Contraceptive Status Research Articles

Philippines 1998: results from the Demographic and Health Survey.

This article presents summary statistics gathered from the 1998 Philippine National Demographic and Health Survey. The National Statistics Office and the Department of Health within the framework of the Demographic Health Survey Program of Macro International conducted the survey. The nationally representative survey collected data from 12,407 households. Interviews were also conducted with 13,983 women aged 15-49 years between March 3 and the first week of May 1998. The statistical data presented were on fertility trends, fertility differentials, age-specific fertility, fertility preferences, current contraceptive use, contraception, marital and contraceptive status, postpartum variables, infant mortality trends and differentials, and children's health.

Nicaragua 1998: results from the Demographic and Health Survey.

This article presents summary statistics gathered from the 1998 Nicaragua Demographic and Health Survey (Encuesta Nicaraguense de Demografia y Salud 1998, ENDESA-98). Data from the nationally representative ENDESA-98 were collected from 11,528 households. Interviews were conducted with 13,634 women aged 15-49 years and 2912 men aged 15-59 years between December 1, 1997, and May 31, 1998. The statistics presented were on fertility trends, fertility differentials, age-specific fertility, fertility preferences, current contraceptive use, contraception, marital and contraceptive status, differentials in median age at first birth, postpartum variables, and infant mortality. In addition, statistical data on the health and nutritional status of children were also presented.

Mozambique 1997: Results from the Demographic and Health Survey

This article presents the results from the 1997 Mozambique Demographic and Health Survey (DHS) that was conducted by the Instituto Nacional de Estatistica, Maputo, Mozambique, within the framework of the DHS Program of Macro International. The data for the nationally representative survey were collected from 9282 households and complete interviews were conducted with 8779 ever-married women aged 15-49 years and 2335 men aged 15-64 years. The interviews took place between March and July 1997. Among the summary statistics presented in this report are fertility trends, fertility differentials, fertility preferences, contraceptive prevalence differentials, and marital and contraceptive status. Summary statistics involving postpartum variables, infant mortality trends, and nutritional status are also provided.

Jordan Republic 1997: results from the demographic and health survey.

This article presents results from the 1997 Jordan Population and Family Health Survey (JPFHS) that was conducted by the Department of Statistics, Amman, Jordan, within the framework of the Demographic and Health Survey Program of Macro International. The data for the nationally representative JPFHS were collected from 7335 households, and complete interviews were conducted with 5548 ever-married women aged 15-49 years. Among the summary statistics presented in this report are fertility trends, fertility differentials, fertility preferences, contraceptive prevalence differentials, knowledge and current use of contraceptive methods among currently married women, and marital and contraceptive status. Summary statistics on postpartum variables, infant mortality trends, and nutritional status are also included.

Semen quality and human fertility: a prospective study with healthy couples.

Measures of semen quality are used as surrogate measures of male fertility in clinical andrology, reproductive toxicology, epidemiology, and risk assessment. However, only limited data are available to relate those measures to fertility. This prospective study with 210 reproductive-age couples was conducted to provide information on the value of semen quality measures for predicting human male fertility potential and for development of models to estimate the effects of changes in semen quality on fertility in a given population for risk assessment. Couples without known risk factors for infertility and who had discontinued contraception to have a child were accepted. The study followed each couple for up to 12 menstrual cycles while they attempted to conceive and evaluated semen quality measures from multiple ejaculates per man with known abstinence intervals. For each cycle, the day of ovulation was predicted, and the couple was advised to have intercourse multiple times on that day and on the days around it. Among the demographic variables assessed, parity, contraception status prior to entering the study, male education level, and male smoking were associated significantly with 12-cycle pregnancy rate. Several semen quality measures also were associated significantly with pregnancy rate, with percentage morphologically normal sperm by strict criteria and measures involving total number of sperm showing particularly strong associations. Localized regression-smoothing plots of semen quality data against proportion of couples pregnant suggested levels below which fertility declines for several semen quality measures. These results have applications in both clinical andrology and in assessment of risk to male fecundity from environmental or pharmaceutical exposures. In particular, they contribute information on behavior of fertility with varying semen quality and can allow development of models to predict effects on fertility in populations from decrements in semen quality.

Chad 1996-97: results from the Demographic and Health Survey.

