Use of contraceptive methods in Spain: results of a national survey☆

Trends in contraception use in Spanish adolescents and young adults (15 to 24 years) between 2002 and 2008

OBJECTIVE

To assess changes in the use of contraceptive methods, and induced abortion rates, in Spanish adolescents and young adults aged 15 to 24 years, between 2002 and 2008.

STUDY DESIGN

Representative samples of Spanish men and women aged 15 to 24 years were surveyed in 2002 (N = 1826) and 2008 (N = 2000).

RESULTS

The rate of use of contraceptive methods increased from 61% in men and 60% in women in 2002 to 80% and 75%, respectively, in 2008. The most commonly used method was the condom (51% in 2002 and 71% in 2008), followed by the contraceptive pill (18% in 2002 and 18% in 2008). None of the adolescents and young adults surveyed used natural methods or the diaphragm, or had undergone sterilisation. The induced abortion rate increased from 9.28 to 13.48 per 1000 women in the group aged between 15 and 19 years, and from 14.37 to 21.05 per 1000 women in the group aged 20 to 24 years.

CONCLUSION

Despite an increase in the use of effective birth control methods, the rates of abortion rose during the study period, which may indicate that compliance with the use of condoms is inadequate. There is an urgent need to develop educational campaigns or to design specific policies addressing contraception-related issues for young people.

Trends in the use of contraceptive methods and voluntary interruption of pregnancy in the Spanish population during 1997-2007

BACKGROUND

This study was designed to acquire information about the use of contraceptive methods in order to reduce the number of elective abortions.

STUDY DESIGN

Since 1997, representative samples of Spanish women of childbearing potential (15-49 years) have been surveyed by the Daphne Team every 2 years to gather data of contraceptive methods used.

RESULTS

During the study period, 1997 to 2007, the overall use of contraceptive methods increased from 49.1% to 79.9%. The most commonly used method was the condom (an increase from 21% to 38.8%), followed by the pill (an increase from 14.2% to 20.3%). Female sterilization and IUDs decreased slightly and were used by less than 5% of women in 2007. The elective abortion rate increased from 5.52 to 11.49 per 1000 women.

CONCLUSIONS

The factors responsible for the increased rate of elective abortion need further investigation.

The levonorgestrel intrauterine system as an alternative to hysterectomy for the treatment of idiopathic menorrhagia

AIM OF THE STUDY

Prospective, observational study to determine the percentage of hysterectomies cancelled after a year of treatment with levonorgestrel intrauterine system (LNG-IUS) among women diagnosed with idiopathic menorrhagia.

MAIN FINDINGS

Eighty-two women with a mean age of 44.3 + or - 4.9 were enrolled. Throughout 1-year follow-up, progressive and significant reduction was observed in number of days of bleeding (8.9 + or - 4.0 vs. 5.0 + or - 5.4), number of sanitary measures (29.3 + or - 19.4 vs. 8.1 + or - 10.8) and percentage of patients having intense/very intense bleeding (98.8%vs. 6.4%). Duration of menstrual cycle significantly increased from 26.9 + or - 5.5 to 52.6 + or - 33.6 days. Significant improvement in overall health-related quality of life was achieved. Patient satisfaction was good/very good in 70.7%. Considering only women who attended 12-month visit satisfaction reached 91.2%. 75.6% of scheduled hysterectomies were cancelled. Adverse effects were recorded in less than 40% of patients with no significant differences between visits. Adverse effects led to premature discontinuation of treatment in seven cases. No serious adverse effects were encountered.

INTERPRETATION OF RESULTS

LNG-IUS meets the effectiveness and tolerability criteria for being considered as a first choice treatment option for women with idiopathic menorrhagia. Its use may contribute to decrease the large number of hysterectomies scheduled in Spain.

Contraceptive use patterns among Spanish single youth

OBJECTIVE

To examine sexual and contraceptive use patterns, including method choice, among unmarried youth in Spain.

