Women and contraception: knowledge and use of contraceptive methods

This article analyzes knowledge and use of contraceptive methods in women ages 10 to 49 years residing in the southern region of the city of S?o Paulo in 1992. A total of 1,157 childbearing-age women were studied, focusing on variables that might define them as to: knowledge in the use of contraceptive methods and reasons for choosing a given method. We observed that 86% of the women referred knowledge of some contraceptive method, while the most common was the pill (95.3%), followed by condoms (92.6%). Meanwhile, 14% of the interviewees denied knowledge of any contraceptive method. Of the sexually active women (66.4%), 34.9% reported never having used contraceptive methods. Of those who had, 35.3% used the pill, while 42.9% had resorted to sterilization. Only 5.2% used condoms. Despite the high level of knowledge concerning contraceptive methods, especially oral contraceptives and condoms, we observed limited use of same as compared to the high sterilization rate around the age of 27, thus leaving contraception limited to the pill and female sterilization.     

四种常用避孕措施对妇女宫颈细胞学检查结果的影响分析

目的对官内节育器、避孕套、口服避孕药、绝育术4种常用避孕措施的已婚妇女进行宫颈细胞学检查,探讨较理想的避孕方法,提高避孕效果,减少宫颈炎的发生率。方法选择2011年江苏省已婚妇女宫颈癌筛查项目中健康育龄妇女1941例,根据避孕方法分为4组,宫内节育器避孕组、屏障法避孕组、口服避孕药避孕组和绝育术避孕组;采用巴氏涂片染色方法和TBS行宫颈细胞学诊断。结果宫颈细胞学检查≥ASC．US病变的发生率从高到低依次为绝育术避孕组、口服避孕药避孕组、宫内节育器避孕组和屏障法避孕组,分别为7．3％、6．3％、5．4％和2．2％,但差异无统计学意义。结论口服避孕药和绝育术与宫颈细胞学阳性改变有一定相关性;使用宫内节育器和避孕套避孕组炎性反应性改变率略高。     

Women's satisfaction with birth control: a population survey of physical and psychological effects of oral contraceptives, intrauterine devices, condoms, natural family planning, and sterilization among 1466 women.

User satisfaction and the physical and psychological effects of five commonly used contraceptive methods were investigated in a population survey among 1466 West German women. The focus was on effects attributed by current and past users to these methods, rather than objectively assessed effects, to shed further light on personal experiences that are highly relevant to the user but often remain unknown to prescribers and unreported in the medical literature. Within the overall sample, 1303 women were surveyed concerning their current or past use of oral contraceptives (OC), 996 regarding condoms, 342 with respect to intrauterine devices (IUD), 428 in regard to natural family planning (NFP), and 139 in relation to sterilization (respondents completed questions about each method used). It emerged that satisfaction was greatest with sterilization (92% of users), followed by OC (68% of ever users), IUD (59%), NFP (43%), and condoms (30%). Almost one in three NFP users had experienced an unwanted pregnancy during use of this method, as compared with one in 20 OC and condom users. The majority of users reported no mood changes during use of the methods studied. The percentages reporting negative mood changes (various items were scored) were up to 16% among OC users, 23% among condom users, and 30% among NFP users. The latter observations suggested that subjective side effects of a contraceptive agent on mood generally reflected, at least in part, the user's sense of confidence in the method concerned (notably, with regard to efficacy and safety). Oral contraceptives, IUD, and sterilization had a broadly positive impact on sex life, whereas that of condoms was often negative. Whereas OC users often reported less heavy and painful menstruation (in up to 56% of cases), IUD were associated with heavier, prolonged, and more painful menstruation (in up to 65% of cases), as also was sterilization, although to a lesser extent (in up to 32% of cases). Overall, the study findings indicated that OC and sterilization had less negative impact on physical and psychological functioning than the other methods studied, in contrast to what the general public often believes.     