The Chad Demographic and Health Survey (DHS), or Enquete Demographique et de Sante (EDS) Tchad 1996-97, was conducted by the Bureau Central du Recensement, Direction de la Statisque, des Etudes Economiques et Demographiques, Ministere du Plan et de l'Amenagement du Territoire N'Djamena, Chad, within the framework of the DHS Program of Macro International. Data for the EDS were collected from 6840 households, and complete interviews were conducted with 7454 women aged 15-49 and 2320 men aged 15-59. The interviews took place between December 1996 and July 1997. The summary statistics presented were taken from the Chad country report, with exceptions as noted. Included in this article are table and charts presenting valuable data on the general characteristics of the Chad population, fertility, fertility preferences, contraceptive use, knowledge about contraception, marital and contraceptive status, postpartum variables, infant mortality, health, and nutritional status.

Indonesia 1997: results from the Demographic and Health Survey.

The Indonesia Demographic and Health Survey (DHS) was conducted by the Central Bureau of Statistics, State Ministry of Population/National Family Planning Coordinating Board, and Ministry of Health, Jakarta, Indonesia, within the framework of the DHS Program of Macro International. Data from the DHS were collected from 34,255 households and complete interviews were conducted with 28,810 women aged 15-49. The interviews took place between September 1, 1997 and December 31, 1997. The summary statistics presented were taken from the Indonesia country report with exception as noted. Included in this article are table and charts presenting valuable data on Indonesia general characteristics of the population, fertility, contraceptive use, and knowledge about contraception, marital and contraceptive status, infant mortality, and health.

The Correspondence Between Intention to Avoid Childbearing and Subsequent Fertility: A Prospective Analysis

Retrospective studies of pregnancy intendedness have revealed some characteristics that can help identify which women are more likely than others to experience an unintended birth. A comparison of these findings with those from a prospective analysis may shed greater light on the characteristics associated with unintended pregnancy. Data were taken from the 1988 National Survey of Fertility Growth and a telephone reinterview of respondents conducted in 1990. Separate analyses were conducted of women intending to postpone childbearing for at least three years and of women intending to forgo all future childbearing. Logistic regression models were used to identify the effects of social and demographic characteristics, as well as change in marital status and certainty of intentions, on the odds of experiencing a birth in the interval between interviews. Only 10% of women intending to postpone pregnancy for more than three years and 8% of respondents seeking to forgo future childbearing had a birth in the interval between interviews. (These births, referred to as unpredicted births in this article, are roughly analogous to those labeled unintended in retrospective analyses.) Women with incomes below the poverty level were 2-3 times as likely as women with incomes between 100% and 199% of poverty to experience an unpredicted birth. Race was not a significant factor among women intending to avoid future childbearing, and became nonsignificant among those intending to postpone when change in marital status and contraceptive status were taken into account. Women aged 35 and older who wanted no more children were significantly less likely than women aged 20-29 to have an unpredicted birth. Women aged 30-34 who wanted to postpone childbearing were roughly 70% less likely than women aged 20-29 to experience an unpredicted birth. Overall, women who were at risk for a pregnancy but not practicing contraception were 2-3 times more likely than women using an effective method to have an unpredicted birth. There are at least two potential explanations for instances where the correlates of unintended births in the prospective analysis differ from those identified in retrospective studies. Certain subgroups of women may be more likely to classify births as wanted when they are asked retrospectively; alternatively, they may be more likely to experience changes in their living conditions that alter their fertility intentions.

Contraceptive status and sexual function of climacteric Chinese women

The objective of the present survey was to assess the contraceptive status and sexual function of climacteric Chinese women. One cross-sectional study randomly recruited 742 premenopausal, perimenopausal, and naturally menopausal women aged 45–55 years from Beijing. Contraceptive methods were used by 75.6% of premenopausal and 54.2% of perimenopausal women. The primary methods were the IUD and barrier method. The women’s choices of methods were related to parity and frequency of sexual activities. Sexual activity was related to the satisfaction of contraceptive methods. Perimenopausal and postmenopausal women were about half as likely to enjoy sexual activity and to experience orgasms than premenopausal women. Women of higher socioeconomic status had a lower risk for decreased sexual functioning. The IUD was the most popular and the most appropriate contraceptive method for perimenopausal women. Sexual function was associated with the women’s satisfaction with the contraceptive method used, their menopausal status, and their socioeconomic class.

Contraceptive status and sexual behavior in women over 35 years of age in India.

