Contraceptive Continuation Rates Research Articles

Preventing Repeat Teen Pregnancy: Postpartum Depot Medroxyprogesterone Acetate, Oral Contraceptive Pills, or the Patch?

Study Objective To prospectively evaluate the repeat teen pregnancy rates, within one year of delivery, among adolescents who choose the contraceptive patch (Ortho Evra) versus oral contraceptive pills (OCP) versus Depot Medroxyprogesterone Acetate (Depo Provera, DMPA) for postpartum contraception. Design Observational, prospective cohort study. Comparison groups are postpartum teens, who self-select the contraceptive patch (n = 55) versus DMPA (n = 142) versus OCPs (n = 55) immediately postpartum. Setting Medical University of South Carolina, a tertiary medical center. Participants Postpartum teens, 11–19 years old; 72% were African American, and 96% qualified for Medicaid insurance. Interventions A structured telephone interview was performed every 3 months. Main Outcome Measures The primary outcome measure was a repeat pregnancy within 12 months of the index delivery. Secondary outcome variables were contraceptive continuation rates, reasons for discontinuation, side effects and condom usage. Results At 1-year follow-up, repeat pregnancy rates were 14.2%, 29.7%, and 31.8% among DMPA, OCP, and patch users respectively ( P = 0.02). DMPA users were significantly more likely to be using any form of hormonal contraception 1 year postpartum than patch or OCP users. Condom use was similarly low among all cohorts. Conclusion Adolescents who choose DMPA for postpartum contraception are significantly less likely to become pregnant within 1 year of delivery, as compared to teens who choose OCPs or the patch.

A survey of postnatal contraception in opiate-using women

ObjectiveTo document the contraceptive choices and continuation rates for different contraceptives in a group of pregnant women who use opiates.MethodsA prospective study set in a large city in the north...

Community-based distribution and contraception usage in Iran

ObjectiveDespite the availability of free contraception from family planning clinics, the rate of unwanted pregnancy in Iran is still high. The effectiveness of other methods for contraceptive supply should, therefore,...

Effectiveness and acceptability of progestogens in combined oral contraceptives - a systematic review.

BackgroundThe progestogen component of oral contraceptives (OCs) has undergone changes since it was recognized that their chemical structure can influence the spectrum of minor adverse and beneficial effects.MethodsThe objective of this review was to evaluate currently available low-dose OCs containing ethinylestradiol and different progestogens in terms of contraceptive effectiveness, cycle control, side effects and continuation rates. The Cochrane Controlled Trials Register, MEDLINE and EMBASE databases were searched. Randomized trials reporting clinical outcomes were considered for inclusion and were assessed for methodological quality and validity.ResultsTwenty–two trials were included in the review. Eighteen were sponsored by pharmaceutical companies and in only 5 there was an attempt for blinding. Most comparisons between different interventions included one to three trials, involving usually less than 500 women. Discontinuation was less with second-generation progestogens compared to first–generation (RR 0.79; 95% CI 0.69–0.91). Cycle control appeared to be better with second-compared to first-generation progestogens for both, mono-and triphasic preparations (RR 0.69; 95% CI 0.52–0.91) and (RR 0.61; 95% CI 0.43–0.85), respectively. Intermenstrual bleeding was less with third- compared to second-generation pills (RR 0.71; 95% CI 0.55–0.91).Contraceptive effectiveness of gestodene (GSD) was comparable to that of levonorgestrel (LNG), and had similar pattern of spotting, breakthrough bleeding and absence of withdrawal bleeding). Drospirenone (DRSP) was similar compared to desogestrel (DSG) regarding contraceptive effectiveness, cycle control and side effects.ConclusionThe third- and second-generation progestogens are preferred over first generation in all indices of acceptability. Current evidence suggests that GSD is comparable to LNG in terms of contraceptive effectiveness and for most cycle control indices. GSD is also comparable to DSG. DRSP is comparable to DSG. Future research should focus on independently conducted well designed randomized trials comparing particularly the third- with second-generation progestogens.

