Barrier contraceptive methods and preeclampsia

Recent investigations have suggested that women who use barrier methods of contraception may be at increased risk for preeclampsia. We used data from two prospective pregnancy studies to examine the relationship between contraceptive use before conception and preeclampsia. The preeclampsia rates among women using barrier contraceptives were not significantly higher than the rates in women using nonbarrier contraceptives or the rates in women using no contraceptives in either study. The odds ratios for preeclampsia in barrier contraceptive users in the two studies were 0.89 (95% confidence interval [Cl], 0.71 to 1.12) and 0.85 (95% Cl, 0.49 to 1.45) compared with nonbarrier contraceptive users and 0.91 (95% Cl, 0.71 to 1.16) and 0.81 (95% Cl, 0.48 to 1.35) compared with women using no contraceptives. After adjusting for other risk factors, we found no association between preeclampsia and barrier contraceptive use. Additional studies are needed to resolve this issue; however, we would recommend that women not be advised to avoid barrier contraceptives unless more data linking their use to preeclampsia appear.     

Risk factors for uterine fibroids: reduced risk associated with oral contraceptives

Risk factors for pathologically confirmed uterine leiomyomas (fibroids) were investigated using data from the Oxford Family Planning Association study, a long term follow up study of women using various methods of contraception. For each of 535 women who had had a fibroid an individual control was selected who matched the patient on age, date of entry into the cohort, and family planning clinic at recruitment and who was alive (and still being followed up) at the date the patient underwent surgery for fibroids. Case-control analysis showed that reproductive experiences were closely linked to development of fibroids. Risk of fibroids decreased consistently with increasing number of term pregnancies; women with five term pregnancies had only a quarter of the risk of women who had had none. Risk also decreased consistently with increasing duration of oral contraceptive use; the risk of fibroids was reduced by some 31% in women who had used oral contraceptives for 10 years. Risk was strongly related to weight: women who weighed under 55 kg had a particularly low risk, and overall the risk rose roughly 21% for each 10 kg increase. Cigarette smoking was associated with a decreased risk of fibroids; smokers of 20 cigarettes a day had a risk roughly two thirds that of non-smokers. These risk factors have all previously been identified as risk factors for endometrial cancer; this strongly suggests that the underlying risk factor is "unopposed" oestrogen.     

Integrated family planning services: a Nigerian experience

An integrated health and family planning program, operated by the University of Ife Teaching Hospital, was assessed to determine the impact of the integrated approach on family planning service utilization among the predominantly Yoruba residents of the city. In Nigeria, family planning services are generally delivered in clinics which have little or no connection with medical facilities, and service utilization is low. In 1979 the hospital decided to include family planning as part of the routine medical services provided at its 8 clinics located within a 25 kilometer radius of the hospital. Staff members at the clinics were trained in family planning. Trained female fieldworkers conducted motivational activities to encourage the women in the community to use the family planning services of the clinic. The program provided women with an opportunity to obtain contraceptives in a familiar setting and as part of their routine medical care. Neither parental nor spousal consent was required. Yoruba men tend to oppose family planning. Data for the study was obtained from the records of the program's 1495 new acceptors served by the program during its first 2 years of operation. 50.6% of the acceptors were 25-34 years of age, and another 31.7% were between 35-44 years of age. Very few teenagers utilized the services. 96% of the wome were married and they had an average of 4.4 living children. 56% were Catholic, 25% were Protestant, and 16% were Muslim. 37% were illiterate, and another 42.5% could barely read or write. Most were wives of government workers or service men. 88% had never used a modern contraceptive, and 94.5% were not using a method at the time of their first clinic visit. 68.4% of the acceptors were referred to the clinic by the fieldworkers or other health personnel. Only 11.2% sought the services on their own. 85% of the acceptors choose oral contraceptives (OCs), 13% had IUDs inserted, 0.3% were sterilized, and the remaining 2% chose other methods. The low sterilization rate probably reflected the fact that spousal consent was required for sterilization. Side effects reported by the OC users included asthma (9.6%), headaches (5.2%), phlebitis (3.5%), jaundice (1.7%), chest pain (1.5%), depression (1.5%), scanty menses (0.8%), and high blood pressure (0.4%). Among IUD users, 10.8% had intermenstrual bleeding, 18.4% reported pelvic pain, and another 6.8% reported a variety of other problems. 42.1% of the acceptors wanted no more children, and the remainder wanted to avoid the hardships associated with traditional methods of spacing. Correlation analysis revealed that the total number of living children was negatively related to maternal education and that women with sons wanted significantly fewer additional children than women with fewer or no sons. 51% of the acceptors were continuing contraceptive use at the time of the study. The study confirmed the feasibility of an integrated approach. The findings should be of use to government officials who want to improve service utilization in the national family planning program.     

