The pill and the rising costs of fertility control

Until recently it appeared as if oral contraception greatly reduced the costs of fertility control. The advantages of effectiveness and the convenience of this method in preference to coitus-related contraception led to the dramatic increase in oral contraceptive (OC) use during the 1960s in the U.S. The trend in the 1970s is different. OC use has leveled off, and suspicions have arisen that the net costs to women of using this form of birth control are higher than was previously believed. Discontinuation rates by women who have been on OCs have increased despite major improvement in the chemistry of the OC in recent years. In view of the evidence concerning the apparent risks to health associated with OCs, the current trend is not surprising. The range of major diseases for which the relative risk is higher among OC users seems to be broadening, and, as a consequence, the cumulative absolute risk overall of these diseases may be very much higher than was believed when only selected thromboembolic entities seemed to be involved. In order to obtain the public's view about the safety of OCs, 1500 voting age adults have been questioned in national surveys since 1966. 34% of the respondents in 1976 said that they believed the OC to be safe, but 47% of this group meant that it is as safe as aspirin. 34% ranked it as being somewhat less safe than aspirin. Their answers indicate that over time there had been increasing anxiety about the safety of the OC, but no general sense of panic. Even among those who felt it is unsafe, only a minority are willing to label it as "really dangerous."     

Patterns of contraceptive use in Australia: analysis of the 2001 National Health Survey

The purpose of this paper is to review the patterns of contraceptive use in Australia, using data from a nationally representative sample of 5872 women aged 18 to 49. This survey was conducted by the Australian Bureau of Statistics in 2001 as part of the National Health Survey. Results of the analysis indicate that the oral contraceptive pill and condom were the two most frequently used methods. More than 76% of the respondents reported having ever used the pill. Over 23% of women were currently using condoms; of these 80% of the condom users used them for contraception - this included 36% who used condoms for both protection against infection and for contraception - and the remainder used them only for protection. Withdrawal was the third most popular non-surgical method up to age 40. Few women used IUDs, injections or diaphragms. Just over 3% of the respondents were using natural methods with the highest rate reported among those in their 30s. The 'morning-after pill' was reported mostly by women aged 18-24; however, there was no evidence to suggest that it was being used as a primary method of birth control. Contraceptive use declined in older women who turned to sterilization for themselves and/or their partners. Use of the contraceptive pill was somewhat higher among better-educated women, but lower among less-educated women and those from non-English-speaking backgrounds.     

Fertility and family planning in Accra

A sample of 1000 currently married women aged 25-39 and living in 3 geographic areas of the Ghanaian capital were interviewed about their contraceptive knowledge and practice. Slightly over 90% of the respondents said that they had heard of ways to delay or prevent pregnancy. There was no difference between the 3 areas, but more of those aged 30-34 had heard about contraception. The chances that a respondent had heard about contraception increased with the level of education. Catholics were less likely to have heard of any contraceptive methods than Protestants. Also, women engaged in traditional informal occupations were the least likely to have heard of any contraceptive methods. Overall, education emerged as the most important differentiating factor. The pill, condom, and IUD were the best known methods. Regarding actual contraceptive practice, only 41% of the respondents were currently using some form of contraception, with about 19% using modern and 27% traditional methods. Results of contraceptive usage by user characteristics show that the majority of women in 2/3 of the areas rely on a mixture of traditional and modern methods; that the % of users (any method) increases with age up to 30-34 years, after which it decreases. The % of ever-users of any type of contraception in this study is highest for the highest education levels, at 84% for women with 2ndary and post 2ndary education. With the exception of the IUD, douche and folklore methods, better educated women have higher ever-use %s for both traditional and modern methods. While the %s of users increases with education for foam, diaphragm and withdrawal; the reverse is observed for the pill and IUD, probably due to fear of negative side effects. Overall, there are no significant variations in contraceptive use by migration status; but the % of non-users is highest among recent migrants who are also the least likely to have ever used modern methods. Fertility differentials across ethnic groups have been observed in Ghana. The Akan have the highest fertility, followed by the Ewe and Ga-Adangbe with moderate fertility, and the northern ethnic groups with the lowest fertility. The Akan also have the highest % of ever users of modern contraceptives, an inconsistency which may be explained by their recent recognition of the burdens of high fertility and their attempts to control it. Religious differences are pronounced, especially between the traditional category on the 1 hand, and Christians and Muslims on the other. Results of an analysis of variance suggests that family size is the strongest motivation for adopting modern contraception, and that it may be used for limiting rather than spacing births.     

