Reliable Contraception Research Articles

Attitudes and first heterosexual experiences among Indians and Pakistanis in Britain: evidence from a national probability survey

We compare attitudes, experiences of learning about sex and first intercourse among Indians (n = 393) and Pakistanis (n = 365) using a probability survey of Britain's general population aged 16-44 years conducted during 1999-2001 (n = 12,110). Higher proportions of Pakistanis (64.6%) and Indians (28.1%) reported religion as 'very important' versus 6.2% of other ethnicities. Pakistanis were more conservative in their attitudes, e.g. reporting premarital sex as wrong (adjusted odds ratios [AORs] for sociodemographic differences, 4.71 [men] and 6.59 [women]). Pakistanis were more likely to be married at first sex (AORs 6.2 [men] and 9.53 [women]), yet men were more likely than women to be in non-marital relationships at this time (69.4% versus 25.2%). Pakistani men and women and Indian women were more likely to report not using reliable contraception at first sex relative to others (AORs 2.33, 3.16 and 1.90, respectively). Pakistani and Indian women were more likely than others to report school lessons as their main source of sex education (AORs 2.23 and 1.77) and not discussing sex with their parents during adolescence (AORs 2.04 and 2.62). These unique data have implications for ensuring that sex and relationship education and health promotion messages are appropriately planned, targeted and delivered to benefit Pakistanis and Indians.

Effect of extended-cycle regimen with an oral contraceptive containing 30 mcg ethinylestradiol and 2 mg dienogest on bleeding patterns, safety, acceptance and contraceptive efficacy

Background The present study compared the efficacy and safety of a combined oral contraceptive containing 30 mcg ethinylestradiol and 2 mg dienogest (EE/DNG) in conventional and extended-cycle regimen over 1 year of treatment. Study Design In a phase III, randomized, prospective, open, two-arm, multicenter study, 1315 sexually active women (range, 18–40 years) were treated with EE/DNG either conventionally (21/7 days) or according to an extended-cycle regimen (84/7 days). Data were documented on volunteer diaries, and adverse events (AEs) were reported during five visits. Results In the extended-regimen group, the total number of days with bleeding progressively decreased over time, and overall, the volunteers had fewer numbers of days with bleeding/spotting compared to those treated conventionally. Intracyclic bleeding, on the other hand, was more frequent in the extended-cycle group, although its frequency considerably decreased over time. Both regimens offered reliable contraception, with an unadjusted Pearl Index of 0.489 for the conventional regimen and 0.495 for the extended regimen. The number of AEs was higher in the extended-cycle group, although the group differences tended to decrease over time. Conclusions Extended-cycle use of EE/DNG was effective and mostly well tolerated, appearing to be a favorable option for women who need or wish to omit the pill-free interval.

The Use of Anti-Epileptic Medication in Women with Affective Disorders in Early and Late Pregnancy and During Breastfeeding

Valproate, carbamazepine and lamotrigine are used in psychiatry mainly for the treatment of bipolar disorder. Increasing evidence from studies in women with epilepsy indicate that valproate in higher doses is toxic to the susceptible fetus and can cause anomalies in several organ systems as well as widespread deficits in later cognitive development. This agent should not now be prescribed in psychiatry to women during the entire pregnancy and not to women with childbearing potential unless they use highly reliable contraception. Carbamazepine is associated with a relatively small increase in the risk of neural tube defects and together with the uncertainty about its antidepressant and preventative efficacy in bipolar disorder its use in pregnancy should be limited only to special cases who have a history of a particularly favourable therapeutic response to this agent but not others. Whether lamotrigine is associated with a small increase in oral clefts is at present uncertain but the absolute risk is relatively small. Breastfeeding is not contraindicated when women are prescribed valproate or carbamazepine. In contrast, the high serum levels of lamotrigine in breastfed infants and the theoretical risk of severe skin reactions has lead national guidelines to advise against breast feeding during medication with lamotrigine. Pregnancy does not protect from new episodes of bipolar disorder and the early postpartum period is an extremely potent trigger for recurrences. It is therefore essential that reproductive issues are discussed with premenopausal women with affective disorders and that preconception consultations are offered to women who plan a pregnancy. In many countries, advice in these complex situations is available from specialists in perinatal psychiatry. Keywords: Valproate, lamotrigine, carbamazepine, teratogen, anomaly, bipolar disorder, pregnancy, lactation

