Contraception issues and options

Contained in this issue of "National Women's Health Report," published by the National Women's Health Resource Center, is an overview of current issues and options in the field of contraception. The discussion is summarized in a chart that cites the failure rate (lowest experienced and typical), method of use, benefits, and risks/contraindications for oral contraceptives, diaphragm with spermicide, condom, contraceptive sponge, cervical cap with spermicide, female condom, IUD (Progestasert and Copper T 380A), implants, injectables, and surgical sterilization. Also discussed are contraception considerations for three subgroups: adolescents, women over 40 years of age, and breastfeeding women. Readers are urged to carefully assess the risks and benefits associated with the various contraceptive options as well as personal life-style issues. Finally, two women's health specialists present positions for and against the over-the-counter availability of birth control pills.     

Dual protection against unwanted pregnancy and HIV / STDs

"Dual protection" refers to the use of methods which will prevent both unwanted pregnancy and HIV/STD infections during sexual intercourse. Such protection may be achieved through either the use of a barrier method such as a male or female condom together with another contraceptive method, or through the use of the male or female condom alone. In descending order of effectiveness, the following methods can protect against unwanted pregnancy: abstinence; sterilization; Norplant; injection; oral contraceptive pill; IUD; male condom with spermicide; male condom; female condom, diaphragm, or cervical cap; vaginal spermicide alone; and natural family planning. In descending order of effectiveness, the following methods can protect against the transmission of HIV and STDs: abstinence, nonpenetrative sex, long-term mutual monogamy with HIV testing, male condom with spermicide, male condom, female condom, diaphragm and cervical cap, and vaginal spermicide alone. When attempting to provide clients with the family planning and HIV/STD prevention method(s) which best suits their needs, clients' degrees of reproductive health, HIV/STD risk, and motivation must first be assessed. Counseling upon and selection of particular methods may then ensue, followed by skills building of method use and other prevention strategies, follow-up counseling, and HIV/STD testing and treatment either on-site or through referral.     

Contraceptive practice among American women, 1973-1982

During the decade 1973-1982, use of oral contraceptives declined sharply among wives aged 15-44, although the total number of pill users did not decrease after 1979. This drop occurred in all groups of wives examined. At the same time, the prevalence of female contraceptive sterilization rose sharply; this increase occurred mainly among wives aged 35 and older and, of course, among all wives intending no more children. Among other subgroups of married women, the fall in pill use was complemented by a smaller rise in the use of barrier methods--the condom and diaphragm, in particular. The contraceptive status and method choices of never-married and previously married women differed sharply from those of wives as of 1982. Sexually active never-married women were less likely than married women to practice contraception and were more likely to choose the pill when they did. Previously married women were also less likely than wives to practice contraception but, when using a method, were more likely than either never-married or currently married users to depend on one of the more effective methods--sterilization, the pill or the IUD.     

Determinants of contraceptive method choice after first delivery, before first abortion, and after first abortion in East China

A 10% sample of the data from East China from the two-per-thousand fertility and contraception survey of the Chinese State Family Planning Committee was analysed to study determinants of contraceptive choice in three situations: after first surviving delivery; before first abortion after first surviving delivery; and after first abortion. A total of 2880 women were included.

For first method choice after first delivery, the most popular method is the IUD, although there are urban/rural differences. Better educated women in urban areas prefer the condom and IUD to the pill, whereas better educated women in rural areas prefer the pill. Younger women prefer the IUD and the pill. For last method choice before first abortion, women who had no sons had apparently high failure rates on the pill.     

Prévention des grossesses non prévues chez les jeunes en France : pour une double protection des premiers rapports sexuels ?