METHOD

The analysis is based on the 1999 Youth Survey. The analytical sample comprised 696 never-married sexually experienced women aged 15-24 and 1070 men. Logistic regression was used to assess the influence of various socio-demographic factors on contraceptive use, and multinomial logistic regression was used to examine the determinants of method choice.

RESULTS

Given the trend towards earlier sexual initiation and increasing marriage postponement, sexual activity prior to marriage has become the norm in Spain. Nine out of 10 sexually active single youth reported contraceptive use at their last intercourse. Differentials across social subgroups were small, with the exception of those based on educational level. Young women and men with more than one partner in the previous year and those not currently in a stable relationship were more likely to engage in unprotected intercourse. Regarding the choice of method, the analysis revealed that, although condom is the dominant method, there is a tendency to shift to the pill with increasing age and relationship stability.

CONCLUSION

The level of contraceptive protection among unmarried youth is reasonably high, but a nontrivial proportion of youth engage in unprotected sexual activity.

Use of contraceptive methods and risk of unwanted pregnancy in Spanish women aged 40–50 years: results of a survey conducted in Spain

A survey intended to ascertain the rate of use and type of contraceptive methods applied by Spanish women aged 40 to 50 years, and to determine the proportion of women in this group at risk of an unwanted pregnancy, was designed and validated. To achieve representative national results for the study population, it was estimated that a sample size of 2000 women was required. Women were selected using probabilistic, stratified random sampling. The survey questionnaire was prepared by the research group with the collaboration of experts in the conduct of population studies of this type. Participants were interviewed face to face by qualified and trained staff from a specialised company external to the research group. Overall, 1039 women (52%) resorted to some contraceptive method, of which (male or female) sterilisation was the most common. We estimate that in Spain there are 840,000 women (31.8%) aged 40 to 50 years at risk of unwanted pregnancy.

CYP2A6 activity in a healthy Spanish population: effect of age, sex, smoking, and oral contraceptives

This study was performed to assess the influence of age, sex, smoking, and contraceptive use on CYP2A6 activity. In the metabolism of caffeine, the conversion of 1,7 dimethylxanthine (17X) to 1,7 dimethiylurate (17U) is catalyzed primarily by CYP2A6. CYP2A6 phenotype was determined by the urinary ratio 17U:17X in the interval of 4-5 h after caffeine intake in 179 healthy white Spaniards (102 women and 76 men). There were 99 non-smokers and 80 smokers. Among women, 26 were taking oral contraceptives. The age was the most important predictive factor of CYP2A6 activity (P < 0.001) with older subjects having higher activity. The influence of the gender was more modest (P = 0.07) with women exhibiting borderline increased values of the CYP2A6 marker than men. Tobacco smoking did not affect CYP2A6 activity. However, the CYP2A6 marker resulted to be strongly related to the use of oral contraceptives. The women users of oral contraceptives had higher values of CYP2A6 marker than both women not taking oral contraceptives and men (P < 0.001 in both comparisons). The results indicate that age, oral contraceptive use, and possibly gender should be controlled in epidemiological studies dealing with CYP2A6 activity and its relationship with xenobiotics exposure and genetic or pathological factor.

Factors affecting women's selection of a combined hormonal contraceptive method: the TEAM-06 Spanish cross-sectional study

BACKGROUND

Contraceptive efficacy and side effects are primary concerns of women when choosing a contraceptive method.

STUDY DESIGN

This cross-sectional multicenter study was designed to assess the reasons for selecting the contraceptive pill, the skin patch or the vaginal ring in 9700 women, aged 18-49 years, who consulted their doctors for starting or re-initiating combined hormonal contraception. A self-administered questionnaire regarding the reasons for the selection made and for the refusal of the remaining two methods was completed.

RESULTS

The vaginal ring showed the highest acceptance (46%) compared with the pill (39%) and the skin patch (15%), particularly in women aged 35-39 years. The ring and the skin patch were mainly preferred because of the lower probability of inadvertent omission (62% of cases), convenience, and monthly or weekly frequency of use. The pill was preferred because of its proven efficacy (60% of cases) and ease of use. The acceptance of the skin patch increased with age and the pill was mostly accepted only by women in the youngest age groups.

