Contraceptive Preferences Research Articles

Non-latex versus latex male condoms for contraception.

The male condom, which consists of a thin sheath placed over the glans and shaft of the penis, is designed to prevent pregnancy by providing a physical barrier against the deposition of semen into the vagina during intercourse. Beginning in the 1990s, nonlatex male condoms made of polyurethane film or synthetic elastomers were developed as alternative male barrier methods for individuals with allergies, sensitivities or preferences that prevented the consistent use of condoms made of latex. The review sought to evaluate nonlatex male condoms in comparison with latex condoms in terms of contraceptive efficacy, breakage, slippage, safety and user preferences. We searched the the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE using PubMed, EMBASE, Popline, and LILACS for randomized controlled trials of nonlatex condoms. The references of eligible publications were assessed for inclusion. We also wrote to the manufacturers of nonlatex condoms and known investigators in an attempt to locate any other published or unpublished trials not identified in our search. The review included all randomized controlled trials identified in the literature search that evaluated a male nonlatex condom made of polyurethane film or synthetic elastomers in comparison with a latex condom. We evaluated all titles and abstracts located in the literature searches for inclusion in the review. Two reviewers independently extracted data from the identified studies. We entered and analyzed data with RevMan 4.1. Peto odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for the outcomes contraceptive efficacy, condom breakage and slippage, discontinuation of use, safety and user preference. The number of condoms, men, or women was used as the denominator for the ORs. Contraceptive efficacy, early discontinuation, and safety outcomes were also measured with survival analysis techniques and entered into "Additional tables." While the eZ.on condom did not protect against pregnancy as well as its latex comparison condom, no differences were found in the typical-use efficacy in the comparisons between the Avanti and the Standard Tactylon and their latex counterparts. The nonlatex condoms were associated with higher rates of clinical breakage than their latex comparison condoms. The statistically significant odds ratios for clinical breakage for the nonlatex condoms versus their latex comparisons ranged from 2.6 (95% CI: 1.6 to 4.3) to 5.0 (95% CI: 3.6 to 6.8). Few adverse events were reported. In almost all of the comparisons, substantial proportions of participants preferred the nonlatex condom or reported that they would recommend its use to others. Although the nonlatex condoms were associated with higher rates of clinical breakage than their latex comparison condoms, the new condoms still provide an acceptable alternative for those with allergies, sensitivities or preferences that might prevent the consistent use of latex condoms. The contraceptive efficacy of the nonlatex condoms requires more research.

Contraceptive practices and intentions of Ukrainian women

Objective: This study was undertaken to investigate contraceptive practices and factors behind contraceptive preferences among Ukrainian women attending for abortion or gynecological health check-up.Method: Women attending for abortion (n = 919) and healthy non-pregnant women (n = 297) were studied by an anonymous 192-item self-questionnaire in a hospital-based unmatched case-controldesign.Results: The average number of abortions per woman rose with age to 4.6 in the abortion group and 2.4 abortions in the non-pregnant group. In the abortion and non-pregnant groups, no contraceptiveuse during the past year was reported by 27% and 20% and at the time of conception or during the preivous month, by 61% and 51%, respectively. Nevertheless, no intention to use contraception in the futurewas reported by 15% and 8% of women, respectively. A history of previous childbirth (odds ratio (OR) = 1.8), at least two induced abortions (OR = 1.7) and sexual education obtained from literature (OR =1.8) were associated with preference to use modern contraceptives. Intention to use no contraception in the future was associated with giving no answer about acceptance of abortion as a birth control method(OR = 5.4), uncertainty whether to use abortion or an intrauterine device in a situation of choice (OR = 1.8), low income (OR = 1.9) and no answer about housing situation (OR = 3.9). Lack of experiencewith contraception reduced the intention to use any method in the future.Conclusion: Better reproductive education/information and economic incentives could contribute to a change from abortionto use of contraception.

Men's Talk About “Women's Matters”

The place of men in reproductive and contraceptive changes and the role of informal social interaction in these processes have become central themes in recent research on fertility change in sub-Saharan Africa and other developing regions. These two themes, however, have been treated separately in the literature, and this study bridges them by examining men's informal communication on family planning matters through a gender lens. This analysis, based on qualitative data collected in Greater Maputo, Mozambique, indicates that although men's communication on these matters is limited in comparison to women's communication, it nonetheless plays an important role in the formation of men's reproductive and contraceptive attitudes and preferences. Gender ideology emerges as a powerful delimiter of men's communication circles and of the information transmitted in those circles. The author argues that gender barriers in peer communication affect individuals' perceptions of reproductive and contraceptive matters and their corresponding preferences and decisions.

