birth control
Use of injectable progestin (medroxyprogesterone acetate) in adolescent health care.

Isart F, Weber FT, Merrick CL, Rowe S.

Adolescent Young Adult Program, College of Medicine, University of Florida, Gainesville 32610.

To assess medroxyprogesterone acetate (DMPA) prescription practices in adolescent health care practices, an anonymous questionnaire was distributed to 160 American and Canadian physicians attending the 1991 meetings of either the Society for Adolescent Medicine or the North American Society for Pediatric and Adolescent Gynecology. Of 54 (33.7%) physicians who responded, 33 (61.1%) reported prior prescription of an injectable progestin (DMPA) as a form of birth control. Of those, 15 (45.5%) had prescribed it to 10 or more adolescents. Twelve (57%) pediatricians but only 3 (25%) gynecologists reported prescribing DMPA to 10 or more adolescents (p = 0.074). Female physicians were more likely to have prescribed DMPA to adolescents than male physicians (p = 0.009). Mental retardation was considered the strongest "potential indication" for DMPA administration by 48 physicians responding to a 5-point Likert scale. The study suggests that physicians with interest or expertise in Adolescent Medicine are using DMPA as a form of birth control for selected young women in spite of the lack of Food and Drug Administration approval. A centralized DMPA registry is suggested to monitor adverse outcomes in users.

PIP: To assess medroxyprogesterone acetate (DMPA) prescription practices in adolescent health care practices, an anonymous questionnaire was distributed to 160 American and Canadian physicians who attended 1991 meetings of either the society for Adolescent Medicine or the North American Society for Pediatric and Adolescent Gynecology. Of 54 (33.7%) physicians who responded, 33 (61.1%) reported prior prescription of an injectable progestin (DMPA) as a form of birth control. Of those, 15 (45.5%) had prescribed it to 10 or more adolescents. 12 (57%) pediatricians, but only 3 (25%) gynecologists, reported prescribing DMPA to 10 or more adolescents (p = 0.074). Female physicians were more likely to have prescribed DMPA to adolescents than male physicians (p = 0.009). Mental retardation was considered the strongest "potential indication" for DMPA administration by 48 physicians who responded to a 5-point Likert scale. This study suggests that physicians with interest or expertise in adolescent medicine are using DMPA as a form of birth control for selected women in spite of the lack of FDA approval. A centralized DMPA registry is suggested to monitor adverse outcomes in users. author's modified

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1424622&dopt=Abstract birth control



birth control
Use of birth control pills and condoms among 17-19-year-old adolescents in Norway: contraceptive versus protective behaviour?

Traeen B, Lewin B, Sundet JM.

National Institute of Alcohol and Drug Research, Oslo, Norway.

This article addresses the relationship between sexual risk behaviour and contraceptive behaviour, and considers whether adolescents who use condoms are practising birth control or STD protective behaviour. The material comprised a representative sample of 3000 Norwegians aged 17-19 years. Data were collected by anonymous self-administered questionnaires. The response-rate was 63%. At the first sexual intercourse 51% of the adolescents used condoms and 7% birth control pills. At the most recent intercourse 31% used condoms and 38% the pill. Use of the pill was widespread among adolescents with high coital frequency and few coital partners. Use of condoms was not particularly widespread among adolescents who reported a relatively large number of coital partners. Irrespective of the number of years they had been coitally active there was no significant difference between those who intended to use condoms at the next sexual intercourse and those who did not as regards their beliefs about condoms as protection against STDs, HIV and unintended pregnancies. The results from this study indicate that the majority of adolescents who use contraception do this for protection against unintended pregnancy and not for protection against STDs. The preference for the pill may make teenagers less prepared to practise STD protective behaviour in specific situations.

PIP: A study was conducted to examine the relationship between coital frequency and risk behavior in relation to the number of coital partners and contraceptive/protective behavior and to study changes in contraceptive/protective techniques from 1st to most recent sexual intercourse. Data were gathered from 3000 Norwegians aged 17-19 years in anonymous self-administered questionnaires. A 63% response rate was achieved. 51% reported having used condoms at 1st intercourse, while 7% used contraceptive pills. 31%, however, used condoms most recently, while 38% employed the pill. Contraceptive pills were used most commonly among respondents with high coital frequency and few partners. Condom use was not particularly widespread among those with relatively large numbers of coital partners. Concerning beliefs about the ability of condoms to protect against sexually transmitted diseases (STD), HIV, and pregnancy, no significant differences were observed between those planning to use condoms and those not planning to use them at next coitus. In sum, results indicate that the majority of youths use condoms to protect against pregnancy, not STDs. The tendency toward serial monogamous relationships increases dependence upon the pill at the expense of the condom and makes sexually active teens less prepared to protect themselves against STDs in certain situations. Teens need to be taught about the protective value of condoms, with greater condom availability ensured where youths congregate.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1493144&dopt=Abstract birth control



birth control
Family planning, obstetrical and gynecological health care provision in the Soviet Far East.

