Changes In Contraceptive Methods Research Articles

A nationwide analysis of hormonal contraception, sterilisation surgeries and reversal practices amongst Australian men and women from 2001 to 2021

Family planning falls within the spectrum of care within our medical society. We sought to illustrate changes in contraceptive methods over time and evaluate tubal ligation and vasectomy reversal practices in Australia. Yearly data from 2000 to 2021 was extracted from 3 databases: Pharmaceutical Benefits Schedule, Medicare Benefit schedule and Australian Institute of Health and Welfare databases. Population adjusted rates of procedures and medical therapies were calculated using data from Australian Bureau of statistics. Use of Long acting reversible contraception (LARC) has increased by 34.1% from 2001 to 2021, with Mirena being the preferred contraception. The peak age group for tubal ligation during caesarean section was those >35-year-old (64.7%) whereas vasectomy more commonly performed in men aged 35–44. There was a 21.6% decrease in the number of vasectomies over time from 2000–2020. Female surgical sterilisation:vasectomy ratio shows tubal ligation was twice more common than vasectomy. Both macro/microsurgical anastomosis of the vas deferences were conducted: vasovasostomy (VV) and vasoepididymostomy (VE). There was a preponderance in the use of microsurgical approach for VV. Reversal mostly common occurred in those aged 40–44 at 29%. Overall, the rate of vasectomy is continuously falling over time whilst there is a steady incline in the use of LARC from 2020–2021. Both vasovasostomy and vasoepididymostomy reconstruction are practised. Although definitive conclusion from the literature lags, “real-world” trend indicate that micro-surgically conducted vasovasostomy might be the better surgical technique for desired patient outcomes.

Women’s experience of unintended pregnancy and changes in contraceptive methods: evidence from a nationally representative survey

BackgroundIneffective or no use of contraception following an unintended pregnancy contributes to a subsequent unintended pregnancy. This study aimed to determine whether women’s experiences of unintended pregnancies affect changing their contraceptive using patterns.MethodsWe analysed the 2017/2018 Bangladesh Demographic and Health Survey data. The contraceptive switching pattern was computed by comparing women’s contraceptives using data before and after pregnancy. Women were categorised into the following three groups, depending on their patterns of contraceptive use before and after pregnancy: no change, if there were no change in contraceptive using pattern; switched to higher effective contraceptives, if changed from pre-pregnancy less effective contraceptives to post-pregnancy more effective contraceptives; switched to less effective contraceptives, if changed from pre-pregnancy more effective contraceptives to post-pregnancy less effective contraceptives. Women’s intention in the most recent pregnancy was our primary explanatory variable, classified as wanted, mistimed and unwanted. Multinomial multilevel logistics regression was used to determine the association between women’s intention in the most recent pregnancy and women’s contraceptive methods switching patterns from before to after pregnancy.ResultsAround 20% of the most recent pregnancies that ended with a live birth were unintended at conception. No contraceptive use was reported by 37% of women before their pregnancies which decreased to 24% after pregnancies. Overall, around 54% of women who reported no contraceptive use before pregnancy used modern contraceptives after pregnancy. The rate was higher among women who experienced unwanted pregnancy (73.4%) than mistimed (58.8%) and wanted (53.4%) pregnancy. Experience of mistimed pregnancy was associated with a higher likelihood of no contraceptive change (aOR, 1.84, 95% CI 1.41–2.39) and switching to less effective contraceptives (aOR, 1.58, 95% CI 1.10–2.26) than switching to more effective contraceptives. However, unwanted pregnancy was not associated with any significant change in contraceptives use from before to after pregnancy.ConclusionExperience of unintended pregnancy did not change women’s contraception using patterns, which indicates the risk of repeat unintended pregnancies and associated adverse consequences, including maternal and child morbidity and mortality. Policies to ensure access to and use of modern contraceptives among women facing unwanted or mistimed pregnancies are recommended.

