The role of partner influence in contraceptive adoption, discontinuation, and switching in a nationally representative cohort of Ugandan women.

BACKGROUND: Understanding contraceptive use dynamics is critical to addressing unmet need for contraception. Despite evidence that male partners may influence contraceptive decision-making, few studies have prospectively examined the supportive ways that men influence women's contraceptive use and continuation. OBJECTIVE: This study sought to understand the predictive effect of partner influence, defined as partner's fertility intentions and support for contraception, and discussions about avoiding pregnancy prior to contraceptive use, on contraceptive use dynamics (continuation, discontinuation, switching, adoption) over a one-year period. METHODS: This study uses nationally representative longitudinal data of Ugandan women aged 15-49 collected in 2018-2019 (n = 4,288 women baseline; n = 2,755 women one-year follow-up). Two analytic sub-samples of women in union and in need of contraception at baseline were used (n = 618 contraceptive users at baseline for discontinuation/switching analysis; n = 687 contraceptive non-users at baseline for adoption analysis). Primary dependent variables encompassed contraceptive use dynamics (continuation, discontinuation, switching, and adoption); three independent variables assessed partner influence. For each sub-sample, bivariate associations explored differences in sociodemographic and partner influences by contraceptive dynamics. Multinomial regression models were used to examine discontinuation and switching for contraceptive users at baseline; logistic regression identified predictors of contraceptive adoption among non-users at baseline. RESULTS: Among users at baseline, 26.3% of women switched methods and 31.5% discontinued contraceptive use by follow-up. Multinomial logistic regression, adjusting for women's characteristics, indicated the relative risk of contraceptive discontinuation doubled when women did not discuss pregnancy avoidance with their partner prior to contraceptive use. Partner influence was not related to method switching. Among non-users at baseline, partner support for future contraceptive use was associated with nearly three-fold increased odds of contraceptive adoption. SIGNIFICANCE: These results highlight the potentially supportive role of male partners in contraceptive adoption. Future research is encouraged to elucidate the complex pathways between couple-based decision-making and contraceptive dynamics through further prospective studies.

Historia del condón y otros métodos anticonceptivos / History of condoms and other contraceptive methods

El uso del condón es un método eficaz para prevenir enfermedades venéreas y un embarazo no deseado. Años atrás se puede apreciar cómo se debate dónde y cómo los llamados dispositivos intrauterinos fueron utilizados por primera vez. La siguiente investigación se realizó con el objetivo de explicar el surgimiento y la evolución del condón y otros métodos anticonceptivos, para ello se utilizaron un total de 15 referencias bibliográficas. Es indudable que la anticoncepción tiene que figurar como elemento básico de la atención en medicina, el conocimiento de sus orígenes, historia y evolución es fundamental. (AU)

The use of the condom is an effective method to prevent venereal diseases and an unwanted pregnancy. Years ago you can see how it is discussed where and how the so-called intrauterine devices were used for the first time. The following investigation was carried out with the objective of explaining the emergence and evolution of the condom and other contraceptive methods, for which a total of 15 bibliographical references were used. Undoubtedly, contraception must figure as a basic element of medical care, knowledge of its origins, history and evolution is fundamental. (AU)

Projections and opinions from 100 experts in long-acting reversible contraception.

OBJECTIVE: This survey of published researchers of long-acting reversible contraceptives (LARCs) examines their opinions about important barriers to LARC use in the United States (US), projections for LARC use in the absence of barriers and attitudes toward incentives for clinicians to provide and women to use LARC methods. STUDY DESIGN: We identified 182 authors of 59 peer-reviewed papers on LARC use published since 2013. A total of 104 completed an internet survey. We used descriptive and multivariate analyses to assess LARC use barriers and respondent characteristics associated with LARC projections and opinions. RESULTS: The most commonly identified barrier was the cost of the device (63%), followed by women's knowledge of safety, method acceptability and expectations about use. A shortage of trained providers was a commonly cited barrier, primarily of primary care providers (49%). Median and modal projections of LARC use in the absence of these barriers were 25-29% of contracepting women. There was limited support for provider incentives and almost no support for incentives for women to use LARC methods, primarily out of concern about coercion. CONCLUSIONS: Clinical and social science LARC experts project at least a doubling of the current US rate of LARC use if barriers to method provision and adoption are removed. While LARC experts recognize the promise of LARC methods to better meet women's contraceptive needs, they anticipate that the majority of US women will not choose LARC methods. Reducing unintended pregnancy rates will depend on knowledge, availability and use of a wider range of methods of contraception to meet women's individual needs. IMPLICATIONS: Efforts to increase LARC use need to meet the dual goals of increasing access to LARC methods and protecting women's reproductive autonomy. To accomplish this, we need reasonable expectations for use, provider training, low-cost devices and noncoercive counseling, rather than incentives for provision or use.