Use of contraceptive methods by sexually active women in São Leopoldo, Rio Grande do Sul, Brazil

In 2003, a population-based cross-sectional study was conducted in the urban area of S?o Leopoldo, Rio Grande do Sul, Brazil. The sample included 867 sexually active women from 20 to 60 years of age. The objective was to describe the use of contraceptive methods. Data were collected using a standardized questionnaire. The study analyzed the prevalence of contraceptive use and socioeconomic variables in women reporting an active sex life (84.5%), stratified by age groups. Some 627 (61.1%) women reported use of contraceptive methods. In the 20-49-year old group, 48.8% reported using oral contraceptives, 18.7% tubal ligation, 17.3% condoms, and 7.3% IUDs. In the 50-60-year old group, the most widely used method was tubal ligation (79.6%). Regarding tubal ligation, the schooling variable showed a linear trend, that is, women with less schooling showed a higher prevalence. Prevalence of oral contraception was higher in low-income women.     

Trends in Family Planning in Russia, 1994–2003

CONTEXT: Although Russian women have adequate knowledge of modern contraceptives, their level of use of these methods has been low, and abortion rates remain relatively high.
METHODS: In 1994–2003, sexually active women aged 18–49 were interviewed about their contraceptive use as part of the Russia Longitudinal Monitoring Survey. Trends in contraceptive use were examined. Multivariate analyses were conducted to identify characteristics associated with reliable contraceptive use (IUD use or consistent oral contraceptive use) in 1994 and 2003.
RESULTS: In each year, about 25% of sexually active women had used no contraceptive method in the past month, and 20% had used traditional methods. Prevalence of barrier method use increased from 9% to 21% between 1994 and 2003, while that of IUD use declined from 34% to 21%. These changes were especially pronounced in Moscow and St. Petersburg, and among younger women. Common reasons for nonuse were irregular sexual relations (cited by 29% of nonusers in 2003), desire for pregnancy (22%), perceived inability to get pregnant (15%), feeling that contraceptives are uncomfortable or unpleasant (15%), health problems (11%) and the availability of abortion (6%). In 1994 and 2003, the odds of reliable contraceptive use were elevated among women with at least a secondary education (odds ratios, 1.5–1.7), and were reduced among smokers (0.6–0.7).
CONCLUSIONS: Modern, effective contraceptive use has not increased among sexually active Russian women. Growing use of barrier contraceptives may reflect HIV awareness. Obstacles to effective contraceptive use, such as attitudes and health service factors, need further clarification.     

Contraceptive Use and Abortion Among Women Of Reproductive Age in St. Petersburg, Russia

CONTEXT: Although the characteristics associated with contraceptive use among Russian women have been studied, no large-scale research has been conducted on women's use of different contraceptive methods and abortion.
METHODS: A random sample of 1,147 women aged 18–44 completed questionnaires at local women's clinics in St. Petersburg in 2003–2004. Chi-square tests were used to examine differences in selected characteristics among age-groups, and logistic regression was used to assess associations between these characteristics and the use of contraceptive methods at last intercourse and abortion history.
RESULTS: Among women at risk of unintended pregnancy, six in 10 had used reliable contraceptives (the pill, the IUD or condoms) at last intercourse; 42% had used condoms. Women in the middle income level were more likely than women with lower income to have used the pill (odds ratio, 2.1); cohabiting women and those who had had children had lowered odds of using condoms (0.6 and 0.3–0.5, respectively). More than half of those surveyed reported having had an abortion. Characteristics associated with increased odds of having had an abortion included being 25 or older (2.2–3.5), cohabiting (2.9), having high income (1.7), having experienced first intercourse before turning 18 (2.2) and having used no contraceptive method at first sex (1.5). The factor that was most strongly associated with abortion was a woman's number of births (4.9–5.7).
CONCLUSIONS: Educational programs that promote the consistent use of condoms, especially among young women, and family planning programs that reduce financial barriers to contraceptive use, are critically needed in Russia.     