Exploring rise of pregnancy in Bangladesh resulting from contraceptive failure

The objective of this study was to determine how changes in pre-pregnancy contraceptive methods used between 2011 and 2017/18 contributed to the changes in pregnancy resulting from contraceptive methods failure in Bangladesh. We used 2011 and 2017/18 Bangladesh Demographic and Health Survey data. Pre-pregnancy contraceptive methods failure was our outcome of interest, which was determined using women’s response about whether they became pregnant while using contraceptives before the most recent pregnancy. The year of the survey was the main explanatory variable. Descriptive statistics were used to describe the characteristics of the respondents. The difference in contraceptive methods failure across the socio-demographic characteristics was assessed by Chi-squared test. Multilevel poison regressions were used to determine the changes in the prevalence ratio of contraceptive methods failure across the survey years. Contraceptive methods failure rate increased between the surveys, from 22.8% in 2011 to 27.3% in 2017/18. Also, male condom use increased by 2.8%, while withdrawal/periodic abstinence and/or other methods decreased by 2.9%. The failure rates in these two categories of contraceptive methods increased substantially by 4.0% and 9.0%, respectively. Compared to the 2011 survey, the prevalence ratio (PR) of contraceptive methods failure was 20% (PR 1.2, 95% CI 1.1–1.3) high in the 2017/18 survey. This PR declined 13% (PR 1.1, 95% CI 1.04–1.2) once the model was adjusted for women’s and their partner’s characteristics along with the last contraceptives used. This study provides evidence of increasing rates of pregnancy due to contraceptive failure in Bangladesh. Given that this type of pregnancy is known to cause adverse pregnancy outcomes, including abortion, pregnancy complications, maternal and early child morbidity and mortality, policy and programs are needed to reduce its prevalence. Effective coordination between the contraception providers at the healthcare facilities and the households and a proactive role of family planning workers to make couples aware of the effective use of contraceptives are recommended.

ALUR GERAKAN PEMAKAIAN KONTRASEPSI DI JAWA TENGAH (ANALISIS DATA SUSENAS 2017)

Data on users of contraceptive methods are needed to evaluate contraceptive use and plan for future needs. Changes in contraceptive methods and factors that influence the use of certain contraceptive methods are serious things to consider. The purpose of this study was to look at the dynamics and transition path of contraceptive use in Central Java. 2017 National Socio-Economic Survey (Susenas) data, especially contraceptive use for couples of childbearing age (PUS) aged 15-49 years is a reference. The statistical method applied in this study is descriptive analysis and inferential test. The results of the analysis show a shift and transition from modern methods to traditional methods. The study also found a positive relationship between the choice of contraceptive methods used and EFA residence. There is a positive relationship between the variables of first marriage age, education and EFA residence to the change in contraceptive method.
 
 Keywords : KB; Purbalingga; Susenas; Temanggung.

Integration of a Comprehensive Contraception Education Program Into Clinical Practice in a Family Planning Clinic

ObjectiveTo improve rates of contraception adherence by implementing a comprehensive contraception educational program for women receiving care at a family planning clinic. DesignQuasi-experimental cohort study in which we evaluated women presenting before (control group) and after program implementation (intervention group) and compared the proportion of women returning for contraceptive method change and/or for unintended pregnancy. SettingFamily planning clinic of a large academic medical center. ParticipantsEnglish-speaking women ages 12 to 50 years who presented to the clinic for pregnancy termination or initiation of a new contraceptive method from May 2012 to May 2014. InterventionA provider-facilitated, patient-centered educational intervention was implemented to foster patient knowledge and choice about contraception. ResultsWe conducted chart review to identify any clinic visit that occurred in the 12 months after the index visit. Pearson’s chi-square test was used to compare results for women in both groups. The intervention group included 201 women, and the control group included 162 women. In the control group, 28% (n = 46/162) returned within the year for unintended pregnancy and/or contraceptive method change, whereas only 17% (n = 35/201) returned in the study group. This difference was statistically significant (p < .05). ConclusionInitiation of a comprehensive contraception educational program was associated with a decrease in rates of return visits for unintended pregnancy and contraceptive method changes. This implies an improvement in adherence to the initially chosen contraceptive method. Such interventions hold promise for improving contraceptive adherence and decreasing unintended pregnancy. Improving contraceptive adherence is a critical first step to decreasing unintended pregnancies.

A brief study on the knowledge and choice of contraception methods in married adolescent girls.

