Views regarding the use of contraception amongst young people in the UK: A systematic review and thematic synthesis

Objectives?The high rate of teenage pregnancy in the United Kingdom continues to be a concern. Factors such as living in a deprived area, poor educational attainment, and living in state-provided care homes have been associated with a greater risk of young motherhood. This study aimed to examine the literature describing perceptions of young people, with a view to gaining a greater understanding of individual contraceptive use and risk factors for young motherhood.

Methods?A systematic review of studies reporting qualitative data was undertaken. Data were synthesised to develop key themes.

Results?Thirty-four papers using qualitative or mixed methods were included in the review. Five key themes are reported; they relate to: use or non-use of contraceptives; attitude to pregnancy; views regarding different forms of contraception; influences on views; gender differences.

Conclusions?The review highlights that individual conceptions of risk, differing perceptions of benefits and concerns regarding the forms of contraception, and varying attitudes towards pregnancy, continue to present obstacles to changing behaviour, particularly in high risk groups. There seems to be a need for interventions to further address negative perceptions of contraceptives, and place a greater emphasis on exploring value judgements regarding contraception and young motherhood.     

Emergency contraception use by Irish teenagers.

OBJECTIVE: To audit teenagers attending a family planning clinic requesting emergency contraception. METHODS: A non-judgemental, relaxed, confidential interview was carried out. RESULTS: Many young Irish women become sexually active at a young age. Many teenagers appear to have problems using condoms correctly while others are taking chances by not using any method of contraception. CONCLUSIONS: These findings have important implications for those drawing up a sexual health strategy for young people.     

Reproductive and contraceptive issues in chronically ill adolescents

Objectives?To address reproductive and contraceptive issues in adolescent girls with chronic medical conditions in order to assist health-care providers when they counsel teenagers about contraceptive methods.

Methods?The review is based on a literature search in Medline (1973–2010) about specific contraceptive use by adolescents with obesity, endocrine, cardiovascular, haematologic, oncologic, neurological, psychiatric, gastrointestinal, hepatobiliary, autoimmune, renal, pulmonary conditions and disabilities. The latest recommendations from the World Health Organisation for adolescents are also added. Contraceptive methods studied were combined hormonal contraceptives, progestogen-only contraceptives, and intrauterine contraceptives.

Results?Adolescents are eligible to use any method of contraception. Contraceptive choices of chronically ill adolescents have changed over time. Given new developments in the field of adolescent sexual and reproductive health care, safe and effective forms of contraception are available for almost every adolescent with a chronic condition. When selecting a method, the nature of the medical illness and the expressed desires of the teenager must be taken into account.

Conclusions?Adolescents, including those with chronic conditions, are sexual beings; they are entitled to sexual and reproductive health care. Decisions on appropriate contraception must be based upon informed choice, after adequate sexual health education.     

Teenagers' struggles with contraceptive use – What improvements can be made?

Objective?To study the experiences of teenagers using contraceptives at an out-patient abortion clinic and to explore the reasons behind their choices.

Methods?Twelve teenagers who had applied for induced abortion were interviewed three to four weeks after abortion. The interviews comprised open questions about contraceptive experiences focusing on hindrance for contraceptive use. Qualitative content analysis was used.

Results?One theme was identified: Struggling with feelings of uncertainty and patterns of behaviour. Three categories emerged from the analysis. Uncertainty dealt with decisions and behaviours that varied with time and between the different individuals. Factors that influence contraceptive use dealt with the persons that the participants had discussed contraceptives with, how they acquired knowledge about contraceptive use and the nature of their behaviour. Anxiety dealt with the side effects of contraception and feelings of fear related to contraceptive use.

Conclusion?The participants had feelings of uncertainty, anxiety and fear towards contraceptive use which led to non use and inconsistent use. Guidance from health care providers and access to youth clinics varied and was unsatisfactory. Parents were supportive of contraceptive use but not active in the process of getting their child to initiate it. Friends and the Internet were the main sources for acquiring information.     

Risk factors for unwanted pregnancy and subsequent abortion among women aged 16 to 25 years in Latvia

Objective?To explore key factors influencing young women when choosing between two methods of emergency contraception (EC).

