birth control
Dimensions of personality organization as predictors of teenage pregnancy risk.

Hart B, Hilton I.

Pace University.

Personality development as measured by Loevinger's Washington University Sentence Completion Test, The Friedman Developmental Level Scoring System for the Rorschach, The Urist Mutuality of Autonomy Scale, The Thematic Apperception Test, and indexes from a structured interview were able to discriminate between teenagers at high- and low-risk for pregnancy. In addition, these measures correlated significantly with each other and enabled a description and comparison of the personality characteristics of adolescents who are at risk for pregnancy and those who are not.

PIP: The hypothesis of this study is that determinative dimensions of personality structure, which can be identified by projective tests, can be used to predict whether late adolescents are or are not at risk for pregnancy. The subjects were 161 never-married college women, aged 17-20 who were classified into 4 groups: 60 who had never had sexual intercourse, 35 sexually active women who always used reliable birth control, 34 sexually active women who did not use contraceptives or did not use reliable ones all the time, and 32 pregnant women who planned to carry the pregnancy to term. The tests used were: Loevinger's Washington University Sentence Completion Test, the Friedman Developmental Level Scoring System for the Rorschach test, the Urist Mutuality of Autonomy Scale for the Rorschach test, the Thematic Apperception Test, and indexes from a structured clinical interview. The birth control group demonstrated high levels of ego development, superego development affective integration, differentiation of psychic development, interpersonal relatedness, capacity for empathy, cognitive maturity, defense structure, self-object differentiation and autonomy. They had a deep awareness of the transition from adolescence to adulthood, recognized their parents as autonomous individuals, used birth control to prevent any disruption in their pursuit of longterm goals, and relied on their own personal moral code. The sexually inactive group demonstrated a reluctance to abandon childhood, closeness to parents and siblings rather than to their peers, conventional "righteous" moral attitudes, primitive defense structure, and faulty ego development. The pregnant group also demonstrated psychic and emotional immaturity, faulty ego development, weak superego, and low regard for social values. They regarded the baby as their ticket to adulthood as well as a restitution for past wrongs and something that belonged to them alone to love and be loved by. The nonbirth control group demonstrated the most variability as well as the most internal conflict between their sexual activity and their needs for parental approval and religious sanction. They were emotionally dependent on family and therefore felt guilt, which they externalized as anger and impulsive risk-taking behavior. The results of this study indicate that prevention of pregnancy among teenagers requires, not only contraceptive advice, but also education in self-awareness and understanding of their personal values and goals as well as the needs and separateness of others.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3361408&dopt=Abstract birth control



birth control
First family planning visits by young women.

Mosher WD, Horn MC.

Family Growth Survey Branch, National Center for Health Statistics.

Data from the 1982 National Survey of Family Growth indicate that among sexually active women aged 15-24, friends and parents are the main sources of referral for first family planning visits. Friends are the leading referral source for women who attend clinics, and parents are the leading referral source for those who go to private doctors. Despite the importance of confidentiality to many teenagers, women who make their first family planning visit before the age of 17 are more likely to be referred by their parents than are those whose first visit occurs when they are 17 or older. Race, age at first visit and income influence women's choice of a provider (clinic or private doctor). Black women, low-income women and younger women are considerably more likely than their counterparts to use a clinic at first family planning visit. At their first visit, sixty-seven percent of women receive birth control counseling, and only 50 percent begin using a contraceptive method. Among clinic users, white women are more likely than black women to begin a birth control method (50 percent vs. 40 percent). Women whose first visit takes place before their first conception (including those who have never been pregnant) are much more likely than women whose first visit occurs after their first pregnancy ends to begin a method. Women who make their first visit during their first pregnancy are more likely than those who are not pregnant to receive a pregnancy test or counseling on matters other than birth control.(ABSTRACT TRUNCATED AT 250 WORDS)

PIP: Data from the 1982 National Survey of Family Growth indicate that among sexually active women aged 15-24, friends and parents are the main sources of referral for 1st family planning visits. Friends are the leading referral source for women who attend clinics, and parents are the leading referral source for those who go to private doctors. Despite the importance of confidentiality to many teenagers, women who make their 1st family planning visit before the age of 17 are more likely to be referred by their parents than are those whose 1st visit occurs when they are 17 or older. Race, age at 1st visit and income influence women's choice of a provider. Black women, low-income women and younger women are considerably more likely than their counterparts to use a clinic at 1st family planning visit. At their 1st visit, 67% of women receive birth control counseling, and only 50% begin using a contraceptive method. Among clinic users, white women are more likely than black women to begin a birth control method (50% vs 40%). Women whose 1st visit takes place before their 1st conception (including those who have never been pregnant) are much more likely than women whose 1st visit occurs after their 1st pregnancy ends to begin a method. Women who make their 1st visit during their 1st pregnancy are more likely than those who are not pregnant to receive a pregnancy test or counseling on matters other than birth control. Multivariate analysis shows that the timing of the visit in relation to the 1st pregnancy is a very important determinant of services received at 1st visit. Only 17% of young women who have ever had intercourse make their 1st family planning visit before 1st intercourse, and 10% make their 1st visit in the same month as 1st intercourse. For the remaining 73% of women, the median delay between 1st intercourse and 1st visit is 23 months. Even women whose 2nd intercourse occurs with 1 month of 1st intercourse experience a median delay from 1st intercourse to 1st visit of 19 months. author's modified

