Contraceptive Advice Research Articles

Adolescent Carrier Testing in Practice: The Impact of Legal Rulings and Problems with “Gillick Competence”

Testing for carrier status for various genetic conditions often takes place during adolescence or young adulthood. This paper aims to add to the discussion of when is the best time to test through an examination of how the law on medical treatment of children appears to be used in practice and how a careful examination of legal rulings might shed light upon best practice in this area. Our focus is on the Gillick ruling (Gillick v West Norfolk and Wisbech Area Health Authority 1986), which dealt with consent and confidentiality with respect to the provision of contraceptive advice to under 16-year-olds, but which has become a general benchmark for consent to medical treatment within UK law. In addition, we draw upon data from a qualitative research study which indicates potential problems with certain practices in respect of the influence of the Gillick ruling on carrier testing procedures. We present evidence that in at least some instances, adolescents have reduced capacity to grasp fully the implications of carrier test results. In the light of our findings we make recommendations for practice concerning the testing of children and young persons.

Contraception and medical gynaecology for HIV-positive women in a one-stop clinic

HIV-positive women may be reluctant to attend gynaecology or family planning clinics for fear of divulging their condition. Therefore, a referral clinic was opened within the HIV clinic. Retrospective case-note reviews of 197 new patients revealed 109 with a variety of medical gynaecology conditions (menorrhagia being the commonest) and 88 sought contraception. The full range of contraceptives was used, including Mirena for the treatment of menorrhagia as well as contraception and the combined pill adjusted for interaction with liver enzyme-inducing antiretroviral drugs. The acceptance of contraceptive advice and gynaecological evaluation by the patients has resulted in improved reproductive health services for these HIV-positive women. In centres with large cohorts of HIV-positive women, this type of one-stop specialist clinic will be very effective in providing high-quality reproductive health care and hence, this type of clinic is recommended for such centres.

Female genital mutilation among antenatal care and contraceptive advice attendees in Sweden

To explore knowledge of, attitudes toward and practice of female genital mutilation (FGM) among women originally from countries where FGM is customary attending antenatal care and contraceptive advice in Sweden. Women in reproductive age living in Sweden who originate from countries where FGM is practiced coming for antenatal care or contraceptive advice at two maternity welfare centers in Stockholm were asked to participate. Interview administered questionnaires and gynecological examination were used for data collection. The data were analyzed by descriptive statistics. Out of 49 women asked, 40 women agreed to participate, of whom 37 had undergone FGM. Most FGM operations had been performed by doctors or midwives. Half of the Muslim women said FGM was allowed by their religion. All women reporting to have undergone 'sunna', an allegedly mild form, had extensive damage to their genitals. At gynecological examination three cases of reinfibulation were detected, of which two had been performed after delivery in Sweden. Twenty-nine women had daughters and three had let their daughters undergo FGM, all of them before settling in Sweden. Problems related to delivery and sexual intercourse were the most commonly mentioned complications of FGM. The reliability of the self-reported form of FGM is low, which may have implications for research, interventions and health care. Although many women express negative attitudes toward FGM and know about serious complications, the religious justifications, the practice of FGM on daughters, reinfibulation on adults and medicalization of the practice indicate attitudes that favor of the continued practice of FGM.

The Combined Contraceptive

Eighty percent of women receive contraceptive advice and treatment through their GP. A sexually active woman has an 85% chance of becoming pregnant within a year without contraception and roughly one in three pregnancies are unplanned. Inadequate advice and choice results in women being dissatisfied with their method of contraception and not using methods correctly. Combined contraceptives are preferred by many women because they are reliable, yet easily and rapidly reversible, and are generally well tolerated. This article aims to give an overview guiding GPs in training on choice of the combined contraceptive as a method of contraception and prescription and monitoring of combined contraceptives in primary care.