Methods?We interviewed 26 young women who accessed community sexual and reproductive health services for emergency contraception after they had chosen an EC.

Results?Most women had an unrealistically high expectation about efficacy of the emergency contraceptive pill (ECP) and lacked knowledge of the intrauterine device (IUD) as an alternative method of EC. Previous use, easy accessibility, ease of use, and advice from peers, influenced women to choose the ECP, whereas past experience of abortion, firm motivation to avoid pregnancy, presentation after 72 hours, and considering that an IUD may provide long-term contraception as well, inclined women to choose the IUD. When participants were shown the IUD, many found it to be smaller and less frightening than they had imagined.

Conclusions?Women need better information and education about the IUD as a highly effective method of EC. Health professionals must provide such information at every opportunity. Showing the IUD during counselling might help correct misconceptions and would improve acceptability. Wider availability of expertise concerning EC-IUDs is essential to assist more women in making informed decisions when choosing a method for EC.     

Teenagers and emergency contraception in the UK: A focus group study of salient beliefs using concepts from the Theory of Planned Behaviour

Objectives?To explore teenagers’ beliefs about emergency contraception (EC) within a Theory of Planned Behaviour (TPB) framework.

Methods?Six single sex focus groups comprising a total of 25 female and 23 male pupils aged 13–16 years conducted in schools in Central England.

Results?Attitudes to emergency contraception (EC) were mainly positive about the rewards of avoiding teenage pregnancy. Participants had positive beliefs about the effectiveness of EC, although knowledge of crucial time limits varied. EC use was more socially acceptable than teenage pregnancy, yet both outcomes were perceived negatively. Motivation to comply with social pressure was influenced by the appraisal of individuals’ intentions. Participants reported high self efficacy in accessing EC, but had concerns over confidentiality and access.

Conclusions?Desire to avoid pregnancy was high in this group, but practical factors and attitudes may be more important for those ambivalent about pregnancy. Adolescents perceive accessing EC as difficult, are concerned about confidentiality, and anticipate negative reactions from staff. Data support the TPB as a suitable framework for understanding attitudes to EC use. Further research should apply quantitative TPB measures to EC use in a wider teenage sample in order to identify potential psychological factors to target in an intervention.     

Sexual behaviour and contraception in people under the age of 20 in Alicante,Spain

Objective?To describe and to analyse the relationship between patterns of sexually-risky behaviour and emergency contraception among young females attending a Family Planning Centre (FPC).

Methods?Data was obtained from a systematic analysis of 384 health records.

Results?Mean age of the sample subjects was 18.24 years (SD 1.47, range 13–20). Of these, 92% were single, 60% students and 83% were with the same partner. Age at first intercourse was 16.5 years (SD 1.52, range 11–20). Those who used condoms systematically totalled 72%. Mean number of sexual partners was 1.85 (SD 2.91, range 1–50). A total of 9% had become pregnant and 2% had had an abortion. Emergency contraception was resorted to by 26% of the young women on at least one occasion. Emergency contraception was related to younger age at first sexual intercourse (p < 0.001) and to a great number of partners (p = 0.011). Of the total number of subjects, 48.4% demonstrated sexually-risky behaviour. This behaviour was related to alcohol consumption (p < 0.0001) and to the existence of dysfunction (p < 0.001).

Conclusions Spanish youngsters have enough knowledge regarding contraception. Condoms are mostly used on the occasion of a first sexual intercourse. However, the frequency of sexually-risky behaviour is still high due to the limited use of condoms in successive sexual relations with the same partner. Sexually-risky behaviour is also related to a high number of partners and to alcohol consumption on weekends.     

Alcohol and drug abuse and risky sexual behaviours in young adult women

Objective: To assess alcohol abuse as a predictor of risky sexual behavior among adolescents and young adult women, a high-risk population for unintended pregnancies.

Subjects: Totally 3163 adolescent and young adult women, 18–29 years, were assessed on sociodemographics, alcohol and drug use and risky sexual behaviors.

Interventions: Participants answered a structured questionnaire on their leisure habits, drug and alcohol consumption, contraception and sexual behaviors.

