Risk Of Unwanted Pregnancy Research Articles

Barrier methods of contraception and cervical intraepithelial neoplasia

This North Carolina-based case-control study examined risk factors for cervical intraepithelial neoplasia (GIN). Cases were 103 women with biopsy-confirmed CIN II or III who were recruited from a referral dysplasia clinic. Controls were 258 family practice patients with normal cervical cytology. All subjects were interviewed regarding their sexual and reproductive history, Pap smear screening, active and passive cigarette exposures, and contraceptive use patterns. When compared with controls, cases were half as likely to have ever used barrier methods of contraception; the adjusted odds ratio was 0.5 (95% CI 0.2–0.9). The risk of CIN II III decreased further with increasing years of barrier method use. Recency, latency, and age at first barrier method use were all associated with a reduced risk of CIN. Men and women should carefully consider the range of benefits of barrier method use as a means to reduce their risk of unwanted pregnancies, sexually transmitted diseases, and cervical neoplasia.

Oral contraceptives and vascular disease.

This update on the cardiovascular risks of oral contraceptives unfortunately adds little to our original 1982 review for the following reasons: 1) There are many different formulations on the market, and they keep changing; 2) Women often use different formulations, stopping and starting as well as switching; 3) The statistical power of the studies often does not permit analyses by specific formulations; 4) The required information (brand name) is sometimes not collected or not collected reliably; 5) Apparently few case-control studies are being conducted to address these issues. Data that are available, interpreted cautiously, suggest either a continuance of the previously observed risk or a small to modest diminution with the use of the newer oral contraceptive formulations. The earlier advice to physicians still seems prudent and is briefly stated: 1) Try to avoid prescribing oral contraceptives for women over 35 years of age; 2) Women who smoke cigarettes should avoid using oral contraceptives, and users should not smoke; 3) Prescribe the formulation with the lowest dose and/or potency of estrogen that is effective and that does not cause unacceptable "breakthrough" bleeding; 4) Women with hypertension should be carefully monitored, and women who develop hypertension while on oral contraceptives should be switched to another form of contraception, if possible. Although oral contraceptives are the most effective form of contraception currently widely available, all risks of a contraceptive method must be compared with corresponding measures of effectiveness and with the risks of unwanted pregnancy. In particular, oral contraceptive users can reduce their risk of myocardial infarction by a reduction or elimination of cigarette smoking.

Contraception after childbirth in Thailand.

SummaryResults from a 1984 national survey indicate that the large majority of Thai women initiate contraception soon after giving birth. Among sterilized women, the vast majority undergo the operation during the immediate post-partum period and thus avoid the risks of subsequent unwanted pregnancy. Rates of initiation of other methods are unusually high at and immediately following the time at which menses return, and hence only modest proportions of Thai women remain at risk of unwanted pregnancy for very long after the birth of a child.

Adolescent sexual decision-making: contraception, pregnancy, abortion, motherhood.

A study was undertaken to define the contribution of developmental parameters to adolescent sexual decision making. Only 1 aspect was examined: once sexually active, what factors distinguish between those who are successful contraceptors and those who become pregnant. 206 sexually active adolescent females between ages 15-18 were studied. 29% were successful contraceptors, 24% were aborters, 24% were currently pregnant, and 23% were mothers at the time of the study. The study focuses on ego development, locus of control, future time perspective, moral development, sex role socialization, and irrational beliefs. Aborters were found to have the most developed future time perspective, lowest demand for external approval, and lowest dependency needs. Teen mothers were found to have the least developed conceptualization of the future, highest level of anxiety and rumination, most external locus of control, and had internalized the most traditional notion of female sex roles. Adolescence is a period of experimentation which becomes the substrate for cognitive growth. Through experimentation one begins to develop an internal locus of control and anticipates the impact that certain actions will have on others. Over time the sense of control and limits of influence are internalized and the need to continually validate it through experimentation is diminished. It would therefore be expected that those with a less internalized locus of control would be more likely not to use contraception. Throughout adolescent life one begins to understand time as an abstract concept and the adolescent begins to perceive herself as a being who will live in the future as well as in the present and past. The notion of prevention is predicated upon a personal conception of future; those adolescents who have the least developed future perspective are most at risk for unwanted pregnancy. In addition the adolescent must feel that the future promises something so that there is competition to the present reality of pregnancy and motherhood. Understanding these processes will enable physicians to guide the adolescent at an appropriate level.