Thomsen RJ.

Bassett Army Community Hospital, Fort Wainwright, AK 99703.

The Soviet model for both obstetrical and gynecological care and family planning provision seems entrenched in the Soviet Far East as found during a July 1991 visit to the Magadan and Chukotka Regions. Modern birth control is minimally practiced, but does include use of the older Soviet Loop intrauterine contraceptive device (IUD), recent introduction of the new Soviet Copper-T IUD and sporadic availability of condoms and foreign made birth control pills. Without male or female surgical sterilizations being performed, the consequence is that the major form of family planning is first trimester abortion. During this visit, I introduced the use of the NORPLANT Subdermal Contraceptive System and the Copper-T380A IUD to physicians at Anadry and Pevek regional hospitals. Gynecological surgery was also performed and fairly typical ob-gyn care units were toured. Ob-Gyn physicians in the Soviet Far East were found to be highly motivated. They look to the West for help in upgrading family planning and ob-gyn health care in the face of severe shortages after a half decade of perestroika.

PIP: The structure, strengths, and deficiencies of the Soviet model of both obstetrical and gynecological care and family planning provision in the Soviet Far East is described as found during a July 1991 medical expedition to the Magadan and Chukotka Regions. The mainstay of family planning is usually 1st trimester abortion. In the Chukotka Autonomous Region, in 1989, there were 198 registered abortions performed/100 live births while in 1990 there were 166 registered abortions/100 births. However, it is possible that the abortion rate is nearly 300/100 live births in the Soviet Far East. The main goal of the visit was to update professionals on the international status of modern birth control. Presentations were made on the Tcu380A IUD (Paragard), and the NORPLANT Subdermal Contraceptive System. NORPLANT or the Tcu380A IUD provide 5 and 6 years of contraction, respectively. A number of NORPLANT insertions were also performed at 2 hospitals. Modern birth control is minimal including the use of the older Soviet Loop IUD, a nonsterile Loop IUD copied after the Lippes Loop. Recently the new Soviet Copper-T IUD was introduced, and condoms (imported from China and Austria) and foreign-made birth control pills are available sporadically. There are no oral contraceptives manufactured in the Soviet Union. There was no evidence of widescale use of condoms in the Soviet Far East. AIDS is discussed widely and tested for in a limited way. Very few tubal sterilizations are performed on women, and no vasectomies are done. At the Pevek Regional Hospital assistance was rendered in surgery of 2 supracervical hysterectomies. There is limited availability of labor monitors, ultrasound, and life-saving equipment in the newborn nurseries. In the Chukotka Autonomous Region, the 1990 perinatal death rates were 18.9/100 live births for Russian women and 16.9/100 live births for native women. A medical effort and assistance from the West could improve these statistics.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1605341&dopt=Abstract birth control



birth control
A diaphragm tampon applied to an ovulation method in a birth control system.

Cattanach JF.

Natural Family Planning and Fertility Clinic, Vic., Melbourne, Australia.

Gynaeseal is a re-usable diaphragm tampon made from latex which forms a unique cervico-vaginal seal and isolates menstrual loss. In a prospective study involving 80 women, Gynaeseal was offered in combination with the Billings Ovulation Method in an advised birth control system. This system included: use of the diaphragm tampon during the menstruation-fertile phase interphase; periodic abstinence during the overtly fertile phase of the cycle; and if extreme reliability was required, for a further 2 days after the Billings method 'rules' allow resumption of intercourse. The diaphragm tampon successfully complemented the Billings Ovulation Method with 44 women (60.4%) assessing the GOM System as being as good, or better than, currently available reversible methods. It functioned effectively as a tampon with 50% (31 women) stating that they used the product as a contraceptive. One woman claimed an unplanned pregnancy. No significant medical complications were recorded. The product has major advantages as a tampon: it is easily and accurately inserted because of the efficient applicator; it isolated menstrual loss within a collection chamber; it protects the cervix; and it facilitates sexual activity. Based on a minimum effective diameter (62mm), the diaphragm tampon does not interfere with the normal physiology of the vagina. There appeared to be no significant distortion of normal adult pelvic anatomy, and properly placed, no sensation of the diaphragm tampon's presence. Regarding insertion of the diaphragm tampon using the spiral-curved applicator: 31 women (42.5%) had little or no difficulty; 29 (39.7%) moderate difficulty; 13 (17.8%) experienced serious difficulty; and 7 (8.7%) were unable to use the product.

