Past Contraceptive Use Research Articles

Women and Reproductive Control: The Nexus between Abortion and Contraceptive Use in Madhya Pradesh, India

This article examines the determinants of contraceptive and abortion behavior and how each of these influences the other, with an emphasis on the role of women's life-course stage and experience. We base our approach on life-course theory, which argues that behavior is influenced by current circumstances as well as experiences over the life course. We use data collected for every pregnancy experienced by 2,444 women in Madhya Pradesh, India, to explore use of temporary contraceptive methods (both modern and traditional) and sterilization, as well as abortion attempts. We use logistic regression to model whether women took these actions in a given pregnancy interval, including past experience with contraception in the abortion analyses and with abortion in the contraceptive analyses. The results suggest that life-course factors play a role in shaping behavior. Moreover, past use of contraceptives has a significant effect on attempted abortion and vice versa. Finally, we find that this relationship changes as women age and accumulate experience.

Four-Year Remission After a Conservative Treatment in a Teenager with a Low-Grade Adenosarcoma of the Cervix

Introduction: The Grady Memorial Hospital Teen Services Clinic serves an inner-city population of adolescent girls with a rate of teenage pregnancy that was higher than national averages at 13.8% during 2008. It is hoped that increased use of long-acting reversible contraceptives (LARCs) such as subdermal implants and intrauterine devices could significantly decrease this. The purpose of this study is to assess via questionnaire the knowledge of and attitudes towards these methods of contraception in this patient population. Methods: An anonymous piloted questionnaire was developed which included questions on pregnancy history, past contraceptive use, contraceptive decision-making, sources of contraceptive information and knowledge of contraceptive efficacy. The questionnaire was administered online to a convenience sample of teens enrolled from clinic. Descriptive statistics were performed and crude and adjusted odds ratios were calculated for the likelihood of desiring LARCs. This study received IRB approval. Results: 196 teens participated in the survey. 39.3% had heard of subdermal implants and 43.8% had heard of IUDs. Having ever been pregnant or having had children did not significantly increase the awareness of these methods. The most commonly cited reason for choosing a birth control method was that a healthcare provider recommended its use, followed by superior efficacy. Having children and self-reported 100% condom use were associated with a significantly higher likelihood of desiring LARCs. When adjusted for young age and having children, girls that reported desiring a pregnancy in more than three years were also significantly more likely to desire LARCs (OR 2.4277, CI 1.0670, 5.7983). Having heard of LARCs from a healthcare provider did not significantly increase desire for a long-acting method. Teens who correctly answered the efficacy questions regarding LARCs were five times more likely to desire long-acting contraception (OR 5.4, CI 1.1320, 51.49). Conclusions: Overall, awareness of LARCs and knowledge of their superior efficacy was poor. This study showed that LARCs have many of the qualities that teens stated were important in their birth control methods, but there is a disconnect between indicated contraceptive priorities, life goals, and contraceptive behavior in this patient population. While the teens reported that a healthcare provider’s recommendation was important to them, having heard of subdermal implants or intrauterine devices from a healthcare provider did not significantly increase the likelihood of desiring LARCs. It is unclear if this discrepancy signifies a bias against LARCs on the part of providers or that current methods of counseling are ineffective. Promoting positive attitudes towards LARCs and reeducation for providers on LARC counseling may be important first steps towards increasing awareness, and ultimately use.

Interstitial cystitis: A Cause of Chronic Pelvic Pain in Adolescents

and medical data were collected, including obesity-related comorbidities, previous and current use of hormonal contraception, sexual activity prior to surgery, sexual orientation, and whether or not they consented to and received the levonorgestrel releasing IUS. Institutional Review Board approval was obtained. Results: There were 26 girls eligible for this study. Two girls had the levonorgestrel releasing IUS placed before, and one after surgery due to individual medical needs. We focused our analyses on the remaining 23 girls. The mean age at the time of surgery was 17.5 years (SD 2.6); mean age at menarche 11.9 years (SD 1.7); mean BMI 51.6 (SD 6.5). Fifty-two percent (12/ 23) reported past hormonal contraception use, with the majority reporting previous use of combined oral contraceptives (COCs). Twenty-six percent were sexually active before surgery and 82 percent (19/23) described themselves as heterosexual. Thirty percent (7/ 23) had polycystic ovary syndrome; 26, 39, and 30 percent described symptoms of menorrhagia, dysmenorrhea, and oligomenorrhea respectively. Ninety-one percent (21/23) of the girls consented to and received the levonorgestrel releasing IUS in the operating room at the time of their weight loss surgery. Conclusions: Severely obese adolescent females seeking bariatric surgery have high rates of menstrual problems and PCOS, and many have appropriately been prescribed COCs. Intrauterine contraception offered at the time of bariatric surgery is feasible and acceptable among severely obese adolescent females, providing both contraceptive and non-contraceptive benefits.