Contraception continuation rates and reasons for discontinuation in Zahedan, Islamic Republic of Iran

We evaluated contraception continuation rates and discontinuation reasons in Zahedan among 1741 women from 1998-2000. By Kaplan-Meier technique continuation rates were 92% for low dose combined hormonal oral contraceptives (OC), 86% for a levonorgestrel-releasing implant, 82% for intrauterine devices (IUD) and 53% for medroxyprogesterone acetate at the first year. After 3 years, continuation was 78% for levonorgestrel implant, 70% for OC, 60% for IUD and 44% for medroxyprogesterone acetate. The commonest reason for discontinuing OC and medroxyprogesterone acetate was changing method; for IUD and levonorgestrel-releasing implant, the commonest reason was side-effects. By Cox regression model, continuation rate and contraceptive type were significantly related to health centre.

Relative Cost Effectiveness of Depo-Provera??, Implanon??, and Mirena?? in Reversible Long-Term Hormonal Contraception in the UK

To estimate the relative cost effectiveness for women aged > or =30 years, starting long-term hormonal contraception with either levonorgestrel intrauterine system (Mirena), etonogestrel subdermal implant (Implanon) or medroxyprogesterone acetate injection (Depo-Provera). This was a modelling study, performed from the perspective of the UK NHS, of contraceptive services supplied by a general practitioner. STUDY PARTICIPANTS AND INTERVENTIONS: A dataset was created from the General Practice Research database (GPRD) comprising 16 835 women aged > or =30 years who received levonorgestrel intrauterine system (n = 6080), etonogestrel subdermal implant (n = 277) or medroxyprogesterone acetate injection (n = 10 478) for their long-term contraception between 1997 and 2002. Contraception-related healthcare resource utilisation values and contraception continuation rates were obtained from the GPRD. The incidence of pregnancy associated with each contraceptive was obtained from the published literature. By combining the GPRD dataset with published clinical outcomes, a decision model was constructed. This was used to estimate the expected annualised direct healthcare costs and consequences of the provision of each type of contraception per woman-year in pounds sterling (pound) at 2002/03 prices. Our model suggests that starting long-term contraception with levonorgestrel intrauterine system or etonogestrel subdermal implant instead of medroxyprogesterone acetate injection is a dominant strategy from the UK NHS perspective. In contrast, starting long-term contraception with etonogestrel subdermal implant instead of levonorgestrel intrauterine system is likely to be the least cost-effective option, since it would lead to an additional cost for each additional avoided pregnancy (pound 21,000). Long-acting reversible hormonal contraception has the benefit of being extremely effective (>99%), and not reliant on patient compliance nor dependent on correct usage. The relative cost effectiveness of using any one contraceptive should be considered in the light of the additional clinical benefits it may confer, user acceptability, QOL, past medical history and the estimated cost of an unintended pregnancy. Choice of contraception is essential to meet diverse user needs and preferences that may change with the user's stage of life. Only by offering choice will the maximum number of women be protected and therefore the greatest savings to the health service be gained.

Probability of contraceptive continuation and its determinants

Probability of contraceptive continuation and factors associated with discontinuation were assessed in a retrospective study of women's records in Alexandria. Contraceptive continuation rates were 88/100, 75/100 and 56/100 women at 6, 12 and 24 months respectively. Reasons for discontinuation included side-effects and health concerns (30.4%), accidental pregnancy and personal reasons (6.4%) and desire for pregnancy (5.4%). Women who were older and who had several children were most likely to continue contraceptive use. Three significant predictors of discontinuation were side-effects and health concerns, age of the woman and contraceptive method. Women should be fully informed of the contraceptive methods available and their side-effects, and counselling programmes should be offered, particularly during the first 2 years of use.

Contraceptive Use in Matlab, Bangladesh: The Role of Gender Preference

Research in several Asian societies has suggested that sons are generally preferred over daughters. The implications of gender preferences for actual fertility behavior have not been adequately investigated, however. This analysis examines the effect of the sex composition of surviving children on the acceptance and discontinuation of contraception in a sample of 3,145 women in Matlab, Bangladesh, who were observed for 60 months. Hazards regression analyses are employed in the analysis. Strong and highly significant effects of gender preference on contraceptive use are observed. The preference is not monotonically son-biased but is moderated toward a balanced composition, because parents desire to have several sons and at least one daughter. These findings suggest that gender preferences, particularly a preference for sons, represent a significant barrier to fertility regulation in rural Bangladesh.