Contraceptive Use and Pregnancy Outcomes among Opioid Drug-Using Women: A Retrospective Cohort Study

Objective

The contraceptive needs of illicit opioid users differ from non-drug users but are poorly understood. The aim of this study was to describe contraceptive use and pregnancy outcomes in opioid-using women, and to examine their association with a range of risk factors.

Method

This retrospective cohort study used UK general practice records, Treatment Outcomes Profile and National Drug Treatment Monitoring System data, and a nested data validation exercise. A cohort of 376 women aged 20–61 years were in active treatment for opioid addiction in October 2010 at two specialised primary care practices in North-East England. Outcomes were age-adjusted prevalence estimates for contraceptive use and pregnancy outcomes in users of illicit opioids. The association between lifestyle-related risk factors and contraception was explored.

Results

Drug-using women made lower use of planned (non-condom) contraception (24% vs 50%, p<0.001), had more frequent pregnancy terminations (0.46 vs. 0.025, p = 0.004) and higher annual incidence of chlamydia (1.1% vs. 0.33%, p<0.001), when compared with age-matched population data. Specifically, there was low use of oral contraceptives (4% vs. 25%, p<0.001), IUCD (1% vs. 6%, p<0.001), and sterilisation (7% vs. 6%, p = 0.053), but higher rates of injectable contraceptives (6% vs. 3%, p = 0.003). A total of 64% of children aged <16 years born to this group did not live with their mother. No individual risk factor (such as sex-working) significantly explained the lower use or type of non-condom contraception.

Conclusions

This is the first study to describe planned contraceptive use among drug-users, as well as the association with a range of risk factors and pregnancy outcomes. The low uptake of planned contraception, set against high rates of terminations and sexually transmitted disease demonstrates the urgent clinical need to improve contraceptive services, informed by qualitative work to explore the values and beliefs influencing low contraceptive uptake.     

Predicting contraceptive method usage among women in west Scotland

Users of the six major methods of contraception are compared across a broad range of variables using data from a community sample. Differences between the groups were apparent for a range of socioeconomic and reproductive variables, and current users of the various methods also differed in their past use of contraception. Users of barrier methods fared particularly well. Few differences were observed for current health status or for the sociocultural variables examined, although users of natural methods differed from all others in their religious affiliation and commitment. Discriminant analysis showed that the most predictive variables distinguishing women who had opted for permanent methods of contraception (female sterilization and vasectomy) were the woman's stated reason for using her current method and her past contraceptive patterns; the inclusion of social, health and reproductive indicators did little to improve the prediction. It is argued that heightened expectations for contraceptive efficacy in the face of increasing concerns about long-term health consequences have contributed to the increased use of permanent methods.     

The Impact of Oral Contraceptive Initiation on Young Women’s Condom Use in 3 American Cities: Missed Opportunities for Intervention

Purpose

To describe women’s condom use and assess predictors of consistent condom use and dual method use in the 6 months after the initiation of oral contraception (OC).

Methods

We conducted a planned secondary cohort analysis among women less than 25 years of age initiating oral contraceptives at public family planning clinics in Atlanta, Dallas and New York City, USA, as part of a randomized trial. These clinics provide care to predominantly African American or Hispanic women of low socioeconomic status. Participants completed interviews at enrollment and at 6 months after OC start. We used multivariate logistic regression to assess factors associated with consistent condom and dual method use at 6 months.

Results

1281 participants met the inclusion criteria for this analysis. At enrollment prior to OC start, 28% were consistent condom users. In the six months after initiation of oral contraception, only 14% always used a condom and 4% always used dual methods. In multivariate analysis, receiving basic advice to always use a condom after OC initiation from a provider during the baseline clinic consultation was associated with a 50% increase in the odds of using condoms consistently. Only 28% of participants were given this condom use advice.

Conclusions

This study documents a decline in women’s condom consistent use subsequent to initiation of the oral contraceptive and suggests that opportunities for positive intervention around condom use among women starting hormonal methods are being missed. Basic condom use advice, which is neither time consuming nor resource dependent, was associated with increased consistent use and should be immediately implemented in all family planning services.     

