Contraceptive use and sterilization among Puerto Rican women.

A comparison of contraceptive use in the early to mid-1980s among married Puerto Rican women aged 15-49 in the New York City area reveals that island-born Puerto Rican women living in New York rely on female sterilization to nearly the same extent as do women living in Puerto Rico (45% and 41%, respectively) and that mainland-born Puerto Rican women use sterilization as much as do all women in the United States (19% for both groups). Puerto Rican women in New York use reversible methods to a greater extent than do women in Puerto Rico (22% v. 16%), but to a lesser extent than do all women in the United States (37%). Although mainland-born Puerto Rican women in New York use reversible methods more than do island-born women in New York (42% v. 23%), they tend not to adopt these methods to the same extent as do all U.S. women during the early reproductive years, when education and employment are critical to socioeconomic attainment.     

Contraceptive sterilization use among married men in the United States: results from the male sample of the National Survey of Family Growth

Background

Surgical sterilization has many advantages. Previous information on prevalence and correlates was based on surveys of women.

Study Design

We estimated the prevalence of vasectomy and tubal ligation of partners for male participants in the 2002 National Survey of Family Growth, a nationally representative survey of US residents aged 15-44 years. We identified factors associated with sterilizations using bivariate and multivariate techniques.

Results

The findings revealed that 13.3% of married men reported having had a vasectomy and 13.8% reported tubal sterilization in their partners. Vasectomy increased with older age and greater number of biological children, non-Hispanic white ethnicity, having ever gone to a family planning clinic. Tubal sterilization use was more likely among men who had not attended college, those of older age and those with live births.

Discussion

One in eight married men reported having vasectomies. Men who rely on vasectomies have a somewhat different profile than those whose partners have had tubal sterilizations.     

Mortality among married older adults in the suburbs of Beirut: estimates from offspring data

OBJECTIVE: Countries in transition are characterized generally by poor statistical infrastructures and a dearth of vital information. In this study we use offspring data to examine mortality trends in married older men and women through a multipurpose household survey conducted in 2002 in the suburbs of Beirut, Lebanon. The country had been ravaged by war for almost 16 years. METHODS: A random sample of 1520 respondents, with either or both parents surviving their 65th birthday, provided information on 1172 fathers and 1108 mothers. Age- and sex-specific mortality rates per 1000 person-years were estimated. Using log-linear Poisson regression, mortality risk was examined for three birth cohorts: those reaching age 65 before (pre-1975), during (1975-1990) and after (post-1990) hostilities in the country. FINDINGS: A total of 1037 parental deaths were reported, yielding an overall mortality rate of 48.7 per 1000 person-years (51.4 among males and 45.3 among females). Compared to the pre-1975 cohort, older adults reaching age 65 during the war years, 1975-1990, had the highest mortality risk for both males (rate ratio, RR = 1.48, 95% confidence intervals, CI = 1.07-2.04) and females (RR = 1.22, 95% CI = 0.95-1.58). Mortality risk was significantly higher in males than females, a gender differential notably largest in the 1975-1990 cohort. CONCLUSION: This is the first population-based study in Lebanon to quantify patterns of mortality in cohorts of married older adults. The results suggest that the hostilities may have contributed to decreased survival, particularly among males. The approach used in the study presents a viable option for testing in larger surveys and population censuses in countries that lack reliable statistical infrastructures.     

Contraceptive knowledge, attitudes and practice among married women in Samaru community, Zaria, Nigeria

Contraceptive use and fertility rates vary substantially among developing countries. In some sub-Saharan African countries, fewer than 10% of married women use contraception. Despite all efforts by governments to ensure availability of the products, prevalence has remained low. We conducted a community-based study to examine contraceptive knowledge, attitude and practice of family planning among married women in Samaru, Zaria, Nigeria. Multi-stage random sampling technique was used to study 200 women in Samaru community of Zaria, Nigeria. Mean age of the respondents was 30.6 +/- 1.5 years. In this study contraceptive prevalence was 12.5% and respondents had a positive attitude towards family planning. Thirty years after Alma Ata of which one of the components is to ensure maternal and child health (MCH) and family planning, contraceptive use in most of the communities in Northern Nigeria is low. There is urgent need to step-up public awareness campaigns on family planning to ensure wide spread acceptability and utilization among women within reproductive age group.     

