Pregnancy Motivations and Contraceptive Use: Hers,His, or Theirs?

ContextStudies increasingly consider the role of pregnancy motivations on contraceptive use. Few studies include measures of men's pregnancy motivations.MethodsWe used baseline data (from a couples-intervention study) to examine the contribution of women's and men's pregnancy motivations and participation in decision making to contraceptive use by women in relatively stable relationships who were not trying to get pregnant. In addition to conducting multivariate analyses, we assessed agreement between a woman's perceptions of and her partner's reports of his pregnancy motivations.ResultsWe observed moderate agreement between men's pregnancy motivations and their partners' perceptions of those motivations. Levels of agreement about participation in decision making were somewhat lower. In bivariate analyses, effective contraceptive use was significantly associated with two measures of pregnancy motivation for men and women. In multivariate analyses, only women not wanting a child in 2 years (adjusted odds ratio [aOR], 1.73), women's (aOR, 1.80) and men's (aOR, 0.78) participation in decision making, women believing their partners favored contraceptive use (aOR, 2.01), relationships lasting 2 or more years (aOR, 1.98), and ethnicity/race (Latina aOR, 0.27; other race aOR , 0.45) were associated with effective contraceptive use.ConclusionProviders and those developing interventions must recognize that some women who are “not trying to get pregnant” have weak motivations to avoid pregnancy, and so should help women to clarify their motivations and seek support from their partners for contraceptive use. To understand the role of pregnancy motivations, future research may include both qualitative and longitudinal quantitative studies.     

Is Depression Associated with Contraceptive Motivations,Intentions, and Use Among a Sample of Low-Income Latinas?

BackgroundLatinas in the United States experience high rates of unintended pregnancy and low rates of contraception use, yet reasons are not completely understood. Depression is common among pregnant and nonpregnant Latinas; its influence on contraceptive motivations, intentions, and use is understudied.ObjectivesWe sought to 1) describe Latinas' contraceptive motivations, intentions, and use; 2) use structural equation modeling to test associations between depression and contraceptive self-efficacy/motivations/intentions/use; and 3) determine whether associations differ by pregnancy status.MethodsThis cross-sectional study included Latinas ages 15 to 45 recruited from an urban Federally Qualified Health Center in Baltimore, Maryland. Structured surveys were used to collect data regarding depressive symptoms measured using the PHQ-9. All other constructs were measured with previously validated questions. Constructs included contraceptive self-efficacy, positive and negative contraceptive motivations (perceived advantages and disadvantages of using contraception), contraceptive intentions to begin or continue contraception use, and contraceptive methods currently used.ResultsAmong pregnant Latinas, depression was associated with negative motivations (β = 0.16; p < .05), negative motivations were associated with intentions (β = ?0.22; p < .01), and contraceptive self-efficacy was associated with intentions (β = 0.43; p < .001). Among nonpregnant Latinas, contraceptive self-efficacy was associated with intentions (β = 0.78; p < .001) and intentions were associated with use (β = 0.40; p < .05).ConclusionsAmong pregnant Latinas, negative motivations intervene in the association between depression and contraceptive intentions. For nonpregnant Latinas, intentions intervene in the association between self-efficacy and contraceptive use. This study underscores the importance of depression screening during pregnancy and encourages practitioners to target contraceptive motivations to improve contraceptive use.     

Contraceptive Method Use by Rural–Urban Residence among Women and Men in the United States, 2006 to 2017

