Hormonal methods for fertility regulation.

To assess the role of contraception and abortion in fertility regulation amongst Southwestern Nigerian women. A survey was conducted through a self- administered questionnaire to women of reproductive age group attending gynecology clinic. Multinominal logistic regression was done to analyze the independent effects of social and demographic variables on the odds that women would adopt any fertility regulation methods instead of doing nothing. Only 13% of surveyed women were using modern contraception. About 42.2% of women had had induced abortion, 15% of them neither use contraception nor abortion. Fifteen per cent of women surveyed used both contraception and abortion for fertility control. Muslims women had lower odds than Christians to use any of three fertility regulation methods instead of doing nothing. Unmarried and high levels of educational attainment were associated with significant odds of adopting each of three fertility regulation methods (Odd ratios; 1.38 - 35.5). There is a need for better fertility regulation. High dependency on abortion especially among the young, unmarried and high level educational status should be discouraged. Government and non-governmental agencies should assist in making modern contraceptives widely available with adequate rural coverage.

High discontinuation rates and the risks of side effects make present contraceptives unacceptable for long-term use. To solve these problems safe effective and usable new methods of fertility regulation must be developed. Biological research in fertility regulation includes product development fundamental and directed fundamental research. New drug development has been slowed by high cost but one expected new product could be a once-a-month pill or injection possibly using prostaglandins and a postcoital drug. Other research investigating use of steroids in males to inhibit sperm production would be particularly useful in family planning programs. Subdermal or internal implantation of agents for long-term release of low-dose progestin is another possibility. Other research involves sterilization techniques particularly reversible vasectomy; new designs for intrauterine devices particularly with copper; and accurate prediction of ovulation rhythm by hormonal monitoring. Fundamental research is investigating the mechanism of hormone production and function synthesis of steroids and new techniques for biological measurement. New products require new knowledge of reproductive physiology. Current directed fundamental research includes investigating the function of the oviducts important transport role in reproduction by study of structure mechanism and fluids. The biochemistry of the ovum spermatozoa and corpus luteum are also being studied. Another facet of current research is evaluating existing contraceptive methods. Large-scale clinical studies involving regular physical examinations and monitoring of a wide range of physiological functions have resulted in a large body of new information concerning pharmacology cancer metabolism and cardiovascular mechanisms. Social science research in fertility control includes such topics as the attitudinal determinants of fertility demographic changes and their effects methods of population control that are politically and philsophically acceptable and the logistics and financing of family planning. With adequate financial support significant progress in fertility regulation should be seen in the United States in the coming years.

SummaryA Continuing search for new methods of fertility regulation has faced both promises and problems. More effective methods have led to more side effects, whereas methods with lesser problems have been less effective. Newer approaches are logically directed towards the development of contraceptive methods which are more effective and have lesser problems. Hence, newer approaches towards fertility regulation require further understanding of the phenomenon of reproduction at the cellular and molecular level and then the derivation of means to modify or intercept one or more of the earlier steps of the reproductive process. It is also vital that new approaches are (a) ethically compatible with the socio-economic, cultural, religious, and nutritional needs of a society; (b) aesthetic, preferably above the waist, and effective with little or no side effects, and (c) that they are long acting as well as of moderate cost. In view of these considerations we have directed our current approaches in the followin...

In the 1960s and 1970s, with the introduction of hormonal contraception, as well as of a new generation of intrauterine contraception, Western countries saw cardinal changes in methods of fertility regulation so significant that the American demographers Ch. Westoff and N. Ryder called them "The contraceptive revolution." By this time, the transition to low fertility in developed countries, as, indeed, in Russia, was completed, and family planning had become a common practice. However, the new technologies significantly increased the effectiveness of birth control, and this change would have important social and demographic consequences. Underestimation of the importance of family planning and underdevelopment of the corresponding services in the USSR and in Russia led to the contraceptive revolution beginning here much later than in the West, not until the post-Soviet years with the arrival of a market economy and information openness. For decades, induced abortion played a key role in the regulation of fertility, and only in the 1990s did modern methods of contraception become widespread and the unfavorable ratio of abortions to births begin to change for the better. The article describes the composition of the contraceptive methods used in countries of European culture and of those in Russia, and attempts to explain the difference between them. Based on national representative sample data, an analysis is made of current practice of contraceptive use in Russia. The conclusion is drawn that the contraceptive revolution in Russia is proceeding rather quickly, but without substantial state support.