PIP: Gynaeseal is a reusable diaphragm tampon made from latex which forms a unique cervicovaginal seal and isolates menstrual loss. In a prospective study involving 80 women. Gynaeseal was offered in combination with the Billings Ovulation Method in an advised birth control system. This system included use of the diaphragm tampon during menstruation-fertile phase interphase; periodic abstinence during the overtly fertile phase of the cycle; and if extreme reliability was required, for a further 2 days after the Billings method "rules" allow resumption of intercourse. The diaphragm tampon successfully complemented the Billings Ovulation Method with 44 women (60.4%) assessing the GOM system as being as good, or better than, currently available reversible methods. It functioned effectively as a tampon with 50% (31 women) stating that the product was superior to fiber tampons. 33 women (45.3%) stated that they used the product as a contraceptive. One woman experienced an unplanned pregnancy. No significant complications were recorded. The product has major advantages as a tampon--it is easily and accurately inserted with its efficient applicator; it isolates menstrual loss within a collection chamber; it protects the cervix; and it facilitates sexual activity. Based on a minimum effective diameter (62 mm), the diaphragm tampon does not interfere with the normal physiology of normal adult pelvic anatomy, and properly positioned, no sensation of the diaphragm tampon using the spiral-curved applicator, 31 women (942.5%) had little or no difficulty; 29 (39.7%) moderate difficulty; 13 (17.8%) experienced serious difficulty; and 7 (8.7%) were unable to use the product. author's modified

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1773618&dopt=Abstract birth control



birth control
New thinking in contraception.

Kubba A.

St Thomas' Hospital, London.

PIP: Contraceptive research and development is currently addressing the preservation of female fertility through birth control, the promotion of birth control as an essential component of a healthy life-style, and prevention of the spread of sexually transmitted diseases. The combined oral contraceptive (OC) remains the most popular birth control method, and the introduction of new progestogens has lowered the incidence of cycle control problems and improved metabolic data. As protection against human immunodeficiency virus (HIV) transmission becomes a central concern among contraceptive users, the condom has increased in popularity. Recent innovations in the field of barrier methods include the female condom and cervical cap; plastic is being tested as a component of male condoms. Advances in IUD technology include Cu-safe 300 (a slim device with an anti-expulsion design), the flexigard (a frameless device associated with reduced pain and bleeding), and levonorgestrel-releasing devices. Among new contraceptive delivery systems are the vaginal ring, Norplant, and monthly combined injectables. Bioself 110, an electronic fertility indicator, refines the practice of natural family planning. For postpartum contraception, researchers are working on a delivery system for natural progesterone, and lactational amenorrhea has gained recognition as an effective method of pregnancy prevention.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1843613&dopt=Abstract birth control



birth control
Patterns of contraceptive use among urban women in Taiwan.

Lethbridge DJ, Wang R.

Patterns of contraceptive use among married urban women in Taiwan were investigated. A convenience sample of 150 women attending health clinics for reasons other than contraceptive care were interviewed about their contraceptive use. The most prevalent contraceptive method used by these women was the intrauterine device, followed by the condom and birth-control pills. Participants had used only one or two contraceptive methods throughout their contraceptive careers, and many stated they were satisfied with their current method. Many participants were able to name the methods of birth control promoted by the Taiwan family-planning promotion program. Knowledge of alternative methods did not significantly relate to current method in use or to desire to change methods.