The fertility rate is 0.25% for 15-19-year-old girls and 16% for 19-year-old girls who are mothers or pregnant with their first child. Fifty-two percent of married adolescents did not have affective contraception. To encourage using the right contraceptive methods in married adolescents, it is essential to examine the behaviors of this group, the level of contraceptive knowledge and the choices they make regarding contraceptive use. One hundred and ten married adolescent females, less than 20 years of age, who visited a gynecology and obstetrics clinic between January 2015 and October 2016 were enrolled in this prospective study. Of them 96.4% were unemployed. At the time of the study, 70% of them were pregnant. Of these pregnancies, 46.4% was a first, 19.1% a second and 8.2% a third pregnancy. The abortion rate in this study was 18.3%, and stillbirth was 2.8%. The interval between pregnancies was 20.9 months. The unplanned pregnancy rate was 45.5% and 37.3% of these unplanned pregnancies resulted in at least one healthy child. The most common contraceptive method was the use of condoms (10.9%). Changes in contraceptive methods resulted in pregnancy in 66.7% of the cases. Although 20.9% of the husbands in the study used contraceptive methods, 40.9% of them felt that their husbands should be using contraception. Of the participants 43.5% received their knowledge regarding family planning and contraceptive methods from local health clinics. Teen marriage, pregnancy and teen parents result in socio-economic and educational difficulties. It is essential to support the adolescent parents using affective contraceptive methods and adolescent-friendly health clinics.

Motivators of contraceptive method change and implications for long-acting reversible contraception (non-)use: A qualitative free-text analysis

ObjectiveTo develop a greater understanding of the motivators of contraceptive method change over time for young Australian women, with a particular interest in long-acting reversible contraception (LARC) use. MethodFree-text comments from the Contraceptive Use, Pregnancy Intention and Decisions (CUPID) Study were used to explore the reasons for contraceptive method change among women who reported one or more contraceptive changes across the three CUPID surveys. Results512 women reported making at least one contraceptive method change, with 740 comments explaining these changes between them. Participants reported a multitude of reasons motivating their contraceptive change. Five key themes were developed to explain these motivators: the natural, sexual and fertile body, specific contraceptive characteristics and other important people. Findings suggest that women’s decisions to switch or discontinue a contraceptive depended largely on her ability (and desire) to juggle its impact on her sexual, fertile and natural body. Importantly, the transient and fluid nature of contraceptive practices were demonstrated, as the women adjusted their method to suit their needs at the time. ConclusionRegarding LARC use, these findings suggest that rather than being appealing, the ‘temporarily permanent’ nature of these methods may be unappealing and incongruent with the needs of some women.

Prospective Longitudinal Analysis of Contraceptive Adherence in a Diverse Postpartum Population [249

INTRODUCTION: To describe contraceptive method adherence at 12 months postpartum in an ethnically diverse primiparous population. METHODS: Primiparous women delivering at greater than 35 weeks of gestation with the nurse–midwifery service at an academic center were followed for 12 months postpartum. Women's self-reported contraceptive choice was collected immediately postpartum and continuation was queried at 1.5, 6, and 12 months. Ethnicity was self-identified. Three contraceptive groups were defined by the woman's choice of immediate postpartum contraception: 1) condoms; 2) intrauterine device or implant (long-acting reversible contraception [LARC]); or 3) oral contraceptive pills, patch, ring, or depot medroxyprogesterone acetate. Our primary outcome measure was time to contraceptive method change and was compared between groups using Kaplan-Meier survival analysis. Individual times were censored if the participant dropped out without method change or had no method change at 12 months. RESULTS: Of 109 women enrolled, 99 were included in the analytic sample based on contraceptive choice. Mean population age was 25.2±5.0 years; 50% were non-Hispanic white, 40% Hispanic, and 9% Native American. Forty-four percent changed their contraceptive method over the course of the year. Kaplan-Meier survival curves were different among the three groups (P=.005). Marginal survival (no change in contraceptive method) at 12 months was 69.1% for LARC compared with 43.8% for condoms and 35.7% for oral contraceptive pills, patch, ring, or depot medroxyprogesterone acetate (overall P=.008). Post hoc testing indicated LARC survival was longer than oral contraceptive pills, patch, ring, or depot medroxyprogesterone acetate (P=.005). CONCLUSION: Women were more likely to continue utilization of LARC methods at 1 year postpartum compared with other methods. Postpartum women frequently change their contraceptive method within 12 months after delivery.