Contraceptive Failure in the United States: An Update

This report provides an update of the authors' previous estimates of first-year probabilities of contraceptive failure for all methods of contraception. Estimates are provided of failure during typical use (which includes both incorrect and inconsistent use) and during perfect use (correct use at every act of intercourse). The difference between these two probabilities provides a measure of how forgiving of imperfect use each method is. These revisions are prompted by recent studies that provide the first estimates of failure during perfect use for periodic abstinence and the cervical cap, by more complete evaluations of implants, and by the appearance of the Copper T 380A and disappearance of other IUDs from the US market. Also provided is a more complete explanation of how the previous estimate of the probability of becoming pregnant while relying solely on chance should be interpreted, and this estimate is revised slightly downward.

The effect of oral contraceptive acceptance on fertility in the postpartum period

In Bangladesh where postpartum amenorrhea is long and contraceptive pill continuation rates are low the result of introducing oral contraception during the period of post partum amenorrhea is actually to decrease the interval to the next pregnancy. In 121 matched pairs from rural Matlab thana in 1979-1980 fertility is increased relative to that of a matched group of non-acceptors. The earlier return to fertility of acceptors persists even though there is a higher acceptance rate in the early postpartum period and women who accept at this time have higher continuation rates than those who accepted later. There is a possibility that a few of the women who were later acceptors may have conceived prior to initiating contraception and discontinued as soon as they became aware of the pregnancy. On the other hand the chance of conception which has been shown to increase in the later months of lactational amenorrhea may be further heightened by a short duration of oral contraceptive use. 1 model shows that the most important variable in determining the delay to the next pregnancy is the contraceptive continuation rate. For the group of women who continued use for more than 6 months the median time to the next pregnancy was close to that of the non-acceptor matched group. This implies that unless program efforts can achieve average continuation of at least 9 months it would be better not to provide oral contraception during the period of postpartum amenorrhea. This position is reinforced by our knowledge of the adverse effects which hormonal contraception particularly combined preparations have on the quantity of milk produced by the lactating postpartum mother.

Comprehensive School‐based Health Clinics: A Growing Movement to Improve Adolescent Health and Reduce Teen‐age Pregnancy

The lack of needed health care and the number of unintended pregnancies among young people in the U.S. have caused many schools to increase the scope of their health services in the past 2 decades. Beginning in the 1970s, some communities also responded to that need with more comprehensive health clinics. By August of 1986, the Support Center for School-Based Clinics at the Center for Population Options had identified more than 60 comprehensive clinics in the U.S. having the characteristics identified in this discussion. Locations of these clinics include Chicago, Kansas City, St. Paul, and West Dallas. These comprehensive health centers provide direct comprehensive primary care, prescribe and/or dispense medications, provide family planning and other services related to sexuality, commonly are operated by established medical providers rather than the schools, and are staffed by nurse practitioners and physicians. These comprehensive centers represent the next step in an evolutionary process of improving adolescent health care in the schools. The Support Center for School-Based clinics collected questionnaire data on the clinics. Most of the comprehensive clinics offer a variety of services. All of the clinics facilitate family planning and minimally provide counseling about sexual activity and birth control, make referrals, and engage in follow-up activities. Direct management of all but 1 clinic is by nonschool agencies. Most clinics strongly encourage patients to discuss any health problems as well as sexual decisions with their parents. Virtually all clinics obtain written consent from parents before students receive medical services. According to the providers, the location of clinics in schools offers many advantages, including: each clinic is accessible and familiar; because the clinic is strictly an adolescent clinic, it can hire staff that like adolescents and are skilled at working with adolescents; many clinic services are consolidated; and the clinics can treat the whole person in an integrated way. Clinic records show the percentage of female students receiving family planning services to have increased from 0% to about 27%, and the 12-month and 24-month contraception continuation rates were 93% and 82% (based on 1982).

