies can lead to negative childbirth experiences.     

Age group differences among pregnant adolescents: sexual behavior, health habits and contraceptive use

STUDY OBJECTIVE: To determine differences in sexual behavior, health habits and contraceptive use among three age groups of pregnant adolescents. DESIGN: Prospective study of pregnant adolescents participating in face-to-face interviews including questions about demographic background, sexual behavior, health history and contraceptive use. SETTING: Urban prenatal clinic. PARTICIPANTS: 300 pregnant adolescents attending their first prenatal appointment. MAIN OUTCOME MEASURES: Sexual behavior, health history and contraceptive use. RESULTS: Our cohort of pregnant adolescents included 61 (20%) 12-15-year-olds, 113 (38%) 16-17-year-olds and 126 (42%) 18-19-year-olds. A greater proportion of 12-15-year-olds were currently in school (90%) compared with 16-17-year-olds (48%) and 18-19-year-olds (38%) (P = 0.01). Of the18-19-year-olds, 41% had a previous pregnancy compared with 3% of 12-15-year-olds (P = 0.01). The youngest age group also had the lowest proportion of any drug use (25%). Contraceptive use (ever) was lower for 12-15-year-olds (46%) compared with 16-17-year-olds (59%), and 18-19-year-olds (66%) (P < 0.01). Reasons for not using contraception at the time of conception also differed by age with 9% of the youngest group reporting they wanted to get pregnant compared with 27% of the 18-19-year-old group (P = 0.01). CONCLUSIONS: Sexual behavior, health habits and contraceptive use in pregnant adolescents differed by age group. Understanding that there are distinct risk behaviors associated with teen pregnancy among these three separate age groups will enhance the thoughtful development and evaluation of programs and policies targeted at preventing first pregnancies and repeat pregnancies in adolescents.     

Continuation and compliance of contraceptive use.

Choosing a method of contraception is an important decision as regards user satisfaction, continuation of use and compliance. The issues of continuation of and compliance with contraceptive use are presented. The continuation rate of a method of contraception is the indicator of the acceptability of that method. The highest continuation rates at the end of the first year are recorded for subdermal implants, intrauterine devices (IUD), the pill and Depo-Provera. Lower continuation rates are found for periodic abstinence, male condom, female condom, diaphragm and spermicides. Continuation rates are highest for methods not affected by compliance. Compliance indicates the degree to which the patient adheres to a prescribed regimen. Lack of compliance can lead to adverse effects of contraceptive use (unintended pregnancy, side-effects, diminished non-contraceptive health benefits) and to discontinuation of the contraceptive method. Also, differences between method effectiveness and user effectiveness can largely be attributed to compliance with the prescribed contraceptive regimens. Health-care professionals have to empower the patient to increase compliance with the existing methods. In addition, the development and use of new contraceptive methods, which take into account the issues of non-compliance, should be encouraged.     

Exploring beliefs and expectations about motherhood in Bulgarian mothers: A qualitative study

Objective

to provide a methodologically robust and in-depth exploration of maternal expectations and beliefs in a non-clinical sample of Bulgarian mothers who described their ideas about motherhood postnatally.

Design

qualitative study using face to face interviews for data collection.

Setting

the cities of Sofia and Varna, Bulgaria.

Participants

10 women, 7 primiparae and 3 multipara, aged 28–32 years, who gave birth within the last 18 months.

Methods

interviews were carried out using a semi-structured schedule. Discussions were audio-recorded with participants' consent, translated and transcribed. Thematic analysis was used under the contextualist theoretical framework.

Findings

four general themes of women's expectations about motherhood were identified, concerning expectations of motherhood, parenting self-confidence, beliefs about the mother–infant dyad and anticipated social support. Findings suggest that there was a substantial discrepancy between expectations and the reality of motherhood, for primiparae and multipara mothers. Unrealistic expectations about motherhood were related to a more difficult postnatal adjustment, lowered self-esteem and feelings of inadequacy.

Key conclusions and implications for practice

the way in which women view themselves as mothers during pregnancy can have a significant impact on their emotional well-being following birth. The implications of these findings are discussed with particular reference to promoting a successful adjustment to motherhood through appropriate antenatal care, focussing on maternal expectations about their new role.     