Effects of oral contraceptive use on body mass index and blood pressure among female villagers in north-east Thailand

The use of contraceptives has become prevalent among females in Thailand in the past 20 years, and oral contraceptive use has been suggested to trigger changes in fat intake, energy expenditure, fat metabolism and blood pressure. Based on field investigations of 391 married women aged 20 years or over in Yasothon Province, North-east Thailand, this study aims to elucidate the effects of oral contraceptive use on body mass index (BMI: kg/m2) and blood pressure, taking into account reproductive histories and socioeconomic conditions. The proportion of obese (BMI > or = 25) subjects was high in the age groups 30-39, 40-49 and 50-59, accounting for, respectively, 39.4%, 51.1% and 48.5% of these populations. The proportion of women with hypertension (90/140 mmHg) was 23.7%, 18.5% and 26.2% in the 40-49, 50-59 and 60-69 age groups. Current contraceptive practices in the studied population included sterilization by operation, oral contraception and injection. These methods accounted for 43.0%, 12.8% and 8.2% of the population, respectively. Sociodemographic factors such as reproductive history, years of education and household income were not significantly related to BMI or to blood pressure (ANOVA with age adjustment). In contrast, oral contraceptive users had significantly higher BMIs and diastolic blood pressures (p<0.01, ANOVA with age adjustment). Multiple regression analysis also revealed that oral contraceptive use was a weak but significant contributing factor to both high BMI and blood pressure when sociodemographic factors were taken into account and controlled for statistically. It can thus be concluded that the use of contraceptive pills, which contain oestrogen and progestin and are provided free of charge to Thai women, tend to increase BMI and to elevate blood pressure.     

Dominance of Sterilization and Alternative Choices of Contraception in India: An Appraisal of the Socioeconomic Impact

Background

The recent decline in fertility in India has been unprecedented especially in southern India, where fertility is almost exclusively controlled by means of permanent contraceptive methods, mainly female sterilization, which constitutes about two-thirds of overall contraceptive use. Many Indian women undergo sterilization at relatively young ages as a consequence of early marriage and childbearing in short birth intervals. This research aims to investigate the socioeconomic factors determining the choices for alternative contraceptive choices against the dominant preference for sterilization among married women in India.

Methods

Data for this study are drawn from the 2005–06 National Family Health Surveys focusing on a sample of married women who reported having used a method of contraception in the five years preceding the survey. A multilevel multinomial logit regression is used to estimate the impact of socioeconomic factors on contraceptive choices, differentiating temporary modern or traditional methods versus sterilization.

Findings

Religious affiliation, women''s education and occupation had overarching influence on method choices amongst recent users. Muslim women were at higher odds of choosing a traditional or modern temporary method than sterilization. Higher level of women''s education increased the odds of modern temporary method choices but the education effect on traditional method choices was only marginally significant. Recent users belonging to wealthier households had higher odds of choosing modern methods over sterilization. Exposure to family planning messages through radio had a positive effect on modern and traditional method choices. Community variations in method choices were highly significant.

Conclusion

The persistent dominance of sterilization in the Indian family planning programme is largely determined by socioeconomic conditions. Reproductive health programmes should address the socioeconomic barriers and consider multiple cost-effective strategies such as mass media to promote awareness of modern temporary methods.     

Sterilization in Canberra

The discussion in this article uses data from the 1979 Canberra Population Survey to assess the degree and nature of the resistance to the use of sterilization, particularly male sterilization. In the 1979 Canberra Population Survey, respondents were asked what methods of contraception they would recommend to a couple who had completed their family. About 2/3 recommended sterilization, with vasectomy a more popular 1st choice, particularly for male respondents, than tubal ligation. Compared to 20% of the 1978 sample, 27% of the 1979 sample reported use of sterilization; the increase may reflect not only the increasing popularity of sterilization, but also improved reporting. The 1979 survey provides some confirmation of the forecast that 60% of Australian couples would use contraceptive sterilization as a method of birth control in their fertile lifetime. However, the forecast that the importance of vasectomy may come to equal that of tubal ligation seems highly unlikely, even though there seems to be some recognition by Canberra respondents that vasectomy is simple, safe and reliable. Data from the Canberra survey shows that although a majority of respondents would use sterilization, female sterilization would be preferred largely because men were more resistant to the idea than females. Other researchers have commented on the feeling that fertility decisions and contraception are ultimately the wife's concern. Respondents born outside Australia, the United Kingdom, and Eire were more resistant to the idea of sterilization, but reported higher use of tubal ligation. It is presently suggested that the choice of vasectomy or tubal ligation, or resistance to these methods, may in fact be important indicators of the assimilation of immigrants and of husband-wife communication of Australia. Future studies of sterilization in Australia might profit from focusing on sterilizationas an independent rather than a dependent variable.     

