Recent use of condoms and emergency contraception by women who selected condoms as their contraceptive method

Twelve-month follow-up of advance provision of emergency contraception among teenage girls in Sweden-a randomized controlled trial

OBJECTIVE

The objective of this study was to evaluate the effect of an intervention with advance provision of emergency contraceptive pills (ECP), condoms, and extended information to a targeted group of teenage girls, compared with a control group, 12 months after intervention.

MATERIAL AND METHODS

A randomized controlled trial among 420 girls, 15-19 years old, requesting emergency contraception at a youth clinic in Sweden was carried out. Data were collected by a questionnaire at the initial visit and structured telephone interviews 12 months after enrolment. Differences between the intervention group and the control group regarding ECP use, time interval from unprotected intercourse to ECP intake, contraceptive use, and sexual risk-taking were analysed.

RESULTS

One year after the intervention 62% of the girls could be reached for follow-up. The girls in the intervention group reported a shorter time interval (mean 15.3 hours) from unprotected intercourse to ECP intake compared to the control group (mean 25.8 hours) (p = 0.019), without any evidence of decreased use of contraceptives or increased sexual risk-taking.

CONCLUSION

Even up to 12 months following the intervention, advance provision of ECP at one single occasion, to a specific target group of adolescent girls, shortens the time interval from unprotected intercourse to pill intake, without jeopardizing contraceptive use or increasing sexual risk-taking. Considering the clinical relevance of these results, we suggest that advance provision of ECP could be implemented as a routine preventive measure for this target group.

Unprotected intercourse among women wanting to avoid pregnancy: attitudes, behaviors, and beliefs

OBJECTIVE

To better understand the behaviors associated with unintended pregnancy, including the frequency and reasons why women engage in unprotected intercourse (UI), to help guide efforts to prevent unintended pregnancy.

METHODS

We surveyed 1,392 women with no history of abortion in 13 family planning clinics across the United States regarding the frequency with which they engaged in UI, the reasons for engaging in UI, attitudes toward UI, and their knowledge about the risks of conception.

RESULTS

Nearly half (46%) of respondents engaged in UI within the past 3 months, mostly owing to barriers accessing birth control (49%), not planning to have sex (45%), and the belief that they could not get pregnant (42%). The most prevalent attitudes about UI were that it "feels better" (42%) or "more natural" (41%). Factors associated with an increased odds of having engaged in UI, included holding the views that UI is okay at certain times, feels better, and is more natural, underestimating the risk of conception from 1 year of UI, experiencing difficulty getting birth control prescriptions, having less than a college education, being ages 20 to 24, and being African American/Black.

CONCLUSION

Compared with our research on abortion clients, family planning clients report high, yet somewhat lower, rates of UI, similar reasons for having UI, and misconceptions about the risk of conception from repeated acts of UI. Long-acting, reversible contraception may offer some of the benefits of UI in terms of spontaneity and pleasure, while reducing women's pregnancy risk.

Use of levonorgestrel emergency contraception in Utah: is it more than "plan B"?

CONTEXT

It is important to understand why some women use levonorgestrel emergency contraceptive pills repeatedly, because the method is not intended for repeated use, and current evidence suggests that it is approximately 77% effective at preventing pregnancy.

METHODS

An anonymous patient survey of 1,040 women aged 18-29 purchasing levonorgestrel at Planned Parenthood clinics in Utah was conducted during a 4-6-week period in 2007. Chi-square tests and analyses of variance were used to examine associations between selected characteristics and level of levonorgestrel use. Logistic regression was used to assess characteristics independently associated with repeated use.

RESULTS

Twenty-nine percent of participants had used levonorgestrel more than twice in the prior year. Fifty-eight percent believed that levonorgestrel is at least 90% effective in protecting against pregnancy; 16% believed that it is 100% effective. In univariate analyses, lifetime number of partners, currently having multiple partners, substance use at last intercourse and perceived effectiveness of levonorgestrel were positively associated with repeated levonorgestrel use in the previous year. The measure most strongly associated with repeated levonorgestrel use in multivariate analyses was perceived effectiveness: Women who believed that the method is 90-99% or 100% effective in preventing pregnancy had greater odds of repeated use than those who believed it is 75-89% effective (odds ratios, 1.8 each).

CONCLUSION

Women who repeatedly use levonorgestrel may have an inflated perception of its effectiveness. Future research, including qualitative research, may help clarify factors that lead to inflated perceptions of effectiveness.

Safety, Efficacy, and Patient Acceptability of the Copper T-380A Intrauterine Contraceptive Device

The ParaGard Copper T 380A intrauterine device (CuT380A) provides reversible contraception that is as effective as sterilization for up to 20 years. The CuT380A is a mainstream, first-line contraceptive option for most healthy women, including nulligravid women, as well as many women who have serious medical problems. Because it is the most cost-effective method of birth control, the CuT380A is the preferred IUD, except for women who desire lighter or no menstrual blood loss. Surveys reveal that 95% of US CuT380A users are “very” or “somewhat” satisfied with their method. This article describes current candidates for IUD use, discusses the mechanisms of action of the CuT380A, provides guidance to reduce barriers to IUD access, suggests counseling points for patients, and outlines techniques to reduce the risks and side effects that can be associated with use of the CuT380A.