PurposePolicy and reproductive health practice changes in the past decade have affected use of different contraceptive methods, but no study has assessed contraceptive method use over this time by rural–urban residence in the United States.MethodsWe used female and male respondent data (2006–2017) from the National Survey of Family Growth (n = 29,133 women and n = 24,364 men) to estimate contraceptive method use by rural–urban residence over time and contraceptive method use by age, marital status, and parity/number of children.ResultsFrom 2006–2010 to 2013–2017, among urban women, we found increased use of two or more methods (11% to 14%); increased use of intrauterine devices (5% to 11%), implants (0 to 2%), and withdrawal (5 to 8%); and decreased use of sterilization (28% to 22%) and pills (26% to 22%). Among rural women, we found increased use of intrauterine devices (5% to 9%) and implants (1% to 5%). We found increased withdrawal use for urban men, but otherwise no differences among men across time. In data pooled across all survey periods (2006–2017), contraceptive method use varied by rural–urban residence across age, marital status, and parity/number of children.ConclusionsIn a nationally representative sample of reproductive age women and men, we found rural–urban differences in contraceptive method use from 2006–2010 to 2013–2017. Describing contraceptive use differences by rural–urban residence is necessary for tailoring reproductive health services to populations appropriately.     

Is Long-Acting Reversible Contraceptive Use Increasing? Assessing Trends Among U.S. College Women, 2008–2013

Objective To assess LARC use trends among college women (18–24 years) and identify groups that have increased LARC use. Methods Data were extracted from the National College Health Assessment-II (NCHA-II) fall 2008–2013 surveys. Logistic regression statistics were used to assess LARC use. Results Although LARC use increased from 2008 to 2013 (aOR?=?2.62; 95% CI 2.23–3.07), less than half of the sample (44%) reported using contraception at last vaginal sex. Only 2.5% of college women in this study reported using a LARC method; of LARC users, 90% reported using an intrauterine device. Nearly all sociodemographic factors were significantly associated with increases in LARC use including: age, sexual orientation, and insurance status. Conclusions LARC use significantly increased among college women. However, less effective methods such as condoms and short-acting reversible contraceptives are used more frequently. Promoting LARC use for women who desire to effectively prevent pregnancy can reduce unintended pregnancy and improve health outcomes for women while in college. Future work should examine the importance of individual and lifestyle factors that influence college women’s decision to choose a LARC method and seek to eliminate barriers to college women choosing a contraceptive method they believe works best for them.     

Contraceptive development: why the snail's pace?

Current contraceptive methods are not well-suited to many Americans. More safe and effective methods would be desirable. A report, "Developing New Contraceptives: Obstacles and Opportunities" was released in January 1990. It summarized 2 years of data collection by the Committee on Contraceptive Development which includes pharmaceutical company executives, physicians, reproductive biologists, public health, legal, and public policy experts, demographers, and economists. Barrier facing the development of new methods in the US were analyzed and ways to speed up research suggested. Particularly ill served are teenagers, young mothers, and comparatively older couples. The health risks of pregnancy, delivery, and labor "may be underrated." The pill is now the most common form of contraception in the US, followed by female sterilization, condoms, and vasectomy. 95% of women, aged 15-44, who have ever had intercourse, have used 1 or more contraceptive methods. Contraceptive discontinuation and failure rates are high, too. No fundamentally new contraceptives have been approved for use since the IUD and the pill in the 60s. Modifications of existing methods are in clinical trials. Obstacles cited were attitudes of the public, federal regulations and product liability, and the organization of and resources available for research. Public attitudes are very conservative. There is no great demand for more products. Since the 1960s, only 1 large pharmaceutical company (Ortho Pharmaceutical Corp.) is still involved in contraceptive research. Activity by small firms, nonprofit organizations, and universities has increased. Federal research funding in reproductive biology has only increased modestly since the mid 1970s. Private foundation support has dramatically declined. The time involved in the great costs of data required for Food and Drug Administration (FDA) approval have reduced research incentives. The average time it takes to get FDA approval has increased in the past 20 years. Weighing the risks and benefits of contraceptives is different from doing that with other drugs, yet FDA procedures do not allow for this. Product liability laws are different in each of the 50 states. Contraceptive development was greatly damaged by the mid 1980s insurance crisis. The committee recommended that the FDA put more importance on the effectiveness and convenience of new contraceptives. A comprehensive postmarketing surveillance system should be set up, and congress should pass a federal products liability law.     

