Contraceptive continuation in high-risk women

Contraceptive continuation in 240 high-risk women was studied over a 24-month period. In the 192 women who actually used contraception, the gross cumulative continuation rate of 27 per 100 women and the pregnancy rate of 38 per 100 women demonstrated that their performance was below that of other reported series. The need for new approaches to the family planning care of these women is indicated (AU)

Some socio-cultural and medical problems related to family planning in Jamaica, West Indies

As a medical officer, the author came to appreciate the impact of poverty on the health and well-being of some rural Jamaican people. He offered contraceptive services as one means of alleviating the situation, but the response was poor. This was not as he had expected, or had been led to believe from earlier studies in Jamaica, so he determined to do further research on the problem, hoping that what would be learnt might be useful in the impending national programme. A KAP survey was first done in study and control populations; then a longitudinal study was set up in the study area, having several components. It aimed to test the stated intention of people against their action in making use of contraceptive service; and to compare the acceptability and use-effectiveness of three methods of contraception: the oral contraceptive, the I.U.D. and a vaginal foam preparation. An educational experiment was also done in the study area, using community leaders of various sorts, designated by the people themselves; they were to operate as agents of change, inducing the people in their communities to adopt contraceptive practices. Finally, there was a comparison of changes in knowledge, attitudes and practice in the study and control populations, the latter of which had no special birth control activities in the interim. Several things were found: The action of people in adopting contraception did not match their stated intentions; very few of the people promising to make use of the services did in fact do so. There was no difference in immediate acceptability of the contraceptive agents offered, but after three months of use the I.U.D. and the oral contraceptives were more acceptable than the foam preparation. The I.U.D. was found to have the greatest use-effectiveness, with the oral contraceptive next, and the foam the least. Due to small numbers, the condom was not compared. The educational experiment did not bring about any difference in the rate of recruitment of new clients from "treated" and "untreated" sections of this study area. After some three years of clinical and educational activities in the study area, there was increased knowledge of contraception and more favourable attitudes towards its use than there was previously; but there was only a very slight increase in its actual practice. These findings were true for both study and control areas (AU)

Some socio-economic and medical problems related to family planning in Jamaica, West Indies

As a medical officer, the author came to appreciate the impact of poverty on the health and well-being of some rural Jamaican people. He offered contraceptive services as one means of alleviating the situation, but the response was poor. This was not as he had expected, or had been led to believe from earlier studies in Jamaica, so he determined to do further research on the problem, hoping that what would be learnt might be useful in the impending national programme. A KAP survey was first done in study and control populations; then a longitudinal study was set up in the study area, having several components. It aimed to test the stated intention of people against their action in making use of a contraceptive service; and to compare the acceptability and use-effectiveness of three methods of contraception; the oral contraceptive, the I.U.D. and a vaginal foam preparation. An educational experiment was also done in the study area, using community leaders of various sorts, designated by the people themselves; they were to operate as agents of change, inducing people in their communities to adopt contraceptive practices. Finally, there was a comparison of changes in knowledge, attitudes and practice in the study and control populations, the latter of which had no special birth control activities in the interim. Several things were found: The action of people in adopting contraception did not match their stated intentions; very few of the people promising to make use of the services did in fact do so. There were no differences in immediate acceptability of the contraceptive agents offered, but after three months of use the I.U.D. and the oral contraceptives were more acceptable than the foam preparation. The I.U.D. was found to have the greatest use-effectiveness, with the oral contraceptive next, and the foam the least. Due to small numbers, the condom was not compared. The educational experiment did not bring about any differences in the rate of recruitment of new clients from "treated" sections of the study area. After some three years of clinical and educational activities in the study area, there was increased knowledge of contraception and more favourable attitudes towards its use than there was previously; but there was only a very slight increase in its actual practice. These findings were true for both study and control areas. An examination of trends in indices of fertility did not demonstrate lower rates in the study as compared with the control area. In fact the trend seemed to be for lower rates in the control area! Most women who attended the clinic had some pelvic pathology, usually minor. This sort of situation could have a grave negative effect on the use of the I.U.D. in particular; as stated above, this method has the greatest use-effectiveness. There were also several complaints judged to be unreasonably adduced to the use of the contraceptive agents. Very few men made use of the services; most of those who came used the condom irregularly. There are speculations about the reasons for non-adoption of contraceptive practices. These include the rural-agricultural and traditional way of life; and other social and cultural factors, including sexual and reproductive behaviour patterns, some of which have at least partly historical bases. The generally low level of education, which is shown to be a characteristic of these people, must have great influence on their adoption of contraception. Recommendations are made for more education-general and specific for contraception; and for greater economic opportunities for these people, which may potentiate their adoption of contraception. There is also a call for greater social support for the aged, which may replace the dependence on large families for old age support. (AU)