Current challenges in contraception in adolescents and young women.

PURPOSE OF REVIEW: Although developing countries have made much progress in expanding the availability and use of family planning services, the need for effective contraception is large, and growing because the largest cohorts in human history are entering their reproductive years. Not only regarding developing countries but also in developed countries, where the usual contraceptive methods, such as the oral contraceptives, intrauterine devices (IUDs) and condoms, have been available for decades, there have been many new advances in contraceptive technology in the last several years. New formulations of oral contraceptives, extended and continuous use of oral contraceptives and long-acting reversible contraceptives (LARC) may have a wider role in contraception and their increased implementation could help to reduce unintended pregnancy. RECENT FINDINGS: Today's oral contraceptive regimens are safer and more tolerable, with equal or improved efficacy as compared to early formulations. Incremental decreases in the estrogen dosage have helped to alleviate some of the unwanted estrogenic side effects of combined hormonal contraceptives. Progestogens have also been controversial in connection with findings of increased venous thromboembolism risks but they have evolved over time, and, in general, newer generations of progestins have minimal side effects. Currently available 'LARC' methods, such as IUDs, the intrauterine system, injectable contraceptives and implants require administration less than once per cycle or month. They are more cost effective than the combined oral contraceptive pill even at 1 year of use. Increasing the access and availability of new formulations of oral contraceptives and LARC methods will reduce the number of unintended pregnancies. SUMMARY: Evidence-based guidelines about the safety of contraceptive methods among women with comorbid medical conditions can help guide providers in determining the best method of contraception for each woman, depending on whether they are in their adolescent, postpartum or perimenopause years. As most patients can safely use highly effective methods of contraception, health providers should promote their use in order to further efforts to reduce unintended pregnancy. This promotion should be done by enabling women to make an informed choice among all contraceptive options.

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.

Guía de prevención del embarazo en la adolescencia en Guatemala / Guide to teenage pregnancy prevention in Guatemala

Guía de trabajo para contribuir a la prevención de embarazo en la adolescencia en donde se definen temas básicos que deben ser abordados desde los diferentes ámbitos de interrelación, tomando en cuenta la participación de los adolescentes, padres, líderes, educadores, comunidad así como los diferentes sectores, a través de acciones preventivas y educación para la salud. Entre las temáticas esenciales en el abordaje de los adolescentes se tienen: crecimiento y desarrollo, sexo, sexualidad, género, autoestima, violencia, ITS VHI/sida, paternidad y maternidad responsable, anticoncepción, aborto, creciendo con características especiales (discapacidad), proyecto de vida, entre otros.

Trends in family planning in Russia, 1994-2003.

CONTEXT: Although Russian women have adequate knowledge of modern contraceptives, their level of use of these methods has been low, and abortion rates remain relatively high. METHODS: In 1994-2003, sexually active women aged 18-49 were interviewed about their contraceptive use as part of the Russia Longitudinal Monitoring Survey. Trends in contraceptive use were examined. Multivariate analyses were conducted to identify characteristics associated with reliable contraceptive use (IUD use or consistent oral contraceptive use) in 1994 and 2003. RESULTS: In each year, about 25% of sexually active women had used no contraceptive method in the past month, and 20% had used traditional methods. Prevalence of barrier method use increased from 9% to 21% between 1994 and 2003, while that of IUD use declined from 34% to 21%. These changes were especially pronounced in Moscow and St. Petersburg, and among younger women. Common reasons for nonuse were irregular sexual relations (cited by 29% of nonusers in 2003), desire for pregnancy (22%), perceived inability to get pregnant (15%), feeling that contraceptives are uncomfortable or unpleasant (15%), health problems (11%) and the availability of abortion (6%). In 1994 and 2003, the odds of reliable contraceptive use were elevated among women with at least a secondary education (odds ratios, 1.5-1.7), and were reduced among smokers (0.6-0.7). CONCLUSIONS: Modern, effective contraceptive use has not increased among sexually active Russian women. Growing use of barrier contraceptives may reflect HIV awareness. Obstacles to effective contraceptive use, such as attitudes and health service factors, need further clarification.

New contraceptive choices.

Family planning users and providers have been calling for more choices. They want contraceptive methods that provide highly effective protection and at the same time cause fewer side effects, cost less, and are easier to use. In response, researchers are improving existing contraceptives and developing new ways to deliver hormones. Offering a wide range of safe, effective, and convenient family planning methods encourages more people to use contraception. Having more choices helps ensure that users are satisfied with their family planning method. Most new methods reaching the market today result from investments made years ago. Virtually all methods undergo a long process of research and rigorous testing for safety and effectiveness and must obtain regulatory approvals before becoming available.

