Will the pill make me sterile? Addressing reproductive health concerns and strategies to improve adherence to hormonal contraceptive regimens in adolescent girls

Assessing the effect of concerns about contraceptive-induced fertility impairment on hormonal contraceptive use by parity and residence: evidence from PMA Ethiopia 2020 cross-sectional survey

OBJECTIVES

This study aims to describe patterns of beliefs about contraceptive-induced infertility and assess their relationship with current contraceptive use, including whether these relationships vary by parity and residence.

DESIGN

We use data from Performance Monitoring for Action Ethiopia, a nationally representative, cross-sectional survey of 7491 women, aged 15-49, to assess agreement with the statement 'If I use family planning, I may have trouble getting pregnant next time I want to.' We used multilevel hierarchical models to identify the association between agreement and use of a hormonal method of contraception among 3882 sexually active, fecund women who wish to prevent pregnancy. We include interaction terms for parity and residence.

RESULTS

4 in 10 women disagreed (42.3%) and 2 in 10 strongly disagreed (20.7%) with the statement. Relative to women who strongly disagreed, women who disagreed and women who agreed had significantly lower odds of using a hormonal method of contraception (adjusted OR (aOR) 0.65, 95% CI 0.44 to 0.97 and 0.46, 95% CI 0.46, 95% CI 0.30 to 0.70). The effect of agreeing with the statement was strongest among high parity women (aOR 0.54, 95% CI 0.30 to 0.95). Greater agreement with the statement at the community-level use was associated with a reduction in the odds of using hormonal contraception but only among rural women.

CONCLUSIONS

Efforts to address concerns around contraceptive-induced fertility impairment through the provision of comprehensive counselling and through community education or mass media campaigns are necessary, particularly among high-parity women and in rural communities. Interventions should acknowledge the possibility of delayed return to fertility for specific methods and attempt to address the root causes of concerns.

The Impact of a Digital Contraceptive Decision Aid on User Outcomes: Results of an Experimental, Clinical Trial

BACKGROUND

Nearly 40% of unplanned pregnancies in the USA are the result of inconsistent or incorrect contraceptive use. Finding ways to increase women's comfort and satisfaction with contraceptive use is therefore critical to public health. One promising pathway for improving patient outcomes is through the use of digital decision aids that assist women and their physicians in choosing a contraceptive option that women are comfortable with. Testing the ability of these aids to improve patient outcomes is therefore a necessary first step toward incorporating this technology into traditional physician appointments.

PURPOSE

To evaluate the effectiveness of a novel contraceptive decision aid at minimizing decisional conflict and increasing comfort with contraception among adult women.

METHODS

In total, 310 adult women were assigned to use either the Tuune contraceptive decision aid or a control aid modeled after a leading online contraceptive prescriber's patient intake form. Participants then completed self-report measures of decisional conflict, contraceptive expectations, satisfaction, and contraceptive use intentions. Individual between-subjects analysis of variance (ANOVA) models were used to examine these outcomes.

RESULTS

Women using the Tuune decision aid (vs. those using the control aid) reported lower decisional conflict, more positive contraceptive expectations, greater satisfaction with the decision aid and recommendation, and more positive contraceptive use intentions.

CONCLUSIONS

Use of Tuune improved each of the predicted patient outcomes relative to a control decision aid. Online decision aids, particularly when used alongside physician consultations, may be an effective tool for increasing comfort with contraceptive use.

CLINICAL TRIALS REGISTRATION #

NCT05177783, ClinicalTrials.gov, https://clinicaltrials.gov/ct2/show/NCT05177783.

Concern that contraception affects future fertility: How common is this concern among young people and does it stop them from using contraception?

Objectives

This study examines the concern that contraception affects future fertility among community college students and its association with contraceptive use.

Study design

We used baseline data from a randomized controlled trial with 2060 community college students assigned female at birth. We used mixed-effects multivariate logistic regression adjusted for clustered data to assess sociodemographic factors associated with concerns about contraception affecting future fertility and to test the association between this concern and contraceptive use.