Contraceptive efficacy and safety of HerbOshield™ vaginal gel in rats

BackgroundSpermicides represent one of the methods of contraception. The synthetic agents available as spermicides produce severe side effects. Hence, there is a need to replace these agents with safe and effective agents such as plant-based contraceptive agents.Study DesignThe objective of the present study was to develop and evaluate a stable, safe, effective and easily acceptable contraceptive delivery system containing herbal drug. Efforts were made to evaluate the contraceptive potential of the hydroalcoholic extract from the seeds of Annona squamosa Linn. and the vaginal gel HerbOshield? containing the extract.ResultsSpermicidal effect was evaluated in vitro using healthy human spermatozoa and in vivo in rats. The in vitro results demonstrated that HerbOshield? vaginal gel is an effective spermicide. At a 100-mg/mL dose, complete immobilization of human spermatozoa was observed within 20 s. None of the treated animals conceived, indicating 100% contraceptive effect as compared to Gynol II, a nonoxynol-9-containing marketed formulation, which showed only 67% contraceptive effect in vivo. HerbOshield? vaginal gel was found to be safe in animals during a 14-day toxicity study.ConclusionsHerbOshield? vaginal gel was found to be safe and effective in rats and could be developed as a potential vaginal contraceptive for future use in humans.     

Contraceptive choice in Vigevano,Italy, 1983–1993

The authors, after general consideration of family planning programs, present a study of 22 714 women, who, in the decade 1983–1993, required contraceptive protection from the Family Planning Centers in the region of Vigevano (Italy). The authors underline the importance of a protocol used before beginning treatment to help prevent women receiving methods carrying too great a health risk. The results show a very high prevalence of oral contraception, increasing in recent years with the introduction of triphasic pills, while use of intrauterine contraception seems to be declining. Other conventional methods, such as barrier (diaphragm and condom) and natural methods, had a low incidence in the sample studied. The reasons for these behaviors are analyzed and the relative trends discussed.

---

Resumen Los autores después, de una consideraciòn general sobre los programas de planificaciòn familiar, presentan un caso-estudio de 22 714 mujeres las cuales en la dècada 1983–93 pidieron protecciòn anticonceptiva en el Centro de Planificaciòn familiar del àrea de Vigevano (Italia). Los autores subrayan la importancia de un protocolo usado antes del inicio del tratamiento para ayudar a prevenir a las mujeres de methodes recihidas que comportaban grande riesgos de salud. Los resultados muestran una muy alta preponderancia de contraceptiòn oral, aumentando en los ultimos años con la introduciòn de las pildoras trifasicas, mientras la contraceptiòn intrauterina parece decaer. Otras métodos convencionales como las barrerra (diafragma y condom) y las métodos naturales tuvieron una, escasa incidencia en el examinado caso-estudio. Las rajones de éstos comportamientos son analizados y las relativas tendencias descutidas.

---

Resumé Après une introduction générale sur les programmes du planning familial, les auteurs présentent une étude de cas portant sur 22 714 femmes qui, au cours de la décennie 1983–93, ont sollicité une protection contraceptive auprès de centres de planning familial dans la région de Vigevano (Italie). Les auteurs soulignent l'importance du protocole appliqué avant de commencer le traitement afin d'éviter que ces femmes ne recoivent des méthodes comportant de trop grands risques pour leur santé. Les résultats font ressortir une très forte prévalence de la contraception orale, en augmentation ces dernières années après l'introduction de la pillule triphasique, alors que la contraception intra-utérine semble être en régression. L'incidence d'autres méthodes classiques, de barrières par exemple (diaphragme, et préservatifs) et méthodes dites naturelles, entrent pour peu en ligne, de compte dans l'étude de cas présentée. L'exposé analyse les raisons de ce comportement et examine les tendances qu'il représente.