Testing a model of contraception use behavior among sexually active female adolescents in Taiwan

The purpose of this cross-sectional study was to test a model of contraception use among sexually active Taiwanese female adolescents, using structural equation modeling. Anonymous questionnaires were distributed to 404 female adolescents who had had sexual intercourse in the previous 3 months. A model was produced in which past contraception use, self-efficacy for contraception use, and decisional balance for using contraception had significant direct effects on current contraception use. Social influences had not only significant direct effects on self-efficacy and on decisional balance, but also a significant indirect effect on current contraception use. These findings provide a reference for the development of contraceptive intervention programs for sexually active female adolescents in Taiwan.

Investigating factors associated with uptake of HIV voluntary counselling and testing among pregnant women living in North Uganda

We investigated factors potentially associated with the uptake of HIV voluntary counselling and testing (VCT), which is the first step in acceding to programmes for the prevention of mother-to-child transmission of HIV infection. For the period 2001–2003, we estimated the VCT uptake among the 12,252 first-time attendees of the Antenatal Clinic (ANC) at Lacor Hospital (Gulu District, North Uganda). Associations between VCT uptake and socio-demographic characteristics and reproductive history were evaluated using log binomial regression models. VCT uptake was 55.6% for the overall study period; it increased from 51.0% in 2001 to 58.6% in 2002 and 57.7% in 2003 (P <0.001). Having some education [primary versus none, adjusted prevalence proportion ratio (PPR) =1.05, 95% confidence intervals (CI): 1.00–1.10] and being unmarried (cohabitating, PPR =1.07, 95% CI: 1.03–1.10; single/widowed/divorced, PPR =1.10, 95% CI: 1.03–1.18) were significantly associated with VCT uptake. Associations of borderline significance were found for: recent change of residence, having a partner with a modern occupation, and past use of contraceptives. VCT uptake is still low in this district of North Uganda. Although some socio-demographic factors were found to have been associated with uptake, the associations were weak and not of public-health significance.

Acceptability and satisfaction using Quick Start with the contraceptive vaginal ring versus an oral contraceptive

Background Many women discontinue their use of hormonal contraception, and even those who continue so may have difficulty using oral contraceptive pills consistently. New delivery systems, including the vaginal ring, may be easier to use, but user acceptability and satisfaction with these new methods may be affected by women's experience with their bodies. Materials and Methods Data for this study were collected as part of a randomized clinical trial on 201 women comparing immediate start of vaginal ring use with immediate start of low-dose oral contraceptive use. We assessed user satisfaction and method continuation 3 months after ring or pill initiation. Results At 3 months, 174 of 201 subjects (87%) had follow-up interviews. Among the 174 study participants with follow-up data, 61% of ring subjects and 34% of pill subjects were very satisfied with their methods (p=.003). For posttrial contraception, 79% of ring subjects chose to continue with the ring whereas 59% of pill subjects chose to continue with the pill (p<.001). Women who reported greater comfort in touching their genitals, greater frequency of masturbation, more comfort with intercourse and past use of vaginal contraceptives and products were not more likely than others to be satisfied with the ring or to continue using it for birth control. Conclusion Women who were allocated to vaginal ring use, regardless of their baseline characteristics or behavior, were likely to be highly satisfied with the method and to continue its use.

Genitourinary medicine: an opportunity to reduce unwanted pregnancy.

We sought to investigate contraceptive use in women attending a genitourinary medicine (GUM) clinic, and to assess the need for a contraceptive service in this setting. Female attendees at Nottingham GUM clinic were invited to complete an anonymous questionnaire regarding past and present contraceptive use and whether a contraceptive service within GUM would be utilized. Four hundred and eighty-nine questionnaires were analysed. The majority had previously used condoms (89.8%) or the combined oral contraceptive pill (COCP) (74.6%), and 46.6% and 37.4%, respectively were currently using these methods. Contraception was frequently used for the dual aims of avoiding both pregnancy and infection (48.5%). General practitioners (GPs) and family planning clinics were most frequently cited as sources of regular contraceptive advice, 58.1% and 47.2% respectively, and emergency contraception 50.8% and 37.3%, respectively. If a contraceptive service was available within GUM 56.9% of respondents indicated they would use it.

