An Intervention Delivered by Mobile Phone Instant Messaging to Increase Acceptability and Use of Effective Contraception Among Young Women in Bolivia: Randomized Controlled Trial.

BACKGROUND: Although the most effective methods of contraception are available in Bolivia, unmet need for contraception among women aged 15 to 19 years is estimated to be 38% (2008), and the adolescent fertility rate is 71 per 1000 women (2016). Mobile phones are a popular mode to deliver health behavior support. We developed a contraceptive behavioral intervention for young Bolivian women delivered by mobile phone and guided by behavioral science. The intervention consists of short instant messages sent through an app over 4 months. OBJECTIVE: This trial aimed to evaluate the effect of the intervention on young Bolivian women's use of and attitudes toward the effective contraceptive methods available in Bolivia. METHODS: This was a parallel group, individually randomized superiority trial with a 1:1 allocation ratio. Women were eligible if they were aged 16 to 24 years, owned a personal Android mobile phone, lived in La Paz or El Alto, reported an unmet need for contraception, and could read Spanish. The target sample size was 1310 participants. Participants allocated to the intervention had access to an app with standard family planning information and intervention messages. Participants allocated to the control group had access to the same app and control messages. Coprimary outcomes were use of effective contraception and acceptability of at least one method of effective contraception at 4 months. Secondary outcomes were use of effective contraception during the study, acceptability of the individual methods, service uptake, unintended pregnancy, and abortion. Process outcomes included knowledge, perceived norms, personal agency, and intention. Outcomes were analyzed using logistic and linear regression. We also asked participants about physical violence. RESULTS: A total of 640 participants were enrolled, and 67.0% (429) of them contributed follow-up data for the coprimary outcome, the use of effective contraception. There was no evidence that use differed between the groups (33% control vs 37% intervention; adjusted odds ratio [OR] 1.19, 95% CI 0.80 to 1.77; P=.40). There was a borderline significant effect regarding acceptability (63% control vs 72% intervention; adjusted OR 1.49, 95% CI 0.98 to 2.28; P=.06). There were no statistically significant differences in any of the secondary or process outcomes. The intervention dose received was low. In the control group, 2.8% (6/207) reported experiencing physical violence compared with 1.9% (4/202) in the intervention group (Fisher exact test P=.75). CONCLUSIONS: This trial was unable to provide definitive conclusions regarding the effect of the intervention on use and acceptability of effective contraception because of under recruitment. Although we cannot strongly recommend implementation, the results suggest that it would be safe and may increase the acceptability of effective contraception if the intervention messages were offered alongside the download of the app. TRIAL REGISTRATION: ClinicalTrials.gov NCT02905526; https://clinicaltrials.gov/ct2/show/NCT02905526.

Quarter of a century of female sterilization in Jos, Central Nigeria.

The study was to assess the types and trend of female sterilization between January 1985 and December 2009 (25 years) in Jos, Central Nigeria. There were 25,313 new acceptors of modern contraceptive methods out of which 4,951 (19.6%) were female sterilizations. Minilaparotomy was the commonest method of female sterilization. Local anaesthesia was the commonest anaesthetic utilized. The women were mostly women of relatively older age, grandmultiparous and with large family size. The women were of mean of 38.4 years, and 60% had more than 5 children at the time of sterilization. Interval sterilization constituted 78.5% of the female sterilizations. The acceptance of female sterilization, however, has declined over the years, as acceptance of the long acting contraceptive implants increases. Female sterilization by minilaparotomy under local anaesthesia was found to be feasible, cost effective and acceptable by majority of clients, and recommended for integration into minor gynaecological procedures in our institutions.

Failure rates among perfect users and during perfect use: a distinction that matters.

To make an informed decision when choosing a contraceptive, women and couples need to know how effective different methods are when used perfectly, where perfect use is defined as following the directions for use. In this article, we show that unbiased estimates of pregnancy rates during perfect use can be guaranteed only if information on consistency and correctness of use is available for each menstrual cycle. The estimated probability of pregnancy during a year of perfect use among the subset of women who always used a method perfectly will be biased upward.