Combined Oral Contraceptive Pills: Profile of Acceptors in a Tertiary Hospital in South-South Nigeria

BACKGROUND: Combined oral contraceptive pills were the first contraceptive method to provide sexual freedom of choice for women through reliable, personal and private control of fertility. They are the most widely used hormonal contraceptives and also the most popular non-surgical method of contraception. OBJECTIVE: To review the profile of acceptors of combined oral contraceptive pills at the University of Uyo Teaching Hospital, Uyo. METHODOLOGY: An 8 year review of all clients that accepted combined oral contraceptive pills in the family planning clinic. RESULTS: There were 1,146 new contraceptive acceptors during the period of study out of which 309 (27.9%) accepted the pills. Majority of the clients were between 20 and 29 years of age (54.0%), were multiparous (72.8%), Christians (99.7%) and 61.2% had tertiary level education. Two hundred and fifty-five women (82.5%) desired to use combined oral contraceptive pills to space births while 7.8% wanted to limit child bearing. There was a high discontinuation rate among the women (45.0%) and out of these 87.9% of the clients changed to other contraceptive methods. All the clients commenced their pills within seven days of menstruation and only the low dose monophasic preparations were available in the family planning unit and thus were given to the clients. CONCLUSION: Women who accept to initiate combined oral contraceptive pills in our center are young, well educated, multiparous women who want to space their pregnancies. However, due to the high discontinuation rate among the clients, there is need for further studies evaluating reasons for the high discontinuation rate, exploring interactions between clients and providers' and also providers' attitude towards combined pills in our environment.     

Depo medroxyprogesterone acetate (DMPA) and combined oral contraceptives and cervical carcinoma in-situ in women aged 50 years and under

Most low-resource settings depend on hormonal contraceptives for their family planning programmes and cervical cancer occurs in higher frequency in these populations. To determine whether hormonal contraception use increases cervical carcinoma in-situ (CIS) risk, a case-control study was conducted in the Kingston and St Andrew Corporate area of Jamaica, using 119 cases from the Jamaica Tumour Registry and 304 population controls matched on year of Papanicolaou (Pap) smear and clinic where Pap smear was obtained. While CIS cases were more likely to have 'ever used' combined oral contraceptives (COC) (OR = 1.4, 95% CI: 0.8, 2.5), depo-medroxyprogesterone acetate (DMPA) use was similar. Compared to women who never used hormonal contraceptives, the risk of CIS was elevated in: women who had used COCs five years or more (OR = 2.1, 95% CI: 1.0, 4.6), women who first used COC for less than 10 years prior to the interview (OR = 1.8, 95% CI: 0.9, 3.7) and women who were 18 to 24 years old when they first used COCs (OR = 1.8, 95% CI: 0.9, 3.4). Similarly, compared to women who never used DMPA, the risk of CIS was elevated in: women using DMPA five years or more (OR = 1.9, 95% CI: 0.7, 4.8), women reporting use within a year prior to interview (OR = 2.8, 95% CI: 0.7, 10.7) and women who initiated use of DMPA when they were 20 and 24 years old (OR = 1.4, 95% CI: 0.7, 3.1). These results suggest that if hormonal contraceptive use confers any risk of CIS, it is confined to long-term users. Increased risk in some groups, however, warrant further study.     