Associations between attitudes toward hormone therapy and current use of it in middle-aged women

Objectives: To investigate the association between attitudes toward hormone therapy (HT) and use of it and explanatory factors for the association found. Methods: All women in two primary healthcare districts aged 45, 50, 55 or 60 in 2000 or 2001 ( n=771) received a questionnaire consisting of quality-of-life instruments and items concerning menopause, health, healthcare, symptoms, sociodemographic factors and attitudes toward HT. Results: A total of 564 women (74%) responded to the questionnaire. In the women with a positive or a neutral attitude, rather than a negative one, the age- and menopause-adjusted odds ratios for current HT use were 18.55 (95% CI 8.55, 40.11) and 2.61 (1.15, 5.93), respectively. Health-related factors, factors concerning one's own person and psychosocial factors were the groups of factors found to contribute to explaining the association between attitudes and current HT use. Together, the three groups of factors explained 42 and 98%, respectively, of a positive and a neutral attitude's association with current use of HT. Individual factors of importance in these factor groups were a feeling of being appreciated outside the home, satisfaction with one's work, marital status, own climacteric period, visits to a physician and past use of hormonal contraceptives. In contrast, level of education and the occurrence of cold sweats/hot flushes was not found to contribute to the explanation. Conclusions: Factors concerned with women's everyday life, contentment with oneself and use of healthcare services were of importance in explaining the associations between attitudes toward HT and current use of it. Consideration at these factors in counselling women about HT is recommended.

Use of copper intrauterine devices and the risk of tubal infertility among nulligravid women.

Previous studies of intrauterine devices (IUDs), many of which are no longer in use, suggested that they might cause tubal infertility. The concern that IUDs that contain copper--currently the most commonly used type--may increase the risk of infertility in nulligravid women has limited the use of this highly effective method of birth control. We conducted a case-control study of 1895 women recruited between 1997 and 1999. We enrolled 358 women with primary infertility who had tubal occlusion documented by hysterosalpingography, as well as 953 women with primary infertility who did not have tubal occlusion (infertile controls) and 584 primigravid women (pregnant controls). We collected information on the women's past use of contraceptives, including copper IUDs, previous sexual relationships, and history of genital tract infections. Each woman's blood was tested for antibodies to Chlamydia trachomatis. We used stratified analyses and logistic regression to assess the association between the previous use of a copper IUD and tubal occlusion. In analyses involving the women with tubal occlusion and the infertile controls, the odds ratio for tubal occlusion associated with the previous use of a copper IUD was 1.0 (95 percent confidence interval, 0.6 to 1.7). When the primigravid women served as the controls, the corresponding odds ratio was 0.9 (95 percent confidence interval, 0.5 to 1.6). Tubal infertility was not associated with the duration of IUD use, the reason for the removal of the IUD, or the presence or absence of gynecologic problems related to its use. The presence of antibodies to chlamydia was associated with infertility. The previous use of a copper IUD is not associated with an increased risk of tubal occlusion among nulligravid women whereas infection with C. trachomatis is.

Risk of ectopic pregnancy associated with gynecological history, past contraceptive use, and smoking habit

Risk of ectopic pregnancy associated with gynecological history, past contraceptive use, and smoking habit

Past contraceptive method use and risk of ectopic pregnancy

The relationship between past contraceptive method use and risk of ectopic pregnancy has been analyzed in a case-control study conducted in Milan, Italy. Cases were 158 women with diagnosis of ectopic pregnancy confirmed by laparoscopy or laparotomy, admitted to a network of university and general hospitals of Milan. The first control group (obstetric controls) included 243 women who gave birth at term (more than 37 weeks' gestation) to healthy infants at the same hospitals where the cases had been identified. The second control group (non-obstetric controls) was a random sample of 158 women admitted to the same network of hospitals where cases had been identified for diseases other than malignant, hormonal, or gynecological in origin. A total of 37 (23%) cases, 21 (9%) obstetric and 24 (15%) non-obstetric controls reported ever IUD use. The corresponding relative risk, RR, of ectopic pregnancy was 3.5 (95% confidence interval, CI, 1.9–6.5) when obstetric and 2.4 (95% CI 1.3–4.6) when non-obstetric subjects were considered as control group. The risk of ectopic pregnancy increased with duration of IUD use: in comparison with obstetric and non-obstetric controls, the RR were 2.3 and 2.0 for users for less than 2 years and 4.3 and 2.6 for longer users. There was no clear relation between time since last IUD use and risk of ectopic pregnancy, and no evidence of a decline of risk with increasing time since stopping use. A total of 80 cases (51%), 115 obstetric (47%) and 70 non-obstetric controls (44%) were ever oral contraceptives users; these differences were not statistically significant (RR 1.1, 95% CI 0.7–1.7, in comparison with obstetric control and 1.2, 95% CI 0.8–2.0, in comparison with non-obstetric ones). Finally, 44 cases of ectopic pregnancy, 70 obstetric controls and 32 non-obstetric ones were ever users of barrier methods of contraception; in comparison with never users, the risk of ectopic pregnancy was 1.2 (95% CI 0.7–1.6) and 1.9 (95% CI 1.0–3.4) for ever users, respectively, when the comparison group was obstetric and non-obstetric controls.