The effect of oral contraceptive formulation and field-workers: A cautionary tale

This paper examines oral contraceptive continuation rates and reported side effects in a large scale clinical research project conducted in Sri Lanka. The project evaluated standard- and low-dose pills used with and without vitamin supplements. Differences in continuation rates and perception of side effects are used to illustrate the impact that family planning field-workers can have on women's use of oral contraceptives.

The Development of NORPLANT Implants

The NORPLANT contraceptive implant system is long-acting and highly effective. A single visit to the clinic for subdermal placement of implants can provide protection from pregnancy for 5 years or longer. Research and development began in 1966 at the Population Councils laboratories and was completed by the Councils International Committee for Contraception Research (ICCR). The method is a product of international science; research groups in Asia North and South America the Caribbean basin and Europe participated. The development of NORPLANT illustrates successful cooperation between private industry and a publicly supported research organization in contraceptive research. The NORPLANT system is a low dose progestin only contraceptive method for women. The drug levonorgestrel is delivered by means of 6 silastic capsules implanted subdermally in the arm by a minor surgical technique. Effectiveness is achieved by the steady release of the progestin from the interior of the capsules through silastic into the blood. Contraceptive effectiveness and continuation rates are 2 important factors used to evaluate a method to regulate fertility. On these measures the NORPLANT system has proved to be superior to any method of reversible contraception. Its high degree of effectiveness long-acting feature and estrogen-free composition may have special appeal to women seeking contraception during lactation to older women for whom pills containing estrogen may be contraindicated and to women seeking hormonal contraception who for logistical or motivational reasons are unsuccessful in using oral or injectable contraceptives over an extended period of time. The NORPLANT contraceptive implant system can be considered a truly reversible sterilization or a reliable method for birth spacing. It will be an important addition to the array of methods offered by family planning programs in the years ahead.

The effectiveness of contraceptive programs for teenagers

This paper critically reviews the effectiveness of adolescent family planning programs in the United States. Various models for evaluating family planning programs and the findings from empirical studies of adolescent programs are reviewed. During the past decade there have been major increases in the availability and utilization of contraceptive services by adolescents. Most of those who are sexually active are now aware that these services exist. Program continuation rates among adolescents are not high, in part, because of the sporadic nature of adolescent sexual activity. Data on contraceptive continuation and pregnancy rates in these programs are limited, since few studies follow up clinic noncontinuers. Among clinic continuers pregnancy rates are relatively low, suggesting that at least some programs are effective in reducing pregnancy and/or fertility rates (number of children born) in their target populations. Ecological analyses seem to indicate that programs have had an impact on adolescent marital fertility.

Continuation of Contraception on Java-Bali: Preliminary Results from the Quarterly Acceptor Survey

Review of recently tabulated contraceptive continuation and pregnancy rates for Java-Bali and the constituent provinces. It was found that IUD continuation rates are higher than those for pill or condom, although considerable variation between provinces occurs. East Java and Bali seem to be recording the most and Jakarta and Yogyakarta least success in use continuation. Older, higher parity acceptors tend to use for longer periods, irrespective of method. Similarly, age and parity do not seem to affect the relationship between pill, IUD and condom continuation rates. Pill acceptors are more likely to terminate for physical, emotional, or health reasons than condom or IUD acceptors. Younger and lower parity groups show a greater likelihood of termination in order to have another child. Sources of bias in the rates were also examined. Using a rough adjustment procedure it was found that women lost to follow-up are not a serious bias in the 1st round results, with the exception of differential response by province. As subsequent rounds of the survey are completed, however, the lost-to-follow-up bias is likely to be a more important source of error in reported continuation rates. Factors to adjust acceptor statistics for women who denied ever using family planning were also presented.