Condom use and HIV risk behaviors among U.S. adults: data from a national survey

CONTEXT: How much condom use among U.S. adults varies by type of partner or by risk behavior is unclear. Knowledge of such differentials would aid in evaluating the progress being made toward goals for levels of condom use as part of the Healthy People 2000 initiative. METHODS: Data were analyzed from the 1996 National Household Survey of Drug Abuse, an annual household-based probability sample of the noninstitutionalized population aged 12 and older that measures the use of illicit drugs, alcohol and tobacco. The personal behaviors module included 25 questions covering sexual activity in the past year, frequency of condom use in the past year, circumstances of the last sexual encounter and HIV testing. RESULTS: Sixty-two percent of adults reported using a condom at last intercourse outside of an ongoing relationship, while only 19% reported using condoms when the most recent intercourse occurred within a steady relationship. Within ongoing relationships, condom use was highest among respondents who were younger, black, of lower income and from large metropolitan areas. Forty percent of unmarried adults used a condom at last sex, compared with the health objective of 50% for the year 2000. Forty percent of injecting drug users used condoms at last intercourse, compared with the 60% condom use objective for high-risk individuals. Significantly, persons at increased risk for HIV because of their sexual behavior or drug use were not more likely to use condoms than were persons not at increased risk; only 22% used condoms during last intercourse within an ongoing relationship. CONCLUSIONS: Substantial progress has been made toward national goals for increasing condom use. The rates of condom use by individuals at high risk of HIV need to be increased, however, particularly condom use with a steady partner.     

Induced abortion and sterilization among women who became mothers as adolescents.

Four cohorts of urban women who delivered a child before reaching age 18 were followed for periods ranging from 6 to 12 years to determine use of abortion and sterilization. The two more recent cohorts had been served by comprehensive service programs. About 40 per cent of each of teh groups used abortion or sterilization to control fertility. Most of the women seeking abortion had no subsequent term or near term deliveries, suggesting that such a request may signal a desire to terminate childbearing, at least for a few years. A high proportion of the young mothers obtained abortions during the second trimister, even for repeat abortion.     

HIV risks among women who are married to men who have sex with men in India: a qualitative investigation

In countries such as India, men who have same-sex partnerships may marry women due to cultural pressures regardless of their sexual desires and preferences. The wives of such men may be at risk for HIV but limited existing research addresses this issue. This qualitative study used in-depth interviews to investigate HIV-related risk among married men who have sex with men (n = 34) and women who were aware of their husband’s same-sex behaviour (n = 13) from six research sites in five states and a Union Territory in India: Delhi (Delhi), Visakhapatnam (Andhra Pradesh), Hyderabad (Telangana), Bengaluru (Karnataka), Chennai and Madurai (Tamil Nadu). Thematic analysis revealed that wives of men who have sex with men were at risk for HIV from their husbands’ sexual practices, which are often hidden to avoid the potential consequences of stigmatisation, as well as from gender-based inequities that make husbands the primary decision-makers about sex and condom use, even when wives are aware of their husband’s same-sex behaviour. Innovative interventions are needed to address HIV-related risk in couples where wives remain unaware of their husband’s same-sex behaviour, and for wives who are aware but remain within these marriages.     

Comparison of contraceptive use between the Contraceptive CHOICE Project and state and national data

Background

We compared contraceptive prevalence reported in the Contraceptive CHOICE Project (CHOICE) at time of enrollment with estimates from representative surveys, the 2006–2008 National Survey of Family Growth (NSFG) and 2006 Missouri Behavioral Risk Factor Surveillance System (BRFSS).

Study design

We calculated survey weights for CHOICE participants and compared selected demographic characteristics and prevalence estimates of current contraceptive methods being used at the time of enrollment.

Results

Compared with the NSFG, CHOICE participants at the time of enrollment were less likely to be contraceptive pill users (16.1% vs. 24.0%) and more likely to use condoms (23.8% vs. 13.8%). Compared with the BRFSS, CHOICE participants were more likely to use condoms (20.4% vs. 12.9%) and withdrawal (6.6% vs. 0.4%).

Conclusion

Despite differences in sampling strategies between CHOICE and state and national surveys, the contraceptive prevalence estimates were largely similar. This information combined with the high rates of long-acting reversible contraception (LARC) use after enrollment by CHOICE particiants that have been previously reported by study participants may imply that cost and restricted access to LARC could be essential factors in the low rates of LARC use in the United States.     