Intrauterine device use and risk of tubal pregnancy: an Indonesian case-control study.

We assessed the risk of tubal pregnancy among women who (1) were currently using an intrauterine device (IUD) and (2) had discontinued IUD use while still sexually active and at risk of pregnancy using data from a multicentre case-control study of married women conducted in Indonesia. Cases were 560 women diagnosed with histologically confirmed ectopic pregnancy from April 1989 to August 1990 at any one of 11 participating hospitals. Controls were 1120 non-pregnant women similar in age and place of residence to the cases. In-person interviews were conducted to collect information regarding current and past contraceptive use as well as other demographic and personal characteristics. Women currently using an IUD were considerably less likely than women not currently using contraception, but more likely than users of hormonal or surgical means of contraception, to develop a tubal pregnancy. Women who had discontinued using an IUD had a 70% subsequent increase in risk of tubal pregnancy (adjusted RR = 1.7, 95% Cl: 1.1-2.5) relative to women who had never used an IUD. This increase in risk was most pronounced in women who reported multiple episodes of IUD use and, to a lesser extent, in women with a long (> 3 year) duration of IUD use. The associations we observed are similar to those previously reported in studies conducted in developed countries. The results are of particular interest because this study was conducted in a location in which the Dalkon Shield IUD was never available, and among a population of married, gravid women for whom IUD use is generally considered most appropriate.

Is human papillomavirus associated with cervical neoplasia in the elderly?

There have been no studies in the United States of human papillomavirus (HPV) in elderly women. This paper presents cross-sectional data on HPV and cervical neoplasia among 232 women age 65 or more. HPV deoxyribonucleic acid (DNA) testing was performed using a modified dot-blot hybridization technique. The prevalence of HPV DNA positivity was 3.5% (95% confidence interval (CI) 0.9%, 6.0%). There were six cases of histologic cervical neoplasia. The crude odds ratio for cervical neoplasia among HPV DNA positives was 18.3 (95% CI 2.8, 120.3). The adjusted odds, controlling for age, prior screening history, current sexual activity, and past contraception use, were 12.2 (95% CI 1.2, 122.9). Ever having had a Papanicolaou smear was protective, and there was a trend for the odds of having neoplasia to increase with age. Additional studies with larger samples of elderly women are needed. If confirmed, the results suggest that, independent of past screening, HPV may increase the risk of having cervical neoplasia for elderly women.

Family Planning in Rural Uganda: Knowledge and Use of Modern and Traditional Methods in Ankole

Ankole has recorded the highest fertility in Uganda over the past several decades. One of the main proximate determinants of fertility in the area is the low level of contraception. A study of knowledge and use of modern and traditional contraceptive methods is reported in this paper. It is shown that higher proportions of women known and practice traditional methods compared with modern ones. Several factors contributing to past low use of modern contraceptives in the area are examined and current contraceptive use is also examined.

Depot medroxyprogesterone (Depo-Provera) and risk of breast cancer.

To determine whether use of the injectable contraceptive depot medroxyprogesterone acetate (Depo-Provera) affects the risk of breast cancer in women. A population based case-control study. Nationwide community study. 891 Women aged 25-54 with newly diagnosed breast cancer were compared with 1864 women selected at random from the electoral rolls. Women were interviewed by telephone about past use of contraceptives and about possible risk factors for breast cancer. Relative risk of breast cancer in women who had used medroxyprogesterone. Medroxyprogesterone had been used by 110 patients and 252 controls. Overall, the relative risk of breast cancer associated with any duration of use was 1.0 (95% confidence interval 0.80 to 1.3). In women aged 25-34 the relative risk was 2.0 (1.0 to 3.8). The relative risk was highest in women aged 25-34 who had used the drug for six years or longer, although there were few women in this category. Women who had used it for two years or longer before age 25 had an increased risk of breast cancer (relative risk 4.6; 1.4 to 15.1). Despite the lack of an overall association these findings suggest that medroxyprogesterone may increase the risk of breast cancer in young women.