     

Pregnancy Intention and Contraceptive Use among Women by Class of Obesity: Results from the 2006–2010 and 2011–2013 National Survey of Family Growth

Objective

Conflicting research findings on the association of obesity and pregnancy intention may be due to their collective definition of obesity at a body mass index of 30 kg/m² or greater. However, obese women with a BMI of 40 kg/m² or greater may be both behaviorally and clinically different from obese women with a lower BMI. This study reexamines this relationship, stratifying by class of obesity; the study also explores variations in contraceptive use by class of obesity given their potential contribution to the incidence of unintended or unwanted pregnancy.

Vital Signs: Trends in Use of Long-Acting Reversible Contraception Among Teens Aged 15–19 Years Seeking Contraceptive Services — United States, 2005–2013

Background

Nationally, the use of long-acting reversible contraception (LARC), specifically intrauterine devices (IUDs) and implants, by teens remains low, despite their effectiveness, safety, and ease of use.

Methods

To examine patterns in use of LARC among females aged 15–19 years seeking contraceptive services, CDC and the U.S. Department of Health and Human Services’ Office of Population Affairs analyzed 2005–2013 data from the Title X National Family Planning Program. Title X serves approximately 1 million teens each year and provides family planning and related preventive health services for low-income persons.

Results

Use of LARC among teens^* seeking contraceptive services at Title X service sites increased from 0.4% in 2005 to 7.1% in 2013 (p-value for trend <0.001). Of the 616,148 female teens seeking contraceptive services in 2013, 17,349 (2.8%) used IUDs, and 26,347 (4.3%) used implants. Use of LARC was higher among teens aged 18–19 years (7.6%) versus 15–17 years (6.5%) (p<0.001). The percentage of teens aged 15–19 years who used LARC varied widely by state, from 0.7% (Mississippi) to 25.8% (Colorado).

Conclusions

Although use of LARC by teens remains low nationwide, efforts to improve access to LARC among teens seeking contraception at Title X service sites have increased use of these methods.Implications for public health practice: Health centers that provide quality contraceptive services can facilitate use of LARC among teens seeking contraception. Strategies to address provider barriers to offering LARC include: 1) educating providers that LARC is safe for teens; 2) training providers on LARC insertion and a client-centered counseling approach that includes discussing the most effective contraceptive methods first; and 3) providing contraception at reduced or no cost to the client.     

GIS and Its Use

1 Brief introduction of GISGISisthe abbreviationof Geographic Information Systems.As organized data can be accessed bypointingtoa regionon a map,GIS has become useful in a wide variety of applications.Information systems that support this type of appli-ca…     

Substance Use and Intimate Partner Violence: Clarifying the Relevance of Women’s Use and Partners’ Use

Research has shown that, when women and/or their partners are involved in substance use, women’s risk for intimate partner violence (IPV) is higher. Prior research has not examined whether substance use by both women and their partners contributes independently or interactively to women’s risk of victimization and has not identified factors moderating the effect of substance use by victim or partner. Mental health and social support are explored as moderators of the association between women’s victimization and substance use by victim or partner in a study of 590 impoverished women residing in the Los Angeles area. This study found that substance use by both the woman and her partner independently predicted IPV and that social support moderated the effect of women’s substance use. These findings clarify the relevance of substance use in the context of intimate relationships and that of social support as a buffer against IPV among impoverished women.     