Change in trend of contraceptive uptake — effect of educational leaflets and counseling

Background The study was conducted to determine the impact of counseling and educational leaflets on contraceptive practices of couples. Study Design Randomization of 600 women was done in two groups matched for age, parity and socioeconomic status at the Department of Obstetrics and Gynaecology, Shifa Foundation Community Health Centre, Shifa International Hospital, Islamabad, Pakistan. In Group A, the intervention group was exposed to contraceptive counseling and educational leaflets in the postnatal ward after delivery, whereas in Group B, the nonintervention group was not given any formal contraceptive advice. Later on, both groups were assessed regarding their contraceptive practices. Results At their follow-up visit (8–12 weeks) postpartum, 19 (6.3%) women in the nonintervention group had started contraceptive use, whereas 153 (50.8%) had decided to start contraception in the next 6 months, and 129 (42.8%) women were still undecided. The main contraceptive user was the male partner ( n=117, 38.8%), and the most common method used was coitus interruptus ( n=62, 36.3%). In the intervention group, 170 women (56.9%) had started using contraceptives, whereas 129 (43.1%) had decided to start contraceptive use in the next 6 months. The predominant contraceptive user was the females ( n=212–70.9%), and the most popular method chosen was oral contraceptive pills ( n=111, 37.1%). Conclusion There is a definite increase in contraceptive uptake in women provided with educational leaflets and counseling session with a shift toward use of more reliable contraceptive methods.

Contraception in Women with Cardiac Disease

Cardiac disease is the main cause of maternal mortality in the UK; therefore, accurate and appropriate contraceptive advice for women with cardiac disease is an essential part of any consultation. All females should be counseled regarding pregnancy and contraception before they become sexually active, with information tailored to their diagnosis and risks of a pregnancy. In this review, we discuss current clinical recommendations and practice in a number of different cardiac conditions, including congenital heart disease, as well as highlighting future developments and challenges with contraception in women with cardiac disease.

Consent and the law

In the article ‘Consent in Practice: a case review’ in the June issue (PN 19, 5, 34-37) the terms Gillick competence and Fraser Guidelines were used as if they were interchangeable – they are not. Lord Fraser specifically addressed the issues of contraception and minors. When referring to the provision of contraceptive advice in Medical Ethics Today, the British Medical Association refers to his judgment as the Fraser Guidelines. Leading legal reference sources make no reference to Fraser Guidelines.

Choices in contraception

Provision of good information on contraceptive choices for new mothers is important. Many new mothers risk an unplanned second pregnancy because they are confused about what forms of contraception they can use safely after giving birth. Postpartum ovulation can occur as early as 28 days following delivery however women who are fully breastfeeding their baby are likely to suppress ovulation for a longer time (Too, 2003). The onset of the first menstrual period following delivery is a sign of impending fertility so it is therefore advisable for breastfeeding women to use some sort of contraceptive protection if they do not wish to become pregnant, regardless of their breastfeeding and/or amenorrhoea status. The chosen contraception should not interfere with the quantity or quality of the milk supply. Women should be offered accurate, evidence based information during contraceptive counselling, which must include the failure rates and the health risks/benefits so that they can make an informed decision about their preferred method. Midwives are ideally placed to give contraceptive advice and this article aims to discuss the contraceptive choices that are available for new mothers in particular those who breastfeed.

Users' views of new providers of emergency contraception: a qualitative study

Objectives: To explore users' views on increased availability of emergency contraception (EC) from two new providers of EC. Context: EC was previously available from general practitioners (GPs), Family Planning Centres, Accident and Emergency Departments and Brooke Advisory Centres. Recently, EC has also become available from pharmacies and Walk-in Centres (WiCs). Design: Qualitative study using in-depth interviews. Setting and Participants: Twenty-nine women from two (WiCs) and two pharmacies in Avon. Results: Women selected their provider on the basis of convenience and accessibility. WiC users valued the advice and personal nature of the contact with WiC nurses. Women who accessed EC from a pharmacy were amenable to answering questions to obtain EC but did not see this as a time to receive contraceptive advice. Women's attitudes to pharmacy supply of EC may be related to its associations as a place of business. Phrases such as over-the-counter may reinforce this notion, reflecting the business-like nature of the questioning and the impersonal nature of the interaction. While women considered the increased availability of EC to be generally positive, some had concerns about younger women accessing EC, particularly from a pharmacy. Conclusions: Women had a favourable view of their provider of EC, whether from a pharmacy or WiC. Concerns about pharmacy access may be related to its associations as a place of business where consumers have more power in the encounter. For some, this type of ‘easier’ access was considered inappropriate for younger users.

