Contraception in Germany: a review

Ready, Willing, and Able: Contraceptive Use Patterns Across Europe

An "East-West" divide in contraceptive use patterns has been identified across Europe, with Western European countries characterized by the widespread use of modern contraception, and Central and Eastern European countries characterized by a high prevalence of withdrawal, the rhythm method, or abortion. Building on the Ready-Willing-Able framework, this study aims to gain more insight into the micro- and macro-level socioeconomic, cultural, and technological determinants underlying contraceptive use. Data from the Generations and Gender Survey (2004-2011) covering four Western and seven Central and Eastern European countries are used, and multinomial multilevel analyses are performed. Results reveal that individuals who intend to delay parenthood are more likely to use any contraceptive method, whereas holding more traditional values and having a lower socioeconomic status are associated with a higher likelihood of using no or only traditional methods. Regional reproductive rights and gender equality interact in complex ways with these associations. At minimum, our results underline the complexity of the processes underlying the persistent difference in contraceptive use across Europe.

Factors influencing the contraceptive method choice: a university hospital experience

OBJECTIVE

To analyze the factors influencing behavior of women in choosing contraceptive methods.

MATERIAL AND METHODS

A total of 4022 women who were admitted to our clinic in a year, were the subjects in this current study for contraception choices. Relationship between the current contraceptive choice and the age, marital status, educational level, gravidity and induced abortions were evaluated.

RESULTS

Current users of any contraceptive methods were found to make up thirty-three percent of the entire study population. The most preferred method of contraception was an intrauterine device (46.4%), followed by, condom (19.2%), coitus interruptus (16.4%), tubal sterilization (11%), oral contraceptives (5.7%) and lastly the "other methods" that consisted of depot injectables and implants (1.2%). Among other contraceptive methods, the condom was found to be used mostly by the younger age group (OR:0.956, 95% CI:0.936-0.976, p<0.001), while tubal sterilization was preferred mainly by the elderly population (p<0.001, OR:1.091, 95% CI:1.062-1.122). Women that have a higher educational level, were found to use OC (76.3%, OR:5.970, 95% CI:3.233-11.022), tubal sterilization (59.6%, OR:4.110, 95% CI:2.694-6.271) and other methods (62.5%, OR:3.279, 95% CI:1.033-10.402) more commonly than the low educational group (p<0.001).

CONCLUSION

These results demonstrated that the rates of both contraception utilization and the usage of more effective methods of contraception need to be increased by providing better family planning systems and counselling opportunities.

[From a method for family planning to a differentiating lifestyle drug: images of the pill and its consumer in gynaecological advertising since the 1960s in West Germany and France]

Based upon flyers and advertisements for the contraceptive pill from 1961 until 2005, this paper discusses the ways in which the drug and its female users were represented in the marketing of two West European countries, France and the German Federal Republic. As my analysis suggests, national differences are only discernible in the marketing until the end of the 1970s. In West Germany, the pill was depicted from early on as a contraceptive, whereas, due to the restrictive legal situation, in France the pill was marketed as a multi-purpose drug. Nevertheless, the sources in both countries emphasized the safety of the drug. Likewise the representations of women changed from the notion of the married mother to a more diverse image, including young, modern and active women. From the early 1980s on, French and German materials conformed to one another. Now more classification systems were developed, emphasizing the differences between types of pills and types of women. Lifestyle, leisure and fun became increasingly central topics. Correspondingly, the female user was often portrayed in a sexualized way and represented as an active consumer with individual needs and wishes.

Change in contraceptive choices and the effect of education on use of contraception at the family planning clinic of Şişli Etfal Training and Research Hospital, Istanbul, Turkey

OBJECTIVE

To investigate change in contraceptive use and the effect of education on fertility and contraceptive attitudes at our family planning clinic.

METHODS

For this retrospective review, medical charts from Sişli Etfal Training and Research Hospital Family Planning Center were obtained. Records were evaluated for 2514 women in 1997 and 2268 women in 2002.

RESULTS

During the 6-year period studied, significant decreases occurred in the number of births, elective abortions, gravidity and number of living children (p < 0.001). When the patterns of method use were compared, use of intrauterine devices and of coitus interruptus diminished whereas pill and condom use increased. Parallel with the rise in educational level, intrauterine device use declined whereas pill and condom use rose significantly (p < 0.001).

CONCLUSION

The sociocultural and educational levels of women affect their contraceptive choices. Policies aimed at raising the socioeconomic and educational level of women should be supported to prevent maternal and fetal complications as a result of unwanted pregnancies.