Contraceptive use and method choice in Turkey

According to the 1993 Turkish Demographic and Health Survey knowledge regarding modern contraception in Turkey has not led to a corresponding level of contraceptive use. Between September and December 1999 a prospective study was conducted on 1672 married women who applied in a family planning unit. These women were investigated as to their use and choice of method of contraception; the effects of various variables including age and education and number of surviving offspring of these women on the patterns of contraceptive use. Overall 87.3% of the married women were using contraceptive method. Majority were modern method users (71.6%) although a substantial proportion (15.7%) was using traditional methods particularly withdrawal. A significant positive correlation between the age of these patients and their contraceptive preferences towards modern methods was noted. The educational level of women did not seem to effect the contraceptive preference of women. On the other hand the association between the number of living children and contraceptive use was positive. Overall the study indicates the need for contraception among women in Turkey. Thus more efforts should be directed towards increasing the availability and accessibility of family planning services.

Contraceptive methods used and preferred by men and women.

In 1997, a random sample of Finnish men (n = 395) and women (n = 393) aged 18-50 years received a postal questionnaire concerning family planning, in which they were asked which contraceptive methods they had ever used and which three methods they considered to be best. Men's contraceptive preferences were compared to those of women. The response rate for men was 45% and for women 56%. The majority of both men and women had used, together with their partners, condom, oral contraceptives (OCs) and intrauterine devices (IUDs). The use of diaphragm, Norplant, Depo Provera and postcoital IUDs was not common. Among the men, 2-11% did not know whether their partner/partners had used the contraceptives in question. Concerning the three best contraceptive methods, men placed the condom first and women OCs. No male or female respondents rated postcoital emergency pills a superior method. Both men and women appreciated the most reliable means.

Unmet need for couples: An analytical framework and evaluation with DHS data

While estimates of unmet need continue to be an important measure of the extent of demand for contraception and family planning programs success in developing countries, there are various reservations about the validity of these estimates. For instance, the traditional formulation of the measurement has relied solely on information from women while inferences from the findings are often drawn for couples. As more survey data have become available for both men and women in a number of countries, there is increasing evidence suggesting that husbands' preferences are indeed important determinants of the reproductive behavior of couples. This paper developsan analytical framework for measuring unmet need for couples. The approach: (1) takes a fresh look at the classification of pregnant and amenorrheic women, and (2) incorporates the contraceptive use and fertility preferences of husband and wife in estimating the level of unmet need in six sub-Saharan African countries. Our findings shows that taking these factors into account results in a 50 to 66 percent reduction in the level of unmet need in these countries. The importance of husbands' variables in determining the level of unmet need is clearly evident when examined among fecund couples in which the wife is neither pregnant nor amenorrheic. The implications of these findings for family planning programs and research are discussed.

Levels of Fertility Have Declined Steadily in Egypt, But Unwanted Childbearing Remains Common

In the 1995 Egypt Demographic and Health Survey (EDHS) a total of 14779 ever-married women aged 15-49 were interviewed. Data on marriage and fertility contraceptive use fertility preferences maternal and child health and female circumcision were obtained. Overall it is noted that fertility in Egypt has declined by about 30% since 1980. Between the 1980 Egypt Fertility Survey and the 1995 EDHS the total fertility rate among the women dropped from 5.3 lifetime births per woman to 3.6 births. Such a decline has been greatest in rural areas. If such trends continue it is believed that the average Egyptian woman will have 3.6 live births over her total reproductive years. Moreover knowledge of a contraceptive method was reported to be nearly universal among married women but only 48% actually use one. The most widely used method is the IUD (30%) followed by the pill (10%). It is also noted that almost 97% of these women have undergone female genital excision.

In accordance with nature: What Japanese women mean by being in control

The persisting ban on oral contraceptives in Japan more than 30 years after their approval abroad is often used as evidence that Japanese women are unliberated victims of male domination. In fact, many Japanese feminists oppose oral contraceptives, and many women worry about taking these chemicals into their bodies. This paper investigates Japanese women's apprehension regarding contraceptive pills. In 1995, the author interviewed 31 patients in obstetric‐gynaecology departments in Tokyo. Their narratives contain four ideas that are important in understanding their contraceptive preferences: ‘inside’, ‘the path of blood’, ‘natural rhythm’, and the relationship between self and body. Analyses of these themes indicate that Japanese women do not share the usual American preconceptions regarding oral contraceptives: they do not take it for granted that male sexual desire is uncontrollable, neither do they think of their bodies as the objects for control. Japanese women value men's willingness to use condoms although their failure rate is higher than oral contraceptives. The ability to control the relationship and not the female body is key.