A qualitative analysis of women's short accounts of labour and birth in a Western Australian public tertiary hospital

This paper reports the findings of the postnatal qualitative arm of a larger study, which investigated women's prenatal and postnatal levels of childbirth fear. Women's expectations and experiences of labour and birth in a Western Australian public tertiary hospital were identified following thematic analysis of short written accounts from 141 participants who had given birth in the previous 6 to 14 weeks. Four major categories emerged to describe features and mediating factors in the trajectory of childbirth and the early puerperium. "Anticipating Labour and Birth," "Labour and Birth Depicted," "Mediating Factors and their Consequences," and "Evaluating, Resolving, and Looking Ahead" portray women's comparative reflections on expectations and realities of birth, on mediating influences, and on moving on from their experience. These findings will provide maternity care professionals with insight into the personal and environmental features of the childbirth setting which colours women's recollections. Being aware of what women value during labour and birth will reinforce the need for professionals to provide care using a mindful approach that considers the potential psychological, emotional, and behavioural implications of events.     

Somali women's experiences of antenatal care: A qualitative interview study

ObjectiveTo explore Somali women's experiences of antenatal care in Norway.DesignA qualitative study based on individual semi-structured interviews conducted either face-to-face or over the phone.SettingNorway.ParticipantsEight Somali-born women living in Norway.Key findingsFour themes were generated from the analysis. From their experiences of antenatal care in Norway, the Somali women described: 1) when care was provided in a way that gained their trust, they made better use of the available health services, 2) the importance of continuity of care and of sharing commonalities with the caregiver, 3) a need for accessible information, specifically tailored to the needs of Somali women and 4) how culturally insensitive caregivers had a negative impact on the quality of care.Conclusion and implications for practiceThe Somali women in this study were grateful for the care provided, although the quality of antenatal care did not always meet their needs. This study should serve as a reminder of the importance of establishing trust between the pregnant woman and the caregiver, strengthening interpretation services and assuring tailored information is available to Somali women at an early stage. The findings further suggest that antenatal care for Somali women may be improved by offering continuity of care and improving clinical and cultural skills in clinicians. Suggestions for practice, and future research, include initiating group antenatal care especially tailored to Somali women.     

Oral contraceptive use and secondary amenorrhea.

Among 1099 patients seen over an 8-year period for amenorrhea or oligomenorrhea, 115 (10.5%) had developed amenorrhea after ceasing oral contraception. These patients were the subject of a special study. Those who were treated received either clomiphene alone, hMG/hCG therapy, or both. There was no correlation between the incidence of either spontaneous or treatment-induced ovulation and menstruation and the duration of use of oral contraception, previous parity, or the nature of prior menstrual cycles. The incidence of treatment-induced resumption of menses was essentially the same as that for spontaneous resumption. An average duration of 30 months of oral contraceptive use did not significantly affect urinary excretion levels of estrogens and gonadotropins.     

Interactions between intrauterine contraceptive device use and breast-feeding status at time of intrauterine contraceptive device insertion: analysis of TCu-380A acceptors in developing countries.

OBJECTIVE: This paper is a reassessment of earlier findings from a preliminary analysis of data from a multicenter international trial regimen on breast-feeding and non-breast-feeding women in which events related to insertion, expulsion, and removal of the TCu-380A intrauterine contraceptive device (ParaGard 380) were investigated. STUDY DESIGN: Performance of the TCu-380A through 12 months after insertion was compared with life-table rate analysis, chi 2, Fisher exact test, or Student's t test. Variables were events reported during intrauterine contraceptive device insertion and events throughout the 12 months of study participation by breast-feeding status. RESULTS: Breast-feeding among intrauterine contraceptive device users was associated with fewer insertion-related complaints and lower removal rates for bleeding and pain. No uterine perforations were reported throughout the study. CONCLUSION: Differences in the performance of the TCu-380A intrauterine contraceptive device suggest physiologic effects associated with lactational amenorrhea. The TCu-380A intrauterine contraceptive device is a viable option for women breast-feeding at the time of intrauterine contraceptive device insertion.