The aim of this paper is to survey the current contraception use and analyze the sexual patterns in women above 35 years of age in India. Five hundred women, of whom 250 were at least 35 years old and 250 were less than 35 years old (control group) were interviewed with the help of a prepared questionnaire. A permanent surgical method of contraception had been accepted by 40.4% of women > or = 35 years old versus 16.8% of women < 35 years old. Of various temporary methods, an intrauterine device (IUD) was used by 5.2% and 22.8% oral contraceptive pills (OCs) by 1.2% and 9.6%, and natural methods by 6.4% and 3.2%, in women > or = 35 years and < 35 years, respectively. No contraception was used by 25.6% women > or = 35 years. A history of medical termination was given by 67.18% of non-contraceptive users vs. 27.41% of contraceptive users in women > or = 35 years. Coital frequency was noted at 4.32 times/month in women > or = 35 years but 7.2 times/month in women <35 years. Among contraceptive users > or = 35 years, coital frequency was 4.9 times/month compared with 3.9 times/month in non-contraceptive users. There is a high acceptance of irreversible sterilization and a high abortion rate in women > or = 35 years. Use of contraceptives was linked with increased sexual activity and a decreased abortion rate.

Contraceptive Practices and Trends in France

Contraceptive use has been legal in France for the past 30 years, and patterns of use changed substantially from the 1960s to the 1980s. Given the rapidity with which use patterns change and the possible impact of rising concern about infection with HIV and other sexually transmitted diseases, it is important to determine trends of contraceptive practice into the 1990s. A total of 5,900 French households were selected in 1994 for inclusion in the Fertility and Family Survey. Respondents were questioned about their contraceptive use patterns and family formation status. The results were compared with those of comparable surveys conducted in 1978 and 1988. Two-thirds of French women used some form of reversible contraceptive method in 1994. Oral contraceptive use has grown steadily in France: About 40% of women aged 20-44 reported using the pill alone or combined with another method in 1994, compared with 34% in 1988 and 28% in 1978. Condom use has also been on the rise: Nearly 8% of women were using condoms alone or combined with another method in 1994, up from 5% in 1988 and 6% in 1978. IUD use has declined from 19% in 1988 to 16% in 1994, and both male and female sterilizations remain rare. Contraceptive behavior in France appears unique among developed countries, with fairly high levels of oral contraceptive use--even among older women--relatively high levels of IUD use and little reliance on either male or female sterilization. As with other countries, however, condom use has climbed in recent years, and is especially common at first intercourse.

Guatemala 1995: Results from the Demographic and Health Survey

The Guatemala National Survey of Maternal and Child Health was national in scope, but lacked data from 1 region (2% of the population). 5459 households took part; complete interviews with 5160 women aged 15-44 took place. The survey was done between September 25-December 16, 1987. Summary statistics are presented in tables. They give general population characteristics (both demographic and economic); distribution of survey sample population by socioeconomic characteristics (percent women); fertility statistics--trends, differentials, and age-specific fertility; fertility preferences (ideal number of children, desire to stop childbearing; planning status of births by birth order); current contraceptive use--contraceptive prevalence differentials; contraceptive prevalence by age and parity; source of contraceptive supply for current users of supply or clinic methods; contraception facts--"knowledge and use of contraceptive methods among women married or in union;" reaction to getting pregnant among women who do not use contraceptives, and women who gave up a method in the last 5 years. Nuptiality and contraceptive status are given in charts headed by "current marital status." Postpartum variables given include: "duration of postpartum interval by current status;" "differentials in breast feeding and amenorrhea;" and "postpartum status by duration since birth." Infant mortality trends, differentials, 1977-87; and children ever-born and surviving are also given. "Health: disease, treatment, and prevention, as given by "percent of children 12-23 months of age with health and, of those, percent immunized;" "percent of children under 5 years" with diarrhea 2 weeks before the survey, and of those, percent receiving different treatments;" and "type of assistance during delivery for births" in the 5 years before the survey. Nutritional status: anthropometric measures lists the percent of undernourished among children who are aged 3-36 months according to child's weight-for-height; and percent of undernourished children aged 3 to 36 months according to children's height-for-age.

Factors affecting contraceptive use in Ghana.

The relationships between selected demographic and socioeconomic variables and current use status of contraception were examined using logistic regression technique. Information on current contraceptive use was provided by 3156 out of 4488 currently married women aged 15-49 interviewed in the 1988 Ghana Demographic and Health Survey. Respondents' approval of family planning emerged as the most important predictor of current contraceptive use, followed by discussion of family planning with partner and level of education. As a policy measure, information, education and communication programmes on family planning should be intensified, particularly in rural areas. Female education, at least up to secondary level, should be given top priority.

Current status of injectable hormonal contraception, with special reference to the monthly method.