Vaginitis in Intrauterine Contraceptive Device Users

Objectives: This study aimed to assess clinical, microbial changes in IUD users and other contraceptive methods in referent to urban health centers in Hamadan city, Iran. Methods: Detailed history and gynecological examination were conducted on women (IUD users, n = 100) or other contraceptive methods (controls, n = 160) in the health centers. Results: Frequencies of the different vaginal pathogens, high indices of infection by bacterial vaginosis (12.0%) candida albicance (7.0%) and low indices of trichomoniasis (5.0%) were found in present study, but none of them in both groups was significant. Menorrhagia was more frequent among women with IUD than that among women without IUD (P < 0.05). A trend of erosion cervix and dysmenorrhea being more frequent among women with IUD was also found (P < 0.05). Conclusions: IUD is the safety in general; however, an increase occurred in the frequency of vaginitis.

Good intentions: risk factors for unintended pregnancies in the US cohort of a microbicide trial

Background The study was conducted to assess socio-behavioral and biological factors associated with unplanned pregnancy in the US cohort of a microbicide trial. Study Design We conducted a mixed-method, nested case-control study of risk factors for pregnancy within the US cohort of the microbicide trial HPTN 035. We developed an instrument to assess attitudes and beliefs about fertility control/contraceptive utilization among 122 women. Cases were HPTN 035 participants who became pregnant while enrolled, matched by time on study 1:4 with controls. Univariable and multivariable analysis were performed with pregnancy as the outcome of interest. Results Contraceptive method change during the trial was associated with unplanned pregnancy (OR=1.76). Participant desire/partners' desire for future children (OR=4.95) and young age (OR=0.88 annually above age 19 years) were independently associated with unintended pregnancy. Conclusion Within a trial that enrolls heterosexually active women, there may be ways to identify those at highest risk of becoming pregnant a priori.

Impact of Induced Abortion on Fertility in Romania

The topic of induced abortion as a method of birth control in the formersocialist European countries has been a subject of broad debate. Legal or illegal abortion, depending on legislation restrictions, was widely used in periods when people had reduced control over their reproductive life. Romania, a former socialist country, is an interesting case to study because of the very dramatic swings in its abortion policies coupled with important changes in available contraceptive methods associated with the fall of the Soviet Empire. The study investigates the impact of induced abortion on the risks of first-, second- and third-order births in Romania during the last 35 years, using data from the Reproductive Health Survey, Romania, 2004. The legalization of abortion in 1990, after two decades of total prohibition, had an immediate effect on second- and third-order births, but it contributed less to the decrease of primo-fertility. Investigations regarding the “first and second demographic transition” that initially involved women desiring fewer children and then women modifying the timing of those births show changes in the use of abortion to achieve birth plans. The effect of abortion on fertility has decreased over time.

Advance Provision of Emergency Contraception for Pregnancy Prevention

Advance provision of emergency contraception can circumvent some obstacles to timely use. We performed a meta-analysis to summarize randomized controlled trials evaluating advance provision of emergency contraception to explore effects on pregnancy rates, sexually transmitted infections, and sexual and contraceptive behaviors. In August 2006, we searched CENTRAL, EMBASE, POPLINE, MEDLINE, a specialized emergency contraception article database, and contacted experts to identify published or unpublished trials. We included randomized controlled trials comparing advance provision to standard access, defined as any of the following: counseling (with or without information about emergency contraception) or provision of emergency contraception on request at a clinic or pharmacy. Two reviewers independently assessed study quality. We performed a meta-analysis using Review Manager software. Eight randomized controlled trials met inclusion criteria, representing 6,389 patients in the United States, China, and India. Advance provision did not decrease pregnancy rates, despite increased use (single use, odds ratio [OR] 2.52, 95% confidence interval [CI] 1.72-3.70; multiple use: OR 4.13, 95% CI 1.77-9.63) and faster use (weighted mean difference -14.6 hours, 95% CI -16.77 to -12.4 hours). Advance provision did not increase rates of sexually transmitted infections (OR 0.99, 95% CI 0.73-1.34), unprotected intercourse, or changes in contraceptive methods. Women who received emergency contraception in advance were as likely to use condoms as other women. Advance provision of emergency contraception did not reduce pregnancy rates and did not negatively affect sexual and reproductive health behaviors and outcomes compared with conventional provision. III.

