birth control
Contraceptive practices of female physicians.

Zbella EA, Vermesh M, Gleicher N.

To evaluate a potential bias between methods of birth control used and prescribed by physicians, we surveyed sexually active female physicians in regards to their own methods of birth control. When the contraceptive practices of female physicians are compared to those of the general population, no difference in use of various contraceptive methods is found. Among female obstetrician-gynecologists, however, the intrauterine device continues to be a disproportionally popular method of contraception. It is concluded that no gender bias exists in prescribing patterns of contraceptives since contraceptive use in female physicians is identical to that of the general populations.

PIP: To evaluate a potential bias between methods of birth control used and prescribed by physicians, the authors surveyed sexually active female physicians in regards to their own methods of birth control. In Chicago in 1984, the authors distributed 1000 questionnaires; 314 were completed. Of these 314 respondents, 235 were between ages 25 and 44 and were sexually active. Results show that 10% used oral contraceptives, 14% used IUDs, 32% used some form of barrier method, 23% were sterilized, and 8% used the rhythm method. 13% used no form of birth control. When contraceptive methods by age group are compared between female physicians and the general population, there is no difference with 1 exception: female physicians aged 25-35 show a lower rate of sterilization than the general population (3% versus 12%). Once medical training and childbearing are completed, sterilization becomes the most common method of contraception. With increasing age, female physicians exhibit the same trends in contraceptive choice as the general population, namely decreasing use of oral contraceptives and barrier methods and a more steady use of the IUD and the rhythm method. Female physicians expose themselves to the possibility of unwanted pregnancy to the same extent as the general population. A surprising finding was the relative increase in IUD use among female obstetrician-gynecologists when compared to all other female physicians as well as to the general population. Since no difference in the use of the various contraceptive methods was noted between female physicians and the general population, it can also be concluded that apparently no gender bias exists among physicians who provide contraceptive advice.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3757510&dopt=Abstract birth control



birth control
Male involvement in family planning.

Spencer B.

PIP: The prevailing focus of birth control programs on women's methods is a result of the prevailing attitude that the purpose of birth control measures is to protect women from excessive child bearing while allowing men to have their pleasure and escape the consequences of their actions. Male methods of contraception, such as coitus interruptus and condoms, although they have historically played a far greater role than women's methods, are denigrated as being unreliable or associated with extramarital sex respectively. Family planning clinics promote diaphragms, cervical caps, or pills in preference to condoms or coitus interruptus. Only 8% of the world contraceptive budget is spent on male methods. In the UK, family planning services are available free -- to women. If men choose sterilization, they are expected to pay for it themselves. Nevertheless, the increasing popularity of vasectomy shows that men are willing to accept responsibility for birth control. Male involvement needs to be promoted through small-scale studies and social marketing technics away from the medical setting, and condoms and vasectomy services must be available. The pill has placed the responsibility for birth control on the woman, but the responsibility must be shared, no matter which partner initiates the contraceptive precaution. The importance of behavioral factors is shown by the fact that most contraceptive failures are due to human error.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12282033&dopt=Abstract birth control



birth control
Definitive birth control and the physician--ethical issues.

Sobel RJ, Gert B.

We analyze the ethical issues related to the physician's role in informing about, advising, rejecting, or performing a definitive birth control procedure (sterilization). We define a rational request for tubal ligation, the limited delaying (or facilitating) role that guidelines for deciding on ligation should have, the justifiable reasons for rejecting a request, and the physician's obligations and options. We also consider the need to supply adequate information, the implications of recommending a second-best treatment, and the pivotal place of the "likelihood of regret" in medical decision-making.