Objections to tubal sterilization: What reversibility can and cannot overcome

In a study of 1074 women, 696 and 338 subjects would not seriously consider permanent and hypothetically reversible sterilization, respectively; they were asked to explain their feelings. The reason accounting for most objections to permanent sterilization (65%) was irreversibility and of the subjects who would not consider reversible sterilization or were unsure, 42.7% attributed their principal objection to unnecessary surgery, a factor at least currently intrinsic to the procedure and not readily overcome by education. Many of the remaining objections to both permanent and reversible sterilization may be amenable to change either through education or financial subsidies.In response to a question concerning female attractiveness subsequent to permanent sterilization, 3% of the sample felt attractiveness would decrease and 17.5% were unsure of the surgery's effect. Unsure responses were largely negative in character. This issue is important because of its relationship to intention to undergo sterilization. Upon consideration of reversible sterilization, negative and unsure responses significantly declined, even on the part of those women whose friends have had a poor experience with currently available procedures. Thus, whereas the option of reversibility cannot overcome objections to surgery, it does overcome those regarding permanency; moreover, the temporary character it bestows upon surgical sterilization appears to help certain individuals overcome their fears of losing their physical appeal as a result of such procedures.     

Demographic consequences, client satisfaction, and reasons for selecting sterilization among vasectomy and tubectomy clients in Bangladesh

A follow-up study of vasectomy and tubectomy clients in Bangladesh showed that the mean ages of the vasectomy clients and their wives were significantly higher than the mean ages of the tubectomy clients. These findings suggest that the number of births averted by vasectomy is less than what might be expected from tubectomy. Between 20 and 60% of the tubectomy clients stated that they (or their husbands) had previously used contraception, while only 2% of the vasectomy clients indicated that they or their wives had previously used contraception. More than 95% of the tubectomy clients, compared to less than 48% of the vasectomy clients, were satisfied about having a sterilization procedure. A large proportion of the dissatisfied vasectomy clients indicated that they had chosen vasectomy rather than some other method of contraception primarily because of financial incentives. The small percentage of dissatisfied tubectomy clients indicated that their concern was about possibly having a child die and not being able to replace that child.

Further differences in the perceived satisfaction among vasectomy compared to tubectomy clients is evidenced by the fact that less than 30% of the vasectomy clients, compared to more than 70% of the tubectomy clients, indicated that they had recommended the procedure to another man (woman). While more than 80% of the tubectomy clients cited themselves, their husbands or a close family member as the most influential person in their decision to have a tubectomy, the vasectomy clients never mentioned their wives, rarely another family member, and in less than half the cases themselves.

This study suggests that client satisfaction with tubectomy in Bangladesh can be attributed to the desire of tubectomy clients to terminate childbearing. The positive responses of tubectomy clients appear to be consistent in spite of urban-rural, religious, and socioeconomic differences, as measured by education of the clients and their husbands' occupation. On the other hand, the lack of satisfaction of the vasectomy clients can be attributed in part to the use of the incentive system, causing recruitment of clients who were not primarily motivated by a desire to terminate childbearing, nor apparently in need of sterilization based on their limited reproductive potential.     

Body weight and mortality among adults who never smoked

In a 12-year prospective study, the authors examined the relation between body mass index (BMI) and mortality among the 20,346 middle-aged (25-54 years) and older (55-84 years) non-Hispanic white cohort members of the Adventist Health Study (California, 1976-1988) who had never smoked cigarettes and had no history of coronary heart disease, cancer, or stroke. In analyses that accounted for putative indicators (weight change relative to 17 years before baseline, death during early follow-up) of pre-existing illness, the authors found a direct positive relation between BMI and all-cause mortality among middle-aged men (minimum risk at BMI (kg/m2) 15-22.3, older men (minimum risk at BMI 13.5-22.3), middle-aged women (minimum risk at BMI 13.9-20.6), and older women who had undergone postmenopausal hormone replacement (minimum risk at BMI 13.4-20.6). Among older women who had not undergone postmenopausal hormone replacement, the authors found a J-shaped relation (minimum risk at BMI 20.7-27.4) in which BMI <20.7 was associated with a twofold increase in mortality risk (hazard ratio (HR) = 2.2, 95% confidence interval (CI) 1.3, 3.5) that was primarily due to cardiovascular and respiratory disease. These findings not only identify adiposity as a risk factor among adults, but also raise the possibility that very lean older women can experience an increased mortality risk that may be due to their lower levels of adipose tissue-derived estrogen.     

