The acceptability of combined oral hormonal contraceptives in Shanghai, People's Republic of China

"Every Medicine Is Somewhat Poisonous": Understanding the reluctance to use oral contraceptives among unmarried women seeking abortion in China

OBJECTIVES

In this study, I examined the low uptake of oral contraceptives (OCs) in China and the factors affecting the reluctance among unmarried Chinese women seeking abortion to use OCs to prevent unintended pregnancies.

STUDY DESIGN

I conducted ethnographic and participant observation in multiple medical facilities and interviewed 62 women who were seeking or had had an abortion between 2013 and 2017 in a coastal city in east China. I analyzed data regarding the women's perceptions and experiences of using OCs through a thematic analysis approach.

RESULTS

The women reported fear of side effects, including infertility, weight gain, and mental health issues and their view on traditional Chinese medicine further validated their skepticism toward Western medicine. Discouragement from male partners and a lack of sexual and reproductive education also caused their hesitancy and misunderstandings of OCs.

CONCLUSIONS

This study contributes to a more nuanced understanding of the barriers to OC use in China. It resonates with existing studies that associate the reluctance to use OCs with the fear of side effects and highlights the influence of sociocultural specificities and couple interactions in shaping contraceptive use.

IMPLICATIONS

Tackling premarital abortions is one of the priorities of the Chinese government in the face of the population crisis. Service providers and educators should understand unmarried women's reluctance to use OCs and provide comprehensive sexuality education and postabortion counseling services to women and men to dispel culturally specific misconceptions.

Quality of Life and Health Status of Jordanian Women Users of Various Contraceptive Methods and Associated Factors: Implications for Contraceptive Policies

AIM

The study aimed at investigating the differences in health status of women users and non-users of contraceptive methods and assess differences in contraception quality of life (CQoL) according to method used.

METHODS

Across sectional study with 372 women between the ages of 18 and 49 years old were recruited. Participants completed the health status and the CQoL questionnaire, which was validated using factor analysis combining three factor loading measures with a good Cronbach's alpha reliability coefficient.

RESULTS

Results showed that there were no significant differences in health status between users and non-users. There was a significant difference in QoL according to the method used at the p <0.05 level for the three conditions F (2193) = 6.0 and p = 0.003. Post hoc analysis indicated that the total CQoL was significantly higher in IUD users (M = 55.7, SD = 9.6) than users of natural methods (M = 50, SD = 9.0, p < 0.01). In addition, the total CQoL was significantly higher among women from the southern region (M = 56.7, SD = 9.0) than from the northern and mid-regions (M = 49.5, SD = 0.07 and M = 52, SD = 10, respectively, p < 0.01).

CONCLUSION

The physiological changes of women's QoL was affected by the use of the IUD method with significantly lower QoL scores than those who used oral contraceptives and non-hormonal methods. In addition, there was no significant difference in health status between users and non-users of contraceptive methods.

IMPLICATIONS

The study has implications for contraceptive counselling on quality of life of women users of IUD and women from the south region and provides opportunities for the advancement of the reproductive health services in Jordan.

The experiences and perceptions of family planning of female Chinese asylum seekers living in the UK

INTRODUCTION

Chinese family planning policy is unique. There is limited sex education and the state is highly influential. This has resulted in extremely wide coverage of contraception with long-acting methods being favoured. The Chinese constitute a large proportion of asylum applicants to the UK. This study examines how their experiences and decisions about family planning in the UK are shaped by their cultural background.

METHODS

Data were drawn from 10 semi-structured qualitative interviews with female Chinese asylum seekers recruited through a family planning clinic in the UK.

RESULTS

The increased autonomy provided by the UK system was appreciated by the participants. Choice of contraceptive method was influenced by traditional cultural beliefs and values, and the effect of hormonal contraception on menstruation was particularly concerning. Women arrived from China with little knowledge of contraception. Friends from a similar background were the most trusted source of advice. When transitioning from China to the UK unwanted pregnancies had occurred amongst unmarried women who had missed out on sex education while living in China.

CONCLUSIONS

Chinese societal and cultural practices continue to influence family planning decisions made within the UK. Culturally competent health strategies are needed to ensure Chinese immigrant women fully benefit from family planning within the UK.

Comparison of women's breast cancer risk factors in Geneva, Switzerland and Shanghai, China

BACKGROUND

We compared the prevalence of known and suspected breast cancer risk factors among women in Geneva, Switzerland, where the annual incidence of breast cancer is high, to women in Shanghai, China, where incidence is lower.

METHODS

Different translations of the same woman's health questionnaire were administered to women aged 35 to 74 years in Shanghai (n=631) and Geneva (n=1,212) during 1996-1997 and reproductive and lifestyle factors compared.

RESULTS

Shanghai women reported older age at menarche (median 15 vs. 13 years), fewer nulliparity (7.3 vs. 21.6%), younger age at first live birth (median 25.7 vs. 28.4 years), and shorter duration of reproductive life (median 35.7 vs. 38.4 years). Geneva women had a greater prevalence of current cigarette smoking (22.4 vs. 1.8%), oral contraceptive use (61.1 vs. 10.0%), hormone replacement therapy use (23.4 vs. 0.8%), and family history of breast cancer (8.6 vs. 1.4%). Among women who breastfed, Shanghai women had more than twice the duration of breastfeeding than Geneva women (median 48 vs. 21 weeks).