Results: Most of the young adult women perceive that sexuality is an important part of their life but not a main concern (77.6%) and that alcohol removes the barriers to have sex (62.3%). Additionally, 77.0% claimed that contraception had “a lot” (53.4%) and “quite” (23.6%) influence on the quality of their sexuality. However, up to a 38.4% of the interviewed women had had sex without using any contraception and 29.6% of them acknowledged that had taken alcohol and of these, 40.7% said that alcohol was responsible for not using contraception. Alcohol abuse predicted an increase in risky sexual behaviours (4.45 CI: 2.01–9.75, p?Conclusions: These findings suggest that contraception-related behavioural interventions for young adult women should discuss the link between alcohol and sexual risk behavior.     

Prevalence of sexual activity and family-planning use among undergraduates in Southwest Nigeria

Objective?To assess the prevalence of sexual activity and family-planning use among undergraduates in a private tertiary institution in Nigeria.

Methods?A cross-sectional survey of 283 undergraduate students.

Results?Out of 283 students, 245 (86.6%) are sexually active in the last month. Out of these 245, 219 (89%) are currently using a family-planning method. In the study population, the percentages of awareness, ever use, and current users are 89%, 77%, and 75%, respectively. The most commonly known, ever used, and currently used contraceptive is condom followed in descending order by calendar method, oral pills, coitus interruptus, injectable contraception, emergency contraception, intrauterine contraceptive device, and diaphragm. Unmarried students and male gender show statistical significance with condom use. The reasons for preferring the current contraceptive method, among 219 current users, include safety, cost, ready availability, and partner's preference, among others. Most of the nonusers gave no reason for a failure to use a contraceptive, but others felt that contraceptives are dangerous, while a minority were ignorant of any method. Though many use a condom, this use is inconsistent.

Conclusion?There is a high level of sexual activity among these undergraduates. Many are aware of family planning, and the condom is the most commonly known and used method, though not consistently. Reproductive-health education should be promoted among youths in Nigeria.     

‘The real deal’: A feasibility study of peer-led sex education for early school leavers

Objectives?To explore female early school leaver's experience of sexual activity and sex education, and to assess the feasibility and potential impact of a peer-led sex education intervention.

Methods?Forty five young female early school leavers and ten peer educators participated in the study. The ten peer educators, early school leavers who were teenage mothers, were trained to deliver the peer-led education intervention. Both quantitative (self-completed questionnaire) and qualitative (focus groups) research methods were used to evaluate the intervention.

Results?The average age of participants was 17.5 years. The average age at leaving school was 15 years. Many participants were smokers and took alcohol on a regular basis. Over three quarters of the young women were sexually active. Although most used contraception in the past, over 30% had not the last time they had sex. While participants' knowledge around sexual issues showed some improvement following the pilot intervention, there was little change in attitudes to sexual behaviour.

Conclusions?This feasibility study was very well received by both peer educators and participants. To assess the effectiveness of the intervention we recommend that a larger randomised control trial be conducted.     

Changes in contraceptive practice and the transition of reproduction pattern in the Czech population

Objectives?To analyse changes in contraceptive practice among Czech women, during the last two decades, and to evaluate the associated demographic impacts.

Methods?Recent trends in fertility and abortion are presented and compared with earlier survey data on contraceptive use. Data from four Czech surveys carried out as part of international projects in 1993, 1997, 2005, and 2008 were used to document changes in contraceptive practice among Czech women.

Results?Greater availability and greater acceptance of new birth control methods have resulted in increased contraceptive use and in the replacement of traditional methods with more effective alternatives. While only 42% of women in union (married and cohabiting) used condoms, the pill or an intrauterine contraceptive in 1993, 75% of all women with a partner currently use effective contraceptives. The fertility transition towards delayed childbearing has not resulted in additional requirements in terms of family planning as no increase in the abortion rate among young women is observed.

Conclusion?The shaping of a new reproduction pattern in the Czech Republic has been accompanied by significant improvements in contraceptive practice. Despite the fact that the Czech population cannot be considered to perform outstandingly in terms of use of contraception, any remaining unmet need for modern contraception is marginal.     

Weight gain,body image and sexual function in young patients treated with contraceptive vaginal ring. A prospective pilot study

Introduction: Oral contraceptives could induce mood changes. As far as our knowledge, there are no studies in literature that have examined the role of vaginal contraception in self-perceived body image.