The primary health care and its role in the reproduction of the population of Vojvodina

Introduction. The problem of depopulation has been a serious threat to the province of Vojvodina leading to changes in the age structure, decrease in working and defensive population, increase in health and social service costs. The aim of this study was to examine how to improve women's health care at primary level during prenatal, perinatal and postnatal period in order to give birth to a healthy child, preserve general and genital health and promote the ability to take care of the child and give birth to another child or children. Material and methods. The investigation included 300 patients (100 patients from each center: health centers in Temerin, Mali Idjos and Zitiste) of reproductive age. All patients completed an anonymous questionnaire with 24 questions by choosing one of the offered answers or by writing an answer where necessary - concerning the primary health care and its role in the reproduction of the population of Vojvodina. Results. Half of the investigated patients did not use contraception. 32.66% of women visited their GP to control their pregnancies; 26.33% to treat their diseases, 11.33% for contraception advice, 2.66% for treatment of infertility and 27.33% for other reasons. More than half of the polled patients thought that there was a need for improvement of the work in women's health centers. 74.66% of patients suggested education on different types of health care and family planning associated with the use of modern equipment for diagnostics (13.33%). Conclusion. The primary health care has a significant role in the process of reproduction of the population and these results point to the necessity of a more active role in the improvement of women's health, as well as in the implementation of measures in the population planning policy. .

Is there a role for midwives in family planning?

As part of their sphere of practice we, as midwives, have a duty to offer family planning advice (Nursing and Midwifery Council as specified by the EU Second Midwifery Directive 80/155/ EEC Article 4—activities of a midwife “To provide sound family planning information and advice” (Nursing and Midwifery Council (NMC), 2004). We are also required to offer information to enable women to make choices regarding screening for sexually transmitted diseases such as syphilis, hepatitis B and C and Human Immunodeficiency Virus (HIV). In my professional experience, and taking into account the predominance of articles which focus on this latter area of practice in the literature, I would question whether the maternity services place more emphasis on the midwife's role in antenatal screening for sexually transmitted diseases rather than giving contraceptive advice. From the dearth of literature regarding contraceptive advice found in the midwifery journals, it might be supposed that less value is attached to offering contraceptive advice. Perhaps we should be asking how effective we, as midwives, are in fulfilling this aspect of our role?

Uncovering and responding to needs for sexual and reproductive health care among poor urban female adolescents in Nicaragua

To meet the needs of female adolescents from low-income urban areas for sexual and reproductive health (SRH) care, vouchers providing free-of-charge access to SRH care at 19 primary care clinics were distributed in Managua, Nicaragua. These vouchers substantially increased the use of services, demonstrating that many adolescents are willing to use such services, if readily accessible. The voucher redemption made it possible to identify the nature of existing, but largely unmet, needs for SRH care. The medical files from 3301 consultations with female adolescents were analysed using descriptive statistical methods and multiple logistic regression. Female adolescents presented SRH problems that merited medical attention. The mean number of problems presented was 1.5 per consultation: 34% of the vouchers were used for contraceptives, 31% for complaints related to sexually transmitted infection (STI) or reproductive tract infection (RTI), 28% for advice/counselling, 28% for antenatal check-up and 18% for pregnancy testing. A new category of health care users emerged: sexually active girls who were neither pregnant nor mothers and who sought contraceptives or STI/RTI treatment. Contraceptive use doubled among the sexually active non-pregnant voucher redeemers. Consultation with a female doctor younger than 36 years was associated with a higher chance of having contraceptives prescribed. Accessible and appropriate SRH care has the potential to make an important contribution to the increased contraceptive use, decreased risk of unwanted teenage pregnancies and decreased prevalence of STIs/RTIs among underserved adolescents. Once adolescents access the services, providers have a crucial role in ensuring current and continuing needs are met.