Advance provision of emergency contraception for pregnancy prevention (full review).

Emergency contraception can prevent pregnancy when taken after unprotected intercourse. Obtaining emergency contraception within the recommended time frame is difficult for many women. Advance provision, in which women receive a supply of emergency contraception before unprotected sex, could circumvent some obstacles to timely use. To summarize randomized controlled trials evaluating advance provision of emergency contraception to explore effects on pregnancy rates, sexually transmitted infections, and sexual and contraceptive behaviors. In August 2006, we searched CENTRAL, EMBASE, POPLINE, MEDLINE via PubMed, and a specialized emergency contraception article database. We also searched reference lists and contacted experts to identify additional published or unpublished trials. We included randomized controlled trials comparing advance provision and standard access, which was defined as any of the following: counseling which may or may not have included information about emergency contraception, or provision of emergency contraception on request at a clinic or pharmacy. We evaluated all identified titles and abstracts found for potential inclusion. Two reviewers independently abstracted data and assessed study quality. We entered and analyzed data using RevMan 4.2.8. We calculated odds ratios with 95% confidence intervals for dichotomous data and weighted mean differences with 95% confidence intervals for continuous data. Eight randomized controlled trials met our criteria for inclusion, representing 6389 patients in the United States, China and India. Advance provision did not decrease pregnancy rates (OR 1.0; 95% CI: 0.78 to 1.29 in studies for which we included twelve month follow-up data; OR 0.91; 95% CI: 0.69 to 1.19 in studies for which we included six month follow-up data; OR 0.49; 95% CI: 0.09 to 2.74 in a study with three month follow up data), despite increased use (single use: OR 2.52; 95% CI 1.72 to 3.70; multiple use: OR 4.13; 95% CI 1.77 to 9.63) and faster use (weighted mean difference (WMD) -14.6 hours; 95% CI -16.77 to -12.4 hours). Advance provision did not lead to increased rates of sexually transmitted infections (OR 0.99; 95% CI 0.73 to 1.34), increased frequency of unprotected intercourse, nor changes in contraceptive methods. Women who received emergency contraception in advance were equally as likely to use condoms as other women. Advance provision of emergency contraception did not reduce pregnancy rates when compared to conventional provision. Advance provision does not negatively impact sexual and reproductive health behaviors and outcomes. Women should have easy access to emergency contraception, because it can decrease the chance of pregnancy. However, the interventions tested thus far have not reduced overall pregnancy rates in the populations studied.

Ringing the changes in contraceptive methods

Ringing the changes in contraceptive methods

Motivational antecedents to contraceptive method change following a pregnancy scare: a couple analysis.

In this study we develop and then test a couple model of contraceptive method choice decision-making following a pregnancy scare. The central constructs in our model are satisfaction with one's current method and confidence in the use of it. Downstream in the decision sequence, satisfaction and confidence predict desires and intentions to change methods. Upstream they are predicted by childbearing motivations, contraceptive attitudes, and the residual effects of the couples' previous method decisions. We collected data from 175 mostly unmarried and racially/ethnically diverse couples who were seeking pregnancy tests. We used LISREL and its latent variable capacity to estimate a structural equation model of the couple decision-making sequence leading to a change (or not) in contraceptive method. Results confirm most elements in our model and demonstrate a number of important cross-partner effects. Almost one-half of the sample had positive pregnancy tests and the base model fitted to this subsample indicates less accuracy in partner perception and greater influence of the female partner on method change decision-making. The introduction of some hypothesis-generating exogenous variables to our base couple model, together with some unexpected findings for the contraceptive attitude variables, suggest interesting questions that require further exploration.