BackgroundDespite the expanded range of contraceptive options and the fact that the first acts of intercourse are well protected, abortion rates among young women in France have increased in the last 15 years. These contraceptive failures could result from the lower effectiveness of the condom compared with the pill, and/or the occurrence of contraceptive gaps when switching from the condom to the pill. Adding to the existing literature, this paper explores the conditions by which women and men discontinue using the condom.MethodsThe study sample was comprised of 1552 men and 1849 women under the age of 30, who participated in the National Survey on Sexual Health in France. Respondents answered questions on contraceptive use, duration of condom use, condom discontinuation and the switch to another method of contraception at the time of condom discontinuation in the context of their first and last sexual relationships.ResultsCondoms, used by a large majority of respondents during the first acts of intercourse, were rapidly discontinued in favor of other methods, particular the pill, for continuing relationships. However, one in ten respondents (women and men alike) had unprotected intercourse after condom discontinuation, when condom use was discontinued in the first trimester of their relationship. Abortions were more frequent among respondents who reported they did not use a condom at the start of a relationship or among women who did not switch to another form of contraception after discontinuing condom use.ConclusionWhile condoms are widely used during the first acts of intercourse, the rising abortion rates among young people suggests frequent contraceptive failures, which partly result from unprotected intercourse following condom discontinuation. These results question the dichotomy between HIV campaigns based on condom use and campaigns to reduce unintended pregnancies, which promote use of other forms of contraception, such as the pill. To reduce the incidence of unprotected intercourse, it would be important to promote the use of condoms at sexual debut, both as a contraceptive and preventive method against STIs, and provide counseling about all available contraceptive options, including the use of emergency contraception as a backup option in case of errors of use of the condom.     

The vaginal contraceptive diaphragm and the condom--a reevaluation and comparison of two barrier methods with the rhythm method

The use-effectiveness and continuation rates of two barrier methods of contraception, the diaphragm and condom, were studied during a two-year follow-up in a group of 85 and 98 women, respectively. All were highly motivated. Results were compared to a group of 64 women using the periodic abstinence or rhythm method, i.e. not using any contraceptive. The patients selected the method of contraception they preferred and were instructed in their proper use. Results showed good continuation rates in the groups using a diaphragm and the condom for 2 years, for a total follow-up of 5570 cycles. Pregnancy rate after 24 months of use, as calculated by Pearl's formula, was 2.48 for the diaphragm, 3.21 for the condom, and 5.19 in the rhythm group. No serious side effects or complications occurred in either group. The study demonstrated a fair acceptability and use-effectiveness for barrier contraceptive. We suggest that these harmless and complication-free methods may still be reasonable alternatives for the "modern" methods, the pill and the IUD.     

Barrier and spermicidal contraceptives in adolescence

This article describes both barrier and spermicide methods of contraception including the male and female condom, diaphragm, contraceptive sponge, Lea Shield, cervical cap and multiple spermicide options. Their efficacy, differences and proper use are discussed with an emphasis on the adolescent user.     

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。     

Contraceptive failure in China

This study examines patterns and differentials of contraceptive failure rates by method and characteristics of users, using the Chinese Two-per-Thousand Fertility Survey data. The results show that contraceptive failure rates for modern methods including sterilization are some of the highest in the world. The first year failure rates are 4.2% for male sterilization, 0.7% for female sterilization, 10.3% for IUD, 14.5% for pill, and 19.0% for condom. There are also some differentials in contraceptive failure rates by users' sociodemographic and fertility characteristics. Contraceptive failure rate declines with women's age for all reversible methods. Rural women have higher sterilization, IUD, and condom contraceptive failure rates than urban women. Women with two or more children have a higher failure rate for sterilization methods but have lower failure rates for other methods.     

Contraception after abortion

A study conducted among patients of a Washington, D.C. clinic to examine acceptance of contraception at the time of abortion and its use 6 months afterwards is described. Of 303 women who obtained abortions in the clinic in January 1972 and were interviewed about 6 months later, 93% chose a method of contraception at the time of abortion and 91% were using contraception at the time of follow-up. 86% chose the pill or IUD at the time of abortion and 78% were protected by the pill, IUD, or sterilization 6 months after the abortion. Although 1/4 of the women changed methods during the 6-month period after the abortion, the vast majority were highly persistent in using effective methods of contraception. It is noted that since 8 of 10 women had used contraception at some time before the abortion, caution must be taken in attributing the high prevalence of use following abortion to the experience of pregnancy and abortion. However, it is also pointed out that only 56% of the single teenagers had used any method of contraception at any time before their abortion, but 88% were using a method when interviewed 6 months after the abortion, and 74% of them were using the pill or IUD. These data suggest that the experience of becoming pregnant and obtaining an abortion in a clinic which offers contraceptive counseling and services leads to increased use of contraception, especially of the more effective methods.     