В 1960-70-е годы с появлением на рынке гормональной контрацепции и внутриматочной контрацепции нового поколения, в западных странах произошли кардинальные перемены в сфере внутрисемейного регулирования рождаемости настолько значительные, что американские демографы Уэстоф и Райдер назвали их «контрацептивной революцией». К этому времени переход к низкой рождаемости в развитых странах, как, впрочем, и в России, был завершен, и планирование семьи стало массовой практикой, однако появившиеся технологии позволили значительно повысить эффективность контроля рождаемости, что имело важные социальные и демографические последствия.
 Недооценка важности планирования семьи и неразвитость соответствующих служб в СССР и в России привели к тому, что контрацептивная революция здесь началась с большим опозданием, уже в постсоветские годы с приходом рыночной экономики и информационной открытости. На протяжении десятилетий ключевую роль в регулировании рождаемости играл искусственный аборт, и только в 90-е годы получили широкое распространение современные методы контрацепции и неблагоприятное соотношение абортов и рождений стало меняться к лучшему. В статье описаны структуры применяемых контрацептивных методов в странах европейской культуры и современной России, сделана попытка объяснить различие этих структур. 
 На материалах национального репрезентативного выборочного обследования проанализирована современная практика применения контрацепции в России и сделан вывод о том, что контрацептивная революция в России идет довольно высокими темпами, хотя и не получает существенной поддержки государства.

The global population is currently expanding at the unprecedented rate of nearly 1 billion per decade, with 94% of the increase occurring in the developing world. New methods of fertility regulation are urgently needed, and the development of birth control vaccines by active immunization against antigens specific for reproduction has made substantial progress during the last two decades. These vaccines are meant to have an outstanding impact on future control of worldwide population growth by providing safe, effective, long-lasting and reversible contraception. The most advanced of these vaccines are based on the placental pregnancy hormone human chorionic gonadotropin (hCG), and have already entered clinical trials. However, immunological cross-reactivity and lack of efficacy of anti-hCG antibodies seriously challenge this strategy. Conversely, efforts to understand the molecular events involved in the fusion of sperm and egg have led to the identification of new target structures for the development of fertility-regulating vaccines. Herein, we summarize the current state of birth control vaccines and discuss the risks and drawbacks of this approach to fertility regulation.

It has been estimated that in the next 20 years the number of couples in the reproductive age groups in developing countries alone will have grown to nearly 1 billion. The demand for fertility control will necessarily increase and the bulk of current research is aimed at making the currently available methods safer and more acceptable. It is generally believed that no completely new method of fertility regulation will emerge in the next 20 years or so due to restraints placed by drug regulatory agencies and the prohibitive costs of testing a new drug. Given the world-wide recession the trend has been for a declining investment in financial support for research and development of new contraceptive technology1,2. Sterilization, steroidal contraceptives and IUCDs are all very effective. The crucial issues in the near future will therefore be aimed at optimizing the use of currently available methods and improving their safety, and, to a lesser extent, efficacy with minor alterations in composition or delivery systems. Nevertheless there is still hope for a novel breakthrough in contraception from the work which is being done at present by independent researchers. Perhaps these may bear fruition in the twenty-first century. This chapter will review briefly these novel investigations but will stress mainly the work presently under way on improving methods of fertility control.