Contraception use and associations with intimate partner violence among women in Bangladesh

This study examines the association between contraception use and intimate partner violence (IPV) among women of reproductive age in Bangladesh. The observational study of 10,996 women used the chi-squared test and logistic regressions to assess the associations. Almost 80% of all respondents had used contraceptives at some point in their lives. About half of the respondents (48%) were victims of physical violence, while 11% experienced sexual abuse from their husbands. Urban residents, higher educated women and women aged 20-44 were more likely to use contraceptives than their peers in rural areas, those with lower education and those in their late forties (45-49 years). Women exposed to physical violence were almost two times (OR 1.93, CI 1.55-2.41) more likely to use contraceptives compared with their non-abused peers. Sexual abuse had no significant association with contraceptive use. Physical violence is a predictor for higher levels of contraceptive use among women in Bangladesh. The findings emphasize the importance of screening for IPV at health care centres. The differences in urban and rural contraceptive use and IPV exposure identified by the study have policy implications for service delivery and planning.     

Contraceptive use and method preference among women in Soweto, South Africa: the influence of expanding access to HIV care and treatment services

Objective

Preventing unintended pregnancy among HIV-positive women constitutes a critical and cost-effective approach to primary prevention of mother-to-child transmission of HIV and is a global public health priority for addressing the desperate state of maternal and child health in HIV hyper-endemic settings. We sought to investigate whether the prevalence of contraceptive use and method preferences varied by HIV status and receipt of highly active antiretroviral therapy (HAART) among women in Soweto, South Africa.

Methods

We used survey data from 563 sexually active, non-pregnant women (18–44 years) recruited from the Perinatal HIV Research Unit in Soweto (May–December, 2007); 171 women were HIV-positive and receiving HAART (median duration of use = 31 months; IQR = 28, 33), 178 were HIV-positive and HAART-naïve, and 214 were HIV-negative. Medical record review was conducted to confirm HIV status and clinical variables. Logistic regression models estimated adjusted associations between HIV status, receipt of HAART, and contraceptive use.

Results

Overall, 78% of women reported using contraception, with significant variation by HIV status: 86% of HAART users, 82% of HAART-naïve women, and 69% of HIV-negative women (p<0.0001). In adjusted models, compared with HIV-negative women, women receiving HAART were significantly more likely to use contraception while HAART-naïve women were non-significantly more likely (AOR: 2.40; 95% CI: 1.25, 4.62 and AOR: 1.59; 95% CI: 0.88, 2.85; respectively). Among HIV-positive women, HAART users were non-significantly more likely to use contraception compared with HAART-naïve women (AOR: 1.55; 95% CI: 0.84, 2.88). Similar patterns held for specific use of barrier (primarily male condoms), permanent, and dual protection contraceptive methods.

Conclusion

Among HIV-positive women receiving HAART, the observed higher prevalence of contraceptive use overall and condoms in particular promises to yield fewer unintended pregnancies and reduced risks of vertical and sexual HIV transmission. These findings highlight the potential of integrated HIV and reproductive health services to positively impact maternal, partner, and child health.     

Use of maternal-child health services and contraception in Guatemala and Panama

This paper presents data from 2 recent maternal-child health (MCH) and family planning surveys in Guatemala and Panama and examines the extent to which the use of contraception is influenced by the use of MCH services as compared with the influence of an increase in parity. Fieldwork was initiated in July 1984 but not completed until April 1985. A total of 8240 women aged 15-49 years, of all marital statuses, completed interviews, representing 91% of households with eligible respondents. The findings suggest that utilization of MCH services and parity independently are associated with a woman's decision to use contraception. The study also found 2 groups that appear to be particularly in need of both MCH and family planning services: high parity women and Indians. Nonuse of MCH and family planning services may be due in part to their strong cultural beliefs. In both Guatemala and Panama, improved health care services for these 2 groups should be a priority. Contraceptive use in Panama was over twice as high as in Guatemala. However, method choice and residence-ethnicity patterns of use were similar in each country. In both countries and in all residence-ethnicity groups, female sterilization was the most prevalent method in use, followed by oral contraceptives, except for Panama rural Indians. In Panama, contraceptive use increases up to ages 30-34 and then declines, with a sharp decline for women 40-44. In Guatemala, contraceptive use is generally low for ages 15-24, then increases to a fairly constant level for ages 25-39.     