Contraceptive patterns among women and men in León, Nicaragua

The aim was to study the contraceptive patterns among men and women in León, Nicaragua. A questionnaire about sexual, contraceptive, reproductive and socioeconomic issues was directed to 7,789 households including 22% of all women of the municipality aged 15–49 years (n = 10,867). A subsample of 388 men and 413 women aged 15–49 years was drawn at random. Refusals were less than 2%. Private interviews revealed that among fertile women who had been sexually active within the last three months, non-pregnant and wishing to avoid pregnancy, 77% were contracepting. Female sterilization was the most common contraceptive method (39%), followed by intrauterine device (16%). Even though around 60% of women at some time had tried oral contraceptives, only 13% of contraceptors used them currently. The rhythm and interruption methods together constituted only 4%. Condom use was low and mainly occasional. Contraceptive use in sexually active women aged 15–44 years was lower among those having lower education, living in rural areas, and living under poverty conditions. The predominance of female sterilization and the occasional condom use—mainly reported by men—reflects a situation of relative male control over contraception and reproduction. This probably originates from “machista” values where men having many children with different women are considered strong. There was also a significantly higher use of contraceptives among the better-off women and men compared with the extremely poor. The situation of many poor women, in a country with limited contraceptive services, is worrving considering that abortion is illegal and the threat of HIV epidemic is growing. The situation for adolescents is particularly problematic with low experience in contraceptive use.     

Vaginal wetness: an underestimated problem experienced by progestogen injectable contraceptive users in South Africa

This paper reports on the common experience of vaginal wetness amongst South African users of progestogen-only injectable contraceptives. The observations emerged in the course of a community-based cross-sectional household survey undertaken in a rural district of KwaZulu-Natal in South Africa. The purpose of the survey was to elicit self-reporting on side effects of injectable contraceptive methods. Eight hundred and forty-eight women aged 15-49 were interviewed and 22.1% reported current use of an injectable contraceptive method, either depot medroxyprogesterone acetate (Depo-Provera) or norethisterone oenanthate (Nur-Isterate). Other modern methods used were oral hormonal contraceptives (4.5%), male condoms (1.3%), the intrauterine device (0.1%), and tubal ligation (0.1%). Vaginal wetness was reported by 18.4% of users and was one of the most common side effects, second only to amenorrhoea (62.5%). It was also what 17.5% of the women liked least about using this method. According to almost half the respondents, men regard women who use the injectable contraceptive as "wet", "cold" and/or "tasteless". These survey findings were supported by participants of 14 focus group interviews held in the sub-district. Since some South African men may prefer dry sex the perception that the injectable contraceptive increases vaginal wetness may be problematic for women who use it. Whilst vaginal wetness can only be classified as a subjective side effect at this stage, further investigations are needed as many South African women opt to use this method.     

上海市闵行区流动人口避孕情况及影响因素分析

目的：了解上海市闵行区流动人口的避孕现状及其影响因素,为以后的避孕节育相关干预研究提供依据。方法：应用流行病学横断面调查的研究方法,对符合入选标准的流动人口进行结构式问卷调查,主要调查研究对象的基本人口学信息、避孕方法的使用情况及相关的避孕知识等。结果：本次调查的1 414名有过性行为的流动人口中,目前避孕措施使用率为91.94%（1 300人）。其中宫内节育器占到51.08%,其次是男用避孕套（25.00%）,结扎（17.15%）,口服避孕药（3.69%）。与18～24岁的对象相比,年龄在30～34岁,35～39岁,40～44岁以及≥45岁的研究对象的避孕措施使用率较高（OR分别为2.16, 6.67, 2.47和2.84）。与家庭月收入低于500元的对象相比,收入越高的对象,其目前采取避孕的比例就越高（500元~、1 000元~、2 000元~、≥3 000元组的OR分别为2.19,3.11,2.32和3.18）;与避孕节育知识得分≤16分的对象相比,得分为17～31分以及得分≥49分的研究对象避孕措施的使用率较高（OR分别为2.46和2.32）。结论：研究对象避孕方法的使用和选择受到年龄、婚姻状况、经济状况、避孕知识等多方面因素的影响,以后应继续加强流动人口避孕节育知识的宣传和教育,要把经济收入低、文化程度低和避孕节育知识薄弱的流动人口作为重点干预人群。     