CONCLUSIONS

Convenience, frequency of use and lower probability of inadvertent omission were the primary determinants of contraceptive choice rather than the women's profile.

Satisfaction among women: differences between current users of barrier (male condom) and non-barrier methods

OBJECTIVES

To determine the differences in and factors related to satisfaction between barrier (male condom) and non-barrier method users.

METHODS

A semi-structured questionnaire was used for collecting data for this cross-sectional survey. The questionnaires were completed via one-on-one interviews by the researchers. The study group was selected using stratified random sampling. Exclusion criteria were, being unmarried, pregnant, in postmenopausal status and using traditional methods. A total of 434 currently married women using modern contraceptive methods participated in the study. Contraceptive users were dichotomized into two groups as non-barrier method users and barrier method users.

RESULTS

About half of the participants (n = 191, 44%) were barrier method users. Their mean age was 33.7 +/- 7.3 years, 66.6% (n = 131) were well educated and reported significantly less pregnancies, given births, living children and abortions (reproductive history events) than non-barrier users. Barrier method users were significantly more likely to be satisfied with their contraceptive method of choice (OR: 2.4; 95% CI 1.2-5.2). Among barrier method users, deciding the type of the contraceptive method themselves had significant effect on satisfaction.

CONCLUSION

In our study, satisfaction was mostly affected by heavy side effects and health risks of the methods resulting in less satisfaction with the contraceptive method among non-barrier method users. Other factors which may influence satisfaction deserve further investigation.

Counselling and knowledge about contraceptive mode of action among married women; a cross-sectional study

Background

Family planning counselling which covers knowledge transfer about contraceptive mode of action, by enabling informed choice, improves compliance to and efficiency of contraceptive methods.

The objective of this study was to investigate associations between family planning counselling, counsellor and correct knowledge about mode of action of modern contraceptive methods among married women.

Methods

For this cross-sectional study, stratified (according to current modern contraceptive method in use) random sampling was performed from the registries of two primary health care centres. Main outcomes were; prevalence of family planning counselling, professional background of the counsellor and correct knowledge about mode of action. A semi-structured questionnaire developed by the researchers was applied via face-to-face interview. The answers about mode of action were categorized as correct vs. incorrect by consensus rating.

Results

Prevalence of counselling and correct knowledge about mode of action was 49.0% and 39.3%, respectively. Higher educated women were significantly more likely to know the mode of action (p < 0.001). Being counselled by a physician (54.1%, n = 120) was not associated with correct knowledge about mode of action (p = 0.79). Non-barrier method users were less educated (p = 0.001), more often counselled (60.8% vs. 8.0%) and less knowledgeable (p < 0.001) about mode of action of their contraceptive method, compared to condom users. Nevertheless, counselled non-barrier method users were significantly more likely to know the correct mode of action of their chosen method (p = 0.021) than counselled condom users.

Conclusion

The beneficial effect of counselling on knowledge about mode of action of the more complicated, medical (non-barrier) contraceptive methods suggests that the use of family planning counselling services in primary health care should be promoted; furthermore, counselling strategies and content should be re-structured for better efficacy.

Influence of sociodemographic variables on dental service utilization and oral health among the children included in the year 2001 Spanish National Health Survey

OBJECTIVES

To ascertain the possible influence of sociodemographic variables on dental service utilization and oral health among Spanish children.

METHODS

This is a descriptive cross-sectional study using secondary individualized data drawn from 4,023 interviews conducted with parents or guardians of children aged 3-15 years as part of the 2001 Spanish National Health Survey. The dependent variables analyzed were use of dental services in the preceding 12 months, and caries ever. Classification of children was affirmative if their parents answered that the last time their child visited the dentist it was for a filling and/or had fillings in his/ her teeth/molars. Independent variables were sex, age, size of town or city, parents' educational level and monthly income of the family unit.