The Sexuality Connection in Reproductive Health

Sexuality and power relations based on gender are relevant to researchers, policymakers, and service providers in the reproductive health field, because they underlie virtually all of the behaviors and conditions that their programs address. Yet, a review of conventional treatments in the demographic and family planning literature reveals that, when they consider these topics at all, researchers typically adopt narrow definitions of sexual behavior and focus almost exclusively on risks of pregnancy and disease. This article proposes an analytic framework as a guide to researchers and family planning providers. It relates four dimensions of sexuality to reproductive health outcomes and concludes that family planning policies and programs should address a broader spectrum of sexual behaviors and meanings, consider questions of sexual enjoyment as well as risk, and confront ideologies of male entitlement that threaten women's sexual and reproductive rights and health.

African-American adolescents' knowledge, health-related attitudes, sexual behavior, and contraceptive decisions: implications for the prevention of adolescent HIV infection.

African-American adolescents (N = 195) completed measures of knowledge related to acquired immunodeficiency syndrome (AIDS), attitudes toward condoms, health locus of control, vulnerability to human immunodeficiency virus (HIV) infection, peer sexual norms, personal sexual behavior for the past 6 months, and contraceptive preferences. Hotelling's T2 tests revealed that girls were more knowledgeable about AIDS, reported fewer sexual partners, held more positive attitudes toward precautionary sexual behavior, and perceived themselves to have greater self-control than boys. Five variables accounted for 44% of the variance in condom use: condom use from the 1st intercourse occasion, earlier grade in school, lower belief in an external locus of control, and higher scores on the Effect on Sexual Experience and Self-Control subscales of the Condom Attitude Scale. Implications for the content, format, and timing of HIV prevention with African-American adolescents are discussed.

Post-partum contraceptive preference in high-risk parturients in Maputo.

A total of 171 consecutive high-risk parturients in Maputo Central Hospital were studied regarding post-partum contraceptive choice in order to plan a new post-natal clinic approach in maternal health care. It was found that contraceptive interest was much less in women with experience of child loss than in women with all children surviving (p less than 0.005). The findings were useful in planning various measures to meet the documented demand for available methods under adverse circumstances of scarce manpower and material resources.

Solutions to some problems in the implementation of conjoint analysis

Methodological problems encountered in implementing conjoint analysis include (1) the impractically large set of multiattribute choice alternatives created by the factorial combination of more than a few attributes, (2) the hypothetical nature of the alternatives in the choice set, and (3) the assumption that each individual’s preferences can be described by the same composition rule. The techniques of tailoring, belief matching, and axiom testing are suggested as solutions to these problems, and their use is demonstrated in a conjoint analysis study of individuals’ contraceptive preferences. It is noted that tailoring and belief matching can also be used as methodological enhancements in functional measurement studies.

Barriers to Contraceptive Services

More than 1/2 of the pregnancies that occur each year in the US are unintended and 1/2 of these end in abortion. An attempt was made to determine the contraceptive availability, needs and preferences of low-income women via a telephone survey of 760 women, 18-35 years of age, living in 4 urban locations and a mail survey of all family planning clinics and private obstetrician-gynecologists in each of the 4 communities, as well as other physicians and clinics mentioned by the women. Although 94% of the women said they had used some contraceptive method at some time, 23% were not currently practicing contraception. Both nonuse and the use of less effective methods appear to be caused by method-related fears, dislike of available methods, and a general negative feeling about contraception. Less effective methods may be avoided because women view them as offering less protection and dislike their coitus-dependent qualities. Structural or provider-related concerns, such as cost, were seldom reported as barriers to contraceptive use. The primary barrier to clinic use is the apparent belief of many women that clinics do not offer personalized care and provide lower quality care than private physicians. Private physicians are avoided because of high cost and their lesser acceptance of Medicaid or Medi-Cal reimbursement. Encouraging more favorable attitudes toward contraceptive methods and improving access to and knowledge of inexpensive, personalized family planning services appear to be critical factors in fostering better contraceptive practice among low-income women in the US.