Adolescent Pregnancy Prevention Services in High School Clinics

In 1973 the St. Paul Maternal and Infant Care (MIC) Project opened a health clinic in a local junior-senior high school. This article describes the evolution of the program and services offered and discusses the impact of its birth control activities on the adolescent population served. Wide use of services and high rates of contraceptive continuation led fertility rates to decline by 56% between 1973 and 1976 from 79 to 35 births per 1000. A retrospective review of the records of all students who received family planning services and prenatal care between 1973 and 1979 showed that 403 students had received initial family planning educational medical and counselling services in the 3 MIC school clinics. By the end of the 3rd year 92% of pregnant students had obtained prenatal services and the school dropout rate after delivery declined from 45% to 10%. The 12-month contraceptive continuation rate for 1973-76 calculated by the life-table method was 86.4 per 100 women and the continuation rate for the later years of the project increased to 92.8 per 100 women. Comparison of the high school clinic group with the overall MIC adolescent population served shows a higher proportion in the school group belonging to minority races and a lower proportion of never-pregnant contraceptors. Significantly fewer patients were lost to follow-up in the school group than in the overall MIC teen clinic group. Factors contributing to the effectiveness of the program in the schools included consistency of staff offering personalized services with guaranteed confidentiality accessibility of free services and provision of educational and social as well as medical services.

First year clinical experience with six levonorgestrel rods as subdermal contraception

Previous clinical experience with six levonorgestrel subdermal capsules showed a very good contraceptive effectiveness and continuation rate, but with a high proportion of bleeding disturbances, particularly of increased bleeding. It was hypothesized that bleeding could be reduced by higher plasma levels of the steroid, using subdermal rods instead of capsules, as rods have been shown to have a release rate 3 or 4 times that of the capsules. Fifty volunteers were enrolled in a study of the clinical performance of 6 subdermal levonorgestrel rods. Results were compared with a previous experience with 100 volunteers who wore 6 levonorgestrel capsules for a year in the same clinic. Requirement for volunteers to enter the study were the same for capsules and rods. The proportion of women wearing 6 subdermal rods who had increased bleeding was about one half as for the women using 6 levonorgestrel capsules. On the other hand, women using rods had about twice the incidence of amenhorrea, and about four times more hypomenorrhea (4 days or less of bleeding in a 90-day period). There were no pregnancies among the rod users and the discontinuation rate for medical reasons was not higher than for capsule users in the same clinic.

Family Planning for the Mentally III

An increase in the birth rate among mentally ill women and the fact that pregnancy and childcare often exacerbate psychotic and depressive events, indicate a need for family planning services for mentally ill patients. These services should be integrated with various mental health programs because of the special attention and time required when working with mentally ill clients. An example of a coordinated family planning and mental health program exists in Massachusetts where family planning services were instituted in 3 state mental hospitals, in both community and private hospitals with psychiatric wards, and in a mental health guidance center. Follow-up studies show significant contraceptive continuation rates after the patient has been discharged from the hospital.

Oral Contraceptive Continuation Rates in the Singapore National Program, 1966-1972

A study of a random sample of 3,564 oral contraceptive acceptors in the Singapore national program clinics with a maximum of 60 months of experience produced findings as follows: The typical pill acceptor was aged 26.9 years with 2.5 children, married for 4.2 years, had at least primary education, was not working, and started on the pill 2.3 months after her last pregnancy. Thirty-three percent of the oral contraceptive acceptors were still continuing with the pill by the cutoff date for the study, 30 June 1972, and the median period of pill use among those still using was 33.6 cycles. The median number of cycles of pill use among discontinued users was only 5.2. The main reasons for discontinuation were side effects of the pill and planned pregnancy. For the discontinued users, 43 percent had used alternative methods of protection, mainly condoms. Cumulative continuation rates per thousand women were 792 after the first cycle, 680 after the third, and 475, 346, 247, and 225 after cycles 12, 24, 48, and 59, respectively.

SINGAPORE: The Use of Oral Contraceptives in the National Program

To study contraceptive continuation rates in Singapore from July 1967 to August 1968 a sample was taken of 2969 women prescribed oral contraceptives. 54% were continuing the method as of December 31 1968. Of those with more than 1 continuous segment the majority used an alternate method such as the condom. 46% discontinued pill use 70% for known reasons such as medical and planned/unplanned pregnancy. Proportion of discontinued users peaked after first cycle of use and then dropped sharply at the second and third cycles. About 65% of discontinued users employed another contraceptive method usually the condom. Women under 25 years had higher proportion without a contraceptive method than those aged 35 and over; family size also correlated with using an alternate method. Continuation rates were positively correlated to age and number of living children. Women without formal education had higher continuation rates than those with some education as did women whose last pregnancy had terminated 3 or more months earlier.