A pre-coital pill? A preliminary in vitro study

The use of the progestogen-only pill as a 'pre-coital contraceptive' was tested by in vitro studies of sperm-mucus interaction. The results suggest that a single tablet of levonorgestrel 30 microg, or norethisterone 350 microg, was effective in preventing sperm migration in the cervical mucus about 12 hours later. This suggests that the progestogen-only pill may be effective as a 'morning before pill'.     

The pill in Japan: will approval ever come?

The Japanese Ministry of Health and Welfare voted in March 1998 to indefinitely delay the licensing of oral contraceptives in Japan. Over years of attempts to gain approval of the pill for contraception, health officials have cited a range of reasons for their position against the pill, including concern over side effects, fears about the potential spread of sexually transmitted diseases if pill use replaces condom use, and worries about the environmental effects of hormonal contraceptive use. Japan is unique in banning all hormonal methods of contraception. The author describes the history of hormonal agents in Japan, from their initial approval in the country for noncontraceptive therapeutic uses in the late 1950s through the defeat in March 1998. Given the higher failure rates associated with condom use and fertility awareness, it is no wonder that abortion is rather common in Japan. Making hormonal methods of contraception available would help to prevent unwanted pregnancies. The uphill battle to legalize the low-dose pill in Japan continues.     

Conflicting advice? Australian adolescents' use of condoms or the pill.

CONTEXT: Teenagers are exposed to two potentially conflicting sexual health messages, one emphasizing the prevention of sexually transmitted diseases (STDs) and the other stressing pregnancy prevention. To protect teenagers from both STDs and unwanted pregnancy, it is important to know what method choices they make and why. METHODS: Data from a 1997 national survey of 3,550 Australian secondary school students were used to examine teenagers' method choice and patterns of advice-seeking about contraception and STD prevention. Logistic regression analyses were conducted to identify factors associated with the exclusive use of condoms or the pill. RESULTS: Virtually all 961 currently sexually active students were using at least one contraceptive method--primarily condoms (78%) or the pill (45%). Some 31% were using condoms exclusively, and 10% were using the pill exclusively. Older students and those who had sought contraceptive advice had elevated odds of using the pill rather than condoms exclusively (odds ratios, 4.4 and 2.6, respectively), while those who had had only casual partners in the last year had a reduced likelihood of exclusive pill rather than condom use (0.1). Furthermore, the more students believed that their peers used condoms, the less likely they were to report exclusive pill use (0.4). Parents were the most frequent source of advice about contraception, followed by physicians and teachers. The most common sources of advice about HIV and other STDs were parents, teachers and then physicians. CONCLUSIONS: Young people must be educated about the distinction between safer sex and contraception, and about how to prevent both STDs and pregnancy. Providing parents with current sexual health information may help to improve young people's sexual health.     

Can a pill prevent HIV? Negotiating the biomedicalisation of HIV prevention

This article examines how biomedicalisation is encountered, responded to and negotiated within and in relation to new biomedical forms of HIV prevention. We draw on exploratory focus group discussions on pre‐exposure prophylaxis (PrEP) and treatment as prevention (TasP) to examine how the processes of biomedicalisation are affected by and affect the diverse experiences of communities who have been epidemiologically framed as ‘vulnerable’ to HIV and towards whom PrEP and TasP will most likely be targeted. We found that participants were largely critical of the perceived commodification of HIV prevention as seen through PrEP, although this was in tension with the construction of being medical consumers by potential PrEP candidates. We also found how deeply entrenched forms of HIV stigma and homophobia can shape and obfuscate the consumption and management of HIV‐related knowledge. Finally, we found that rather than seeing TasP or PrEP as ‘liberating’ through reduced levels of infectiousness or risk of transmission, social and legal requirements of responsibility in relation to HIV risk reinforced unequal forms of biomedical self‐governance. Overall, we found that the stratifying processes of biomedicalisation will have significant implications in how TasP, PrEP and HIV prevention more generally are negotiated.     

The abortion pill: a solution for unsafe abortions in developing countries?

The abortion pill is a new abortion technique which does not require technically skilled health personnel. Several clinical researchers have stated that the ease of administration of the abortion pill gives it the potential to save lives in countries where thousands of women die annually from complications of failed abortions due to poor health services. This article discusses medical and users' aspects of the abortion pill, with particular emphasis on its use in developing countries, and questions the usefulness of the abortion pill in areas where health care facilities are in short supply. It stresses the need to consider the social, cultural and health care context in which the abortion pill will be used before it is sold on the world market. The safety and efficacy of the abortion pill could be adversely affected by the way women perceive its effectiveness, women's beliefs about conception and pregnancy, and their health status. In the present two-phase administration form the abortion pill is not likely to be appropriate for use in developing countries with a shortage of health care facilities.     

Are affluent, well-educated, career-orientated women knowledgeable users of the oral contraceptive pill?

OBJECTIVE: Studies have shown poor knowledge of oral contraceptives among women attending government health clinics and women in rural areas. Little is known about the level of contraceptive knowledge in educated, affluent, career-orientated women, although it could be expected that access to information would be greater. The study objective was to describe the profile, knowledge and understanding of oral contraceptive users in a private general practice in Johannesburg, South Africa. METHODS: Over a period of 3 months, all women attending a private general practice who were using an oral contraceptive were asked to complete an anonymous questionnaire. Informed written consent was obtained in all cases. RESULTS: Fifty-one women participated in the study. Most women were nulliparous (71%), held a tertiary educational qualification (80%), were employed (84%) and were not concerned about the cost of their pill (65%). Most respondents (86%) obtained their information from a doctor. However, only 12% of women were aware of the danger of extending the active pill-free interval. Less than half (49%) were aware that their pill was less effective if taken more than 12 hours late and only 31% of women knew that their pill was effective again after taking seven active tablets. CONCLUSIONS: Educated, affluent women attending a private general practice lacked basic knowledge of the oral contraceptive pill. Consultations by practitioners need to be improved.     

Simplification at last?

The HIPAA transaction standards-meant to streamline financial and administrative transactions--have instead devolved into a kind of free-for-all. Now the first operating rules are in hand to standardize use of the standards and gain the efficiencies originally intended.     

Accreditation at what cost?

Analyses the implications of the management of labour for an organization undertaking an accreditation exercise. Considers the King's Fund Organizational Audit (KFOA) accreditation scheme, which is concerned with process and facilities, and assesses the quality of the hospital environment in which the health care product is supplied. Concludes that, given the current enthusiasm for finding best practice in health care and the ever-increasing number of cost-effectiveness analyses of therapeutic interventions, it seems somewhat contradictory that interventions which cover the whole environment in which health care interventions are performed are not treated in the same way.