Use of the “NYC Condom” among People Who Use Drugs

We assessed awareness and use of the “NYC Condom” among persons who use heroin and cocaine in New York City. The NYC Condom distribution program is the largest free condom distribution program in the USA, with over 30 million condoms distributed per year. It includes a condom social marketing program for a specific brand, the NYC Condom with its own packaging and advertising. People who use heroin and cocaine are at relatively high risk for HIV infection and are an important target population for the program. In order to assess awareness of the NYC Condom, structured interviews and blood testing for HIV, HSV-2, and sexually transmitted infections (STI) were conducted among entrants to the Beth Israel Medical Center drug detoxification and methadone treatment programs. Participants were asked about drug use, sexual risk behaviors, and awareness and use of the NYC Condom. Univariate and multivariable regression analyses were conducted to examine the associations between use of NYC Condoms and consistent condom use with primary and casual sexual partners. A total of 970 subjects were recruited between February 2011 and December 2012. Subjects were primarily African–American and Hispanic, with a mean age of 43. Fifty-five percent of subjects reported being sexually active with primary sexual partners, and 25 % reported being sexually active with a casual partner for the 6 months prior to the interview. Sixty-five percent of subjects had heard of the NYC Condom, 48 % of those who had heard of the condom had used it, and 58 % of those who had ever used it were currently using it (in the previous 6 months). In multivariable regression analyses, current use of NYC Condoms was strongly associated with consistent condom use with primary sexual partners (adjusted odds ratio (AOR)?=?3.99, 95 % confidence interval (CI) 1.85–8.58) and consistent condom use with casual sexual partners (AOR?=?4.48, 95 % CI 1.49–13.42). In terms of market share, 38 % of subjects consistently using condoms with primary partners were using the NYC Condom, and 47 % of those consistently using condoms with casual partners were using the NYC Condom. The NYC Condom is an important tool for reducing sexual transmission of HIV and STI among persons who use drugs in the city. Given the strong relationship between using the NYC Condom and consistent condom use, further efforts to promote the NYC Condom brand would be easily justified.     

Contraceptive vaginal ring — a rising star on the contraceptive horizon

Two studies were carried out at AIIMS to judge efficacy, side-effects and acceptability of the contraceptive vaginal ring, a Silastic ring with an inner core containing 6.0 mg levonorgestrel mixed with Silastic and an outer core of Silastic only. It releases levonorgestrel at a constant rate of 20 g/day and remains effective for 90 days. The first study of 50 women lasted for 12 months and the second study of 46 women lasted 24 months. Menstrual irregularity in 36% of women was the commonest reason for discontinuation. The majority of women experienced menorrhagia or irregular spotting per vaginum. Vaginal irritation or increased vaginal discharge was the second commonest reason for discontinuation and was noted in 23% of subjects. Repeated spontaneous expulsions accounted for discontinuation in 6% of subjects. No method-related failure was noted in the study. Follow-up study revealed users to be happier with the ring than with any other method and no spouse complained of feeling the ring during coitus.With its ease of administration, absence of gastrointestinal side-effects and a high success rate, the contraceptive vaginal ring is a promising contraceptive method for the last decade of the 20th century.

---

Resumen Se realizaron dos estudios en AIIMS con el objeto de determinar la eficacia, los efectos secundarios y la aceptabilidad de un anillo anticonceptivo de silastic cuya parte central, que contenía 6.0 mg de levonorgestrel mezclado con el silastic, se hallaba rodeada de silastic únicamente. El dispositivo descarga levonorgestrel en una proporción constante de 20 g diarios y tiene una eficacia de 90 días. El primer estudio, realizado con 50 mujeres, tuvo una duración de 12 meses y el segundo, con 46 mujeres, se prolongó a 24 meses. El abandono de este método fue determinado principalmente por irregularidades menstruales en el 36% de las pacientes. La mayoría de las mujeres experimentaron menorragia o microrragia vaginales. La segunda razón más común de interrupción fue la irritación de la vagina o un flujo mayor en el 23% de las mujeres, y expulsiones espontáneas y repetidas provocaron el abandono en el 6% de las pacientes. En el curso de este estudio no se observó ningún fracaso atribuible al método. Los estudios de seguimiento indicaron que las usuarias estaban más satisfechas con este método que con cualquier otro, y las parejas de estas mujeres no sintieron el anillo durante el coito. La facilidad de colocación, la ausencia de efectos secundarios gastrointestinales y el porcentaje elevado de éxito hacen esperar que durante la última década del siglo XX el anillo vaginal sea un método anticonceptivo prometedor.