PIP: This contraceptive usage study among 150 married Chinese women of child bearing age attending health clinics in Taipei, Taiwan is concerned with determining contraceptive methods in current use, experience with and intent to use abortion, and knowledge of birth control methods. Clinics visits were unrelated to childbearing or pregnancy concerns. The sample population reflects a more highly educated population, where 30% were college educated compared to 6% in the Taiwan population 40 years. The mean age of marriage for the sample was 24 instead of 21 years. Study participants had a mean of 1.66 births, and although all were not actively seeking to become pregnant, 22% were not using any protective measures. The most common birth control method was the IUD (25w4%), which is greater than US use, followed by the condom, then the pill. The pill is less frequently used than in the U.S. Typical use (47%) involved 1 method only throughout their contraceptive careers. 26% had used 2 methods, and 7% 2 methods. 13% had tubal sterilization, which is lower than int he U.S. No spouses had vasectomies. 57% are using the IUD, pill, or condom. 19% had never used birth control. Of the 120 using a contraceptive method, 64% were unwilling to change method. 11% expressed interest in changing, and 25% were unsure. The desire to change method was not related to the method used. Satisfaction with the method used may reflect the ability to prevent pregnancy rather than the absence of side effects, which include menorrhagia and anemia. Exposure to speculative reports of cancer and pill use is limited. 25% admitted to having had a least 1 abortion; 17% had only 1 abortion compared to earlier reports of 44.6% having had 1 abortion. There was a correlation between the number of pregnancies and the years of marriage, and willingness to use abortion if pregnancy occurred. The age of 1st use of birth control and length of use of birth control were related to willingness. Reliability of use, and episodes of unprotected sex were not significantly related. The methods named as most frequently used were the same as those promoted by family planning programs. The mean number was 3.29. Knowledge was related to increased educational level. There was not a relationship to the number of methods named or desire to change methods. Increased knowledge of methods may be slightly related to abortions.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1955408&dopt=Abstract birth control



birth control
Patterns of contraceptive use and pregnancy among young Hispanic women on the Texas-Mexico border.

Russell AY, Williams MS, Farr PA, Schwab AJ, Plattsmier S.

Department of Pediatrics, School of Medicine, University of Texas Medical Branch, Galveston 77555-1307.

Our objective was to identify significant family planning and health access problems of young Hispanic women on the Texas-Mexico border. Samples of 300 young Hispanic women living in each of the twin cities of El Paso and Juarez were interviewed regarding their knowledge, attitudes, and experiences with respect to birth control, pregnancy, maternal and child health, and health-care services. Knowledge and attitudes of the women about birth control technology were assessed along with their beliefs regarding the use of such technology. Results showed that contraceptive knowledge and usage patterns for young Hispanic women in Juarez and El Paso were significantly different. They relied on different types of birth control methods and also differed with respect to confidence in these methods and related medical services. Both groups reflected positive attitudes toward both child bearing and use of birth control although Juarez women were significantly more favorable toward child bearing. Both groups overwhelmingly favored female doctors. The young women studied have accepted the need for birth control, prefer fewer children, and have some degree of confidence in medical services. Their knowledge and use of reliable versus unreliable birth control devices appear to be major areas requiring culturally sensitive intervention.

PIP: Social work students administered a questionnaire to 600 randomly selected adolescent females from El Paso, Texas, and Juarez, Mexico, to examine their knowledge and use of contraceptive methods and their attitudes about pregnancy, contraception, and child care. 11.7% of the El Paso respondents and 16.7% of the Juarez respondents had been pregnant at some time. Oral contraceptives (OCs) were the most known contraceptive method. Women in El Paso were more likely to be familiar with OCs (98% vs. 91.3%), condoms (93.7% vs. 74.7%), vaginal methods (79.7% vs. 67.8%), and withdrawal (65.3% vs. 44.5%) than were those in Juarez (p = .001). On the other hand, more Juarez women than El Paso women knew about injectables (79.8% vs. 34.1%), sterility or tubal ligation (89.9% vs. 63.3%), vasectomy (73.2% vs. 69%), Billing's method (19.2% vs. 5.3%), and the rhythm method (73.6% vs. 36.4%) (= = .001). Many women from both cities used ineffective methods. Women in Juarez were much more likely to use the rhythm method than those in El Paso (26.4% vs. 3.4%; p = .001). Women from both cities, particularly those in Juarez (p = .001), believed more information on contraception was needed. They felt strongly that men should also be responsible for family planning and approve of women using contraceptives. They believed that couples should have fewer children. Juarez women has a more positive view of pregnancy and childbearing than did El Paso women. El Paso women were more likely to visit a physician in the last year for reasons other than check-ups (mean number of visits, 1.88 vs. 1.25; p = .005). Most women preferred to receive maternal and child health/family planning services from a female physician (56% in Juarez and 64.3% in El Paso). These findings indicated that cultural differences in contraceptive knowledge and usage as well as confidence in various methods and related medical services existed. They emphasized the need for culturally relevant education, research, and service programs concerning adolescents in the Texas-Mexico border region.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8399249&dopt=Abstract birth control