PIP: The ethical issues relating to the physician's role in informing about, advising, rejecting, or performing sterilization are analyzed. Attention is directed to the following: what constitutes a rational request for this definitive procedure; the proper use of guidelines--rules or criteria--by the physician in responding to a request; the dimensions of adequate information; the implications of recommending an alternative, 2nd-best treatment; and the options and obligations of the physician. To harm oneself without adequate reason is an irrational act; as tubal ligation is an intrinsically harmful act, it must be justified by an adequate reason. An adequate reason is precisely defined as a conscious and rational belief in the direct or indirect benefits to be gained from the procedure. The future good resulting from tubal ligation must outweigh the intrinsic harm. A guideline whose intent is to reject functions as an absolute barrier. A guideline whose use may lead to a delay serves to give the individual time to act thoughtfully, wisely, and carefully. The guidelines, rules, or criteria for performing, advising, accepting, or rejecting tubal ligation appropriately fall into this latter category. The function of these guidelines is to test whether a woman is likely to regret her decision to have a tubal ligation. Age, parity, marital status, socioeconomic state, and general health each are relevant considerations in testing a request for permanent birth control. None are absolute barriers. Each of these considerations, including any medical disorders the patient may have, are subsidiary rather than primary determinants. They are weighted by the physician as he or she decides on the likelihood of the patient regretting her decision. A woman can make a rational request for sterilization only if she has been properly informed. The woman of reproductive age should be well informed about all accepted methods of birth control, including methods directly involving her partner. It is unlikely that there will be any intractable disagreements if: the rationality of the request is appreciated by the physician; his or her application of the guidelines for tubal ligation requests reflects an understanding of the limited purpose of these guidelines; and he or she is impeccable in fully informing the woman of her rational options.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3793442&dopt=Abstract birth control



birth control
Birth control failure among patients with unwanted pregnancies: 1982-1984.

Sophocles AM Jr, Brozovich EM.

Three hundred twenty-three patients who underwent abortion counseling between 1982 and 1984 were interviewed to determine the cause of birth control failure. Twenty-three percent employed no birth control and 27 percent used diaphragms, the majority either inconsistently or incorrectly. Twenty-two percent of the pregnancies were due to oral contraceptive-related failures; and the remainder were due to spermicide, condom, rhythm method, multiple method, and intrauterine device failures. Overall, fewer than one quarter of unwanted pregnancies among the predominantly white, middle-class population studied resulted from failure to obtain contraception, and only 19 percent represented technical failure despite correct and consistent use. The majority (51 percent) occurred because of human error, ie, either incorrect or inconsistent use of available contraceptive modalities. These findings contrast sharply with those of a similar study performed between 1969 and 1974. At that time failure to obtain contraception accounted for more than one half of the failures. Whereas the development and distribution of contraceptive technology was the challenge of the 1960s and the 1970s, reducing the number of birth control failures through anticipatory patient counseling is the challenge of the current decade.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3941300&dopt=Abstract birth control



birth control
Development of a decision aid for women choosing a method of birth control.

Wall EM.

The choice of a contraceptive method is complex and difficult. This study identifies issues for concern for women in selecting a birth control method, examines the accuracy of a self-administered questionnaire based upon these outcomes in predicting actual use, and in a preliminary fashion evaluates the usefulness of such an instrument as a decision aid. A questionnaire was designed to assess women's perceptions of the likelihood of each issue of concern for four birth control methods--oral contraceptives, intrauterine device (IUD), diaphragm, and foam or condoms--as well as the relative value of each issue. It was then tested among a convenience sample of 106 women. A weighted score was constructed by combining likelihood and value estimates for each contraceptive method. The method with the highest score was compared with actual contraceptive use and the intention to use such methods in the future. Positive predictive values were highest for pill use (83 percent) and lowest for IUD use (40 percent). While 65 percent of the sample were satisfied with their current method, 60 percent also found the questionnaire helpful. This attitude was most prevalent among younger, unmarried women. A decision aid for contraceptive decision making appears to be reasonably predictive of actual contraceptive use and helpful in thinking about the choice of a birth control method.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=4056670&dopt=Abstract birth control



birth control
[Implementation and expansion of family planning services: questions and controversies]

[Article in Portuguese]

Canesqui AM.