人工流产后避孕指导服务效果的研究

目的：评价人工流产后避孕指导服务对降低再次人工流产和妇科疾病的作用。方法：选择2011年1月—2013年1月因意外妊娠而自愿接受人工流产并患有妇科炎症的900例妇女作为研究对象,观察组患者接受流产后避孕指导服务,对照组未接受流产后避孕指导服务。术后电话随访1年,调查2组避孕措施选择的不同,比较重复人工流产率及对妇科疾病的影响。结果：观察组和对照组人工流产术后选择的避孕措施排在前2位的均是宫内节育器和男用避孕套。观察组选择用男用避孕套率低于对照组,差异有统计学意义（χ2=28.145,P＜0.01）,而对于口服避孕药和体外排精,对照组的选择率大于观察组（P＜0.05）。观察组发生重复流产者81例（19.29%）,而对照组发生重复流产者149例（30.63%）,差异有统计学意义（χ2=15.22,P＜0.01）。观察组与对照组重复流产的原因如下,宫内节育器失败、避孕药失败、男用避孕套失败、安全期避孕、体外排精、未避孕。通过多因素Logistic回归分析结果得出,安全期避孕、未避孕、体外排精是重复流产者避孕失败的独立危险因素。结论：人工流产后避孕指导服务可使流产后妇女选择有效的避孕方法,降低妇科疾病的风险,减少再次非意愿妊娠和重复性人工流产。     

Protecting against both pregnancy and disease: predictors of dual method use among a sample of women

Although male condoms are the best form of protection against HIV/STDs, they are not the most effective method for preventing unintended pregnancy. Consequently, use of condoms and a highly effective contraceptive-referred to as dual use-is recommended as the optimal protection against both disease and pregnancy. However, little is known about the factors that promote dual use. This study examined associations of dual method use with women's background characteristics, intrapersonal factors, and relationship characteristics. Data are from a random sample of women selected from a large managed care organization in the Pacific Northwest. The analytic sample contained 371 women who completed a telephone survey and reported use of contraceptives in the past 3 months. Three mutually exclusive method use groups were constructed: effective contraceptive only (hormonal methods, intrauterine device, surgical sterilization) (59%), condom only (24%), and dual use (18%). Variables hypothesized to influence dual use were compared across the three groups in bivariate and multivariate analyses. Findings indicate that women who were younger, reported more than one sexual partner in the past year, and were highly motivated to avoid HIV/STDs--were more likely to use dual methods rather than condoms only or an effective contraceptive method. Women confident about using condoms without feeling embarrassed or breaking the sexual mood were more likely to use dual methods rather than a single effective method. Finally, women with confidence in their ability to use condoms correctly are more likely to rely solely on condoms. Policy and practice implications are discussed.     

Family planning, sexually transmitted diseases and contraceptive choice: a literature update--Part I.

Couples who use contraceptives not only protect themselves against unwanted pregnancies, but also may reduce their risk of becoming infected with a sexually transmitted disease (STD). No currently available method, however, is highly effective in protecting simultaneously against pregnancy and infection. Thus, couples who place high priority on minimizing both risks may have to use two methods. The need for contraceptive methods that provide effective protection against both pregnancy and STDs has been intensified by the HIV epidemic, but progress has been slowed by the lack of integration between the STD and family planning fields. The first part of this two-part article discusses the similarities and differences between the two fields, examines the impact of STDs on contraceptive use and services, and reviews the scientific literature dealing with the effects of condoms, spermicides and barrier-and-spermicide methods on the risk of STD transmission. Part II (which will appear in the next issue) examines what is known about the effects of oral contraceptives, the IUD, tubal sterilization and abortion on reproductive tract infections. The second part also includes a discussion of the trade-offs involved in choosing a contraceptive and presents estimates of the first-year rates of unplanned pregnancy and gonorrhea infection (given an infected partner) that would occur among women using various contraceptive methods.     