Warning about contraceptive device given.

PIP: The British Department of Health has issued a warning that the contraceptive device Persona may be an unreliable method of fertility control. This method tests hormone levels in urine to enable women to avoid unprotected intercourse during the fertile phase of the menstrual cycle. A pre-marketing clinical trial conducted by Upipath, the manufacturer of Persona, claimed a 94% reliability rate. However, the Medical Devices Agency has been unable to substantiate this claim and received numerous complaints from users, general practitioners, and trading standards officers. The warning letter advises physicians that, although Persona is basically a test-based form of the rhythm method, its technological basis may raise user expectations of accuracy. The letter notes that users should be aware a 94% reliability may also be expressed as a risk of 1 in 17 users becoming pregnant per 12 months of use. Persona is not considered suitable for women whose menstrual cycles do not fall into the 23-35 day range, those who have recently given birth or are breast feeding, and users of hormonal contraception.^ieng

First FDA medical device regulations will affect development of many experimental contraceptives.

PIP: New Food and Drug Administration regulations designed to protect human subjects involved in clinical testing of experimental devices require obtaining consent from each experimental subject after he or she is informed of possible risks, and reporting of any unanticipated adverse effects to the FDA within 20 days. Responsibility for adhering to the standards is divided between the manufacturer, who is forbidden to make a profit from clinical trials, the clinical investigator, and the Institutional Review Board. Implants intended to remain in the body 30 days or more are specifically included as significant risk devices, and this ruling will affect research on many devices designed to be implanted in the fallopian tubes and vas deferens and on IUDs not containing physiologically active components. Many contraceptive devices besides implants are affected, as are all instruments and most reagents used in prenatal diagnostic testing. The manufacturer is required to file a final report on the investigation to the FDA within 6 months of completion of tests. Once the FDA has ruled on whether a new device may be marketed, the agency has the authority to release a detailed summary of the clinical trials.^ieng

[Evaluation of local contraceptives]. / Einschätzung lokaler Kontrazeptiva.

PIP: The content of a radio discussion concerning local contraceptive methods is summarized. The condom, contraceptive foam, and diaphragm have a 97% rate of effectiveness and are indicated for 20-30% of contraceptive users. This is true especially of teenagers, where the condom can help prevent the spread of venereal disease. Physicians seem to be prejudiced against local contraceptive methods. Spermicidal preparations have not been shown to have a damaging effect on sperm or ovum. The IUD is 97-98% effective and is indicated for 20-30% of the cases, while oral contraceptives are 99.6% effective and are indicated for 30-40% of the population.^ieng

Contraceptive specifications: report on a workshop.

PIP: It was suggested at a meeting in 1967 on the behavioral sciences and family planning programs that social scientists should be involved in the design of new contraceptives. The Center of Population Research and the Population Council held a 2-day workshop in August 1969 to develop a more rational approach to the design of new contraceptives by working out the specifications for the variety of methods suitable for use by different population groups. The potential impact of improved contraception is great. According to the 1965 National Fertility Survey, 20% of all births occurring between 1960-1965 were unwanted. If 3/4 of these births were averted, a reduction of 15% in the number of births in 1960-1965 would have taken place. Characteristics of contraceptives are numerous, and it is recommended that the goal should be a variety of methods that would be useful under differing circumstances. In the development of new methods of contraception, it is acceptability, even more than effectiveness, that investigators are trying to improve. There are a number of social and psychological factors affecting acceptability. The kinds of contraceptives considered acceptable may differ at various stages of family growth. Contraceptives must be dependable, acceptable, harmless, simple, and cheap. In making observations and suggestions for research, it was noted that the development of an ideal contraceptive that is universally preferred is unlikely. Research should aim toward an improved contraceptive system or technology--a variety of methods rather than a single best method.^ieng