PIP: Even though the Brazilian government's position on birth control in the last few years has been ambiguous, it is moving away from the pro-life attitude that was prevalent in the 1960s and through the mid-1970s. The economic conditions during this period created a sense of urgency in establishing family planning programs to divert possible economic and social repercussions. The creation and expansion of family planning services in the last 2 decades have improved the distribution of contraceptives, related health care, and research. The problems of birth control and family planning are the same in Brazil as in the rest of the world. There is and always will be a moral, ethical, religious, or political question from the groups that traditionally oppose these concepts. The theme of responsible birth control is 1 of the tools used in the attempt to get the message across. Some results of irresponsible birth control are abortions, poverty, and misery. Proposals for integrating the various family planning services have not been implemented due to a lack of priorities in spending the available funds. Most of these health groups place responsibility for providing these methods of family planning upon the State. The groups say the State needs to consider women's freedom, sexuality and personal preferences in providing the family planning programs. A few groups prefer private sector sponsorship in order to preserve the woman's options concerning health care. The need for health care and the question of democracy both need to be taken into consideration when dealing with human reproduction. Attention should also be paid to the quality of health service, in order to guarantee less distortion of the issue and provide better medical care for all.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3852389&dopt=Abstract birth control



birth control
Communication and contraceptive practices in adolescent couples.

Polit-O'Hara D, Kahn JR.

This study presents a descriptive analysis of the content, frequency, and timing of couple communication regarding birth control among stable, sexually active adolescent couples, and the effect of communication on actual contraceptive practices. The sample consisted of 83 couples in which the female partner was 15-18 years old. All couples had been sexually active at least two months prior to the interview. The majority of couples had discussed birth control on at least one occasion, but discussions prior to first intercourse were atypical. Couples with good communication patterns were more likely to practice effective contraception. One-fourth of the respondents felt that contraception had not been adequately discussed, and these individuals were found to be most at risk to an unintended pregnancy.

PIP: This study presents a descriptive analysis of the content, frequency, and timing of couple communication regarding birth control among stable, sexually active adolescent couples in the Greater Boston area, and the effect of communication on actual contraceptive practices. The sample consists of 83 couples in which the female partner was 15-18 years old. All couples had been sexually active at least 2 months prior to the interview. The majority of couples had discussed birth control on at least 1 occasion, but discussions prior to 1st intercourse were atypical. Couples with good communication patterns were more likely to practice effective contraception. 1/4 of the respondents felt that contraception had not been adequately discussed, and these individuals were found to be most at risk to an unintended pregnancy. Couples were recruited by means of a public service announcement aired on several rock stations in the Greater Boston area. Each teenager was paid US$20 for participating in the study. The 83 couples were heterogeneous with respect to socioeconomic status, type of residence and personal ambitions. Respondents were from large cities with over 100,000 population (33.7%) as well as small towns of under 25,000 (38%). 70% of respondents had spent their childhood in 2-parent families, although only 40% resided in 2-parent households when interviewed. 51% were Catholics and 52% expected a college education. The mean age was 16.9 for girls and 18.5 for boys. The couples were interviewed separately, but simultaneously for 1-1 1/2 hours. 3 forms of data were used: 1) a topic guide to gather information about the subjects' living arrangements, family and friendship patterns; 2) an interview schedule consisting of 124 questions on the subjects' sexual activity, contraceptive knowledge and practices, and communication; 3) 52 Likert-type items designed to measure attitudes toward birth control, risk-taking, self-esteem, goal orientation, communicativeness, and couple intimacy. Results clearly indicate that conversations per se about birth control were not sufficient to cause couples to practice effective birth control e.g. the pill. Even frequency of such discussions was not a determinative factor. Rather, the quality of the interaction was more important to decision-making. The most commonly reported type of discussion focused on whether or not the girl should go on the pill. Effective communication may not lead to joint decision-making and hence to effective contraception, but may represent a means of negotiating acquiescence once a decision has been made by 1 partner. A cognitive/behavioral approach may be useful in teaching decision-making.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3984813&dopt=Abstract birth control