Women's satisfaction with birth control: a population survey of physical and psychological effects of oral contraceptives, intrauterine devices, condoms, natural family planning, and sterilization among 1466 women

User satisfaction and the physical and psychological effects of five commonly used contraceptive methods were investigated in a population survey among 1466 West German women. The focus was on effects attributed by current and past users to these methods, rather than objectively assessed effects, to shed further light on personal experiences that are highly relevant to the user but often remain unknown to prescribers and unreported in the medical literature. Within the overall sample, 1303 women were surveyed concerning their current or past use of oral contraceptives (OC), 996 regarding condoms, 342 with respect to intrauterine devices (IUD), 428 in regard to natural family planning (NFP), and 139 in relation to sterilization (respondents completed questions about each method used). It emerged that satisfaction was greatest with sterilization (92% of users), followed by OC (68% of ever users), IUD (59%), NFP (43%), and condoms (30%). Almost one in three NFP users had experienced an unwanted pregnancy during use of this method, as compared with one in 20 OC and condom users. The majority of users reported no mood changes during use of the methods studied. The percentages reporting negative mood changes (various items were scored) were up to 16% among OC users, 23% among condom users, and 30% among NFP users. The latter observations suggested that subjective side effects of a contraceptive agent on mood generally reflected, at least in part, the user's sense of confidence in the method concerned (notably, with regard to efficacy and safety). Oral contraceptives, IUD, and sterilization had a broadly positive impact on sex life, whereas that of condoms was often negative. Whereas OC users often reported less heavy and painful menstruation (in up to 56% of cases), IUD were associated with heavier, prolonged, and more painful menstruation (in up to 65% of cases), as also was sterilization, although to a lesser extent (in up to 32% of cases). Overall, the study findings indicated that OC and sterilization had less negative impact on physical and psychological functioning than the other methods studied, in contrast to what the general public often believes.

Is asthma an endocrine disease?

The prevalence of pediatric asthma has increased in many parts of the world. This increase started more than 30 years ago and is particularly obvious in studies which document the onset of asthma in native populations when they change to a "Western" lifestyle. Besides a genetic influence, numerous environmental factors have been described for the development of asthma. Genetic factors are unlikely to explain the sharp increase within the short time period and also allergen and pollution exposure or any specific infection does not actually seem to be the main cause for this phenomenon. Another factor, however, that fits well into the geographical and temporal background of the asthma epidemic is the mother's oral contraceptive use. We therefore review the epidemiological association with later asthma in the children, give a summary of estrogen effects on immune function and develop a preliminary theory how oral contraception could influence later pregnancy.

Minimizing the problem of poor compliance in adolescents. Clinical experience with a modern low-dose gestodene-containing oral contraceptive

Adolescents represent a particularly difficult group with respect to compliance. Not only is incorrect pill intake a common problem, but unnecessary discontinuation also occurs regularly. Reasons for poor compliance are varied, but inadequate information and problems with cycle control and weight gain are particularly important. Choosing a well-tolerated oral contraceptive can help to improve compliance, and clinical experience from a large, multicenter trial suggests that monophasic gestodene (75 micrograms gestodene/30 micrograms ethinylestradiol) is a suitable preparation for this group of women. An investigation of 5,602 adolescents with an average age of 16.4 years found good contraceptive reliability and excellent cycle control. The incidence of spotting and breakthrough bleeding was low and declined during the course of the study. The preparation was tolerated well, and the incidence of adverse events was low, with only 4.4% of women withdrawing from the study due to adverse events. An increase in body weight was uncommon. At the end of the study, 85.0% of adolescents rated monophasic gestodene as good and 9.6% as satisfactory.

Contraceptive use and attitudes in reunified Germany

Contraceptive use and attitudes were assessed in a random sample of 1064 German women. The majority (76%) of the sexually active, fertile women who were not pregnant and did not wish to get pregnant at the time of the survey were using very reliable contraceptive methods, namely oral contraceptives (OCs), intrauterine devices (IUDs) or sterilization. Comparison with a previous survey showed that contraceptive practice in West Germany had improved considerably since 1985. Attitudes towards the most reliable methods available (OCs, IUDs and sterilization) were found to be ambivalent. Perceived side effects and health risks were a particular matter of concern to the respondents. Although most respondents (88%) recognized that condoms prevent the transmission of AIDS, 66% of those who had occasional sexual partners did not use barrier methods. It is concluded that German contraceptive practice is reasonably effective and that if attitudes were to become more realistic the level of effectiveness could even be raised.