Sequence of events following adoption of contraception: An exploratory analysis of 1973 fertility history data

Abstract

Fertility histories from the 1973 United States National Survey of Family Growth are analyzed in the context of a model of contraceptive use based on a Semi‐Markov processes. This model provides a means of constructing data‐based estimates of probabilities of pregnancy following initial acceptance of a contraceptive method. The algorithm used to construct these estimates recognizes multiple intervals of contraceptive used prior to the events: pregnancy, marital dissolution, or sterilization.

Estimated probabilities of the events marital dissolution and pregnancy for women seeking to delay pregnancy are presented, as are probabilities of contraceptive sterilization for women seeking to prevent subsequent pregnancy. These estimates are compared to one‐step transition probabilities and directly observed NSFG data on pregnancy, marital dissolution, or contraceptive sterilization in an attempt to judge the validity of the model and to assess biases which may result from its use.     

Contraceptive sterilization: A comparison of Mexican‐Americans and Anglos living in U.S. counties bordering Mexico

Abstract

Prior to the U.S.‐Mexico Border Survey of Maternal and Child Health and Family Planning conducted by the Centers for Disease Control in 1979, little information was available about the extent to which Mexican‐Americans in the U.S., relative to Anglos, were using male and female sterilization for contraceptive reasons. This paper compares Mexican‐Americans and Anglos for (a) prevalence of contraceptive sterilization; (b) social and demographic characteristics of users of contraceptive sterlization; and (c) tuning during the reproductive life cycle when contraceptive sterilization occurs. For both Mexican‐Americans and Anglos, contraceptive sterilization (male and female) was the second most prevalent method used. Anglos were more likely to use male than female sterilization (22.4 per cent and 19.5 per cent), while Mexican‐Americans were much more likely to use female than male sterilization (23.2 per cent and 5.8 per cent). Having an unwanted last live birth and/or high parity were important factors related to the use of female sterilization for both Mexican‐Americans and Anglos.     

The Role of Quality Health Services and Discussion about Birth Spacing in Postpartum Contraceptive Use in Sindh,Pakistan: A Multilevel Analysis

IntroductionRapid population growth, stagnant contraceptive prevalence, and high unmet need for family planning present significant challenges for meeting Pakistan’s national and international development goals. Although health behaviors are shaped by multiple social and environmental factors, research on contraceptive uptake in Pakistan has focused on individual and household determinants, and little attention has been given to community characteristics that may affect access to services and reproductive behavior.MethodsIndividual and community determinants of contraceptive use were identified using multivariable multilevel logistic regression to analyze data from a 2014 cross-sectional survey of 6,200 mothers in 503 communities in Sindh, Pakistan.ResultsOnly 27% of women who had given birth in the two years before the study reported using contraceptives. After adjusting for individual and community characteristics, there was no difference in the odds of contraceptive use between urban and rural women. Women who had delivered at a health facility had 1.4 times higher odds of contraceptive use than women who delivered at home. Those who received information about birth spacing from a doctor or relatives/friends had 1.81 and 1.38 times higher odds of contraceptive use, respectively, than those who did not. Living in a community where a higher proportion of women received quality antenatal care and where discussion of birth spacing was more common was significantly associated with contraceptive use. Community-wide poverty lowered contraceptive use.ConclusionsQuality of care at the community level has strong effects on contraceptive use, independent of the characteristics of individual households or women. These findings suggest that powerful gains in contraceptive use may be realized by improving the quality of antenatal care in Pakistan. Community health workers should focus on generating discussion of birth spacing in the community. Outreach efforts should target communities where the demand for contraception appears to be depressed due to high levels of poverty.     

Self‐reported activation during the premenstrual and menstrual phases of the menstrual cycle

Abstract

A total of 171 female subjects completed a self‐report questionnaire dealing with activation (AD‐ACL) during the premenstrual and menstrual phases of their cycles. Significant variation between the two phases was found for all four activation factors: activation was highest premenstrually. Contraceptive use interacted significantly with cycle phase for the General Activation factor. Subjects taking oral contraceptive preparations also had lower scores on the Deactivation‐Sleep factor.     