Patterns of contraceptive use in China

This article uses demographic and contraceptive use data from China's 1982 census, 1982 national fertility survey, and National Family Planning Commission to examine the country's patterns of reproductive and contraceptive behavior. Although China's fertility is near replacement level, it varies considerably among the country's subregions. One-half of all 15-49-year-old married fecund women who practice contraception are using intrauterine devices (IUDs); this means that about 70 percent of the world's IUD users are in China. Although China and the United States have similar overall contraceptive use rates, pronounced differences exist regarding the types of contraceptive methods used. Among China's subregions, contraceptive use rates vary considerably. The greater the percentage of minority groups in a subregion, the lower its contraceptive prevalence rate. The lower the proportion urban in an area, the greater the use of the IUD, except in areas with large numbers of minorities. Among the subregions, associations between urban/health variables and pill/condom use rates are strongly positive, and associations between urban/health variables and IUD use rates are strongly negative.     

Knowledge and use of contraceptive methods in rural Sereer,Senegal

This paper presents results from a retrospective survey carried out in a rural setting in Senegal (on 804 20-to-69-year-old men and 1,039 15-to-54-year-old women), and aims at improving the understanding of contraceptive knowledge and practice. Contraceptive knowledge was measured through spontaneous and recognized contraceptive methods; contraceptive practice was measured through the past and present use of contraception. The gap between spontaneously-cited methods and recognized methods is important. While about 80% of men and 70% of women had ever heard about any contraceptive method, only 46% of men and 23% of women could spontaneously mention a specific contraceptive method (respectively 33% and 17% mentioned a modern method). Analyses have shown that individual characteristics such as age, education, migration are all determinants of contraceptive knowledge. Married men and women are more likely to know about methods such as the pill, intra-uterine device (IUD) and injections, as a result of family planning campaigns, which have focused on these methods and targeted married women. Nevertheless, contraceptive practice is still low. Only 16% of men and 4% of women have ever used any method. Contraceptive prevalence (current use) of women is only 1.9% for all methods and 1.5% for modern methods. The more widespread use of condoms by young men (about 30% of single men have ever used a condom, against only 7% of ever married men) reflects its recent diffusion associated with a decrease in male age at first intercourse. The low contraceptive use by women reveals their lack of accessibility to contraception. Young generations are not able to find an adequate answer to their needs in the villages, where family planning still targets marital contraception. Recommendations are formulated in order to integrate adolescents more fully in policy programs.     

One-year results using a risk scoring system in a family planning clinic

During one year (from 1/1/85 to 12/31/85) 1038 women sought contraception at a family planning clinic. Contraception was recommended using a risk scoring system to increase the suitability of a method to the needs of an individual woman. Among the 546 women fitted with a IUD (copper or unmedicated), the continuation rate was 90.49%. Removal rates for pregnancy or bleeding were small compared with the rates published in the current literature. Among the 472 women using oral contraceptive pills (combined or triphasic), the continuation rate was 99.16%: the triphasic pill was well accepted, without discontinuation for menstrual disruption, pregnancy, or gastrointestinal side-effects. Only 20 women (1.92%) selected a barrier method (diaphragm with spermicide) suggesting the need to improve the image of barrier methods as safe and reliable. We conclude that prescribing contraception using a risk scoring system increases the appropriateness to the needs of the woman, thereby eliminating many complications and side-effects.     