A significant number of advances in fertility regulation is now under development. These advances in technology represent modest gains rather than dramatic breakthroughs; they frequently involve a bio-engineering input, include collaboration between public agencies and industry, and are closely related to the needs of developing countries. Such advances are the result of the existence of specialized programmes whose major objective is the development of new technology. As yet a similar specialized public mechanism to undertake the wide range of activities associated with product development and introduction of the new technology into family planning programmes does not exist. The three major phases of the contraceptive development process are defined (biomedical development, product development, and product introduction-market development) and four areas requiring greater attention identified. A product development laboratory that would accept responsibility for dosage form development, stability testing, quality control procedures, product and packaging modifications, and the production of supplies for biomedical research would increase the acceptability of existing methods and accelerate new developments. A contraceptive information service that would provide ‘full disclosure’ product related information to managers of family planning programmes is also needed. A patent and licensing administration for the public sector would assure that new contraceptives developed with public funds would be made widely available to family planning programmes at a reasonable cost. A contraceptive introduction planning unit that would consider the programme implications of new methods of fertility regulation and assist countries in planning for their introduction also needs to be established as part of the ongoing international research programmes or as a new mechanism. The availability of a specialized capacity to assume responsibility for public leadership in these four areas would contribute significantly to the development of new contraceptive methods tailored to the needs of developing countries and to the success of current international contraceptive research and development efforts.

Introducción. En Colombia, la regulación de la fecundidad es un derecho, pero es necesario tener acceso a la información y a los servicios para poder decidir libremente tener hijos o no. Se presentan los factores que intervienen, entre ellos los psicosociales, para el cumplimiento terapéutico de los métodos de regulación de la fecundidad.
 Objetivo. Determinar los factores psicosociales en el cumplimiento de los métodos de regulación de la fecundidad y su asociación con variables sociodemográficas.
 Materiales y métodos. Se llevó a cabo un estudio descriptivo transversal con enfoque cuantitativo, con una muestra de 318 mujeres y la aplicación de una encuesta.
 Resultados. El 61,6 % de las mujeres de la muestra estaba entre los 20 y los 29 años de edad; el 42,3 % obtuvo información de los métodos de regulación de la fecundidad de profesionales de la salud; el 90,0 % siempre los utilizó durante las relaciones sexuales; el 81,4 % tuvo, en promedio, dos hijos; el 19,6 % declaró haber quedado embarazadas utilizándolos; el 91,3 % expresó que es una responsabilidad compartida por la pareja, apoyándolas a seguir las indicaciones del profesional en el 66,0 %; el 56,9 % asistió siempre al control de regulación de la fecundidad. Se encontró asociación entre el nivel educativo de las mujeres y la responsabilidad en el uso de los métodos; el 97,8 % tenía educación superior y consideraba que la responsabilidad es de la pareja, y el 80,1 % de las mujeres con hijos acudía siempre a los controles.
 Conclusiones. Los factores psicosociales inciden en el cumplimiento de los métodos de regulación de la fecundidad, dado que un porcentaje significativo refirió como estado conyugal la unión libre, lo que les permitía autonomía para la elección del método y apoyo de la pareja. Las mujeres participaron voluntariamente en el programa y hubo satisfacción con la atención y con la información brindada por el proveedor del servicio.

2 - Epidemiology of induced abortion

The attitudes of women of reproductive age in Scotland, Romania and Slovenia to the idea of a contraceptive pill which is taken only once each month or only when menses are delayed was investigated. In all three centres, the great majority of women felt positive towards the idea of a once-a-month pill which inhibited ovulation and greater than 50% found a pill which inhibited or interfered with implantation an acceptable idea. Only 24% of women in Scotland were attracted to the idea of a pill which was taken only if menstruation was delayed by 1 or 2 days, that is a pill which would cause an abortion, while in contrast 58% of women in Slovenia and 80% in Romania thought that such a method of controlling fertility would be acceptable. Attitudes were not related to age, social class or marital status but were influenced by religious belief and in Scotland by a history of abortion. In countries where the availability of contraception is limited and abortion is common, women would seem to welcome another method of fertility regulation--even one which disrupts the very early stages of pregnancy.