Adolescent reproduction and contraception

Adolescence refers to the time period between childhood and adulthood during which the body experiences a growth spurt becomes capable of reproduction and undergoes great psychological change. It is a time of dynamic change that varies from culture to culture and is influenced by factors such as socio-economic status societal expectations environment and family. In the 1970s less than 50% of 19-year-old girl children were sexually active but by the 1980s more than 50% of 17-year-old girl children were reportedly sexually active. The Youth Risk Behaviour Surveillance Systems reports that 46.7% of high school students have had sexual intercourse with 63% reporting that they used a condom at last intercourse. Adolescents who are exposed to more sexual content in the media and who perceive greater support from the media teen sexual behaviour report greater intentions to engage in sexual intercourse and more sexual activity. Many adolescents will not seek contraceptive advice or services until well after their first sexual intercourse experience. Most do not seek contraceptive services until they have been sexually active for 6 months yet 50% of adolescents who fall pregnant will conceive with in the first 6 months of unprotected intercourse. Initial access to health care is therefore crucial for preventing unintended adolescent pregnancies and sexually transmitted infections. A female seeking a pregnancy test is at risk and yet there are no clinical guidelines for follow up of these young women. (excerpt)

Specialist contraceptive counselling and provision after termination of pregnancy improves uptake of long-acting methods but does not prevent repeat abortion: a randomized trial

One in four abortions in the UK is undertaken for women who have had one before. Women undergoing abortion in Edinburgh were targeted for improved contraceptive advice and provision in this randomized trial. Between November 2001 and May 2002, women recruited at assessment for abortion were randomized at admission to receive specialist contraceptive advice and enhanced provision (316 women) or standard care (297 women). Randomization was based on the week of admission. Contraceptive use 16 weeks after abortion was assessed by questionnaire and subsequent abortions by review of the hospital records 2 years later. Women receiving specialist advice and enhanced provision were more likely to leave the hospital with contraception (271 versus 115, P < 0.001), which was more likely to be a long-acting method (141 versus 78, P < 0.001) than women receiving standard care. Four months later, there was no significant difference in contraceptive prevalence or continuation, but women in the intervention group were more likely to be using contraceptive implants (32 versus 6, P < 0.001). Two years later, 14.6% of women in the intervention group (44/302) and 10% of controls (27/268) had undergone another abortion in the same hospital (P = 0.267). Specialist contraceptive advice and enhanced provision had a short-lived effect on contraceptive uptake and increased the use of long-acting methods but did not appear to reduce repeat abortions.

Contraceptive counselling and social representations: a qualitative study.

Contraceptive use is a complex issue and several studies have been conducted in an effort to understand user behaviour. It is of interest to explore the representations of professionals who give advice on contraception, since their views could have an impact on contraceptive use. Individual in-depth interviews of 65 healthcare professionals likely to provide contraceptive advice to patients at a Swiss maternity unit. 83% of healthcare professionals interviewed were favourable to contraception in general while being highly critical of its practical efficacy. The methods most often spontaneously cited were oral contraceptive pills, male condom, intrauterine devices and hormonal implants. Theoretically, all methods should be proposed during contraceptive counselling but in practice interviewees have different social representations of user groups and associate them with specific contraceptive methods. Personal experience appears to play a bigger role than scientific knowledge. The counsellor's social representations probably play an important role in determining user behaviour. These representations should be taken into consideration in the training of healthcare professionals in this field.

Contraceptive counselling and social representations: a qualitative study.