Results

Most participants (69%) worried about contraception affecting their future fertility. Multivariable results indicated that first-generation college students (adjusted odds ratio [aOR], 1.24; 95% confidence interval [CI], 1.01-1.55) and non-English speakers at home (aOR, 1.30; 95% CI, 1.04-1.64) were more concerned. Racial and ethnic differences were significant, with Black non-Hispanic (aOR, 2.83; 95% CI, 1.70-4.70), Asian/Pacific Islander non-Hispanic (aOR, 2.12; 95% CI, 1.43-3.14), and Hispanic (aOR, 1.54; 95% CI, 1.17-2.02) participants more likely to be concerned than White non-Hispanic counterparts. Participants who received contraceptive services in the past year had lower odds of this concern (aOR, 0.72; 95% CI 0.59-0.88). Furthermore, participants with this concern had lower odds of using contraception (aOR, 0.67; 95% CI, 0.49-0.91), especially hormonal contraception (aOR, 0.77; 95% CI, 0.61-0.97).

Conclusions

Most students feared contraception's impact on fertility, and this fear was associated with not using contraception. Disparities in this concern may be tied to discrimination, reproductive coercion, and limited reproductive health care access. Addressing concerns about contraception affecting future fertility is crucial to person-centered contraceptive counseling.

Implications

This study examines the concern that contraception affects future fertility among sexually active female community college students and its impact on contraceptive use. Most participants expressed concerns about contraception affecting future fertility. Addressing future fertility concerns in patient-centered contraceptive counseling is crucial for reaching young people.

A Patient Decision Aid (i.ARTs) to Facilitate Women's Choice Between Oral and Long-Acting Injectable Antiretroviral Treatment for HIV: Protocols for its Development and Randomized Controlled Pilot Trial

BACKGROUND

Many women with HIV (WWH) have suboptimal adherence to oral antiretroviral therapy (ART) due to multilevel barriers to HIV care access and retention. A long-acting injectable (LAI) version of ART was approved by the US Food and Drug Administration in January 2021 and has the potential to overcome many of these barriers by eliminating the need for daily pill taking. However, it may not be optimal for all WWH. It is critical to develop tools that facilitate patient-provider shared decision making about oral versus LAI ART modalities to promote women's adherence and long-term HIV outcomes.

OBJECTIVE

This study will develop and pilot test a web-based patient decision aid called i.ART+support (i.ARTs). This decision aid aims to support shared decision making between WWH and their providers, and help women choose between oral and LAI HIV treatment.

METHODS

The study will occur in 3 phases. In phase 1, we will utilize a mixed methods approach to collect data from WWH and medical and social service providers to inform i.ARTs content. During phase 2, we will conduct focus groups with WWH and providers to refine i.ARTs content and develop the web-based decision aid. In phase 3, i.ARTs will be tested in a randomized controlled trial with 180 women in Miami, Florida, and assessed for feasibility, usability, and acceptability, as well as to evaluate the associations between receiving i.ARTs and viral suppression, ART pharmacy refills, and clinic attendance.

RESULTS

This study was funded in March 2021. Columbia University's IRB approved the study protocols (approval number IRB-AAAT5314). Protocols for phase 1 interviews have been developed and interviews with service providers started in September 2021. We will apply for Clinicaltrials.gov registration prior to phase 3, which is when our first participant will be enrolled in the randomized controlled trial. This is anticipated to occur in April 2023.

CONCLUSIONS

This study is the first to develop a web-based patient decision aid to support WWH choices between oral and LAI ART. Its strengths include the incorporation of both patient and provider perspectives, a mixed methods design, and implementation in a real-world clinical setting.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/35646.

FertiSTAT: A Potential Tool for Adolescent Sexual Health

STUDY OBJECTIVE

The FertiSTAT (fertility status awareness) tool provides personalized advice on reducing risk factors for infertility and seeking medical advice on the basis of lifestyle and reproductive profile. The aim of our research was to test the FertiSTAT tool in younger patients (14-24 years). A secondary objective was to screen for and evaluate knowledge of risk factors that affect fertility. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Patients aged 14-24 years attending consultations at Geneva University Hospitals received a quantitative questionnaire before consultations. Questions covered lifestyle, gynecological history, perception of fertility, and pregnancy intent. We investigated respondents' beliefs with regard to risk factors for infertility through "true/false" questions. We selected questions relevant to our population from the original FertiSTAT questionnaire to calculate each respondent's FertiSTAT score. Scores ranged from "blue" (low risk, score 1) to "red" (risk of infertility, score 4).