The Zygote Argument remixed

John and Mary have fully consensual sex, but they do not want to have a child, so they use contraception with the intention of avoiding pregnancy. Unfortunately, although they used the (generally reliable) contraception in the way in which it is supposed to be used, Mary has become pregnant. The couple decides to have the baby, whom they name ‘Ernie’. Now we fill in the story a bit. The universe is (we suppose) causally deterministic, and 30 years later Ernie performs some action A and thereby brings about event E. We also stipulate that Ernie meets plausible compatibilist conditions for acting freely (in performing A). That is, we suppose that there are no uncontroversially freedomand responsibility-undermining conditions present in the context in which Ernie performs A, and, further, that Ernie meets plausible compatibilist conditions for acting freely. Let us say, for example, that one adopts the theory according to which the freedom-relevant condition on moral responsibility is that the agent exhibits ‘guidance control’ of his action (Fischer 1994) and (Fischer and Ravizza 1998). On this approach, one acts freely (and thus meets the freedomrelevant condition for moral responsibility) in so far as one acts from one’s own, suitably reasons-responsive mechanism. We can then simply stipulate that, in the relevant context, Ernie acts from his own, suitably reasonsresponsive mechanism (in performing A and thereby bringing about E). If one prefers a different set of compatiblist-friendly conditions for acting freely, one can simply stipulate that Ernie meets them; indeed, the plausible compatibilist-friendly conditions seem to be compatible with each other, and thus Ernie could presumably meet all of them in the relevant context. In such a case, and given that the epistemic condition on acting freely and moral responsibility is met, I am inclined to say that Ernie acts freely in performing A and is morally responsible for performing A (and bringing about E). Of course, this is simply my inclination; I recognize that my view about such a case is contentious. Obviously, one would need an argument for the compatibility of causal determinism and acting freely (and moral responsibility), in order to defend the view to which I am inclined here. But it does seem very clear to me that the precise circumstances of Ernie’s conception some 30 years earlier have nothing to do with whether he acts freely and is morally responsible in the context in question (30 years later). More specifically, it certainly is irrelevant to Ernie’s moral responsibility that John and Mary did not intend to have a baby and that they used contraception in an effort to prevent a pregnancy! And surely it would not change things at all, with respect to Ernie’s moral responsibility, if we modified the

Intrauterine Contraception in Adolescents and Young Women: A Descriptive Study of Use, Side Effects, and Compliance

Objective Describe characteristics, compliance, efficacy, and side effect profile of adolescents and young women who use intrauterine contraception (IC). Study Design Retrospective chart review of adolescent and young women who had IC devices placed over a 3-year period. Comparative statistics between devices and population characteristics were performed using the Fisher exact and the t test. Results Eighty-nine patients were included in the study. The mean age at insertion was 19.5 years (range 16-22 years). Copper was used in 13% of patients; levonorgestrel (LNG) was used in 87%. The mean duration of use was 331.3 days (copper vs LNG; P = .2254). Side effects included infection (9%, but no pelvic inflammatory disease), pain (28%), partner felt strings (9%), and bleeding (32%). Reasons for removal included side effects (25%), desired fertility (5%), expulsion (3%), and pregnancy (2%). There were no pregnancies associated with the LNG IC, and there were fewer removals because of side effects than with the copper IUD ( P = .0180). Conclusion IC is a reliable method of contraception in teens and young adults. There were fewer removals because of side effects in the LNG group, although overall other variables are similar between methods.

Hormonelle Kontrazeption

Hormonal contraception with systemic disesases can sometimes be a difficult decision. On the one hand these patients often need comfortable and reliable contraception – on the other hand they are at risk for certain complications, which can be triggered by hormonal contraception. This article provides an overview of current WHO recommendations. In addition, the possibility and risks of hormonal contraception in defined situations are discussed. The article gives guidelines for the systematic approach to these conditions.

Sexual behavior and contraception among young Polish women

To analyze sexual behavior and the use of contraception among young women in Poland. Cross-sectional study. 1,478 young women in higher (78.9%) and secondary (21.1%) education. Gdansk region in Poland. The data were gathered between September and December 2008 by the use of a questionnaire prepared for the purpose of this study, completed anonymously and in person by the young women. Sexual activity had been initiated by 67.2% of the women studied at a mean age of 18.7 years (±1.97). Assessment was made of changes in their contraceptive practice between the time of sexual initiation and later sexual activity. Since their first experience of intercourse 67.0% did not change their contraceptive methods. As many as 40.1% continued using either low effective methods or no contraception. Early sexual initiation was linked to a significantly lower likelihood of highly effective contraception, more frequent unprotected sexual intercourse and more sexual partners (p < 0.05). Over half of women assigned to a 'high-risk' group with regard to the chance of unintended pregnancy and sexually transmitted infection, declared that their behavior did not carry any risk, similar (p > 0.05) to those who did not have a history of hazardous behavior. Sexual behavior differentiates Polish women from the women in Western Europe. Despite the welcome tendency toward choosing reliable contraceptives, use of appropriate contraception is still insufficient.