Use of Contraception and Attitudes towards Contraceptive Use in Swedish Women - A Nationwide Survey

ObjectiveTo describe contraceptive use and attitudes towards contraceptive use in Sweden which has the highest abortion rate in Western Europe. Secondary objectives were to investigate knowledge of contraceptive methods and outcomes of unplanned and unwanted pregnancies.DesignTelephone survey.SettingNational survey of women living in Sweden.PopulationWomen between 16 and 49 years.MethodsThe survey contained 22 questions with free text and multi choice answers on demographics, contraceptive use, knowledge of and attitudes towards contraception, the importance of monthly bleeding and experience of unintended pregnancy.ResultsA total of 1001 women participated in the survey. Of all women, 721/1001 (72.1%) currently used contraception whereas 268/1001 (26.8%) women did not. Long acting reversible contraception, (LARC; implant and intra uterine contraception) was used by 24.3% of women. The unmet need of contraception in Sweden was estimated at 8.9% (89/1001 women). A total of 781 (78%) women had never experienced an unintended pregnancy whereas 220 (22%) women had had at least one unintended pregnancy. Users and non-users alike stated that one of the most important characteristics of a contraceptive method is its effectiveness.ConclusionsSweden has a large unmet need for contraception. Furthermore, a large proportion of women have experienced at least one unintended pregnancy. Increasing contraceptive use and promotion of LARC is a possible way forward in the effort to reduce the rates of unwanted pregnancies.     

Contraceptive use and efficacy in a genetically counseled population

Abstract

This paper reports contraceptive use and efficacy rates among 648 married women aged 15 to 44 who had received genetic counseling six months previously. Over half (53.5 per cent) of the counseled population were using non‐surgical contraception; 20 per cent were pregnant or postpartum; 10 per cent were seeking to become pregnant; 11 per cent were sterilized. Only 4.5 per cent were neither using contraceptives nor seeking to become pregnant. Women who were certain about their reproductive intentions after counseling utilized contraceptives effectively, with only two pregnancies at six months among those seeking to delay wanted pregnancies and only one pregnancy among those seeking to prevent pregnancy. This represents six‐month contraceptive failure rates of 4.3 and 2.1 per cent respectively for the two groups, rates similar to those with comparable intentions in the U. S. population at large. A distinguishing characteristic of the genetically counseled group was that 32 per cent of contraceptive users reported that their reproductive intentions were uncertain after counseling. The six‐month pregnancy rate in this uncertain group was 10 per cent.     

Changes in contraceptive use and fertility: Panama, 1976 to 1984

Abstract

From 1976 to 1984 important demographic changes occurred in Panama. The total fertility rate declined from 4.5 to 3.7, and contraceptive use amongmarried women 20–44 years of age increased from 55 per cent to 63 per cent. However, using data from three national level reproductive health surveys which were conducted in Panama in 1976, 1979, and 1984, we found that most of the changes took place between 1976 and 1979. Since 1979, overall contraceptive use and fertility have remained virtually unchanged, although there has been an important method‐mix shift toward an increase in the use of contraceptive sterilization and IUD's, with an accompanying decline in the use of oral contraceptives. Although the singulate mean age at marriage remained relatively constant, the average duration of breastfeeding rose 23 per cent during the period. Further gains in contraceptive prevalence and reduction in unplanned fertility in Panama will largely depend on enhanced program efforts first begun in the early 1970's by the Panama Ministry of Health. Future program efforts especially should be directed toward encouraging young couples to space their children more effectively by using temporary methods of contraception.     

Demographic and contraceptive patterns among women in northern Mindanao,the Philippines

Abstract

Desired family size and contraceptive behavior of 986 ever‐married women aged 15–54 from Northern Mindanao, the Philippines, are described. Using the Dow and Werner typology of demographic and contraceptive patterns, it was found that a majority of the women were traditional in their demographic attitude and contraceptive behavior. A substantial proportion of the women desired medium to large families. Inconsistency in attitude and behavior was also manifested by women who desired small families but have never used efficient family planning methods. Sociodemographic characteristics of these women are described. A majority of the women who have never used efficient contraception also never practiced family planning. Rhythm was the primary method of birth control among demographic innovators and traditionals who have ever used inefficient methods; the pill was popular among contraceptive innovators and the moderns. A considerable proportion of the demographic innovators and the traditionals were not currently using any family planning method; a lesser proportion of contraceptive innovators and moderns were also not using birth control methods. Relevance of the findings to family planning programs is pointed out. Recommendations are given.     