Injectable contraceptives are a valid option in every family planning program. Contraceptives which are administered every 2 or 3 months, containing only progestogen agents (DepoProvera, Noristerat) have proven efficacious and do not show long-term safety problems. They differ from other contraceptives in their long lasting action and by not presenting the contraindications of the estrogens. Their most prominent side-effect is the irregularity of cyclic bleeding. Although bleeding irregularities are not life threatening, many users stop the treatment for that reason. Monthly contraceptives comprising progestogens and estrogens, maintain or improve the high efficacy of the earlier forms and have the added benefit of allowing bleeding to resemble the physiologic one. This increases acceptability and the continuation rate. There is no long-term inconvenience. At this point, the greatest experience is with the formulation known as Topasel or Perlutal. Other formulations (Cyclofem, Mesigyna) are beginning to be commercialized and their characteristics must still be confirmed through daily use. Indications, contraindications, precautions and warnings for the use of monthly injectable contraceptives are basically identical to those of the combined oral contraceptives, as are the side-effects. Efficacy, though, proves to be superior, which can be correlated to a simpler method of use and less risk of error when using it. Main motivation factors are: efficacy, simplicity in usage, reversibility and confidentiality.

Women Breastfeeding Infants Longer in Many Developing Countries

Findings on breast feeding practices and trends are presented for developing countries. Analysis is based on data from World Fertility Surveys during the late 1970s and Demographic and Health Surveys during the 1980s for the following countries: Egypt Ghana Kenya Morocco Senegal Tunisia Indonesia Sri Lanka Thailand Colombia the Dominican Republic Ecuador Mexico Peru and Trinidad and Tobago. The mean duration of breast feeding rose significantly in Colombia the Dominican Republic Ecuador Ghana Kenya Peru and Trinidad and Tobago. The range of the increase was from 0.8 months in the Dominican Republic to 4.2 months in Trinidad and Tobago. Significant declines in breast feeding occurred in Thailand (2.6 months) and Morocco (1.1 months). Indonesia and Sri Lanka had the longest mean breast feeding durations of respectively 26.7 and 23.2 months. Changes in socioeconomic and demographic characteristics of population led to decreases in the mean duration of breast feeding of up to 2.4 months in all countries with the exception of Ghana and Trinidad and Tobago. However behavioral changes compensated in part for the influence of socioeconomic factors. Latin American countries had the largest increases in mean breast feeding duration due to behavioral factors. In other countries the impact of behavioral factors was more variable. The author suggests that continued promotion of breast feeding will be necessary in order to counteract the socioeconomic shifts that contribute to declines in breast feeding duration. In all countries urban children were breast fed for shorter intervals. Higher income womens use of the pill and short birth intervals decreased the likelihood of longer breast feeding duration. Population shifts in contraceptive use urbanization and educational status were expected to result in declines in breast feeding.

Single-dose fosfomycin trometamol versus 5-day cephalexin regimen for treatment of uncomplicated lower urinary tract infections in women

A randomized study was conducted to assess the clinical and microbiological efficacies of a single 3-g dose of fosfomycin trometamol for the treatment of uncomplicated lower urinary tract infections in women compared with a 5-day regimen of cephalexin at 0.5 g four times daily. One hundred twelve women, all of whom had documented infections with bacteria sensitive to both antibiotics, were included. Fifty-eight women received fosfomycin trometamol, and 54 women received cephalexin. The two groups did not differ in age, severity, or duration of current urinary tract infection, menstrual status, sexual activity, or use of contraceptives. Ninety percent of pathogens in the fosfomycin trometamol group and 81% in the cephalexin group were Escherichia coli (the difference is not significant [NS]). A clinical evaluation at the 5-day follow-up showed that 91% of the women in each group were free of symptoms, while five women in each group were considered therapy failures and were treated by another antibiotic course. A microbiological evaluation at the 5-day follow-up showed a 91% eradication rate in the fosfomycin trometamol group and an 83% eradication rate in the cephalexin group (NS). At the 1-month follow-up, a clinical evaluation demonstrated prolonged resolution in 86 and 78%, respectively, of the participating women (NS). A microbiological evaluation at 1 month demonstrated prolonged eradication in 47 (81%) women treated with fosfomycin trometamol and in 37 (68%) women treated with cephalexin (NS). Three and six women, respectively, had relapsed. No adverse reactions were reported by the fosfomycin trometamol-treated women, while three women treated with cephalexin reported mild adverse reactions but completed the study period. Fosfomycin trometamol in a single 3-g dose is as effective as a 5-day regimen of cephalexin for the treatment of uncomplicated lower urinary tract infection in women.