Contraceptive behaviour of Czech and Romanian women: comparison of representative national samples

ObjectiveTo investigate the contraceptive behaviour of Czech and Romanian women and their attitudes towards different forms of contraception. Study designAnonymous questionnaire research among 1011 Czech and 1001 Romanian women between 15 and 50 years of age. The samples were representative of both the Czech and Romanian female populations with respect to age, education and the size of their place of residence. ResultsThe majority of women use contraception when in a stable sexual relationship. We found a higher percentage of women using contraception among Czech women. Romanian women more often use less reliable methods in a stable relationship, and condoms. Czech women use hormonal contraception much more. Women in the Czech Republic would more often agree to use a condom and, in particular, to use hormonal and intrauterine contraception. More Romanian women than Czech women prefer the method of infertile days. The use of contraception is influenced by the factors of age, education and size of the place of residence. ConclusionThe majority of Czech and Romanian women protect themselves against unwanted pregnancy. Czech women are more frequent users of contraceptives in general and, in particular, of hormonal contraception. Romanian women tend to use less reliable methods of contraception but on the other hand, they more often use condoms as a means of protection.

Perceptions of clients regarding family planning service delivery in a clinic of the Greater Johannesburg Metropolitan Council

Unwanted pregnancies with their negative impact on both women and children occur on an ongoing basis in Gauteng, South Africa. One way to prevent unwanted pregnancies is to use areliable contraceptive method available free of charge from primary health care clinics providing family planning services throughout Gauteng Province. A literature review was completed on women and access to family planning services and an interview schedule (questionnaire) was developed. The purpose of this study was to describe guidelines to meet the expectations of clients accessing family planning services provided by a clinic in Region F, Area 28 of the Greater Johannesburg metropolitan council. This quantitative, exploratory, descriptive and comparative study measured the gaps between the expectations of participants on service delivery and the extent to which these expectations were met. A convenience sample was conducted and consisted of 50 women of reproductive age (ages 15 to 49) attending the family planning clinic. Pre-testing of the instrument was conducted. Structured interviews with a interview schedule were conducted before and after women attended a family planning service. Inferential statistics indicated that there was a significant gap between the client expectations of family planning service delivery and the extent to which these expectations were met. Of the sixty-four items where women indicated the extent of their expectations the findings on only three items were not statistically significant. These gaps were addressed by proposing managerial guidelines to be implemented by the nurse manager in charge of the facility, on which this article will focus. Validity and reliability principles were ensured in the study. Ethical principles were adhered to during the research process.

Advance Provision of Emergency Contraception among Adolescent and Young Adult Women: A Systematic Review of Literature

Objective The purpose of this review is to summarize the findings of randomized controlled trials assessing the advance provision of emergency contraception (EC) to women 24 years of age or younger. Design We conducted a comprehensive search of the PubMed database from 1950 to November 11, 2009. This review includes seven studies that randomly assigned women aged 24 and younger to advance provision of EC or a control group. Results All studies reviewed found that women assigned to advance provision were more likely to use EC, though not all reached statistical significance. Furthermore, studies assessing time to EC use (N = 4) found that those with advance provision used EC sooner following intercourse. Most studies found that women assigned to advance provision of EC did not engage in more sexual risk taking behaviors (assessed by reported number of sexual partners, number of episodes of unprotected intercourse, and acquisition of sexually transmitted infections) or switch to less reliable contraceptive methods. Despite increased use and decreased time to use, women who were provided EC in advance did not report significantly lower pregnancy rates. Conclusions The existing literature suggests that among women 24 years of age or younger, advance provision has a positive impact on use and time to use of EC. Most findings indicate that increased use of EC does not have significant negative effects for ongoing contraceptive use or sexual risk taking behaviors. Despite increased use, advanced provision of EC has not been associated with a significant corresponding decrease in pregnancy.

