birth control
Fertility in women after age forty-five.

Kushner DH.

Pregnancy after age 45 years is infrequent and the mother and baby should be considered as a high risk. There is a greater incidence of spontaneous abortion, gestational trophoblastic disease and chromosomal abnormalities in the fetus. Birth control practices should be discontinued after 49 years of age in the best interest of the woman's sexuality if abortion is acceptable to her. The patient should be completely informed of the risks and, in the event of pregnancy, abortion should be advised.

PIP: Data relating to pregnancies at age 45 years and older at Columbia Hospital for Women in Washington, D.C. during the 1967-1977 period are presented. The data were obtained from the individual medical records of 72,005 pregnant women selected on review of computerized summary reports of the annual admissions of private and staff obstetrical patients to the hospital. 105 charts of private patients 48-55 years were reviewed in relation to pregnancy and menstrual abnormalities. On the basis of age and obstetrical history, the patients were selected for inclusion in this study. They were contrasted according to age, gravidity, parity, abortions, outcome of pregnancy, complications, and birth control practices. There were 10 patients who menstruated to age 55 with an occasional missed period, 63 patients menstruated regularly to age 50, and the remainder had irregular menses before complete cessation of menstruation. None of these patients after age 49 years used contraception or hormone replacement therapy. 25 of this group had endometrial biopsies as an office procedure or hospital dilatation and curettage for irregular bleeding. 8 of the 25 demonstrated secretory endometrium with evidence of ovulation. There were no pregnancies in this group of women. There were 82 pregnancies that occurred in women 45 years of age and older. The oldest in this group delivered 6 days after her 49th birthday and 1 week beyond her expected date of confinement. This was her 10th pregnancy. There were 24,779 abortions in the study period. The total number of induced abortions during the period was 17,869 with 31 patients 45-51 years of age. There were 4 patients 48-49 years of age and 1 patient 51 years. The data collected reconfirm that pregnancies in older women are infrequent and must be considered as high risk. The gynecologist should counsel the patient realistically as to her chances of becoming pregnant after age 48. The risk of pregnancy in the older woman relative to the risk of various birth control practices must be carefully weighed.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=45103&dopt=Abstract birth control



birth control
Knowledge and attitudes of family planning in Khartoum Province, Sudan.

Khalifa M.

PIP: Data on contraceptive knowledge and attitudes, collected in a 1977 fertility survey undertaken in the Khartoum Province of the Sudan by the Sudan Family Planning Association, was presented. The data, collected from an urban sample of 1474 wives and 1036 husbands and a rural sample of 494 wives and 264 husbands was analyzed primarily by constructing percent distributions. Knowledge of contraception was fairly high. Among rural respondents, 99% of the wives and 97% of the husbands were aware of birth control. Respective figures for the urban sample were 99% and 98%. Among the 2753 respondents who knew of at least 1 method of birth control, all except 7 rural husbands were familiar with OCs. More than 3/4 of the rural women knew about injectables, IUDs, and lactation. 86% of the rural women were also aware of female sterilization; however, only 26% knew about male sterilization. Among the rural women, knowledge of diaphragms, condoms, rhythm, abstinence, and withdrawal ranged from 32%-50%. Knowledge of specific methods tended to be slightly higher among urban women than among rural women; however, only 44% of the urban women compared to 88% of the rural women were aware of lactation as a birth control method. Urban wives were similar to rural women in that the proportion aware of female sterilization (90%) was higher than the proportion aware of male sterilization (41%). In urban areas, husbands were somewhat less knowledgeable about specific methods than wives, and this same pattern was observed among rural respondents. Urban men tended to be more knowedgeable about birth control than rural men. Despite the relatively high knowledge levels, the use of birth control was disapproved of by many of the respondents. Among the rural wives, 36% disapproved of birth control, 49% approved of birth control, 12% approved of it only under certain circumstances, and 3% had no opinion. Respective figures for urban women were 29%, 56%, 12%, and 3%. Respective figures for rural men were 52%, 23%, 22%, and 3%, and for urban men they were 47%, 30%, 22%, and 1%. In both urban and rural areas, the level of approval was highest among educated women, recently married women, and women of high socioeconomic status. In urban areas, women who grew up in urban environments were more likely to approve of birth control than women with rural backgrounds. For both urban and rural men, the level of approval was highest among recently married men and among men with high socioeconomic status. Among rural women who approved of birth control only under certain circumstances, 83% approved of using birth control when maternal health was endangered, 42% approved its use to prevent births under adverse economic conditions, 29% approved its use to limit family size, and 38% approved its use for spacing births. Respective figures for urban women were 56%, 42%, 37%, and 34%. The respondents were asked why they approved or disapproved of family planning. Major reasons for disapproving of birth control were that it was contrary to religious beliefs and harmful to maternal health. Major reasons for approving the use of birth control were that it made it possible to give better care to each child, it eased the financial burden on the family, and it contributed toward maternal health. The reasons given by male and female respondents were very similar. The major findings were presented in a set of 8 tables.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12267407&dopt=Abstract birth control



birth control
[Attitude of patients and health workers as a factor influencing the utilization of reproductive health services in connection with birth control]

[Article in Bulgarian]

Nalbanski B.