Contraception for adolescents

In the contraceptive clinic of the Margaret Sanger Research Bureau, about 3000 patients are served each year, with at least 15% under 18. Of those attending the Teen Center as of 1972, aged 17 and younger, 15% used the diaphragm, 26% the IUD, 43% oral contraceptives, 10% foam or condom, and 5% a long-acting injectable. The Teen Center's program is limited to 200 girls, and along with contraceptive services, provides peer group discussions which help the girls decide which contraceptive to choose. Girls choose the diaphragm mostly when intercourse does not occur frequently. The IUD is best for those who fear the possibility of forgetting to use contraception. Although the IUD is not ideal for nulliparous women, gentle and slow insertion techniques reduce unpleasant symptoms. The girl who wishes to run no pregnancy risk whatsoever, who is not fearful of side effects, who has no strong feelings about ingesting chemicals, who is confident of not forgetting to take the pill regularly, and who desires the convenience of routine is most likely to select the oral contraceptive. The risks of the effect of oral contraceptives on the growing body are countered by the greater potential harmful effects of pregnancy producing much higher estrogen levels than caused by the pill. Because of the different needs of teenagers, they are seen every 3 months. Since the clinic's beginning in February 1971, about 8% have dropped from the program; 12 girls became pregnant and 9 had subsequent abortions. The low dropout rate is attributed to the teenagers' perception that the staff accepts and cares about them.     

育龄妇女使用避孕措施后随访服务的调查

目的通过对已使用避孕措施育龄妇女进行随访服务的调查分析,为计划生育优质服务进一步深化提供依据。方法对南海区桂城街道980名已使用避孕措施的育龄妇女采用随机抽样的方法进行随访调查。结果随访对象中使用避孕措施种类以IUD最多,占44.8%,对IUD、男女绝育手术、避孕套知晓率最高,愿意继续使用现用避孕措施的对象比例较大。落实避孕措施的单位以区、镇街计划生育服务机构为主,占60.8%,对现用避孕措施接受程度有94.6%的对象表示坚持使用。随访对象满意度较高的服务内容主要有:服务态度、服务质量、服务环境。对随访服务认为很有必要的占88.7%,随访形式以面对面或电话随访模式最受对象认可,随访对象最想知道的宣教知识以避孕节育、生殖健康知识为主。结论为育龄群众提供全程、高质量和形式多样的随访服务是提高避孕措施使用率和续用率的有效途径,能避免或减少意外妊娠的发生;日常化、常规化的随访服务使优质服务内容更加完善,服务质量更加提升。     

育龄妇女使用避孕措施后随访服务的调查

目的通过对已使用避孕措施育龄妇女进行随访服务的调查分析,为计划生育优质服务进一步深化提供依据。方法对南海区桂城街道980名已使用避孕措施的育龄妇女采用随机抽样的方法进行随访调查。结果随访对象中使用避孕措施种类以IUD最多,占44．8％,对IUD、男女绝育手术、避孕套知晓率最高,愿意继续使用现用避孕措施的对象比例较大。落实避孕措施的单位以区、镇街计划生育服务机构为主,占60．8％,对现用避孕措施接受程度有94．6％的对象表示坚持使用。随访对象满意度较高的服务内容主要有：服务态度、服务质量、服务环境。对随访服务认为很有必要的占88．7％,随访形式以面对面或电话随访模式最受对象认可,随访对象最想知道的宣教知识以避孕节育、生殖健康知识为主。结论为育龄群众提供全程、高质量和形式多样的随访服务是提高避孕措施使用率和续用率的有效途径,能避免或减少意外妊娠的发生：日常化、常规化的随访服务使优质服务内容更加完善,服务质量更加提升。     

Contraceptive use and the need for family planning in Puerto Rico

In 1982, 69 percent of Puerto Rican women in union were practicing contraception. Forty-five percent relied on contraceptive sterilization (40 percent, female, and five percent, male), eight percent were using the pill, four percent each, the IUD and the condom, five percent relied on rhythm, and three percent were using other methods. Thus, sterilization is the dominant form of fertility regulation in Puerto Rico, and there is relatively little use of reversible methods for childspacing. Reliance on female sterilization peaks among women in union in the age-group 35-44 (54 percent), whereas pill use is highest among those aged 15-24 (approximately 23 percent). Overall, eight percent of all women aged 15-49 are at risk of unintended pregnancy because they are fecund, sexually active, not pregnant or seeking pregnancy and not using any kind of contraceptive method. However, among women in union, this risk ranges from nine percent among those aged 30-39 to 22 percent among women aged 15-19. Reliance on sterilization rather than reversible methods of contraception is strongly influenced by socio-demographic variables. Women with less than a high school education, the wives of blue-collar workers, women living outside of the major cities and those born in Puerto Rico depend upon sterilization more than do women with a college education, the wives of white-collar employees, women living in cities and those born outside of the country. These findings point to the need for improved availability of reversible family planning services, especially for young women, and those whose childbearing is incomplete.     