计划生育与避孕药具管理工作浅析

目的对计划生育与避孕药具管理之间的关系进行分析。方法以2009年1月～2010年l0月间87例使用避孕药具失败的孕妇作为分析对象,采用当面访谈的方法对其避孕失败的原因进行调查和统计。在整理调查报告的基础上,对其一般情况、采用的避孕方法、避孕失败的原因等内容进行回顾性分析。结果在接受问卷调查的2320人当中,共有87例使用避孕药具失败,避孕药具的有效率为96.25%。87例避孕失败的孕妇中有74例是使用安全套避孕失败,其中有52例是因为未能坚持使用,有14例是因为未能坚持全程使用,有4例是因为避孕套破损,4例是其他原因导致避孕失败。在11例使用避孕药失败的孕妇中,失败与未按照规范服药,或药物保管不当所导致的药物失效有关。2例使用避孕膜避孕失败的孕妇则是因为没有掌握正确的使用时间。结论想要做好计划生育与避孕药具的管理工作,关键就在于加强对有关知识的宣传力度,帮助人们树立计生观念,只有这样,才能使工作得到更多的支持,收到更好的效果。     

The relationship of tubal infertility to barrier method and oral contraceptive use

We studied past contraceptive use in 283 nulliparous infertile women who had a diagnosis of tubal adhesions or occlusion and in 3833 women admitted for delivery at seven collaborating hospitals from 1981 to 1983. The relative risk of tubal infertility associated with barrier contraceptive use or oral contraceptive use was calculated using multivariate logistic regression to control for confounding by region, age, religion, education, smoking, number of sexual partners, time since menarche, and use of other contraceptive methods. Women who had ever used barrier methods of contraception were at a significantly decreased risk of tubal infertility (relative risk = 0.6; 95% confidence limits, 0.5 and 0.8). When type of barrier method used for the longest time was evaluated, those who used the diaphragm or condoms plus spermicides were at lower risk than those who used condoms or spermicides alone. Overall, past use of oral contraceptives neither increased nor decreased a woman's risk of tubal infertility, but there was evidence that the association between oral contraceptives and tubal infertility may vary by the amount of estrogen and type of progestogen in the oral contraceptive used. We conclude that contraceptive users who use barrier methods that combine both a mechanical and chemical barrier, such as diaphragms, cervical caps, and condoms plus spermicides, have the clearest protection against tubal damage.     

An epidemiologic study of contraception and preeclampsia

The primary hypothesis of this study was that contraceptive methods that prevent exposure to sperm and seminal fluid (condoms, diaphragms, spermicides, withdrawal) are associated with an increased risk of developing preeclampsia during the subsequent pregnancy. A case-control study was conducted comparing the contraceptive and reproductive histories of 110 primiparous women with preeclampsia with 115 pregnant women without preeclampsia, aged 15 to 35 years, who gave birth at North Carolina Memorial Hospital, Chapel Hill, between 1984 and 1987. Controls were frequency matched to cases by age, race, and distance from the hospital. Unconditional logistic regression analysis indicated a 2.37-fold (95% confidence interval, 1.01 to 5.58) increased risk of preeclampsia for users of contraceptives that prevent exposure to sperm. A dose-response gradient was observed, with increasing risk of preeclampsia for those with fewer episodes of sperm exposure. These results were supportive of the hypothesis that birth control methods that prevent sperm exposure may play a role in the etiology of preeclampsia.     

Use of oral contraceptives by women with epilepsy

Oral contraceptives have not been associated with exacerbation of epilepsy despite warnings in package inserts. No clinical study has provided scientific evidence of worsening of seizures in epileptic women who use oral contraceptives, and improvement in seizure control has occurred in some cases. The main concern about use of oral contraceptives in this population is their effectiveness in preventing conception. Failure rates are higher in groups of women taking enzyme-inducing antiepileptic drugs. The degree of increased metabolism of estrogen and progestin components is highly variable and unpredictable among individuals. Use of higher doses increases protection against conception but also increases the risk of side effects, particularly in patients in whom no enzyme induction occurs. The strength of hormones in the pill should be selected individually when initiating use. Some women may require higher doses for full contraceptive effect.     