Combining NovaSure® endometrial ablation and Essure® hysteroscopic sterilization: a feasibility study to evaluate the confirmation tests

Since NovaSure® endometrial ablation (GEA) is not reliable as contraception, a reliable permanent contraceptive method which can be offered during the same operative session is often preferred by patients. We present a series of 24 patients treated by NovaSure® GEA followed by Essure® hysteroscopic sterilization at the same session. Bilateral placement of the micro-inserts after GEA was successful in all 24 patients. Confirmation by ultrasound and plain X-ray of the pelvis indicated a correct position in all 48 tubes. Routine follow-up by hysterosalpingography (HSG) to document bilateral tubal occlusion was only possible in 17/23 (74%) patients; these 34 tubes were blocked. In 6/23 (26%) patients, tubal occlusion could not be determined by HSG because of minimal filling of the uterine cavity with contrast medium. The latter was caused by severe uterine synechiae. All patients were satisfied with the result of GEA at 3 months; 19 women (83%) reported amenorrhea and the others, a strong reduction in menstrual blood loss. The combination of Essure® hysteroscopic sterilization and NovaSure® GEA is feasible and safe. However, after this combined approach the HSG as confirmation test is not always useful because of severe synechiae.

Pregnancy prevention, reproductive health risk and morality: a perspective from public-sector women's clinics in St. Petersburg, Russia

The use of reliable contraception in Russia remains lower and rates of induced abortion higher than in Western Europe, even though reliable contraception has been accessible for nearly two decades now. Due to the organisation of women's health services in Russian cities, gynaecologists can have a major influence on women's contraceptive choices, but little is known about their attitudes and practices in terms of contraception promotion. This study draws on qualitative observation and interview data of gynaecologists in public-sector women's clinics in St. Petersburg, Russia's second largest city in order to investigate their perceptions of various birth control methods and contraception counselling. Also in focus are clinical counselling practices. The results reveal that gynaecologists in St. Petersburg had up-to-date knowledge of the latest contraception methods and that they were willing to promote their use. They took an active role in counselling, although the coverage was not full. The depth of counselling varied considerably and counselling practices were mainly paternalistic. Yet, in about a third of the observed cases, patient preferences were incorporated into clinical decision-making. The gynaecologists perceived reliable contraception essentially as a means of fostering future fertility and avoiding harmful health consequences of induced abortions. Using reliable contraception was equated with being a responsible and morally respectable woman. The results suggest that links between health, risk and morality are vividly present in contraception counselling in St. Petersburg, and that reliable contraception has become a powerful source of new moral demands for individual women to foster their reproductive function.

Adding the Standard Days Method® to the contraceptive method mix in a high-prevalence setting in Peru

OBJECTIVE: To determine what contribution the Standard Days Method® (SDM) makes to the contraceptive mix offered by regular health services in areas of Peru where contraceptive prevalence rates (CPR) are already high. METHODS: SDM was added to the family planning methods offered by the Ministry of Health in two provinces in Peru in September 2002. Retrospective interviews were conducted in March-June 2004 with 1 200 women who had chosen SDM as their contraceptive method and had used it for 2-20 months. Data were also obtained from the databases of the participating health services. The evaluation covered SDM demand, whether or not clients were switching to SDM from other modern methods, and SDM continuation and effectiveness. RESULTS: Demand for SDM stabilized at 6% of all new family planning users. Most users had not been using any reliable contraception at the time they started using SDM. About 89% of those who began using SDM at least 6 months before the interview were still using it at 6 months. The 12-month typical use pregnancy rate was estimated to be around 10.0 per 100 women years. CONCLUSIONS: Adding SDM to a program's existing contraceptive method mix can increase coverage even in an already high-CPR setting. Most women who choose SDM do not switch from any other modern family planning method. Continuation compares well with other modern user-directed methods. SDM effectiveness, when offered in regular service delivery circumstances, compares well to efficacy trial findings.

Asian women's use of specialist Contraception, Sexual and Reproductive Health Services in Leicester, UK

BackgroundThere is evidence to suggest that Asian women in the UK have specific contraceptive and sexual health needs. It has been reported that Asian women may use less reliable contraceptive...