深圳市龙岗区流动人口非意愿性妊娠女性避孕知识测试问卷分析

目的分析流动人口非意愿性妊娠女性避孕知识情况及其影响因素。方法选择2005年10月—2006年12月间深圳市龙岗区非意愿性妊娠女性480例,随机分为回顾性问卷组和相关性问卷组,采用自填式问卷的方式进行调查。结果回顾性问卷组的育龄女性在避孕方法的了解上与相关性问卷组中接受避孕知识指导前的育龄妇女相比,有统计学意义(χ2=19.175,P0.01)。回顾性问卷组知晓率最高的避孕方法依次为宫内节育器、避孕套和口服避孕药。接受避孕知识指导后,相关性问卷组知晓率最高的避孕方法依次为宫内节育器、口服避孕药和女性绝育术(P0.01)。接受避孕知识指导后,相关性问卷组中对意外妊娠风险及人流并发症的知晓率为95.6%,要高于回顾性问卷组(χ2=36.341,P0.01);有92.7%的育龄女性知道知情选择,与回顾性组22.8%的知晓率相比,有显著性差异(χ2=242.017,P0.01)。不了解有多种避孕药方法、认为副作用较大和认为偶尔不避孕也不会怀孕在影响避孕行为的因素中占有较大比例,是影响避孕行为的主要因素。结论加强对避孕知识和人工流产危害性的宣传,提高避孕服务的可及性和可得性,有助于提高育龄女性自我保健能力及生殖健康水平,有效地降低非意愿性妊娠的发生。     

Contraceptive knowledge and attitudes among 14–24‐year‐olds in New South Wales,Australia

Objectives: To investigate correlates of contraceptive knowledge and attitudes and describe differences in contraceptive knowledge by contraceptive category among young people in New South Wales. Methods: A total of 119 young people aged 14 to 24, recruited from youth centres, completed a contraceptive knowledge and attitude survey. Results: Overall contraceptive knowledge was low. Females had significantly better knowledge than males. There was high knowledge about condoms and withdrawal and low knowledge about shorter‐term hormonal methods (oral contraceptive pill and vaginal ring) and long‐acting reversible contraceptive (LARC) methods. Nearly half of respondents agreed that ‘contraceptives make sex seem less romantic’, while 58% agreed that ‘contraceptives are difficult to use’. Despite this, both genders had positive attitudes to contraception, with females’ attitudes significantly more positive than males. Conclusions and implications: While young people, particularly young women, expressed attitudes conducive to contraceptive use, many are unaware of basic facts about methods, including highly effective LARC. Our findings reflect the modest reproductive and sexual health education received by Australian young people and cultural norms of condoms and oral contraceptives as default methods and highlight the need to improve knowledge, among young men, in particular, about the most effective contraceptive methods.     

Attitudes toward contraceptive methods among African-American men and women: similarities and differences.

PURPOSE: Men's attitudes toward contraceptives are an understudied area, even though many men participate in contraceptive decision making. The purpose of this study was to examine attitudes and perceptions regarding a selection of contraceptive methods among a national sample of African Americans, with a particular focus on gender differences. METHODS: Data come from a telephone survey of African Americans (aged 15-44 years) living in the contiguous United States. For the present analyses, the sample was restricted to 152 men and 281 women who reported having had a sexual partner of the opposite gender at some point in their lives. Bivariate analyses compared men and women's ratings of birth control pills, male condoms, female condoms, Norplant, Depo Provera, female sterilization, and male sterilization along several dimensions: bad/good, harmful/beneficial, difficult/easy, dangerous/safe, immoral/moral, and effectiveness. Multiple logistic regressions were performed to determine the association between gender and contraceptive attitudes, adjusting for sociodemographic variables. RESULTS: Male condoms were given the most favorable ratings along most dimensions by both African-American men and women. In general, ratings of male condoms, female condoms, and Norplant did not significantly differ by gender. African-American men did, however, give female and male sterilization, birth control pills, and Depo Provera significantly poorer ratings than did African-American women. CONCLUSION: African-American men had less favorable evaluations of some contraceptive methods than did African-American women. Further research is needed to examine how such gender differences may play a role in contraceptive decisions.     