The Hirsute Woman: Challenges in Evaluation and Management

ObjectiveTo review the etiology, pathogenesis, diagnostic approach, and management of hirsutism.MethodsWe discuss the clinical course of hirsutism and provide our recommendations on the various treatment options available.ResultsHirsutism is a common clinical problem characterized by the presence of increased terminal hair growth in androgen-dependent areas of the skin. The development of hirsutism depends on the presence of the pilosebaceous unit, which is genetically determined, as well as the presence of the androgen receptor and intracellular 5α-reductase activity, which converts testosterone to its more active metabolite, dihydrotestosterone. A detailed history and physical examination and the following laboratory tests can diagnose most causes of hirsutism: early-morning follicular phase measurement of total testosterone, testosterone not bound to sex hormone-binding globulin, dehydroepiandrosterone sulfate, 17-hydroxypro- gesterone, prolactin, and thyrotropin levels. Oral contraceptive preparations may be effective monotherapy formild hirsutism. For the treatment of more severe hirsutism, oral contraceptive pills combined with spironolactone are as effective as oral contraceptive pills containing cyproter- one acetate, which are not available in the United States. Because of teratogenicity, spironolactone should be used with caution in premenopausal women when it is administered without an oral contraceptive pill. Metformin is an alternative therapy for hirsutism in women with polycystic ovary syndrome who have other indications for metformin use. Metformin is not as effective as antiandrogens for the management of hirsutism. The use of glucocorticoids, finasteride, or flutamide is not recommended.ConclusionsHirsutism can be evaluated with a detailed history and physical examination and a limited number of hormonal tests. Serious disorders presenting as hirsutism are rare and can be excluded with the recommended evaluation. Treatment is targeted at reducing the production and bioavailability of testosterone, as well as blocking target tissue androgen action. (Endocr Pract. 2011;17:807-818)     

Impact of Weight‐Cycling History on Bone Density in Obese Women

Objective: The purpose of this study was to examine the effect of weight cycling (as defined by the frequency and magnitude of intentional weight loss) on bone mineral density and bone mineral content in obese sedentary women. Research Methods and Procedures: Bone mineral content and density measured by DXA, submaximal physical fitness assessment, nutrient intake, oral contraceptive use, and weight‐cycling history were assessed in 195 healthy, overweight sedentary women (age, 21 to 45 years; body mass index, 27 to 40 kg/m²) before beginning a behavioral weight‐loss intervention. Results: After controlling for body weight, multivitamin use, oral contraceptive/estrogen use, and calcium and magnesium intake, women who had a history of weight cycling did not have significantly lower total‐body bone mineral content or density or total femur bone mineral density. In addition, 99% of subjects were above or within one SD of age and gender normative data for total femur bone mineral density. Discussion: It does not seem that a history of weight cycling has an adverse affect on total femur and total‐body bone mineral density in overweight sedentary premenopausal women.     

Explaining the Role of Proximate Determinants on Fertility Decline among Poor and Non-Poor in Asian Countries

ObjectivesWe examined the overall contributions of the poor and non-poor in fertility decline across the Asian countries. Further, we analyzed the direct and indirect factors that determine the reproductive behaviour of two distinct population sub-groups.DesignData from several new rounds of DHS surveys are available over the past few years. The DHS provides cross-nationally comparable and useful data on fertility, family planning, maternal and child health along with the other information. Six selected Asian countries namely: Bangladesh, India, Indonesia, Nepal, Philippines, and Vietnam are considered for the purpose of the study. Three rounds of DHS surveys for each country (except Vietnam) are considered in the present study.MethodsEconomic status is measured by computing a “wealth index”, i.e. a composite indicator constructed by aggregating data on asset ownership and housing characteristics using principal components analysis (PCA). Computed household wealth index has been broken into three equal parts (33.3 percent each) and the lowest and the highest 33.3 percent is considered as poor and non-poor respectively. The Bongaarts model was employed to quantify the contribution of each of the proximate determinants of fertility among poor and non-poor women.ResultsFertility reduction across all population subgroups is now an established fact despite the diversity in the level of socio-economic development in Asian countries. It is clear from the analysis that fertility has declined irrespective of economic status at varying degrees within and across the countries which can be attributed to the increasing level of contraceptive use especially among poor women. Over the period of time changing marriage pattern and induced abortion are playing an important role in reducing fertility among poor women.ConclusionsFertility decline among majority of the poor women across the Asian countries is accompanied by high prevalence of contraceptive use followed by changing marriage pattern and induced abortion.     

Contraceptive choice of limiters ages 35–44 in the United States: An examination of selection of method from among a number of possible choices

Abstract

Utilizing a subsample of the 1970 National Fertility Survey and discriminant analysis, the choice of contraceptive method was examined. First, choice from among rhythm, chemicals, condoms, oral pill, and IUD was examined. Two significant characteristic dimensions were isolated. The first dimension was interpreted as a distinction among methods from more‐effective to less‐effective. The second dimension was concluded to represent an aesthetics‐health dimension, dividing methods between coitus‐related versus not‐coitus‐related. Second, the choice between these methods and sterilization was examined. The results indicated that income and the number of births to be averted play an important role in the choice of sterilization.     