Hormonal contraception and risk of cancer

Fear from increased cancer risk is one of the most significant reasons for low acceptance of reliable contraceptive methods and low compliance. In this review, we included all cohort and case-control studies published in English up to December 2008. They were identified through a search of the literature using Pubmed and EMBASE. Data about breast cancer risk indicate a slightly increased risk among current users of oral contraceptives (OC), an effect which disappears 5-10 years after stopping. Combined OC have a significant protective effect on the risk of ovarian cancer, and the protection increases with duration of use (relative risk decreased by 20% for each 5 years of use). The significant risk reduction has been confirmed for BRCA 1 and 2 mutation carriers. The risk of endometrial cancer is reduced by about 50% in ever users, a benefit which is greater with increasing duration of use. An association has been found between increased risk of cervical cancer and long-term OC use. Current OC use has been associated with an excess risk of benign liver tumours and a modest increased risk of liver cancer. None of large prospective cohort studies with prolonged follow-up has observed an increased overall risk of cancer incidence or mortality among ever users of OC, indeed several have suggested important long-term benefits. Specifically, protective effect of OC can be used as chemoprevention in young women who are BRCA mutation carriers. Women wishing to use combined OC can be reassured that their decision is unlikely to place them at higher risk of developing cancer.

Excluding pregnancy among women initiating antiretroviral therapy: efficacy of a family planning job aid

BackgroundGuidelines for initiating ART recommend pregnancy testing, typically a urine test, as part of the basic laboratory package. The principal reason for this recommendation is that Efavirenz, a first-line antiretroviral medication, has the potential of causing birth defects when used in the first trimester of pregnancy and is therefore contraindicated for use by pregnant women. Unfortunately, in many African countries pregnancy tests are not routinely provided or available in ART clinics, and, when available outside clinics, are often not affordable for clients.Recently, the World Health Organization added a family planning job aid called the 'pregnancy checklist,' developed by researchers at Family Health International, as a recommended tool for screening new ART clients to exclude pregnancy. Although the checklist has been validated for excluding pregnancy among family planning clients, there are no data on its efficacy among ART clients.This study was conducted to assess the clinical performance of a job aid to exclude pregnancy among HIV positive women initiating ART.MethodsNon-menstruating women eligible for ART were enrolled from 20 sites in four provinces in Zambia. The pregnancy checklist was administered followed by a urine pregnancy test as a reference standard. Sensitivity, specificity, and positive and negative predictive values were estimated.ResultsOf the 200 women for whom the checklist ruled out pregnancy, 198 were not pregnant, for an estimated negative predictive value of 99%. The sensitivity of the checklist was 90.0%, and specificity was 38.7%. Among the women, 416 out of 534 (77.9%) did not abstain from sex since their last menses. Only 72 out of the 534 women (13.4%) reported using reliable contraception. Among the 416 women who did not abstain, 376 (90.4%) did not use reliable contraception.ConclusionThe pregnancy checklist is effective for excluding pregnancy in many women initiating ART, but its moderate sensitivity and specificity precludes its use to completely replace pregnancy testing. Its use should be encouraged in low resource settings where pregnancy tests are unavailable or must be rationed. Family planning methods should be available and integrated into ART clinics.

Sex education and contraceptive use at coital debut in the United States: results from Cycle 6 of the National Survey of Family Growth

Background The study was conducted to characterize the relationship between formal sex education and the use and type of contraceptive method used at coital debut among female adolescents. Methods This study employed a cross-sectional, nationally representative database (2002 National Survey of Family Growth). Contraceptive use and type used were compared among sex education groups [abstinence only (AO), birth control methods only (MO) and comprehensive (AM)]. Analyses also evaluated the association between demographic, socioeconomic, behavioral variables and sex education. Multiple logistic regression with adjustment for sampling design was used to measure associations of interest. Results Of 1150 adolescent females aged 15–19 years, 91% reported formal sex education (AO 20.4%, MO 4.9%, AM 65.1%). The overall use of contraception at coitarche did not differ between groups. Compared to the AO and AM groups, the proportion who used a reliable method in the MO group (37%) was significantly higher (p=.03) (vs. 15.8% and 14.8%, respectively). Conclusions Data from the 2002 NSFG do not support an association between type of formal sex education and contraceptive use at coitarche but do support an association between abstinence-only messaging and decreased reliable contraceptive method use at coitarche.