Egypt 1992: Results from the Demographic and Health Survey

The Egypt Demographic and Health Survey (DHS) was conducted by the National Population Council in Cairo, Egypt, within the framework of the DHS Program of Macro International Inc. Data were collected from 10,670 households. Information was collected from 2466 husbands as well as in interviews with 9864 women aged 15-49. The interviews took place between November 7, 1992 and February 8, 1993. Information is presented on general characteristics of the population, the distribution of survey sample population by socioeconomic characteristics, fertility, fertility preferences, current contraceptive use, contraception, marital and contraceptive status, postpartum variables, infant mortality, health, and nutritional status.

Factors affecting desired family size in Bangladesh.

Factors affecting desired family size in rural Bangladesh are examined using data from contraceptive prevalence surveys conducted between 1983 and 1991. The analysis suggests that mothers having two sons and one daughter are more inclined to perceive their family as complete than those having three sons and no daughter. Logistic regression analysis indicates that important determinants of desire for more children are age of woman, current contraceptive use status, work status, and family planning worker's visit. The policy implications of these findings are discussed.

Prevalence of chlamydial antibody in pregnancy

In this matched-pair study 139 pregnant women were matched on the basis of age to an equal number of non-pregnant women with no signs of genital infection. The mean age was 28.7 years (range 20-41). The cut-offs used for detection of chlamydial antibody were 1:64 and 1:128 for IgG and 1:16 for IgA. IgG antibody at 64 was detected in 37.4% of pregnant women, compared to 46% of controls (p = 0.145). There was, however, a statistically significant difference between the groups for IgG at 128 (gravidae = 15.8%; controls = 28%; p = 0.014). IgA were detected in 8.6% and 16.5% of subjects, respectively (p = 0.047). IgG levels did not vary with increasing age among the pregnant women, but rose significantly with age in non-pregnant controls (logistic regression p-values = 0.011 and 0.006, for IgG at 64 and 128, respectively). IgG-positive women in the control group tended to be older than pregnant IgG-positive women (p = 0.06). These differences could not be explained by marital status, parity or use of oral contraceptives. In view of the lack of epidemiological differences, biological explanations might be invoked.

Oral Contraception and Risk of a Cerebral Thromboembolic Attack

OBJECTIVE--To assess the risk of cerebral thromboembolism in women using low dose oral contraceptives. DESIGN--A retrospective case-control study. SETTING--All Danish medical, neurological, neurosurgical, and gynaecological departments. SUBJECTS--All 794 women in Denmark aged 15-44 who had suffered a cerebral thromboembolic attack during 1985-9 and 1588 age matched randomly selected controls. RESULTS--Of 692/1584 case/control questionnaires sent out, 590/1396 (85.3%/88.1%) were returned. Among the cases, 15 refused to participate, 69 had a revised or unreliable diagnosis, 40 had had thromboembolic disease previously, 13 were pregnant, and 152 had a disease predisposing to a cerebral thromboembolic attack. Of the 323 cases without a known predisposition, 320 reported use or non-use of oral contraception. Among the 1396 controls, eight refused to participate, were mentally retarded, or lived abroad; 18 returned an uncompleted questionnaire; 17 had had thromboembolic disease previously; 31 were pregnant; and 130 had a disease predisposing to a cerebral thromboembolic attack. Thus 1198 non-predisposed controls were available, among whom 1197 reported use or non-use of oral contraception. Among the 320 cases, 116 (36.3%) were oral contraceptive users at the time of the cerebral thromboembolic attack. By comparison there were 191 users (16.0%) among the 1197 controls, giving a crude odds ratio of 3.0. After multivariate analysis, including confounder control for age, smoking, years of schooling, and trend in use of different types of oral contraceptives during 1985-90, pills containing 50 micrograms oestrogen were associated with an odds ratio for cerebral thromboembolic attack of 2.9 (95% confidence interval 1.6 to 5.4), those containing 30-40 micrograms oestrogen an odds ratio of 1.8 (1.1 to 2.9), those containing progestogen only an odds ratio of 0.9 (0.4 to 2.4). The odds ratio did not change with increasing age or with duration of oral contraceptive use. A 50% increased risk of a cerebral thromboembolic attacks among cigarette smokers (after confounder control) was independent of oral contraception status and age. CONCLUSION--Low dose oral contraceptives are associated with an increased risk of cerebral thromboembolic attack. Combined or sequential pills containing 30-40 micrograms oestrogen are associated with a one third reduced risk compared with preparations containing 50 micrograms oestrogen. Progestogen only pills did not increase the risk of a cerebral thromboembolic attack.