---

Resumé Deux études one été réalisées à l'AIIMS afin de déterminer l'efficacité, les effets secondaires et l'acceptabilité d'un anneau contraceptif au Silastic dont la partie centrale contenant 6,0 mg de lévonorgestrel mélangé au Silastic est enrobée de Silastic uniquement. Ce dispositif libère le lévonorgestrel en quantité constante de 20 g par jour et reste efficace pendant 90 jours. La première étude, faite sur 50 femmes, a duré 12 mois et la seconde, avec 46 femmes, a été prolongée à 24 mois. L'abandon de cette méthode a été déterminé le plus souvent par des irrégularité menstruelles recontrées chez 36% des patientes. La plupart des femmes ont présenté des ménorragies ou des microrragies vaginales. On a constaté comme seconde raison la plus commune d'interruption l'irritation du vagin ou un écoulement vaginal accru chez 23% des intéressées, et des expulsions spontanées et répétées one provoqué l'abandon chez 6% des sujets. Aucun échec imputable à la méthode n'a été signalé au cours de ces études. Les visites de suivi ont révélé que les utilisatrices étaient plus satisfaites de cette méthode que de n'importe quelle autre et aucun partenaire ne s'est plaint de sentir l'anneau pendant le coït. Facilité de mise en place, absence d'effets secondaires gastro-intestinaux et pourcentage élevé de succès font espérer que pendant la dernière décennie du 20-ème siècle l'anneau vaginal s'avérera une méthode de contraception prometteuse.

     

Who's Responsible? Correlates of Partner Involvement in Contraceptive Decision Making

ObjectivesResearchers have begun looking at joint responsibility for contraceptive decision making as a mechanism to increase effective contraceptive use. This analysis identifies correlates of partner involvement in contraceptive decision making.MethodsParticipants were first-time users of either oral contraceptives or Depo-Provera recruited from 10 family planning clinics in Texas (n = 481). Participants completed a self-administered questionnaire that was available in both English and Spanish. Chi-square statistics were used to compare demographics, relationship characteristics, and condom use before and after initiation of the new hormonal method by who is responsible for birth control use. Characteristics that were significant in bivariate testing were then included in a multivariate logistic regression model.ResultsForty-five percent of women reported sole responsibility for contraceptive use and 55% reported joint responsibility with their partners. In multivariate models, consistent condom use before and after the initiation of hormonal contraception and duration of sexual activity with main partner for less than 2 years were associated with increased likelihood of joint responsibility for contraceptive decision making. Women whose partners were classified as high risk had reduced the odds of joint responsibility for contraceptive decision making.ConclusionWomen at increased risk for sexually transmitted diseases (high-risk partners) and their partners may represent a target population for interventions aimed at increasing joint responsibility for contraception use. Continuous engagement in contraceptive decision making among long-term couples should also be encouraged.     

Peer Reviewed: Prior Contraceptive Use Among Women Who Gave Birth in the US-Mexico Border Region, 2005: The Brownsville-Matamoros Sister City Project for Women’s Health

Introduction

Dramatic population growth in  the US-Mexico border region suggests more effective family planning services are needed, yet binational data are scarce. The Brownsville-Matamoros Sister City Project for Women''s Health collected binational, standardized data from 947 postpartum women in Cameron County (Texas) and Matamoros (Tamaulipas, Mexico) hospitals from August through November 2005.

Methods

We analyzed these data to estimate the proportion of women with unintended pregnancy and the proportion of these women who reported contraceptive use, and to identify associated factors.

Results

The current pregnancy was unintended for 48% of women overall. Almost half of these women reportedly used birth control at conception, but many used low-efficacy methods. Among women with unintended pregnancy who did not use contraception, 34.1% of Mexico residents believed they could not become pregnant and 28.4% of US residents reported no reason for nonuse. Overall, contraceptive use to prevent pregnancy was less common among younger than older women and among women who had not graduated high school compared with those who had. Among Mexico residents, those who had a source of routine health care were more likely than those who did not to have used contraception.

Conclusion

More effective contraceptive practices are needed in this population, especially among younger and less-educated women. A cooperative binational approach that integrates reproductive and family planning services may be most effective.