Contraceptive practice of the tribal women in tea garden area of North Bengal

A total of 860 tribal tea garden women in the Jalpaiguri district were surveyed by means of detailed questionnaires to obtain information of their contraceptive knowledge and practices and also to see the literacy rate among themselves. Analysis was done of their literacy level, family planning awareness, access to information and communication, methods of contraception adopted and utilisation of healthcare facilities. Majority (85%) of the tea garden women including all the age groups were illiterate. The overall contraceptive prevalence was 40.2% but most of the current users (22.6%) subjected to tubal sterilisation for family planning, couples were not enthusiastic about using the reversible methods; 59.7% women had lack of adequate information regarding various contraceptives. Contraceptive practice, as birth spacing method, needs to be given tremendous emphasis in order to improve the reproductive health of the tribal women. Education, information, choices and rights for decision-making only can achieve this.     

Vitamin A,pregnancy, and oral contraceptives

It has been shown that women receiving oral contraceptives have increased levels of serum vitamin A. High vitamin A levels may constitute a teratogenic hazard. Women who conceive soon after discontinuing oral contraceptive therapy may be especially at risk to this hazard. An increase in vitamin A levels in women taking oral contraceptives has been confirmed. During early pregnancy there is no significant difference in vitamin A levels between women who have recently been taking oral contraceptives and those who have not. The authors were not able to demonstrate that either taking oral contraceptives shortly before pregnancy or a high vitamin A level during the first trimester of pregnancy, comparable to that of a woman taking oral contraceptives, has any detrimental effect on the outcome of pregnancy. It seems unlikely that women conceiving soon after discontinuing oral contraceptive, has any detrimental effect on the outcome of pregnancy. It seems unlikely that women conceiving soon after discontinuing oral contraceptive therapy run any teratogenic risk from increased vitamin A levels.     

知情选择社区干预对农村已婚育龄妇女避孕行为的影响

目的评估避孕方法知情选择社区干预对农村已婚育龄妇女避孕行为及人工流产发生状况的影响。方法在全国不同省的三个县分别选择两个乡镇，随机分配到干预组和对照组。干预社区开展避孕方法知情选择社区干预研究和计划生育常规工作；对照社区仅开展计划生育常规工作。通过结构式问卷调查测量育龄妇女的避孕行为和流产状况，评估干预的效果。结果干预提高了研究对象自主选择避孕方法的比例。干预期间更换或新采取避孕措施的对象（409人）中，干预组中自主选择的比例高于对照组，干预效应的OR值为2．46，95％可信限为1．50～4．04。但本研究未发现干预活动对研究对象的避孕率、避孕方法更换率、新采取率、停用率等有影响，干预期间两组的人工流产发生率无统计学差异。结论避孕方法知情选择社区干预能提高育龄妇女的避孕方法自主选择能力，而对避孕率、人工流产率无明显影响。     

中国、日本、印度、南非、美国五国1970—2030年计划生育状况与趋势预测

 目的    分析并预测中国、日本、印度、南非、美国已婚/同居育龄女性计划生育状况,为满足育龄女性计划生育需要提供依据。方法    从《全球避孕及方法使用状况2016》(World Contraceptive Use 2016)中选取1970—2030年五国已婚/同居育龄女性的避孕节育数据,通过U检验和χ2检验比较五国1970—2016年间的计划生育现状及2017—2030年间的预测趋势。结果    相比于1970年,2016年五国总的计划生育需求增大,避孕节育率上升,未满足的计划生育需要下降(P<0.001)。2016年,五国避孕节育率分别为83.3%、59.9%、56.4%、64.9%、73.7%,未满足的计划生育需要分别为3.8%、13.1%、15.5%、12.2%、7.2%。同时,五国避孕方法的构成发生改变(P<0.001),现代避孕方法使用率高于传统避孕方法,且其满足总的计划生育需求的比例自1970—2016年也不断提高。2017—2030年五国总的计划生育需求、避孕节育率、未满足的计划生育需要、避孕方法的构成、未满足的现代避孕方法需要均有改变(P<0.001)。预测至2030年,中国将是避孕方法使用人数最多的国家,印度将是未满足的计划生育需要人数最多的国家;其中中国、印度有可能是现代避孕方法使用人数最多的国家,印度可能是传统避孕方法使用人数最多的国家。结论    当前五国已婚/同居育龄女性总的计划生育需求大、避孕节育率高、未满足的计划生育需要下降。预测此后至2030年间,该状况仍有可能延续,因此有必要提供适宜的避孕方法以维护生殖权利。     