Creencias vinculadas al uso del preservativo masculino en adolescentes españoles sexualmente activos / Beliefs linked to the usage of male condom in sexually active spanish teenagers

El objeto de este trabajo es identificar qué creencias sobre el preservativo masculino influyen en su uso. Participan en esta investigación 315 adolescentes activos sexualmente (55.6 por ciento de los hombres y 44,6 porciento de mujeres) con una media de edad de 18 a 27 años

New contraceptive choices across reproductive life.

The range of contraceptive options and consumer awareness of new contraceptive methods have both increased significantly over the past 10 years. New methods available in Australia include lower-dose oral contraceptive pills, new oral progestogens, progestogen implants, a progestogen-bearing intrauterine device and polyurethane female condoms. Contraceptive options which may soon be introduced in Australia include novel methods of administering combined (oestrogen-progestogen) contraception, such as dermal patches and vaginal rings.

Still waiting for the contraceptive revolution.

PIP: There was considerable anticipation in the mid-1960s with the marketing and uptake of the oral contraceptive pill and the IUD that many other new forms of contraception would be available to the general public before the turn of the century. Much of that enthusiasm about contraceptive advances has since waned. Only three new contraceptive methods received US Food and Drug Administration approval during the 1990s, none as soon as advocates had expected, while the only other important changes were the gradual adjustment of pill formulations to expose users to a smaller total dosage of hormones and the introduction of new hormones already widely used in Europe. The lack of decisive advances is not the result of a paucity of candidate methods. In 1993, for example, an estimated 100 experimental contraceptive methods were being studied around the world. Many of those methods had, however, been in the works for years, while others were only slight modifications of products already on the market. Regulatory and legal issues, public opinion and politics, and financial issues have been identified as key obstacles to why the contraceptive reality has failed to match 1960s expectations. The author explains who sponsors contraceptive research and describes the ongoing development of spermicides and barrier methods, injectables, vaginal rings, implants, IUDs, methods for men, vaccines, and menses induction.^ieng

Trends in contraception and sterilization in Australia.

Life-history data collected in a national survey of women in 1986 are used to derive the first national estimates of trends in contraception and sterilization in Australia over the last 30 years. The pill rapidly became the method of choice after its release in 1961. The intrauterine device, the other truly modern method, has never attained the same popularity. The move toward sterilization dates from the early 1970s and has been so complete that women of 35 or older are now more likely to be protected by a ligation or laparoscopic sterilization than by the pill or, indeed, by all other methods combined. Unmarried women are now indistinguishable from married women on the basis of their use of contraception, and childless married women are now more likely to be using a reversible method than married women with children.

PIP: This article presents data -- the first of its kind -- on national trends in contraception and sterilization in Australia from 1956-86. As part of a life-history survey of Australian women, researchers interviewed 2,547 women aged 20-59, collecting data on the use of contraception over time. The data indicates that use of traditional methods of contraception (withdrawal, periodic abstinence, etc.) was most common among the oldest women. However, no more than 12% of any age group relied on traditional methods. The use of modern methods has increased more rapidly than the use of traditional methods has declined. Since their introduction in 1961, oral contraceptives quickly became the preferred method. In 1986, 1/2 of all women in their early 20s were using oral contraceptives, as well as 2/5 of women in their late 20s, and 1/4 of the women in their early 30s. The data indicates that the younger the woman, the less likely she is to have relied on a contraceptive method other than the pill. Another important development concerns the reliance on sterilization, which began in the early 1970s. Among women 35 and older, reliance on sterilization has surpassed the use of oral contraceptives. In 1986, 35% of women 40-44 had received a tubal ligation and 11% had undergone a hysterectomy. Also, 16% of these women had partners who had undergone a vasectomy. Condoms and other coitus-related methods were not found to be very popular. However, the study does point out that the use of condoms for noncontraceptive reasons (STDs and AIDS prevention) could increase. Finally, the study revealed no difference in contraceptive use between married and unmarried women, but did show that childless women were more likely to use a reversible contraceptive than women with children.

Trends in postpartum contraceptive choice.

Patterns of postpartum contraceptive choice are analyzed in a middle class private practice population between the years 1966 and 1981. The effect of age, parity, difficulty in conceiving, future pregnancy plans, and type of delivery are noted. A general decline in the use of oral contraceptives and intrauterine devices with a corresponding increase in the use of barrier methods is documented. Although very few changes among contraceptive techniques occurred between six weeks and six months post partum, an appreciable number of patients, more than half the sample, did change contraceptive techniques between pregnancies. Thus, women perceive different needs at different times during their reproductive lives. To serve patients effectively, a wide range of contraceptives must be available to accommodate changing demands.