Contraceptive use is a complex issue and several studies have been conducted in an effort to understand user behaviour. It is of interest to explore the representations of professionals who give advice on contraception, since their views could have an impact on contraceptive use. Individual in-depth interviews of 65 healthcare professionals likely to provide contraceptive advice to patients at a Swiss maternity unit. 83% of healthcare professionals interviewed were favourable to contraception in general while being highly critical of its practical efficacy. The methods most often spontaneously cited were oral contraceptive pills, male condom, intrauterine devices and hormonal implants. Theoretically, all methods should be proposed during contraceptive counselling but in practice interviewees have different social representations of user groups and associate them with specific contraceptive methods. Personal experience appears to play a bigger role than scientific knowledge. The counsellor's social representations probably play an important role in determining user behaviour. These representations should be taken into consideration in the training of healthcare professionals in this field.

Emergency contraception and prevention of induced abortion in India

ObjectiveInduced abortion is associated with high morbidity and mortality in India. Use of regular contraception with emergency contraception (EC) as backup can reduce the incidence of induced abortion. The study...

Postpartum contraception

Why is so little time given to considering contraception during pregnancy and in the immediate postpartum period? Pregnancy may be the result of careful planning and previous knowledgeable use of contraception, but too often it is simply the unintended consequence of a lack of biological understanding or ignorance and fear of contraceptive methods. An extremely small percentage of women discuss postpartum contraception antenatally. Although most do discuss it with a midwife on the postnatal ward, this is mainly a brief, limited encounter as the new mother is about to leave hospital. For most women the definitive postpartum contraceptive advice is given at the 6-week postnatal visit to the GP. We should not underestimate the importance of the immediate postnatal period as an opportunity to influence ongoing contraceptive use and reduce the risk of further unintended pregnancy. These issues may be particularly important in adolescent mothers whose prior use of contraception will usually have been extremely poor. This advice aims to give an overview of the range of contraceptive choice available to postpartum mothers, either breastfeeding or bottle-feeding. Each method is reviewed in terms of its positive and negative effects and its particular suitability or special precautions during use in this particular life-stage.

Lactational amenorrhoea method as a contraceptive

Lactational Amenorrhoea Method or LAM, is a highly effective form of natural family planning. If used correctly, it is over 98% effective (Szarewski and Guillebaud 2000), which rates very favourably when compared to other forms of contraception. Yet midwives appear to be reluctant to include this choice of contraception when discussing this issue postnatally with breastfeeding women. This article will look at the evidence to support the efficacy of LAM, the criteria women need to follow (the Bellgio consensus statement) to comply with LAM, some common fears and misconceptions surrounding LAM and the professional responsibilities of the midwife in relation to postnatal contraception advice.

An exploratory survey of the practice of rheumatology nurses addressing the sexuality of patients with rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic progressive inflammatory condition primarily affecting the joints. It is characterized by pain, stiffness and fatigue. Research has demonstrated that the symptoms of RA can negatively impact on a patient's sexuality and patients would welcome the opportunity to discuss their sexual needs with a health professional. To identify current perceived practice, skills, and knowledge of rheumatology nurses in addressing the sexuality of patients with RA. A postal questionnaire was sent to 132 rheumatology nurses identified from the British Health Professionals in Rheumatology Handbook. The questionnaire sought to identify the nurse's role in the assessment and management of RA patients' sexuality. Seventy six questionnaires were returned (response rate of 57.5%). Sixty nine respondents stated that sexuality should be included within the nursing assessment. The main factors that influenced whether sexuality was discussed was privacy, the level of knowledge and skills and time. Nurses felt that while contraceptive advice for patients treated with cytotoxic drugs was discussed in depth, the patient's sexual relationship was not discussed at all. The majority of respondents (83%) had never received any training in this area and would undergo training if they had the opportunity. While rheumatology nurses acknowledge the importance of including sexuality in the care management of patients with RA, in practice the impact of the condition on a patient's sexuality is only discussed briefly. Rheumatology nurses have identified the need for further training in this complex area.