北京市未婚青年避孕行为的调查研究(英文)

Ｕｎｗａｎｔｅｄｐｒｅｇｎａｎｃｙａｎｄｐｒｅｇｎａｎｃｙｔｅｒｍｉｎａｔｉｏｎａｍｏｎｇｎｅｖｅｒｍａｒｒｉｅｄｙｏｕｎｇｗｏｍｅｎａｒｅｗｏｒｌｄｗｉｄｅｐｒｏｂｌｅｍｓｔｈａｔａｆｆｅｃｔｗｏｍｅｎ ,ｔｈｅｉｒｆａｍｉｌｉｅｓａｎｄｔｈｅｗｈｏｌｅｓｏｃｉｅｔｙ Ｕｎｗａｎｔｅｄｐｒｅｇｎａｎｃｙａｍｏｎｇａｄｏｌｅｓｃｅｎｔｓｒｅｓｕｌｔｓｉｎａｔｌｅａｓｔｔｗｏｍｉｌｌｉｏｎｕｎｓａｆｅａｂｏｒｔｉｏｎｓａｎｎｕａｌｌｙｉｎｔｈｅｗｏｒｌｄ ,1　ａｎｄｕｎｓａｆｅａｂｏｒｔｉｏｎｓａｒｅ…     

Contraceptive use behavior among never married young women who are seeking pre gnancy termination in Beijing

Objective To identify contraceptive use behavior and its determinants among never married young women with an unwanted pregnancy and seeking pregnancy termination in Beijing.Methods A cross-sectional study, adopting the Lawrence’ PRECEDE-PROCEED model was conducted in 1999 in Beijing, China. A total of 306 unmarried young women, aged 18 to 24 years and requesting pregnancy termination, were face to face interviewed.Results Only 13% of the young women insisted on contraceptive use, and almost an equal proportion occasionally or never used contraceptives (26% and 27%, respectively). Among 224 women who had contraceptive use during the past 12 months, the methods used most often were condom (49%), withdrawal (28%) and the rhythm method (16%). One of the most important reasons cited by 73 percent of women who had never used contraceptives was that they did not realize the risk of getting pregnant. The results of logistic regression analysis revealed that knowledge on contraception, boyfriend’s approval of contraceptive use, perceived risk of getting pregnant, perceived availability of contraceptive services and discussion of contraception with boyfriend were important indicators of a young woman’s contraceptive use behavior.Conclusion These results indicate an urgent need to develop sex education on conception and contraception among young women and men. It is equally important to enhance young women’s perception about the risk of unwanted pregnancy and the complications of induced abortion. Promoting men’s cooperation and participation in contraceptive use as well as strengthening communication on contraception between young women and their partners is essential.     

Zimbabwe: a family planning profile

This brief article focuses on the history of family planning in Zimbabwe, available services, community-based distribution, contraceptive use, and program problems. Family planning services were first available in Zimbabwe in 1953. The Rhodesian Family Planning Association (RFPA) was established formally in 1965. RFPA distributed contraceptives in 1966 and trained for the first time "field educators" in 1967. The first community-based distributors were trained in 1972. The Ministry of Health integrated the RFPA into its department in 1981. In 1985, the family planning association became a parastatal and was renamed the Zimbabwe National Family Planning Council (ZNFPC). Services today are provided through 37 family planning clinics. The distribution of contraceptives includes IUDs, condoms, pills, and injectables. Harare and Bulawayo centers receive referrals and perform tubal ligation, vasectomy, and infertility counseling. 700 community-based distributors (CBDs) received a 6-week training course in order to educate about oral contraceptives, encourage their use, and screen clients for high blood pressure and side effects for oral contraceptives. CBDs use bicycles to make home visits and also have access to motorcycles. Each CBD averages 135 clients/month. Most visits are revisits. CBDs provided 25.3% of family planning in 1988. Local clinics provided 19.1% of family planning. Ministry of Health facilities provided 14.8% of services. ZNFPC clinics provided 13.7% of services. Private doctors or pharmacies provided 2.3% of services. 38% of women currently in a union used family planning in 1984, and 43% used it in 1988. 36% in 1988 used modern methods. The pill was the most common method, followed by withdrawal. Logistics of supplies and equipment remain problematic.     