"The Relationship of Tubal Infertility to Barrier Method and Oral Contraceptive Use"

We studied past contraceptive use in 283 nulliparous infertile women who had a diagnosis of tubal adhesions or occlusion and in 3833 women admitted for delivery at seven collaborating hospitals from 1981 to 1983. The relative risk of tubal infertility associated with barrier contraceptive use or oral contraceptive use was calculated using multivariate logistic regression to control for confounding by region, age, religion, education, smoking, number of sexual partners, time since menarche, and use of other contraceptive methods. Women who had ever used barrier methods of contraception were at a significantly decreased risk of tubal infertility (relative risk = 0.6; 95% confidence limits, 0.5 and 0.8). When type of barrier method used for the longest time was evaluated, those who used the diaphragm or condoms plus spermicides were at lower risk than those who used condoms or spermicides alone. Overall, past use of oral contraceptives neither increased nor decreased a woman's risk of tubal infertility, but there was evidence that the association between oral contraceptives and tubal infertility may vary by the amount of estrogen and type of progestogen in the oral contraceptive used. We conclude that contraceptive users who use barrier methods that combine both a mechanical and chemical barrier, such as diaphragms, cervical caps, and condoms plus spermicides, have the clearest protection against tubal damage. (JAMA1987;257:2446-2450)

The Demand for Family Planning: A New Approach

A new "supply-demand" measure of family planning demand is compared with others commonly used to target prospective family planning clients. In analyses of data from six cross-sectional surveys the new measure consistently explains past contraceptive use better than the others. Time series analysis for two countries yields similar results. Family planning program officials may wish to consider exploring the use of this measure to target prospective clients.

The Relationship of Tubal Infertility to Barrier Method and Oral Contraceptive Use

We studied past contraceptive use in 283 nulliparous infertile women who had a diagnosis of tubal adhesions or occlusion and in 3833 women admitted for delivery at seven collaborating hospitals from 1981 to 1983. The relative risk of tubal infertility associated with barrier contraceptive use or oral contraceptive use was calculated using multivariate logistic regression to control for confounding by region, age, religion, education, smoking, number of sexual partners, time since menarche, and use of other contraceptive methods. Women who had ever used barrier methods of contraception were at a significantly decreased risk of tubal infertility (relative risk = 0.6; 95% confidence limits, 0.5 and 0.8). When type of barrier method used for the longest time was evaluated, those who used the diaphragm or condoms plus spermicides were at lower risk than those who used condoms or spermicides alone. Overall, past use of oral contraceptives neither increased nor decreased a woman's risk of tubal infertility, but there was evidence that the association between oral contraceptives and tubal infertility may vary by the amount of estrogen and type of progestogen in the oral contraceptive used. We conclude that contraceptive users who use barrier methods that combine both a mechanical and chemical barrier, such as diaphragms, cervical caps, and condoms plus spermicides, have the clearest protection against tubal damage.

Patterns of contraceptive use among female adolescents: Method consistency in a clinic setting

Major changes in contraceptive use among adolescents in the United States have been documented through surveys and analysis of family planning program service statistics. While we know of the changes in the adolescent population as a whole and those served by organized family planning programs, little is known about the patterns of contraceptive use by individuals. This study examines patterns of contraceptive use among 547 clients of a new contraceptive and counseling service for adolescents in New York City. The principal concern is consistency of contraceptive method use as determined from clinic statistics. Findings show generally high degrees of method consistency, with new and current users displaying more consistency than prior users. Among clients who switch methods, two major patterns emerged: switching among the more effective methods and from less effective to more effective methods. Younger new users were the most consistent subgroup suggesting that a service designed for adolescents may have a positive influence on teenagers without prior contraceptive experience. Prior users were the least consistent subgroup suggesting that programs incorporate screening procedures to identify prior users and to develop new approaches to understanding their past contraceptive use patterns to improve their future use.

Assessment of reproductive knowledge in an inner-city clinic

A number of studies have shown that misinformation and lack of information about the menstrual cycle contributes to unwanted fertility, particularly among black women. A short, self-administered questionnaire was developed and tested in an inner-city, prenatal clinic serving a primarily low-income undereducated, black clientele. Data were gathered concerning numbers of pregnancies and abortions, knowledge of the menstrual cycle, past contraceptive use, including dissatisfaction and discontinuance, and planned future use of contraception. Results showed that the majority of women had had at least one unwanted pregnancy. Their knowledge base about female reproductive function and their poor use of contraception contributed to these unwanted pregnancies. It is concluded that a few key questions can help identify the woman with special informational needs, enabling the health professional to gear educational efforts to the individual patient.