Azadirachta indica A. Juss (neem) as a contraceptive: An evidence-based review on its pharmacological efficiency

BackgroundAzadirachta indica A. Juss. is an Indian medicinal plant with innumerable pharmacological properties. Studies have proven that the phytochemicals from neem possess remarkable contraceptive abilities with limited knowledge on its mechanism of action.PurposeThe present review aims to summarize the efficiency of A. indica treatment as a contraceptive.MethodsThe Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used. Published scientific articles on antifertility, antispermatogenic, antiovulation, hormone altering, contraceptive, and abortifacient activities of A. indica were collected from reputed Journals from 1980 to 2020 using electronic databases. Specific keywords search was completed to collect numerous articles with unique experiment design and significant results. This was followed by the selection of the requisite articles based on the criteria designed by the authors. Data extraction was based on the common research elements included in the articles.ResultsA total of 27 studies were considered for reviewing, which included key pharmacological investigations. In the beginning, authors evaluated a number of publications on the contraceptive properties of A. indica, in which it was revealed that most of the publications were made between 2005 and 2009. All the collected articles were categorised and reviewed as antifertility, antispermatogenic, antiovulation, hormone altering, contraceptive, and abortifacient. Authors also assessed studies based on the plant parts used for pharmacological evaluations including leaves, seeds, stem-bark, and flowers. The article was primarily divided into different sections based on the previous works of authors on phytochemistry and pharmacological review articles.ConclusionAlthough A. indica is not reported with the complete alleviation of reproductive system in both male and female animal models, studies have proven its efficacy as a contraceptive. Extracts and phytochemicals from neem neither reduced the libido nor retarded the growth of secondary sexual characters, thus indicating only a temporary and reversible contraceptive activity. However, there is a dearth for clinical studies to prove the efficacy of A. indica as a herbal contraceptive.     

Estimating the Effect of Intimate Partner Violence on Women’s Use of Contraception: A Systematic Review and Meta-Analysis

BackgroundIntimate partner violence (IPV) is an important global public health problem. While there is a growing literature on the association between IPV and women’s reproductive health (RH) outcomes, most studies are cross-sectional—which weakens inference about the causal effect of IPV on women’s RH. This systematic review synthesizes existing evidence from the strongest study designs to estimate the impact of IPV on women’s use of contraception.MethodsWe searched 11 electronic databases from January of 1980 to 3 December 2013 and reviewed reference lists from systematic reviews for studies examining IPV and contraceptive use. To be able to infer causality, we limited our review to studies that had longitudinal measures of either IPV or women’s use of contraception.ResultsOf the 1,574 articles identified by the search, we included 179 articles in the full text review and extracted data from 12 studies that met our inclusion criteria. We limited the meta-analysis to seven studies that could be classified as subject to low or moderate levels of bias. Women’s experience of IPV was associated with a significant reduction in the odds of using contraception (n = 14,866; OR: 0.47; 95% CI: 0.25, 0.85; I² = 92%; 95% CI_I²: 87%, 96%). Restricting to studies that measured the effect of IPV on women’s use of partner dependent contraceptive methods was associated with a reduction in the heterogeneity of the overall estimate. In the three studies that examined women’s likelihood of using male condoms with their partners, experience of IPV was associated with a significant decrease in condom use (OR: 0.48; 95% CI_OR: 0.32, 0.72; I² = 51%; 95% CI_I²: 0%, 86%).ConclusionsIPV is associated with a reduction in women’s use of contraception; women who experience IPV are less likely to report using condoms with their male partners. Family planning and HIV prevention programs should consider women’s experiences of IPV.     

Determinants of current use of contraception and children ever born in Nepal

Abstract

This paper explores the extent to which women's work for earnings, education and couple communication over family planning influence current contraceptive use and children ever born in Nepal. Data came from the 1996 Nepal Family Health Survey. The findings indicate that education has a significant positive influence on current use of contraception and a significant negative influence on children ever born. There was virtually no relationship between women working and current use of contraception. However, in full models, there was a significant positive relationship for women who earn cash for work on current use and a significant negative relationship for children ever born. Working alone does not increase contraceptive use or reduce the number of children ever born in Nepal, but earning cash for work does. The husband/couple variables also proved to be important determinants of current use of contraception and children ever born.     