Timing of postpartum tubal sterilization using the Filshie clips: an analysis of data from two developing-country centers

Two-hundred-ninety-seven women at a Panamanian center and 148 women at a Philippine center had their tubal sterilization performed during their postpartum hospital stay after an uncomplicated vaginal delivery of a live birth. The sterilizations were all performed with the use of the Filshie clip via minilaparotomy. The timing of the sterilization varied from two hours to six days after delivery. At each of the two centers, women sterilized within 48 hours after delivery were compared with those sterilized at 49 or more hours with respect to surgical difficulties, tubal injuries, complications/complaints, technical failures and lengths of hospitalization after sterilization and before discharge. The one-year gross cumulative pregnancy rates were also compared. No significant differences were detected in any of the above outcome variables between the two timing groups at each center. While the data suggest that tubal sterilizations by the Filshie clip performed two to six days following childbirth are as safe and effective as those performed within 48 hours of delivery, further studies are urged.     

The influence of a vasectomy on the marital relationship and sexual satisfaction of the married man

The purpose of this study was to determine whether a vasectomy had any effect on important aspects of a marriage, such as sexual satisfaction, marital satisfaction, communication, and frequency of sexual intercourse. An experimental research design was used. We collected data by means of a biographical questionnaire, the Enriching & Nurturing Relationship Issues, Communications & Happiness questionnaire (Olson et al., 1985), and the Index of Sexual Satisfaction (Fischer & Corcoran, 1990), which were applied prior to and 5 months after the vasectomy. Results indicated no significant difference between the before and after measurements regarding sexual satisfaction, marital satisfaction, communication, and frequency of sexual intercourse.     

Counseling women who request sterilization: psychodynamic issues and interventions

With large numbers of women seeking sterilization each year, including over half a million in 1983 alone, the problem of regretted sterilization and efforts to prevent regret have become matters of concern to health care providers. This paper describes a sterilization counseling program designed to reduce the likelihood of regretted sterilization. Discussed are factors which help predict satisfaction or regret following sterilization. A psychodynamic approach to sterilization counseling informed by these factors is described. Case vignettes are included, as is a retrospective analysis of candidates counseled during one year of the program.     

已婚妇女现在避孕方法使用情况及其续用意愿调查

目的:了解我国已婚妇女现在避孕方法的使用情况及其续用意愿,并分析其影响因素。方法:采用分层、三阶段与规模成正比的容量比例抽样方法获得调查对象,由调查员入户对抽中的已婚育龄妇女进行面对面的问卷调查。现场调查时间为2005年11～12月。结果:总的来讲,已婚育龄妇女中现在避孕率为84.5%。现在避孕方法构成中,宫内节育器所占比例最高(51.8%),避孕套的比例较低(13.1%)。现在避孕的妇女中,对现用避孕方法的满意度为82.2%,对宫内节育器的满意度为83.9%,对避孕套的满意度为80.4%。避孕方法总的续用意愿比例为69.1%,愿意续用宫内节育器的比例最高(83.6%),避孕套的续用比例为68.2%。续用意愿较差的方法中,大多数人在重新选择时选择了宫内节育器。因素分析结果显示,避孕方法的续用情况主要受方法本身及其使用满意度情况的影响。结论:在我国,育龄人群的避孕服务利用情况已经取得了巨大的进步,今后计划生育工作的重点应该在于进一步提高避孕服务的质量,加强男性参与的宣传,促进育龄人群避孕套的进一步使用。     

Pregnancy rates among Chilean women who had non-surgical sterilization with quinacrine pellets between 1977 and 1989

We describe cumulative pregnancy probabilities among women who underwent quinacrine pellet sterilization in Chile between 1977 and 1989 (N = 1492). We interviewed the women or relatives in 1991–93 and 1994–96, and reviewed hospital records. Mean follow-up was 9.6 years (median 9 years). We recorded 120 pregnancies, including 40 that went to term or near-term. There were nine adverse outcomes in eight infants: one fetal death at 18 weeks gestation; three infants born prematurely; one stillbirth (placental infarct); and four infants with birth defects. There was no clustering of any particular kind of birth defect. For two insertions, the 10-year cumulative pregnancy probability was 8.9 (95% confidence interval 3.7, 14.1). For 3 insertions, the 10-year rate was 7.0 (4.4, 9.5). For women who were under 35 years at insertion, the 10-year rate was 10.7 (7.4, 14.1). For women who were 35 or older at insertion, the 10-year rate was 3.1 (0.6, 5.7). The pregnancy rate varied little for 2 vs. three insertions, but the rate did vary significantly by age, with women who received quinacrine at 35 years or older 0.3 (0.2, 0.5) times as likely to become pregnant as younger women. The 10-year cumulative ectopic pregnancy probabilities for women with two and three insertions of quinacrine were 0.9 (<0.1, 2.6) and 0.5 (<0.1, 1.2), respectively. Pregnancy rates after quinacrine insertion are higher than after surgical sterilization, but ectopic pregnancy rates appear similar.