PIP: In an effort to develop a comprehensive system of birth control, the role of various demographic, social, economic, psychological and medical factors in family planning in Bulgaria are reviewed. Demographic survey of 1830 women indicates the leading role of socioeconomic factors in family planning: 34.2% of the women used birth control methods because of the need to work and 15.1% because of financial difficulties. The efficacy of family planning depends upon the method of contraception. In Bulgaria, 75% of married couples use coitus interruptus, 7% use condoms, 6% use biological methods, and 2.5% use chemical spermicides. Underutilization of oral contraceptive (oc) agents is associated with negative attitude of some women to "new" methods, shortages of pills, negative attitude of health personnel, and fear that hormonal agents have irreversible side effects. These findings emphasize the need for continuous education of married women in safety and effectiveness of oc agents and IUDs.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=474932&dopt=Abstract birth control



birth control
Coital and contraceptive behavior of female adolescents.

Reichelt PA.

Structural interviews conducted with 532 female clients of a teen contraceptive clinic revealed a moderate level of coital activity i(in terms of both frequency of intercourse and number of partners) which typically began at age 15. Prior use of contraception was sporadic and almost exclusively confined to nonprescription methods. Primary reasons for nonuse of birth control included fear of lessening the pleasure of intercourse and lack of access to contraception. The data indicate that a combination of comprehensive sex education and ready access to birth control is necessary to prevent unintended adolescent pregnancy.

PIP: In 1975, a survey of 532 teenage women (under 18) was conducted at a teen center in a large midwestern town. The sample was 70% white, the rest mostly black, and averaged age 16.1 years. 4% had dropped out of school. 92% of the 423 sexually active women were engaged in a monogamous relationship. 56.1% had intercourse with only 1 partner in 1 year; 23.2% had 2 partners. The average age at first sexual experience is 15. Prior use of contraception was sporadic and almost exclusively confined to nonprescription methods. Lack of access to contraception and fear of lessening sexual pleasure were the primary reasons for nonuse of birth control. Data indicates that a combination of comprehensive sex education and ready access to birth control is necessary to prevent unintended adolescent pregnancy. 40% had used withdrawal; 36.9% spermicides; and 60% condoms. Those teenagers who are older at first intercouse tend to use contraception more than younger teenagers.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=475577&dopt=Abstract birth control



birth control
Reversible sterilization: socio-ethical considerations.

Largey G.

PIP: Advances in microsurgical techniques and increased knowledge about the effects of different sterilization methods have led to successful reversals of this procedure in men and women. Reversible sterilizations, therefore, will probably become important as a temporary means of birth control. This medical probability raises the following social and ethical questions about use of the procedure. When used as a means of voluntary birth control, should physicians sterilize the partner in whom reversal is easiest? And should they perform only reversible procedures? Should legislation governing reversible sterilizations be different from that which currently exists? Does use of this method of birth control threaten human rights since reversal is not within the power of an individual to accomplish without a physician? Should welfare recipients be required to undergo the procedure, and if so under what circumstances would reversal be available to them? Are regulations on the sterillization of mentally retarded persons based on the current presumed irreversibility of the procedure, and under what circumstances should retarded persons undergo reversals? Should mentally ill persons be required to undergo sterilization as a prerequisite for return to the community from a sexually segregated institution, and how are the rights of the patients' spouses to procreate considered? What circumstances would govern the use of sterilization as a prerequisite for prisoners to have conjugal visitation or to be incarcerated in co-ed prisons? How would requests for reversals by prisoners be decided? These questions are important when considering the effects of a method of birth control which severely limits an individual's control over the reproductive function of his or her body.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=705361&dopt=Abstract birth control



birth control
[Contraception before pregnancy. Evolution between 1972 and 1975 in the Rhone-Alpes region (author's transl)]

[Article in French]

Blondel B, Breart G, Rumeau-Rouquette C.

The studies was made from two enquiries carried out on women who delivered in June 1972 and 1975 in the Rhone-Alpes region. Contraception therefore dealt exclusively with birth control before a pregnancy. It is clear that contraception has developed significantly: it is practised by 48% of women who were questioned in 1975 as compared with 41% in 1972. There is also a change in the last method used between the two dates: the pill featured in only 17% of all the method used in 1972 and 45% in 1975: on the other hand coitus interruptus went down from 41% to 21%. The spread of the use of the pill is a generalised phenomenon whereas there are several categories of women who do not seem to have used, coitus interruptus less frequently. As far as the social classes are concerned, it is to be pointed out that only non-skilled working-class people have not changed their habits as far as these two methods are concerned. Contraception is practised with more and more success as a method of birth control: on the one hand the number of conceptions which occurred when the women was using a birth control method has gone down from 27% in 1972 to 15% in 1975: on the other hand 51% of those who used a birth control method stopped using it in order to have a baby, whereas in 1972 only 32% did so. Parallel with this evolution, one can point out that the number of women who have 2 or more children has gone down. On the other hand the number of conceptions before marriage and the rhythm of the way the families are constituted has not changed between the two dates.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=712039&dopt=Abstract birth control



birth control
Self-esteem, locus of control, and adolescent contraception.

Herold ES, Goodwin MS, Lero DS.

The relationships between locus of control, self-esteem, and attitudes to contraception and contraceptive behaviors were assessed for 486 single women of ages 13 to 20, attending 10 birth control centers in Southern Ontario, Canada. The Ss voluntarily filled out a questionnaire, and the data were measured with the Fatalism scale of Reid and Ware's I-E scale, a Likert-type self-esteem scale, and a semantic differential birth control pill scale. There were no significant relationships between locus of control and any of the contraception variables. Ss with high self-esteem were found to have positive attitudes toward using birth control pills, to be less embarrassed about obtaining contraception, and to be more effective and consistent contraceptive users.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=759623&dopt=Abstract birth control