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.     

The changing pattern of contraception in Lahore, Pakistan: 1963-80

This paper attempts to test the dictum that social change begins in better educated, economically well-off and relatively less tradition-bound strata of the urban society and that it then spreads to the lower social strata and eventually affects the rural populations also. It analyzes temporal changes in the prevalence of contraception as reported by female respondents in 2 sample surveys conducted in the city of Lahore during 1963 and 1980. Altogether 1960 ever-married females aged over 15 were interviewed in the 1963 survey and 993 in the 1980 survey. Compared to 1980 respondents, those in the 1963 survey were older, educated and belonged to a medium or high socioeconomic status category. In 1963, 18% of the respondents were not aware of any method of contraception; by 1980 this proportion was reduced to 11%. The most spectacular change was observed in the prortion of respondents who were practising family planning. In 1963, only 7% of the respondents had ever used any method of contraception; this proportion increased to 48% in 1980. Moreover, substantial differences were noted with regard to the methods of contraception used. The use of condoms seems to have declined while that of the IUD the pill, sterilization and withdrawal seems to have increased. It is interesting that abstinence remained an important method of contraception. Use of contraception is found to vary with age, education and socioeconomic status of respondents. The degree of association between these 3 characteristics and contraceptive usage increased substantially from 1963 to 1980. 1980 survey results indicate that current as well as ever use of contraception show an inverted V-shaped pattern with age and parity. The prevalence of contraception increases with age, reaching a maximum of 41% for current users and 63% for ever users in the age group 35-39. A similar pattern is observed in relation to the parity of respondents with a maximum amongst women who had borne 6 children. Education shows a positive association with both the current and ever use of contraception. The pattern of current methods used is very similar to that noted for methods ever used. The only major differences relate to the condom and abstinence which show higher prevalence as current methods. In the 1963 survey religion was the main reason given by those expressing an unfavorable attitude toward family planning. In the 1980 survey questions were asked about the specific reasons of the respondents for never using any method of contraception. The desire for more children was the most commonly given reason and recent marriage was the 2nd most common. The strength of religious opposition to contraception seems to have declined substantially in the 1980 survey.     

Contraceptive use dynamics of Asian women in Britain

In-depth interviews were conducted with married Asian women from Indian, Pakistani and Bangladeshi backgrounds, to investigate patterns of contraceptive use and influences on contraceptive decision making. The results show two distinctively different contraceptive 'lifecycles'. Non-professional women typically have little knowledge about contraception until after their marriage or first birth. Their patterns of contraceptive behaviour show low levels of contraceptive use until after their first birth, when condom use is most prevalent. Non-professional women are influenced by their extended family, religion and cultural expectations on their fertility and family planning decisions. Professional women show an entirely different pattern of contraceptive behaviour. They are more likely to have knowledge about contraception before marriage, use some method of contraception throughout their childbearing years (typically the pill) and cite personal, practical or economic considerations in their fertility decisions rather than religious, cultural or extended family influences.     

Oral contraceptive use and increased plasma concentration of C-reactive protein

We examined, in young adult women, the association between current low dose oral contraceptive (OC) use and plasma levels of C-reactive protein (CRP), an acute phase reactant predictive of cardiovascular disease risk. We conducted a cross-sectional analysis of 30 healthy, non-smoking, non-obese women (18 OC users and 12 nonusers) who were subjects in a randomized diet-controlled trial of the effects of soy intake on sex hormone metabolism. The study was sited at a university outpatient general clinical research center. Fasting plasma CRP levels were measured 4 times during 2 menstrual cycles (2 mid-follicular phase and 2 mid-luteal phase) using a high-sensitivity CRP assay. Differences between OC users and nonusers were examined by 3-way analysis of variance. Multiple regression was used to examine the relationship between OC use and CRP. There were no significant differences in baseline demographic characteristics between OC users and nonusers. Plasma CRP levels (mean +/- SE) were 2 times higher among OC users than among non-users (2.0 +/- 0.2 versus 0.9 +/- 0.3 mg/l, p<0.0001) independent of diet assignment, diet treatment order, and phase of the menstrual cycle. In a multivariate model, OC use predicted 32 percent of the variance in CRP levels (p<0.0001). As all CRP levels were within a previously established normal range, further study is indicated to establish the clinical significance of the observed elevated CRP levels in OC users.     