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3371468&dopt=Abstract birth control



birth control
[Birth control in the Netherlands, 1982 and 1988]

[Article in Dutch]

Beets GC.

Analysis of family planning and contraceptive use in the Netherlands for 1988 reveals that "a large share of the [female] population practices reliable methods of birth control. At young ages many girls already take the pill. As the rates of sexual intercourse by age do not differ very much from elsewhere in the western world...the Netherlands can also be characterized as a country with a very low incidence of teenage pregnancy and abortion. From the differential analysis it can be concluded that nonuse of birth control methods coincides with the absence of a male partner. Women with a partner, depending on the completeness of their family, use very reliable methods (pill, IUD, condom or sterilization)." Statistical information on the use of various methods is also presented. (SUMMARY IN ENG) excerpt

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12281687&dopt=Abstract birth control



birth control
Associations of parity, breast-feeding, and birth control pills with lumbar spine and femoral neck bone densities.

Hreshchyshyn MM, Hopkins A, Zylstra S, Anbar M.

Department of Gynecology and Obstetrics, School of Medicine and Biomedical Sciences, State University of New York, Buffalo 14214.

The relationships between parity, breast-feeding, and the use of birth control pills and the bone densities of the lumbar spine and the femoral neck, measured by dual-photon densitometry, were studied in normal women. Femoral neck density was found to decrease by 1.1% per live-birth, whereas lumbar spine density showed no significant association with parity. Breast-feeding was found to increase lumbar spine density by 1.5% per breast-fed child, whereas femoral neck density was not significantly correlated. No significant relationships between the use of birth control pills and the bone densities were found.

PIP: Researchers measured the bone densities of the lumbar spine and the femoral neck using dual-photon densitometry in 352 normal women (range: 21 to 79 years old) in order to study the relationship between the bone densities and parity, breast feeding, and the use of oral contraceptives (OCs). Since the most common manifestations of osteoporosis, a bone disease most often afflicting elderly women, include spinal compression factors and fractures of the femoral neck, the scientists wanted to learn if parity, breast feeding, and the use of OCs increase the risk of acquiring this chronic bone disease. Femoral neck density decreased 1.1% per live birth (p = .039), whereas there was no significant difference between parity and lumbar spine density (p [alpha] = .16; p [beta] = 0). Lumbar spine density increased by 1.5% per breast-fed infant (p = .008), while no significant correlation existed between femoral neck density and breast feeding. Furthermore, researchers observed no significant relationships between OC use and both bone densities. In conclusion, since pregnancy and lactation involve complex hormonal and nonhormonal changes, the researchers find it difficult to pinpoint the mechanisms of these effects.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3407686&dopt=Abstract birth control



birth control
Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause.

Stanton MF, Lowenstein FW.

Mean serum magnesium values with one standard deviation are presented for 224 women during pregnancy and 1559 women taking birth control pills, with 4145 women, aged 15-49 years, as controls. In addition, similar data are presented for 2,884 women, aged 50-74 years, after menopause. All these women were surveyed in the first National Health and Nutrition Examination Survey in the United States of America, 1971-1974 (NHANES I). Information on use of birth control pills is based on two questions taken from the NHANES I medical history interview. Pregnant women had significantly lower serum magnesium values than controls (nonpregnant and no birth control pills), regardless of age or race. Women on the pill also showed significantly lower serum magnesium values than other nonpregnant women of similar age, but the differences were much smaller than those between pregnant women and controls. Women older than 50 years (postmenopausal women) had significantly higher serum magnesium values than premenopausal women. These findings are compared with similar findings from other studies in the United States and other parts of the world.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3611529&dopt=Abstract birth control



birth control
A social psychologic model of female adolescents' compliance with contraceptives.

DuRant RH, Jay MS.