Contraceptive methods used in Romanian practice: The influence of socio-economic factors on an effective use

Objectives: To investigate the changes in contraceptive methods in the last decades in general practice.Methods: Questionnaire and interview of all women.Results: The use of reliable methods of contraception and abortion has changed considerably.Conclusions: The socio-economic situation limits the effective use of contraceptive methods. GP should become more involved in this aspect of the health service.

Contraceptive method change among rural Sri Lankan women

Patterns of contraceptive method change and their association with reproductive motivation and contraceptive failure are examined using data from a 1986 survey of family planning behaviour of rural Sinhalese married women aged 15-44 in seventeen districts of Sri Lanka. A notable degree of rationality in contraceptive method changes occurs with family formation. The attempt to control unwanted fertility leads to more efficacious use of contraception, including traditional methods. Some methodological improvements to the analysis of contraceptive switching are indicated. Implications of the findings for programmatic emphasis on permanent versus non-permanent modern methods are discussed.

A long-term follow-up study of women using different methods of contraception--an interim report.

SummaryIn 1968, a prospective study was started in collaboration with the Family Planning Association to try to provide a balanced view of the beneficial and harmful effects of different methods of contraception. This investigation is now in progress at seventeen clinics and over 17,000 women are under observation. At the time of recruitment, all these women were married white British subjects, aged 25–39 years, who voluntarily agreed to participate. Fifty-six per cent were using oral contraceptives, 25% were using a diaphragm and 19% were using an intrauterine device (IUD). During follow-up each woman is questioned at return visits to the clinic and a record of pregnancies and their outcome, hospital referrals (inpatient or outpatient), changes in contraceptive methods and the results of cervical smears, is accumulated. Women who default are sent a postal questionnaire and, if this is not returned, are telephoned or visited in their homes to collect the necessary information.So far, data obtained during 56,000 woman-years of observation are available for analysis. Follow-up has been maintained with an annual lapse rate of about 0.3%due to withdrawal of co-operation or loss of contact; adherence to the method of contraception in use at recruitment has been reasonably good, and the reporting of pregnancies and hospital admissions appears to have been both reliable and unbiased.The present data include only 24 deaths, so the mortality associated with different contraceptive methods cannot yet be estimated. With regard to morbidity, however, our preliminary results closely resemble those obtained in the prospective study carried out by the Royal College of General Practitioners (1974) and in the principal retrospective studies carried out in Britain and the United States. Women who used oral contraceptives at the start of the study experienced adeficiencyof hospital referrals for cancer, benign lesions of the breast, menstrual disorders other than amenorrhoea, duodenal ulcer, and retention cysts of the ovary; they showed anexcessof referrals for cerebrovascular disease, cervical erosion, skin disorders, self-poisoning, migraine, venous thrombosis and embolism, hayfever, gallbladder disease, amenorrhoea, and sterility. Women who used a diaphragm showed adeficiencyof hospital referrals for carcinoma-in-situ and dysplastic lesions of the cervix uteri and accidental injury; and anexcessof referrals for haemorrhoids and cystitis. Women who used an IUD experienced anexcessof hospital referrals for anaemia, varicose veins and salpingitis. About half of these differences (12 out of 23) were predicted from other studies while some suggestive evidence already existed for a further five. Of the remaining six, some probably reflect the influence of selective factors or chance.Multiple pregnancies, stillbirths, malformations, the sex ratio and birthweight showed no consistent relationship to method of contraception. The outcome of unplanned pregnancies occurring in women using an IUD, however, was remarkably unfavourable both in terms of ectopic gestation and miscarriage.Clear evidence was found of impairment of fertility after discontinuation of oral contraceptives. Whether this is likely to lead to permanent sterility in some women is uncertain.The study has provided data on the efficacy of a wide variety of contraceptive methods. In general the failure rates are in keeping with those obtained in other large-scale studies, save that those for the diaphragm and the sheath are much lower than those usually quoted.The available evidence does not yet allow a final balance to be struck between the benefits and risks associated with the new methods of contraception that have become widely used during the last two decades. It seems clear, however, that there are no material risks associated with the use of the diaphragm apart from the risk of pregnancy and that there may be some unintended benefits.