Effectiveness Of Contraceptive Use Research Articles

Racial and Ethnic Differences in the Relationship Between Risk-Taking and the Effectiveness of Adolescents' Contraceptive Use.

Little is known about whether adolescents' risk-taking in areas other than sex is associated with the effectiveness of their contraceptive method use, or whether any such associations vary by race and ethnicity. Data from the 2011, 2013 and 2015 National Youth Risk Behavior Surveys were used to examine nonsexual risk behaviors and contraceptive method choice among 5,971 sexually active females aged 13-18. Risk-taking profiles for White, Black and Hispanic adolescents were identified using latent class analysis. Multinomial logistic regression was used to estimate the associations between these risk profiles and use of less- or more-effective contraceptive methods at last sexual intercourse. Three distinct risk-taking profiles were identified for White and Hispanic adolescents and two for Black adolescents. Compared with their counterparts in the low-risk "abstainer" group, White adolescents in the "high substance use and violence" group were less likely to use condoms alone (relative risk, 0.4) or a prescription contraceptive paired with condoms (0.3) rather than no contraceptive at all, and more likely to use withdrawal or no method rather than condoms alone (2.4 each). However, higher risk-taking among Whites was positively associated with using prescription contraceptives rather than condoms (1.9). Among Black and Hispanic females, lower risk-taking was associated only with more condom use. Future studies should examine whether interventions designed to reduce adolescent risk-taking improve the effectiveness of contraceptive use, particularly among White females. However, efforts to increase Black and Hispanic adolescents' use of more-effective contraceptives should target barriers other than risk-proneness. Perspectives on Sexual and Reproductive Health, 2020, 52(4):TK, doi:10.1363/psrh.12165.

Influences of Proximate Determinates on Fertility Among Urban and Rural Women in Bangladesh

Bangladesh has met a lot of challenges in recent decades. The remarkable decline in fertility is one of the major challenges faced by this country. The rate of fertility in rural areas is still higher than urban areas. The proximate determinants of fertility which influence fertility directly are analyzed in this study for urban and rural areas separately as well as the study quantify the decomposition of the differences in total fertility rate (TFR) in residence during 1993-94 to 2014. The effectiveness of contraceptive use is found to be the most important factor for declining fertility. The result revealed that the index of contraception shows a declining trend, indicating an increasingly inhibiting effect on fertility in both urban and rural areas of Bangladesh. The inhibition effect of postpartum infecundability decreases with increase in urbanization. The decomposition analysis shows that fertility decline has been occurred due to delay marriage, increase of contraception practice, shortening of postpartum infecundability period, increase proportion in induced abortion and the interaction factor.
 Dhaka Univ. J. Sci. 66(1): 49-54, 2018 (January)

Explaining recent declines in adolescent pregnancy in the United States: the contribution of abstinence and improved contraceptive use.

We explored the relative contributions of declining sexual activity and improved contraceptive use to the recent decline in adolescent pregnancy rates in the United States. We used data from 1995 and 2002 for women 15 to 19 years of age to develop 2 indexes: the contraceptive risk index, summarizing the overall effectiveness of contraceptive use among sexually active adolescents (including nonuse), and the overall pregnancy risk index, calculated according to the contraceptive risk index score and the percentage of individuals reporting sexual activity. The contraceptive risk index declined 34% overall and 46% among adolescents aged 15 to 17 years. Improvements in contraceptive use included increases in the use of condoms, birth control pills, withdrawal, and multiple methods and a decline in nonuse. The overall pregnancy risk index declined 38%, with 86% of the decline attributable to improved contraceptive use. Among adolescents aged 15 to 17 years, 77% of the decline in pregnancy risk was attributable to improved contraceptive use. The decline in US adolescent pregnancy rates appears to be following the patterns observed in other developed countries, where improved contraceptive use has been the primary determinant of declining rates.