CONCLUSIONS

Differences in the prevalence of breast cancer risk factors, in particular reproductive characteristics, may contribute to the large contrast in cumulative risk between women living in Geneva and Shanghai.

Reproductive health services for refugees by refugees in Guinea I: family planning

Background

Comprehensive studies of family planning (FP) in refugee camps are relatively uncommon. This paper examines gender and age differences in family planning knowledge, attitudes, and practices among Sierra Leonean and Liberian refugees living in Guinea.

Methods

In 1999, a cross-sectional survey was conducted of 889 reproductive-age men and women refugees from 48 camps served by the refugee-organised Reproductive Health Group (RHG). Sampling was multi-stage with data collected for socio-demographics, family planning, sexual health, and antenatal care. Statistics were calculated for selected indicators.

Results

Women knew more about FP, although men's education reduced this difference. RHG facilitators were the primary source of reproductive health information for all respondents. However, more men then women obtained information from non-health sources, such as friends and media. Approval of FP was high, significantly higher in women than in men (90% vs. 70%). However, more than 40% reported not having discussed FP with their partner. Perceived service quality was an important determinant in choosing where to get contraceptives. Contraceptive use in the camps served by RHG was much higher than typical for either refugees' country of origin or the host country (17% vs. 3.9 and 4.1% respectively), but the risk of unwanted pregnancy remained considerable (69%).

Conclusion

This refugee self-help model appeared largely effective and could be considered for reproductive health needs in similar settings. Having any formal education appeared a major determinant of FP knowledge for men, while this was less noticeable for women. Thus, FP communication strategies for refugees should consider gender-specific messages and channels.

Attitudes toward oral contraceptive use among women of reproductive age: a systematic review

Despite the effectiveness of oral contraceptives (OCs), their popularity differs across populations. Attitudes are a significant factor that influences OC use. This report systematically reviews 28 studies on attitudes toward OC use among women. The Matrix Method was used to review the literature. Affective, cognitive, and behavioral components of attitudes were analyzed, including satisfaction, safety, fear/anxiety, and inconvenience. In general, negative attitudes still prevail across countries. Positive attitudes are more prevalent in Europe. Effective counseling and education are needed for those negatively disposed toward OC use. For favorable users, compliance strategies for longer continuation with OC regimen must be provided.

Family planning: the unfinished agenda

Promotion of family planning in countries with high birth rates has the potential to reduce poverty and hunger and avert 32% of all maternal deaths and nearly 10% of childhood deaths. It would also contribute substantially to women's empowerment, achievement of universal primary schooling, and long-term environmental sustainability. In the past 40 years, family-planning programmes have played a major part in raising the prevalence of contraceptive practice from less than 10% to 60% and reducing fertility in developing countries from six to about three births per woman. However, in half the 75 larger low-income and lower-middle income countries (mainly in Africa), contraceptive practice remains low and fertility, population growth, and unmet need for family planning are high. The cross-cutting contribution to the achievement of the Millennium Development Goals makes greater investment in family planning in these countries compelling. Despite the size of this unfinished agenda, international funding and promotion of family planning has waned in the past decade. A revitalisation of the agenda is urgently needed. Historically, the USA has taken the lead but other governments or agencies are now needed as champions. Based on the sizeable experience of past decades, the key features of effective programmes are clearly established. Most governments of poor countries already have appropriate population and family-planning policies but are receiving too little international encouragement and funding to implement them with vigour. What is currently missing is political willingness to incorporate family planning into the development arena.

Oral contraceptive and IUD use and endometrial cancer: a population-based case-control study in Shanghai, China

Oral contraceptive (OC) and intrauterine device (IUD) use have been shown to be protective factors for endometrial cancer in several epidemiological studies; however, few studies have been conducted in Chinese populations. We evaluated the association between OC and IUD use and endometrial cancer risk in a population-based case-control study among Chinese women in Shanghai, China. The study included 1,204 newly diagnosed endometrial cancer cases and 1,212 age frequency-matched healthy controls. Logistic regression models were used to estimate adjusted odds ratios (OR) and their 95% confidence intervals (95% CI). In our study population, 18.5% cases and 24.9% controls reported having ever used OCs with an OR of 0.75 (95% CI, 0.60-0.93), after adjusting for known risk or protective factors for endometrial cancer. The risk of endometrial cancer decreased with long-term use of OCs with the OR for more than 72 months of use being 0.50 (95% CI, 0.30-0.85). The effect of OC use remained 25 or more years after cessation of use; the associated OR was 0.57 (95% CI = 0.42-0.78) as compared to nonusers. Similarly, fewer cases than controls had ever used IUD, with the multivariable adjusted OR being 0.53 (95% CI = 0.43-0.65). A reduction in risk was observed regardless the duration of use or age at first and last use. These results suggest that OC and IUD use may confer long-term protection against endometrial cancer.