Trends in contraceptive patterns and behaviors during a period of fertility transition in China: 1988-2006

BackgroundThis paper explores how contraceptive patterns and behaviors changed during the course of China's population transition and a period of low fertility from 1988 to 2006.Study DesignBased on data from Chinese nationwide surveys of family planning and reproductive health undertaken in 1988, 1997, 2001 and 2006, this study uses a multinomial logit model to analyze changes in, regional differences in and determinants of contraceptive behaviors during this period.ResultsThe overall prevalence of contraceptive use among married women aged 15–49 years changed little during these 20 years, holding steady at about 90%. However, there were notable changes in the method mix: the predominant methods used were the long-term methods of the intrauterine device (IUD) and female sterilization, and contraceptive use gradually shifted from sterilization to IUDs and condoms. There existed a close relationship between contraceptive methods used and sociodemographic characteristics. Hans, rural, old and less educated women are more likely to use sterilization, while minorities, urban, young and educated women are more likely to use IUDs.ConclusionThere are marked changes in the method mix among different demographic groups during the course of China's population transition and a period of low fertility. The findings indicate that future works aimed at promoting reproductive health should be diverse among different populations.     

Attitude of rural women towards contraceptive and its use

This study was conducted to determine the attitudes of rural women towards contraceptive use. 500 participants (each having a child under 2 years of age) were randomly selected from 50 villages. Information was collected through questionnaires. Results revealed that most of the mothers (78.8%) had knowledge of one or more modern methods of contraception. Knowledge levels were highest for condoms (55.6%), followed closely by sterilization methods (55.4%). Knowledge of oral pills and IUDs was found among 36.6% and 33.2% of the participants, respectively. As to current usage, condoms were the most commonly used method (10.8%), followed by IUDs (5.4%), oral pills (4.4%), and sterilization (3.6%). Obstacles to their adoption of contraceptive methods were hesitation (59.6%), nonavailability of a service provider (43.2%), fear of side effects (36.6%), and customs, disbelief, or external pressure (22%). This study revealed that the status of women in Indian villages, as reflected with their problems in adopting contraceptive methods, was quite low . Thus, the Indian government is encouraged to strengthen delivery services for contraceptive methods and to make women more aware of the realities of contraceptive use.     

产后避孕的国内外指南

产后避孕方法的选择受妇女生理状态和哺乳的影响,产后即时或尽早落实常规避孕措施,对预防人工流产及其并发症有重要作用。本综述对产后避孕的国内外指南进行复习和比较,重点讨论经产妇可优先选择的宫内节育器(intrauterine contraceptive device,IUD)、雌孕激素复方和单纯孕激素避孕方法及女性绝育术在产后不同时期使用的医学标准,为临床医生在产后帮助妇女选用安全、适宜的避孕方法提供指导。     

Evaluating contraceptive choice through the method-mix approach. An Indian Council of Medical Research (ICMR) task force study

The method-mix approach was used to evaluate informed contraceptive choices in the present study. A total of 8,077 potential clients were given a balanced presentation of all available contraceptive methods in the national program, ie, the CuT 200 intrauterine device (IUD), low-dose combined oral pills (OC), condom, and sterilization (female/male) along with a new method, Norplant(R).(1) The majority of women opted for spacing methods; among them, the IUD was preferred by about 60% of clients, followed by condoms (9%), OC (6%), and Norplant (5%). Sterilization, mainly female, was accepted by about 17% of the women making an informed choice.The economic status of couples did not influence the contraceptive choices, as all the methods were offered free of cost in the present study, which is the current practice in the national program. Illiterate women more often accepted sterilization (about 25%) than did literate women (15%). This is because illiterate women had more children; about 30% of illiterate women had three or more children, as opposed to 16.2% of literate women. However, literacy status did not influence the choice of any specific spacing method. The study also revealed that, by encouraging potential clients to make an informed choice, they could override the provider's bias while accepting a particular type of spacing method. This is evident from the observation that Norplant was the first choice of the provider for 35% of the women, whereas only 5% of women preferred and accepted Norplant. The present study stresses an urgent need to promote the practice of informed choices in the national program with a variety of contraceptive options-especially, spacing methods for improving contraceptive prevalence and reproductive health in the country.