Assessment of DNA damage in women using oral contraceptives

The effect of the use of an oral contraceptive (OC) on the frequency of sister chromatid exchanges (SCEs) and on the response in the alkaline comet assay (single-cell gel electrophoresis (SCGE)) was investigated in 18 women taking contraceptive pills daily for 24 months. As controls, fertile women were included with regular menstrual cycles who received no OC drugs. A significant increase in the number of lymphocytes with DNA migration and an increased frequency of SCE per metaphase were observed in OC users as compared with their age-matched untreated controls (P<0.005). As higher incidences of spontaneous SCEs in peripheral blood lymphocytes have been reported to occur in females during pregnancy due to profound changes in the levels of certain sex hormones such as progesterone and estrogen, particularly during the last trimester, 17 pregnant women served as positive controls in this study in order to test the rate of genetic damage due to those changes. Higher frequencies of SCEs and comet responses were observed in pregnant women than in their matched controls. However, no statistically significant difference in DNA damage was observed between OC users and pregnant women (P>0.05). This study underscores the fact that prolonged and extensive use of these drugs in our daily life may be hazardous and also, that OC users should be aware of multifactorial risk factors (environmental, genetic and life style patterns) that may be responsible for additional DNA damage.     

Assessment of DNA damage in women using oral contraceptives

The effect of the use of an oral contraceptive (OC) on the frequency of sister chromatid exchanges (SCEs) and on the response in the alkaline comet assay (single-cell gel electrophoresis (SCGE)) was investigated in 18 women taking contraceptive pills daily for 24 months. As controls, fertile women were included with regular menstrual cycles who received no OC drugs. A significant increase in the number of lymphocytes with DNA migration and an increased frequency of SCE per metaphase were observed in OC users as compared with their age-matched untreated controls (P<0.005). As higher incidences of spontaneous SCEs in peripheral blood lymphocytes have been reported to occur in females during pregnancy due to profound changes in the levels of certain sex hormones such as progesterone and estrogen, particularly during the last trimester, 17 pregnant women served as positive controls in this study in order to test the rate of genetic damage due to those changes. Higher frequencies of SCEs and comet responses were observed in pregnant women than in their matched controls. However, no statistically significant difference in DNA damage was observed between OC users and pregnant women (P>0.05). This study underscores the fact that prolonged and extensive use of these drugs in our daily life may be hazardous and also, that OC users should be aware of multifactorial risk factors (environmental, genetic and life style patterns) that may be responsible for additional DNA damage.     

Poststerilization regret among women: methodological considerations for the next decade

The literature concerning regret among women following voluntary sterilization shows a lack of methodological rigor. This paper reviews the 7 prospective studies of voluntary sterilization conducted since 1973 that are judged to have adequate design and measurement standards, and suggests methodological considerations for future research. 3 of the studies were conducted in the US, 2 in the UK, 1 in Thailand, and 1 in Pakistan. Only 3 of the 7 studies used control groups and only 3 used standardized pre- and posttest psychological measures. Subjects in all the studies requested sterilization on a voluntary basis. 4 of the 7 studies evaluated contraceptive and menstrual histories before and after sterilization. All the studies varied in their poststerilization follow-up intervals ranging from 2 months and 1 year to 18 months and 2 years. Attrition rates also varied widely across the studies. Although none of these studies presented percentages for precise measures of regret, the overall effect of the sterilization procedure was found to be positive. The relationship between regret and purported indicators of regret, such as depression, anxiety, menstrual difficulties, and desire for reversal, should be documented in prospective, controlled studies. Longer poststerilization follow-up periods are recommended. Responses of childless women and male partners to sterilization should also be considered in future studies. Finally, since repeated references are made to menstrual problems following voluntary sterilization, it is important that studies assessing poststerilization responses control for oral contraceptive (OC) use because OCs reduce menstrual flow and their discontinuation results in a return to normal, although heavier, menstrual flow.