PIP: A theoretical model is proposed to help the clinician organize the multiple interrelationships between factors that may influence a female adolescent's compliance with her birth control method. 1 variable that has been found to be predictive for compliance in adults that was not included in the model is the quality of the patient-physician relationship. This variable was excluded because the model is a social psychological model that focuses on the attitudes and behavior of the female adolescent. The female adolescent's perception of the quality of her relationship with her health care provider can be accounted for under the component of the model discussing costs of acquiring birth control. A table contains a checklist of information the clinician may want to obtain from a patient to help determine if she may be at risk for noncompliance. Factors that influence contraceptive compliance are reviewed: frequency of sexual intercourse, perceived probability of pregnancy, premarital sexual standards and experiences, intimacy of sexual relationship, physical and emotional development, cognitive assessment of pregnancy, parental and peer support, and personality development. Lindemann and DeLamater argue that frequency of intercourse is the "prime mover" in the process of acquiring and using birth control. As the frequency of coitus increases or decreases, awareness of the possibility will increase or decrease. DeLamater hypothesizes that before assessing that pregnancy may be undesirable and thus initiating contraceptive use to prevent pregnancy, a woman 1st must perceive that she is at significant risk for becoming pregnant. Russ proposes that a major reason that sexually active female adolescents fail to use effective birth control is that they do not fully accept sexual intercourse as morally acceptable for themselves and thus are unable to rationally prepare for it. Rains argues that when a female adolescent initiates sexual activity, she is in a state of moral ambivalence, which is defined as being unable to accept her own sexual activity. Based on available data, it is proposed that female adolescent physical development, postmenarcheal age, and length of time since 1st intercourse will be positively associated with both coital frequency and contraceptive compliance. The model also specifies that several factors will have a direct effect on contraceptive compliance, independent of the influence of frequency of sexual intercourse. These include the female adolescent's cognitive assessment of pregnancy, parental and peer support, and their personality development.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3629018&dopt=Abstract birth control



birth control
Comparative analysis of the effectiveness of the diaphragm and birth control pill during the first year of use among suburban adolescents.

Fisher M, Marks A, Trieller K.

Department of Pediatrics, North Shore University Hospital, Cornell University Medical College, New York, NY.

Little attention has been paid to the diaphragm as a contraceptive option for adolescents. To compare diaphragm and birth control pill use by adolescents, 124 females (aged 13-20 years) in a suburban-based adolescent health service were interviewed at least one year after receiving a contraceptive prescription. The 73 diaphragm choosers did not differ from the 51 pill choosers in age, race, or reason for their original visit to the health service. Diaphragm choosers, however, were better students, of higher socioeconomic status, and had had fewer prior pregnancies. In the year following prescription, continuous use for 12 months was reported by 43% of diaphragm choosers and 45% of pill choosers, with significantly more pill (26%) than diaphragm (8%) choosers reporting discontinued use for at least one month while remaining sexually active. Regular use (diaphragm every intercourse, missing less than or equal to 1 pill/month) was reported by 36% of diaphragm choosers compared to 88% of pill choosers; and at least one pregnancy during the year was reported by 15% of diaphragm choosers and 18% of pill choosers. At follow-up interviews, diaphragm subjects disliked the immediate annoyances of the diaphragm, and pill users expressed concern about the potential side effects of the pill. No single factor or set of factors correlated with continuous and regular use of either method. Because both methods present specific problems for certain patients, we suggest that in addition to the pill, the diaphragm should receive serious consideration as a contraceptive option for adolescents.

PIP: Little attention has been paid to the diaphragm as a contraceptive option for adolescents. To compare diaphragm and birth control pill use by adolescents, 124 females (aged 13-20 years) in a suburban-based US adolescent health service were interviewed at least 1 year after receiving a contraceptive prescription. The 73 diaphragm choosers did not differ from the 51 pill choosers in age, race, or reason for their original visit to the health service. Diaphragm choosers, however, were better students, of higher socioeconomic status, and had fewer prior pregnancies. In the year following prescription, continuous use for 12 months was reported by 43% of diaphragm choosers and 45% of pill choosers, with significantly more pill (26%) than diaphragm (8%) choosers reporting discontinued use for at least 1 month while remaining sexually active. Regular use (diaphragm every intercourse missing or=1 pill/month) was reported by 36% of diaphragm choosers compared to 88% of pill choosers; and at least 1 pregnancy during the year was reported by 15% of diaphragm choosers and 18% of pill choosers. At follow-up interviews, diaphragm subjects disliked the immediate annoyances of the diaphragm, and pill users expressed concern about the potential side effects of the pill. No single factor or set of factors correlated with continuous or regular use of either method. Because both methods present specific problems for certain patients, it is suggested that in addition to the pill, the diaphragm should receive serious consideration as a contraceptive option for adolescents.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3667392&dopt=Abstract birth control