Breast-feeding and Fertility Regulation: Current Knowledge and Programme Policy Implications

Recent studies have shown that lactation exerts a strong contraceptive action because frequent stimulation of the nipple during suckling leads to neural inhibition of the hypothalamus, diminished secretion of pituitary gonadotropins, and inhibition of ovulation and menstruation. Any change in breastfeeding practices in the developing world that reduces the present high incidence and long duration of breastfeeding and the high frequency of suckling is likely to increase fertility. Family planning programs should coordinate the use of contraceptive methods with lactational anovulation. The early use of contraceptives may constitute unnecessary double protection where prolonged breastfeeding is likely and, in cases of discontinuation when lactation has been reduced or terminated the mother may be at higher risk of becoming pregnant. The type of contraceptive method chosen should not interfere with lactation; combined oral contraceptives reduce milk volume and may shorten the duration of lactation, but neither hormonal nor nonhormonal contraceptive preparations appear to affect initiation of milk production. The effects of the low levels of steroids reaching the infants of mothers using hormonal contraceptives are not clear, but no adverse infant health effects of IUDs, sterilization, or barrier methods have been shown. Although breastfeeding is a critical factor in infant nutrition, growth, health, and survival, especially among low socioeconomic groups in developing countries, many countries have no consistent policies on lactation or fertility regulation. Policies should be developed according to national health needs and circumstances. National guidelines should include the promotion of breastfeeding for at least 4 months, continuation of breastfeeding after supplementary foods have been introduced, legislative and social support for breastfeeding, and preference for nonhormonal contraception during the 1st 4-6 months postpartum.

Observations on Birth Planning in China, 1977

The People's Republic of China has a national family planning program which encourages late marriage, small families, and long birth intervals. The program attempts to make modern contraceptive, sterilization, and abortion services easily accessible. The birth planning program in 2 communes - Wan-Tou and Chang-Ching - is described in detail. In both communes, propaganda teams seek to reeducate the people to the new norms. Nearly 90% of all eligible women are using some form of birth control; in Wan-Tou more than 60% are using IUDs and less than 10% have been sterilized while in Chang-Ching the proportions are reversed. Both communities view family planning as legitimate and place a high priority on it. Traditional views regarding male superiority and the desirability of large families are the main obstacles to the family planning program. Regional variations exist in contraceptive preferences but practice is higher than 90% throughout the country. Municipal records, a sample of which is discussed, are used to monitor progress. The program has succeeded in lowering the birthrate since the early 1960s but more effort will be needed in the future.

Contraceptives Available by Prescription

The article presents a comprehensive review of the common contraceptive methods. Contraceptive preferences are ranked in tables by physicians and patients with unanimity on oral contraceptives as first preference. Tables also show combination oral contraceptives, sequential oral, and pregestin only contraceptives by trade name, manufacturer, number of tablets per dispensing unit, and progestogen and/or estrogen content. Women using sequential pills are seen to run a greater risk of thromboembolism. Discussion on contraceptive pills includes the effectiveness of various types of pills, the infertility mechanism, physicians' attitudes towards prescribing, risks, side effects and other reasons for nonuse, contraindications, and prescriptive precautions. IUDs are described and discussed regarding comparative effects and action of various types IUD, detractive aspects, precautions, and evaluation of the IUD as a contraceptive. Other contraceptives discussed are the diaphragm, cervical cap, sterilization, and abortion.

Contraceptive practices of wives of obstetricians

A mail survey of a sample of the wives of obstetrician-gynecologists in New York state was conducted in 1972 to investigate changing contraceptive practices. This group was of special interest because it represented women with the best access to the most sophisticated information on contraception. Demographic and attitudinal data, collected from the physicians in an earlier survey, were related to the contraceptive preferences of their wives. Among the physicians' wives who were using contraception reported usage was: oral contraceptive, 27 per cent; intrauterine contraceptive device (IUD), 23 per cent; diaphragm, 14 per cent; condom, 12 per cent; foam, douche, withdrawal, or rhythm, 15 per cent; voluntary sterilization (tubal ligation or vasectomy), 9 per cent. These figures reflect a reported decrease in pill usage from 2 years ago and an increase in the use of the IUD. Among the 64 per cent of physicians who, in a prior survey, said they recommended the pill to their patients post abortion, 28 per cent of their own wives were using it, while among the 12 per cent who had recommended the IUD, 52 per cent of their own wives were using the IUD. A surprisingly large percentage of the wives reported the diaphragm or condom as their means of contraception relative to their husbands' recommendation of these methods. While approximately half of the obstetricians' wives depended on the pill or IUD for contraception, the 1970 National Fertility Survey indicated that only a quarter of white women age 30 to 44 used either of these two methods. This latter group showed a considerably higher tendency to use voluntary sterilization. The contraceptive usage of both groups differs from the general recommendations of the obstetric profession which, in the majority, favors the pill. This would indicate that other, more individual factors operate in determining a woman's contraceptive choice.