宫内节育器与宫腔支撑球囊联合应用治疗中重度宫腔粘连中的临床效果

摘要 目的：探讨宫内节育器与宫腔支撑球囊联合应用治疗中重度宫腔粘连的临床效果。方法：选择2016年12月至2019年8月于西安交通大学第一附属医院宫腔镜诊疗中心接受宫腔镜下中重度宫腔粘连分解术的患者共96例,采用随机对照表法将其分为两组。对照组48例,术后宫腔内放置宫内节育器(intrauterine contraceptive device,IUD);研究组48例,术后放置宫腔支撑球囊(intrauterine support balloon,ISB),3~5 d后更换为宫内节育器。两组术后均给予为期3月的人工周期治疗。术后1月,复查宫腔镜了解宫腔有无再粘连并取出宫内节育器,以此评估手术效果是否有效,术后3月时随访其月经来潮情况。统计比较两组术后5 d内阴道出血量、C反应蛋白水平、发热、下腹痛以及节育器或支持球囊有无脱落等情况,术后1月手术效果及术后3月月经恢复情况。结果：研究组的手术有效率及月经改善比例均显著高于对照组(P<0.05),术后5 d内阴道出血量显著少于对照组(P<0.05);下腹痛及球囊脱落事件发生率显著低于对照组(P<0.05)。两组在C反应蛋白水平、发热发生率对比无统计学差异(P>0.05)。结论：与单独使用宫内节育器相比,联合使用宫腔支撑球囊能提高中重度宫腔粘连分解手术有效率,改善月经,减少术后出血,不增加感染风险,但球囊易于脱落且会增加患者下腹疼痛。     

The use of long acting subcutaneous levonorgestrel (LNG) gel depot as an effective contraceptive option for cotton-top tamarins (Saguinus oedipus)

Cotton‐top tamarins (Saguinus oedipus) are a critically endangered species that have been bred successfully in captivity for many years. For two decades, the Cotton‐top Tamarin SSP^© has been challenged with a high rate of reproduction combined with a history of contraceptive failures and nonrecommended births using the current Depo Provera^® (medroxyprogesterone acetate) injection followed by MGA (melengestrol acetate) implant contraception combination. To address these issues we have developed and tested the use of levonorgestrel (LNG) as an effective contraception option for cotton‐top tamarins. LNG was delivered in an injectable, gel matrix consisting of polylactic‐co‐glycolic acid, triethyl citrate and N‐methylpyrrolidone. This gel matrix forms a biodegradable depot at the subcutaneous injection site providing slow release of the active ingredient. Gel matrix composition and LNG concentration were adjusted in four gel formulations to maximize the duration of contraceptive efficacy while minimizing immediate post‐injection increases in fecal LNG concentration. LNG treatment (68.44±8.61 mg/kg) successfully eliminated ovarian cycles (fecal pregnanediol‐3‐glucuronide (PdG) and estrone conjugates (E₁C)) for 198.8±70.3 days (formulation four; range 19–50 weeks). It was demonstrated that subcutaneous LNG depot injection was an effective, reversible contraceptive option for the management of cotton‐top tamarins in captivity. Zoo Biol 30:498–522, 2011. © 2010 Wiley Periodicals, Inc.     

A scale to measure microbehaviors of oral contraceptive pill use

The ways in which contraceptive methods are actually used is of increasing interest to researchers, clinicians, and policy makers. Although contraceptive "use" has multiple dimensions, existing indicators measure only one aspect of use or combine unidimensional measures to produce a questionable pastiche. This study uses a subsample of 612 respondents from a larger study of first-time patients at a public-health-department family planning clinic to develop a new measure. Psychometric properties of this measure are examined and discussed.     

Contraceptive Charms Among the Plains Indians

Abstract

Although Clark Wissler and Sister M. Inez Hilger have recorded the use of contraceptive charms by the Blackfoot and Arapaho, the Piegan specimen illustrated here may be unique to museum collections. Indications that use of these charms survived into the middle years of the present century suggest the possibility of obtaining more detailed information about their use among other tribes of Plains Indians through field work.     

Do commonly used indices of β‐diversity measure species turnover?

Abstract. Indices of β‐diversity are of two major types, (1) those that measure among‐plot variability in species composition independently of the position of individual plots on spatial or environmental gradients, and (2) those that measure the extent of change in species composition along predefined gradients, i.e. species turnover. Failure to recognize this distinction can lead to the inappropriate use of some β‐diversity indices to measure species turnover. Several commonly‐used indices of β‐diversity are based on Whittaker's β_W (β_W = γ/α, where γ is the number of species in an entire study area and α is the number of species per plot within the study area). It is demonstrated that these indices do not take into account the distribution of species on spatial or environmental gradients, and should therefore not be used to measure species turnover. The terms ‘β‐diversity’ and ‘species turnover’ should not be used interchangeably. Species turnover can be measured using matrices of compositional similarity and physical or environmental distances among pairs of study plots. The use of indices of β‐diversity and similarity‐distance curves is demonstrated using simulated data sets.