Aim: To evaluate the effects of intravaginal contraception on weight gain and perceived body image in relation with the Beck’s Depression Inventory questionnaire (BDI) and the McCoy Female Sexuality Questionnaire (MFSQ).

Methods: Twenty-one adult (18–35?years old) eumenorrheic (menstrual cycle of 25–35?days), lean (body mass index – BMI – of 19–25?kg/m²) women who were referred for hormonal contraception were administered the Stunkard Figure Rating Scale (FRS), BDI and MFSQ. Subjects were studied in basal condition and after 6?months of therapy with vaginal contraception (NuvaRing®; Organon-Schering-Plough Italia, Milan, Italy).

Main outcome measures: BMI, FRS, MFSQ and BDI.

Results: After 6?months of therapy with NuvaRing®, both body weight (60.0?±?8.3; p?=?0.050) and BMI (22.1?±?3.1; p?=?0.028) slightly, but statistically, increased. FRS and BDI showed no differences after the vaginal contraception. Hormonal contraception was associated with a significant decrease in the two-factor Italian MFSQ score.

Conclusions: Vaginal ring seems a good alternative to other hormonal contraceptive not significantly altering the female sexuality and not influencing the FRS and BDI.     

The profile of emergency contraception users in a chlamydia prevalence study in primary care in Belgium

Introduction?We describe the use of emergency contraception (EC) and its association with sociodemographic, contraceptive and behavioural characteristics in a sample of family practice attendants in Belgium.

Methods?The study was part of a large Chlamydia trachomatis (CT) prevalence study in general practice. Sexually active women under 40 who consulted their general practitioner for routine gynaecological care were enrolled in the study. Participants completed a questionnaire on sociodemographic variables, urogenital symptoms, sexual history and sexual behaviour, and delivered a sample for CT testing. Logistic regression analysis was performed to identify determinants of a history of EC use in women in this sample.

Results?Of 815 questioned women, 23.5% had ever used EC. EC users were a heterogeneous group with respect to educational level, age and ethnicity. The use of emergency contraception was associated with the level of urbanisation, condom use, not having children yet, young age of first sexual intercourse, having had multiple partners in the past year, a history of unintended pregnancy, and current or previous STI.

Discussion?Information on availability and correct use of EC, and on the need for additional testing for STI, are necessary to help primary care attendees to preserve their future reproductive health.     

Factors affecting unmet need for contraception among currently married fecund young women in Bangladesh

Objectives: The aim of our study was to explore the factors associated with unmet need for contraception among currently married fecund women under age 25, in Bangladesh.

Methods: This study utilised a cross-sectional data (n?=?4982) extracted from the Bangladesh Demographic and Health Survey (BDHS) 2011. Multinomial logistic regression was used to identify the determinants of unmet need for contraception among currently married fecund young women.

Results: The unmet need for contraception was 17% and contraceptive prevalence was 54% in this young group. Total demand for contraception was 71% and the proportion of demand satisfied was 77%. The results suggest that region, place of residence, religion, husband’s desire for children, visits of FP workers, decision-making power on child health care, reading about FP in newspaper/magazine and number of births in three years preceding the survey were significant predictors of unmet need for contraception.

Conclusions: The BDHS of 2011 found that unmet need for contraception among currently married, fecund women under 25 years old is higher than the national level, and hence different or more intensive programme initiatives are required for them than for older women. The present study identifies important predictors of unmet need for contraception among fecund married Bangladeshi women under age 25.     

Misconceptions and current use of contraception among women of reproductive age in six major cities in Nigeria

Abstract

Objectives: The aims of this study were to assess the determinants of family planning misconceptions and modern contraceptive use, and the influence of misconceptions on the use of modern contraceptive methods.

Methods: We reviewed and analysed data collected between October 2010 and March 2011 among a representative household sample of 13,575 women of reproductive age (15–49 years) in six urban cities in Nigeria. Multiple linear and logistic regression models were used to examine the predictors of misconceptions and current use of contraception and the association between misconceptions and modern contraceptive use.