Case of ischemic colitis in a young adolescent associated with triphasic hormonal contraceptive therapy: a case report and review of the literature

There has been speculation that third generation hormonal contraceptives may be less prone to inducing clotting than the earlier generation products. We present a case of colonic ischemia in a young adolescent receiving pharmacotherapy with a third-generation hormonal contraceptive. Ischemic colitis is an uncommon adverse effect in young adolescents associated with hormonal contraception, especially the third generation agents. We believe this case to be the second-youngest patient reported with ischemic colitis due to this therapy. Clinical vigilance is recommended for women presenting with abdominal pain, with or without hematochezia, who are receiving hormonal contraceptive therapy. Since their introduction in the early 1960's, the combination hormonal contraceptives have been utilized by millions of women for both contraceptive and non-contraceptive purposes. Although a variety of adverse effects can be experienced by individuals taking these agents, it has been demonstrated that these agents are associated with an increased risk of venous and arterial thromboses. Publications more consistently report on the cardiovascular-, pulmonary-, peripheral vascular-, or cerebrovascular-based thrombotic events associated with these agents. During the past several decades changes have been incorporated in the dose and types of compounds included in the combination hormonal contraceptive products in an attempt to reduce the risk of coagulation and other adverse effects. Less common and less frequently publicized are the gastrointestinal-based thrombotic events that result in ischemia and presents as severe abdominal pain, with or without hematochezia. We report an uncommon case of reversible colonic ischemia in who we believe to be the second-youngest adolescent female reported in the literature (youngest aged 16 years) to have this diagnosis associated with the use of a newer, third-generation oral combination hormonal contraceptive (Naranjo scale of 7; Probable).     

Family planning and public health in Georgia: an enlarged commitment

County clinics reached an estimated 4% of eligible women in 1964 in Georgia. Continuing high crude birth rate showed a large gap between those eligible and interested and those, particularly nonwhites, being served. Although family planning was offered in 133 of 157 counties, the statewide postpartum return rate was only 24% in 1963-4. The maternal mortality rate in Georgia in 1964 was 5.7/10000. Of the 57 maternal deaths, 14 were associated with abortion and 15 with parities of 5 or more. Infant mortality rates were also higher than national figures, 29.2/1000. In November, 1974 State Health Department officials and prominent doctors reorganized the program to offer newer, more modern methods, e.g. oral contraceptives and IUDs, summarized the terms of state subsidization, and enabled clinics to consider systematically all the medical requirements for use of modern methods. Because of cost efficiency and ease of use, the IUD was the mainstay of the program. County acceptance increased steadily since June 1965. By 1966, 96 counties had plans for expanding services. By the end of 1965, 2434 devices were inserted, 832 women accepted oral contraceptives, and 4649 women were using traditional methods.     

湖北省农村已婚育龄妇女避孕知情选择现况调查

目的 :了解农村已婚育龄妇女避孕方法的使用情况及知情选择情况。方法 :采用分层整群多阶段抽样的方法 ,以统一调查表 ,由统一培训的专业技术人员对丘陵、平原、山区 1万名农村已婚育龄妇女避孕方法的使用情况及其知情选择情况进行调查。结果 :①宫内节育器和妇女节育术 2种方法占农村已婚育龄妇女现用避孕方法的 91 .79% ,避孕套、避孕药、皮埋、男性节育术等方法仅占 8.2 1 %。②已婚育龄妇女避孕方法的选择只有 39.92 %是自主选择 ,6 0 .0 8%是计生人员建议和政策规定。结论 :计划生育服务提供者和计划生育系统应进一步加强在避孕知识宣传中的作用 ,帮助农村育龄妇女实现知情选择