RESULTS

A total of 47.1% of the study children had visited a dentist, stomatologist or dental hygienist in the preceding 12 months. Children having parents or guardians with the lowest educational level were 1.36 times (95% Cl: 1.10-1.68) more likely to have received no dental care than those having parents or guardians with the highest educational level. The likelihood of not having made use of such dental services rose 2.03-fold (95% CI: 1.58-2.61) in cases where monthly income was less than 900 euros versus greater than 1800 euros. Reported prevalence of caries for the sample as a whole was 31.45%. Children whose parents were in the lowest educational range were 1.37 times (95% CI: 1.08-1.71) more likely to have caries than those in the highest range.

CONCLUSION

There is social inequality in the use of dental services and oral health among Spanish children.

Trends in the use of emergency contraception: An epidemiological study in Barcelona, Spain (1994–2002)

We conducted a retrospective review of the medical records of women requesting emergency contraception (EC) at our emergency department over a 9-year period (1994-2002). EC accounted for 5.9% of all visits (n = 95,288) and increased from 1.26% in 1994 to 9.82% in 2002 (p < 0.001). Reasons for EC were condom problems in 79.5% of cases. EC was used only once by 93% of women. The mean daily number of visits was significantly higher in August (2.46), July (2.01) and September (2.02) than in other months (p < 0.05), and was more frequent on Sunday (3.26), Saturday (2.92) and Monday (2.05) compared to other week days (p < 0.001). New Year's Day and the St. John's Night registered the highest number of visits (mean of 17.2 and 11.7, respectively), with significant differences compared to the remaining days of the year (p < 0.001).

Influence of sociodemographic variables on use of dental services, oral health and oral hygiene among Spanish children

OBJECTIVES

To analyse the possible influence of sociodemographic variables on use of dental services, oral health and oral hygiene among Spanish children.

METHODS

Descriptive cross-sectional study based on 1,676 interviews conducted with parents or guardians of children ages 3-15 years. The dependent variables analysed were: use of dental services in the preceding 12 months; self-reported caries ever; and daily dental hygiene measured as toothbrushing frequency. Independent variables were sex, age, size of town or city, educational level, and monthly income of the family unit.

RESULTS

A total of 60% of the study children had not visited a dental professional in the preceding 12 months. Children having parents or guardians with the lowest educational level were 1.592 times more likely to have received no dental care than those with the highest educational level. The likelihood of not having made use of such dental services rose 2.232-fold in cases where income was < 600 versus >1200 per month. Overall prevalence of self-reported caries for the sample as a whole was 34.4%. Subjects in the lowest income bracket (< 600 per month) were 1.497 times more likely to have caries than those in the highest income bracket. In all, 68.5% brushed their teeth every night, but the percentage rose significantly with age, size of town or city, and income.

CONCLUSION

There is considerable social inequality in the use of dental services, oral health and oral hygiene among Spanish children.

Influenza coverages in Spain and vaccination-related factors in the subgroup aged 50-64 years

This study sought to describe influenza vaccination coverages for different Spanish population subgroups, stressing the analysis of vaccination-related factors in subjects aged 50-64 years and estimating the possible beneficial effect of extending universal vaccination to this age group. A total of 6,400 surveys, targeting subjects over the age of 16 years and drawn from the 1997 Spanish National Health Survey, were used for study purposes. Influenza coverage was observed to rise significantly with age, and the reason cited by most subjects for seeking vaccination was medical indication. Coverage of the 50-64 age group was 21.6% (95% CI 19.4-23.8) and the variables associated with a greater probability of being vaccination were: residence in towns or cities with <10,000 inhabitants (OR 1.45); monthly income of less than 600 (OR 1.71); and presence of associated chronic disease (OR 3.07.) It is estimated that in Spain, 524,514 (40.7%) persons aged 50-64 years with associated chronic disease receive and 764,218 persons aged 50-64 years with associated chronic disease do not receive influenza vaccine. We conclude that the extremely high number of subjects in the 50-64 age range susceptible to influenza-related complications each year constitutes good grounds for universal vaccination being extended to said age group.