Results: Catholic women were significantly more likely to have misconceptions compared with Muslim women (β?=?1.09; 95% confidence interval [CI] 0.58, 1.60; p?<?.001); women with higher education were significantly less likely to have misconceptions about contraception compared with women with no formal education (β=??0.06; 95% CI ?0.96, ?0.29; p?<?.001). Unmarried women living with a partner were not significantly different from those who were not cohabiting (single, separated or widowed) in their current contraceptive use (adjusted odds ratio [OR] 0.91; 95% CI 0.79, 1.04; p?>?.05). Women with lower misconception scores were significantly more likely to adopt and use modern contraception compared with those with high misconception scores (adjusted OR 0.93; 95% CI 0.92, 0.94; p?<?.001).

Conclusion: These findings suggest that programmatic efforts should be geared towards dispelling misconceptions by providing simple factual information related to the benefits of contraception and family planning.     

Knowledge and attitudes towards emergency contraception of health-care providers in a region with a high birth rate

Objective?To assess the knowledge of, attitude towards and practices of emergency contraception among health-care providers at a university hospital located in a region with a high birth rate.

Methods?The survey was conducted among 214 health-care providers working at a university hospital located in eastern Turkey.

Results?Two hundred participants completed the questionnaire. Of the respondents, 26.0% said that they did not know anything about emergency contraception, while the remaining 74.0% said that they knew about at least one of the methods of emergency contraception. But among these, the knowledge of 38.5% of the participants about emergency contraception was accurate and that of 61.5% was inaccurate. Thirty-four percent of the respondents stated that they had previously required personally to use emergency contraceptive methods. The most commonly used emergency contraceptive methods were oral contraceptives (69.1%) and intrauterine device (14.7%). None of the respondents knew anything about mifepristone and levonorgestrel.

Conclusion?There is a knowledge deficit among health-care providers who play a significant role in the dissemination of the information about emergency contraception.     

Contraception,reproductive health and pregnancy outcomes among women exposed to intimate partner violence in Nigeria

Objectives?To examine the association between reproductive health practices/outcomes and exposure to intimate partner violence (IPV) among women in Nigeria. More specifically, the association between IPV and use of contraception; miscarriages,induced abortions, stillbirths, and infant mortality; and having many children, was assessed.

Methods?Data on studied variables were retrieved from the Demographic and Health Surveys of Nigeria 2008, a nationally representative sample of 33,385 women of reproductive age. IPV was defined as exposure to physical, sexual or emotional abuse. The association between contraception use, pregnancy outcomes and infant mortality, and exposure to IPV was assessed using the chi-square test for unadjusted analyses. To control for potential confounding, socio-demographic variables were adjusted for using multiple logistic regression.

Results?Compared with women not exposed to IPV, those who were, exhibited a higher likelihood of using modern forms of contraception; having a history of miscarriages, induced abortions, stillbirths, or infant mortality; and having many children. The aforementioned observations still stood after adjustment for potential confounders (e.g., demographic and socioeconomic factors).

Conclusion?Though causal inference cannot be drawn due to the cross-sectional design, the study has important implications for incorporation of IPV detection and management in initiatives aimed at improving women's reproductive health.     

Resistance against contraception or medical contraceptive methods: a qualitative study on women and men in Istanbul

Objectives?This research was carried out to reveal the attitudes of men and women about contraception in the Umraniye district of Istanbul.

Methods?Focus group discussions were used for data collection. Data from 20 groups of married people (ten groups of men and ten of women) living in Umraniye were analyzed.

Results?Most people attending the focus groups in the study were against having ‘too many’ children. Economic constraints appear to be a leading influencing factor for limiting the number of children. Urbanization also seems to have a strong influence on people's knowledge and attitudes about contraception. Culture and religious beliefs were not found to be major barriers to contraception in general, but they would influence the selection of the type of a certain contraceptive method. More specifically, culture and religious beliefs were barriers to use of medical methods, and they were the main reasons for use of the withdrawal method, which is the most common method used in Turkey.

Conclusions?Men and women are not resistant to contraception, but they are reluctant to use medical methods. The provision of contraceptive services, with special attention to cultural and religious beliefs and values, and the inclusion of appropriate counseling and education sessions during service delivery, may give clients new options and increase the use of medical methods.