Oral contraceptives and vascular disease.

This update on the cardiovascular risks of oral contraceptives unfortunately adds little to our original 1982 review for the following reasons: 1) There are many different formulations on the market, and they keep changing; 2) Women often use different formulations, stopping and starting as well as switching; 3) The statistical power of the studies often does not permit analyses by specific formulations; 4) The required information (brand name) is sometimes not collected or not collected reliably; 5) Apparently few case-control studies are being conducted to address these issues. Data that are available, interpreted cautiously, suggest either a continuance of the previously observed risk or a small to modest diminution with the use of the newer oral contraceptive formulations. The earlier advice to physicians still seems prudent and is briefly stated: 1) Try to avoid prescribing oral contraceptives for women over 35 years of age; 2) Women who smoke cigarettes should avoid using oral contraceptives, and users should not smoke; 3) Prescribe the formulation with the lowest dose and/or potency of estrogen that is effective and that does not cause unacceptable "breakthrough" bleeding; 4) Women with hypertension should be carefully monitored, and women who develop hypertension while on oral contraceptives should be switched to another form of contraception, if possible. Although oral contraceptives are the most effective form of contraception currently widely available, all risks of a contraceptive method must be compared with corresponding measures of effectiveness and with the risks of unwanted pregnancy. In particular, oral contraceptive users can reduce their risk of myocardial infarction by a reduction or elimination of cigarette smoking.

Control of fertility.

In a recent issue of the Journal Gordis et al.1 described the results of an intensive program for contraception in a select group of young, unwed girls whose risk of unwanted pregnancy was high. Despite their risk and their request for contraceptive services, the median period of the girls' participation in the program during the two-year period of experience was only 12 months. With such a high "dropout" rate and a failure rate of 5 per cent who became pregnant one could view these results with despair and conclude that the effort was wasted. That this should not be the . . .

The influence of contraceptive practice upon maternal and child health

When pregnancy is contraindicated on medical grounds, reliance upon the older methods of contraception is usually inadvisable as the failure rates in normal use are high. Despite widespread use of the older methods, normal healthy women in Western countries frequently have unwanted pregnancies and resort to induced abortiion. The incidence of induced abortion cannot be assessed accurately but the incidence of unwanted pregnancy can be estimated with greater certainty from the data of the Scripps Michigan survey, which represented a cross section of the population of married white women in the U.S.A. before the advent of oral contraception. A minimum of 7 per cent of all pregnancies were unwanted, or 300,000 per annum, with a minimum of 127 avoidable maternal deaths per annum. The incidence of unwanted pregnancy rises to 17 per cent among women in the age group 35–39. This indicates that in each generation there are approximately seven million women in the U.S.A. who have one or more unwanted pregnancies. Among these women, there must be several thousand avoidable maternal deaths. In addition to this mortality, there is avoidable morbidity on a much larger scale, particularly in the lower socioeconomic groups in which uncontrolled fertility is a major factor in the ill health of mothers and children. Although fertility is higher in younger age groups, unwanted pregnancies are commoner in older women in whom the hazards of mortality and morbidity are greater. The risks of unwanted pregnancy and of illegal abortion are virtually nonexistent among users of oral contraceptives. Oral contraceptives have proved effective and acceptable among problem families and among illiterate women and others of low educational and socioeconomic status. Unwanted pregnancy and illegal abortion may therefore be regarded as preventable diseases in the community.

Some Relationships between Short Range and Long Range Risks of Unwanted Pregnancy

Some Relationships between Short Range and Long Range Risks of Unwanted Pregnancy