As Snowden said nearly 20 years ago, 'The methods of fertility regulation from which most couples choose represent a choice among unpleasant alternatives. The choice is not so much a positive discrimination but a negative one, in that the methods not chosen are even more disliked than the method that is chosen. The contraceptive methods most people use are therefore the least unpleasant of the unpleasant set of alternatives. However, it is most important that this realistic summary is set against the other reality that consumers greatly prefer the available range of methods to no methods at all.' The choice of methods has now expanded but the decision process has not. Women want what everyone wants. They want their agenda to be addressed in a sensitive, considerate, complete and timely manner. They want to be given all relevant information in a way that they can understand by a person they like and who they can trust to advise them fully, correctly, confidentially and safely. They are quite happy to answer questions as long as they believe that they are necessary. They want the clinician to treat them with respect and to take into account their cultural and personal needs. The clinician must be able to advise them not only on contraceptive issues but also on all areas of sexual health. In short, just like all of us, women want to be treated as equals and trusted with information to enable them to make decisions about their life. Services can always improve and listening to our clients can help us aim for the sky. Let me share with you what they have to say.

The following currently available reversible methods of fertility regulation are discussed: 1) combined oral contraceptives 2) minipills 3) postcoital administration of diethylstilbestrol 3) IUDs 4) diaphragms 5) Depo Provera injections 6) calendar method and BBT method of periodic abstinence 7) condoms and 8) withdrawal. The method of functioning side effects and effectivenes for all these methods are discussed. The following new methods of fertility regulation for future use are discussed briefly: 1) immunological control of fertility and 2) hypothalamic-releasing hormones. The method chosen for each couple should involve a joint decision of the couple and their adviser. This would depend on which phase of fertility the couple is in-premarital eary marital or postfamily completion.

The silence about population growth in recent decades has hindered the ability of those concerned with ecological change, resource scarcity, health and educational systems, national security, and other global challenges to look with maximum objectivity at the problems they confront. Two central questions about population--(1) is population growth a problem? and (2) what causes fertility decline?--are often intertwined; if people think the second question implies possible coercion, or fear of upsetting cultures, they can be reluctant to talk about the first. The classic and economic theories explaining the demographic transition assume that couples want many children and they make decisions to have a smaller family when some socio-economic change occurs. However, there are numerous anomalies to this explanation. This paper suggests that the societal changes are neither necessary nor sufficient for family size to fall. Many barriers of non-evidence-based restrictive medical rules, cost, misinformation and social traditions exist between women and the fertility regulation methods and correct information they need to manage their family size. When these barriers are reduced, birth rates tend to decline. Many of the barriers reflect a patriarchal desire to control women, which can be largely explained by evolutionary biology. The theoretical explanations of fertility should (i) attach more weight to the many barriers to voluntary fertility regulation, (ii) recognize that a latent desire to control fertility may be far more prevalent among women than previously understood, and (iii) appreciate that women implicitly and rationally make benefit-cost analyses based on the information they have, wanting modern family planning only after they understand it is a safe option. Once it is understood that fertility can be lowered by purely voluntary means, comfort with talking about the population factor in development will rise.

Despite the provision of safe and affordable family planning services, 120 million couples worldwide are not using any contraception to limit or space their family, and many who use one or the other method, conceive. According to the National Population Policy (NPP) 2000, various methods of contraception and fertility regulation shall be made accessible to all, so that India's population in 2010 will be 1,107 million instead of 1,162 million. A hospital-based cross-sectional survey conducted in 2006. In-person interviews carried out with attendees of Gynaecology and Obstetrics outpatient clinics, and indoor patients of three hospitals of urban population to collect data regarding knowledge, attitude and practices of family planning methods. A total of 55.2% subjects were aware of contraceptive methods, mostly barrier (52.7%), IUCD (46.1%) and oral pills (43.2%), but only 31.7% had ever used barrier contraception, IUCD 10.3% and oral pills 3.3%. Permanent methods were known to nearly 50% subjects but acceptance was very less, 5% only. Emergency contraception was known to 13.8% subjects. Majority of women have favorable attitude towards family planning, but use of long-acting new methods is still low in our population, which needs to be promoted.