1520例寻求人工流产妇女的避孕实践

为了探讨寻求人工流产(简称人流)妇女最近和以往避孕使用和避孕失败情况,从1996年3月至1996年5月,对河南省郑州市8家大医院1520例来院寻求人流服务的妇女进行了问卷调查。结果表明,本次意外妊娠最常见的原因是避孕失败(1093例,占71.9％),其中有511例的避孕失败是可以及时确认的,426例由于未避孕而造成意外怀孕。在避孕失败中,避孕套失败占比例最高,为29.7％。大多数人流者(77.1％)以往曾经使用过某种避孕方法。但是仅有19.5％的人在初次同房时使用了避孕方法。以往曾用过避孕套的占57.6％,其中有套失败的占50.9％;曾用过避孕片的占16.8％,其中有过片失败的占58.9％。在避孕套和避孕片失败者中,大多数属于使用失败。曾经有过人流史的高达56.4％。结论:大多数人流者适合使用紧急避孕(EC)方法。使用避孕套和安全期避孕法的人群是EC宣教的重点对象。有必要普及避孕套和避孕片具体使用方法的知识。本项目为美国帕斯适宜卫生科技组织(PATH)资助项目,是PATH小规模资助规划的一部分。     

Precautionary tales: Condom and contraceptive use among young Australian apprentices

Condom and contraceptive use at first intercourse have become important reference points in monitoring the sexual health of young people. This study describes the precautionary practices of a national stratified cluster sample of 3133 Australian hairdressing, automotive, and commercial cookery apprentices aged 15 to 24 years. Approximately 77% of the apprentices reported using a condom, the oral contraceptive, spermicide, IUD, or a diaphragm at first intercourse. Of these, 91.7% used a condom either alone or in combination with another method. Among female apprentices, younger age at the time of the survey, year 10 or more schooling, being older at first intercourse, being the same age or older than their partner, and planning first intercourse were associated with increased condom use. First intercourse with a regular partner and planning first intercourse were associated with greater likelihood contraceptive use. Male apprentices were more likely to use condoms, and to use contraception generally, if they were younger at the time of the survey, older at first intercourse, and were involved in planning their first occasion of intercourse. No significant differences were found in rates of precautionary use between the sexes. Rates of condom and contraceptive use at first intercourse in this Australian sample were comparable to those of other developed countries. However, there is still a worrying degree of non‐use, especially among those who engage in intercourse early in their teenage years, who are forced or coerced into sex, or do not plan their first occasion of intercourse.     

Contraceptive use in Canada, 1984

Canada's first national fertility survey, carried out by telephone in 1984, found that 68 percent of all women aged 18-49-73 percent of currently married women, 69 percent of the previously married women and 57 percent of single women--are practicing contraception. Overall, the most widely used method of birth control in Canada is sterilization (male and female), which is relied on by almost 60 percent of all married users and 66 percent of previously married users. Among single women, the preferred method is the pill, chosen by seven out of 10 of such users. Among all women, the major determinant of method choice is age: The pill is overwhelmingly chosen by women under 25, and sterilization, by those 30 and over. While the IUD and the condom are used by roughly 10-14 percent of women in their 20s who practice contraception, these methods decline in importance with increasing age. Highly educated women are less likely than those with little education to elect sterilization, and more likely to rely on barrier methods. Differences in contraceptive prevalence and patterns of use between Catholics and Protestants have all but disappeared in Canada, but church attendance and country of birth appear to exert a modest influence on method choice. As might be anticipated, women whose family size is complete have considerably higher levels of contraceptive use than those who expect to have more children. The survey reveals no difference in contraceptive use between Quebec women and those in the rest of Canada, thus confirming both the accuracy of earlier Quebec studies showing extremely high levels of sterilization and the applicability of these findings to all other Canadian women.(ABSTRACT TRUNCATED AT 250 WORDS)