Finasteride Treatment of Hair Loss in Women

To review available evidence on the safety and efficacy of finasteride in the treatment of alopecia in women. A literature search was conducted through PubMed (1948-March 2010) and MEDLINE (1950-March 2010) using the search terms finasteride and alopecia. References cited in relevant publications were reviewed. All data sources identified were reviewed for inclusion. Reports of finasteride treatment of female alopecia were included in the review. This included prospective and retrospective trials, case series, and case reports. Studies in men were not included. Few pharmacologic options exist for women with alopecia who do not achieve satisfactory responses to topical minoxidil solution. Treatment successes with finasteride in women with female pattern hair loss, although an off-label indication, have been primarily described in uncontrolled studies and anecdotal reports. In 2 controlled clinical studies, finasteride showed no benefit over placebo or no treatment in female pattern hair loss. A finasteride regimen of 1 mg orally daily, as indicated in male pattern hair loss, may be recommended for those who fail or cannot tolerate minoxidil therapy. A 12-month trial is needed to assess stabilization of hair loss, and hair regrowth may take 2 years or longer. Although data are sparse, menopausal status, circulating androgen concentrations, and concomitant symptoms of hyperandrogenism do not appear to predict response to finasteride. Overall, finasteride is well tolerated; however, women of childbearing potential must adhere to reliable contraception while receiving finasteride, and treatment is contraindicated in pregnancy, due to known teratogenicity. Although objective evidence of efficacy is limited, finasteride may be considered for treatment of female pattern hair loss in patients who fail topical minoxidil treatment.

The Effect of Efavirenz on the Pharmacokinetics of An Oral Contraceptive Containing Ethinyl Estradiol and Norgestimate in Healthy HIV-Negative Women

Women of childbearing age represent a growing proportion of people living with HIV. Preventing pregnancy is important in HIV-infected women receiving efavirenz as part of their antiretroviral therapy. The effects of coadministration of efavirenz (600 mg once daily) on the pharmacokinetics (PK) of the active components (ethinyl estradiol [EE] and 17-deacetyl norgestimate [NGMN]) of Ortho Cyclen(®) (Ortho-McNeil-Janssen Pharmaceuticals, Inc., Raritan, NJ, USA) were investigated in 28 healthy HIV-negative women. The peak plasma concentration (C(max)), area under the concentration-time curve for a dosing interval (AUC([τ])), and lowest plasma concentration (C(min)) for EE and NGMN during cycles of treatment with Ortho Cyclen with and without coadministration of efavirenz were compared. Additionally, a post hoc exploratory analysis was conducted to assess the effect of efavirenz on the PK of an additional progestin, levonorgestrel (LNG). Exposures to EE were similar during coadministration of efavirenz and Ortho Cyclen to those during administration of Ortho Cyclen alone. Exposures to NGMN were substantially decreased following coadministration of efavirenz and Ortho Cyclen (adjusted geometric means for C(max), AUC([τ]) and C(min) decreased by 46%, 64% and 82%, respectively) compared with Ortho Cyclen alone. Consistent with NGMN, LNG exposures were decreased 80-86% by efavirenz. Although efavirenz had no significant effect on the PK of EE, exposures to the progestin components of Ortho Cyclen, NGMN and LNG, were substantially reduced. The results reinforce the need to use reliable methods of barrier contraception, even when taking oral contraceptives and efavirenz.

Providing Contraception for Women Taking Potentially Teratogenic Medications: A Survey of Internal Medicine Physicians’ Knowledge, Attitudes and Barriers

The majority of women prescribed category D or X medications may not receive adequate contraceptive counseling or a reliable contraceptive method. Physicians who prescribe potentially teratogenic medications have a responsibility to provide women with contraceptive counseling, a method of highly-effective contraception, or both. Investigate the knowledge, beliefs and barriers of primary care physicians toward providing adequate contraception to women taking potential teratogens. Self-administered confidential survey of primary care internal medicine physicians at an urban, academic medical center. Knowledge of potential teratogenic medications and contraceptive failure rates was assessed. Participants' beliefs about adequacy of their medical education, practice limitations and attitudes toward improving provision of contraception to women on potential teratogens were assessed. One hundred and ten physicians responded (57.3%). Nearly two-thirds (62.3%) of participants had cared for reproductive aged women taking category D or X medications in the past year. The mean percent of correctly identified category D or X medications was 58.4% (SD 22.1%). The mean percent correct for knowledge of published contraceptive failure rates was 64.6% (SD 23.1%). Most respondents (87.6%) felt it is the responsibility of primary care physicians to provide contraception. Time constraints were reported to be somewhat or very limiting by 61.3% and over half felt medical school (63.2%) or residency (58.1%) inadequately prepared them to prescribe or counsel about contraceptives. Primary care physicians commonly encounter reproductive age women taking category D or X medications, but may lack sufficient knowledge and time to counsel about potential teratogens and contraception to prevent fetal exposure to these drugs.