The Incidence of Abortion Worldwide

Accurate measurement of induced abortion levels has proven difficult in many parts of the world. Health care workers and policymakers need information on the incidence of both legal and illegal induced abortion to provide the needed services and to reduce the negative impact of unsafe abortion on women's health. Numbers and rates of induced abortions were estimated from four sources: official statistics or other national data on legal abortions in 57 countries; estimates based on population surveys for two countries without official statistics; special studies for 10 countries where abortion is highly restricted; and worldwide and regional estimates of unsafe abortion from the World Health Organization. Approximately 26 million legal and 20 million illegal abortions were performed worldwide in 1995, resulting in a worldwide abortion rate of 35 per 1,000 women aged 15-44. Among the subregions of the world, Eastern Europe had the highest abortion rate (90 per 1,000) and Western Europe to the lowest rate (11 per 1,000). Among countries where abortion is legal without restriction as to reason, the highest abortion rate, 83 per 1,000, was reported for Vietnam and the lowest, seven per 1,000, for Belgium and the Netherlands. Abortion rates are no lower overall in areas where abortion is generally restricted by law (and where many abortions are performed under unsafe conditions) than in areas where abortion is legally permitted. Both developed and developing countries can have low abortion rates. Most countries, however, have moderate to high abortion rates, reflecting lower prevalence and effectiveness of contraceptive use. Stringent legal restrictions do not guarantee a low abortion rate.

Trends in Unwanted Childbearing in the Developing World

This study analyzes trends in unwanted fertility in 20 developing countries, based on data from the World Fertility Surveys and the Demographic and Health Surveys. Although wanted childbearing almost invariably declines as countries move through the fertility transition, the trend in unwanted fertility was found to have an inverted U shape. During the first half of the transition, unwanted fertility tends to rise, and it does not decline until near the end of the transition. This pattern is attributed to the combined effects of an increase in the duration of exposure to the risk of unwanted pregnancy and a rise in contraceptive use as desired family size declines. The substantial variation in unwanted fertility among countries at the same transition stage is caused by variation in the degree of implementation of preferences, the effectiveness of contraceptive use, the rate of induced abortion, and other proximate determinants, such as age at marriage, duration of breastfeeding, and frequency of sexual relations. The principal policy implication from this analysis is that vigorous efforts to reduce unwanted pregnancies through family planning programs and other measures are needed early in the fertility transition because, in their absence, unwanted fertility and abortion rates are likely to rise to high levels.

Lessons from an audit of unplanned pregnancies.

To determine the effectiveness of contraceptive use a two year audit of pregnant women registered in one group practice was carried out. The methods of contraception used by women with unplanned pregnancies were studied and the rates of failure assessed. Of the 518 pregnancies during the study, 187 (36%) were unplanned. Unplanned pregnancies were most common in the 15-19 age group (54 out of 187), and women aged under 25 used contraceptives less reliably than women aged 25 and over. The combined pill was the most effective method of contraception in all age groups. The methods that resulted in most unplanned pregnancies were the sheath in women aged 25 and over and incorrect use of oral contraceptive or no contraception in those aged under 25. The fear of side effects was an important reason why women did not use the combined pill, being cited by 22 out of 134 women, and inappropriate medical advice was cited by a further 20 women. More discussion between doctors and patients and readily available information on the use of oral contraceptives might help to reduce the number of unplanned pregnancies.

Ethnic models of fertility behaviour in Sri Lanka

Ethnic differences in fertility behavior confirm that socioeconomic variables exert a strong influence on demographic and family planning variables in developing countries such as Sri Lanka. To explain the effects of ethnicity on fertility behavior, predictive path models were developed for the 4 ethnic groups in Sri Lanka--Sinhalese, Tamils, Moors, and Indian Tamils. The path models used in developing predictive models utilized a series of ordinary least squares regression equations. The data were drawn from the 1982 Contraceptive Prevalence Survey. Current residence had direct negative effects on education for all 4 ethnic groups, with women in urban areas achieving higher levels of education than those in rural or estate areas; current residence further had a direct positive effect on husband's occupation, with higher socioeconomic status reported for women from urban areas. Age at marriage--the most important determinant of children ever born-- had strong negative effects on fertility for all ethnic groups, but the effect was most marked among Sri Lankan Tamils. Contraceptive knowledge had the same effect on the effectiveness of contraceptive use in all ethnic groups, suggesting that informational campaigns would enhance the decline of fertility in the country as a whole. 47% of the variance in additional children desired was explained by children ever born (negative effect), ideal family size (positive effect), and child mortality (positive effect). 11% of the variance in contraceptive usage was contributed by education (positive effect), children ever born (positive effect), and husband's occupation (negative effect), while 24% of the variance in effectiveness of contraceptive use was explained by additional children wanted (negative effect) and contraceptive knowledge (positive effect). Overall, these findings suggest that socioeconomic assimilation, with consequent higher levels of education, will facilitate more modern behaviors such as later age at marriage and increased use of effective contraception among ethnic minorities in Sri Lanka.