RESULTS

A total of 279 women aged 14-24 years were included. Nonpregnant patients had overall higher FertiSTAT scores (2.7 ± 0.8). Upon logistic regression analysis, with every additional FertiSTAT point, the odds of being pregnant at the time of survey decreased by 0.48. Risk factors for infertility and knowledge of these risk factors were equally distributed between pregnant and nonpregnant women.

CONCLUSION

Our findings suggest FertiSTAT might be a useful tool in the younger population to whom we extended it, and highlight gaps in knowledge on risk factors for infertility. These findings are of interest when considering FertiSTAT as a starting point to discuss contraception and risk factors for infertility at an age at which risk mitigation would prove most effective in preserving future fertility.

No. 329-Canadian Contraception Consensus Part 4 of 4 Chapter 9: Combined Hormonal Contraception

OBJECTIVE

To provide guidelines for health care providers on the use of contraceptive methods to prevent pregnancy and on the promotion of healthy sexuality.

OUTCOMES

Overall efficacy of cited contraceptive methods, assessing reduction in pregnancy rate, safety, and side effects; the effect of cited contraceptive methods on sexual health and general well-being; and the availability of cited contraceptive methods in Canada.

EVIDENCE

Medline and the Cochrane Database were searched for articles in English on subjects related to contraception, sexuality, and sexual health from January 1994 to December 2015 in order to update the Canadian Contraception Consensus published February-April 2004. Relevant Canadian government publications and position papers from appropriate health and family planning organizations were also reviewed.

VALUES

The quality of the evidence is rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. Recommendations for practice are ranked according to the method described in this report.

SUMMARY STATEMENTS

RECOMMENDATIONS.

'It's just a very personal thing': contraceptive influences and decision making among women living in Italy

Objective: The purpose of the study was to assess contraceptive knowledge, perceptions and experiences among reproductive-aged women in Italy. Methods: As part of a larger mixed-methods study, researchers conducted 46 interviews (June-July 2017) with English-speaking women aged 18-45 living in or near Florence, Italy, who were using the Italian health care system. Researchers used grounded theory to explore women's contraceptive decision making and use. HyperRESEARCH software was used to aid data organisation and analysis. Researchers used a comparative method to contextualise data and identify emergent themes. Results: Participants illuminated knowledge gaps and misinformation about the efficacy and long-term health effects of hormonal contraceptive methods. Family, friends and health care providers influenced their contraceptive choices. Local family planning clinics (consultori) were cited as primary sources of contraceptive information, resources and access. Conclusion: Misinformation may contribute to the underuse of effective hormonal contraception in Italy. The study findings can inform practical recommendations to improve the dissemination of contraceptive information. Improved messaging strategies could address contraceptive concerns (e.g., hormonal effects) and knowledge gaps, which may improve hormonal contraceptive uptake.

Contraceptive knowledge, perceptions, and concerns among men in Uganda

BACKGROUND

Low contraceptive uptake and high unmet need for contraception remain significant issues in Uganda compared to neighboring countries such as Kenya, Ethiopia, and Rwanda. Although prior research on contraceptive uptake has indicated that male partners strongly influence women's decisions around contraceptive use, there is limited in-depth qualitative research on knowledge and concerns regarding modern contraceptive methods among Ugandan men.

METHODS

Using in-depth interviews (N = 41), this qualitative study investigated major sources of knowledge about contraception and perceptions of contraceptive side effects among married Ugandan men.

RESULTS

Men primarily reported knowledge of contraceptives based on partner's experience of side effects, partner's knowledge from health providers and mass media campaigns, and partner's knowledge from her peers. Men were less likely to report contraceptive knowledge from health care providers, mass media campaigns, or peers. Men's concerns about various contraceptive methods were broadly associated with failure of the method to work properly, adverse health effects on women, and severe adverse health effects on children. Own or partner's human immunodeficiency virus (HIV) status did not impact on contraceptive knowledge.

CONCLUSIONS

Overall, we found limited accurate knowledge about contraceptive methods among men in Uganda. Moreover, fears about the side effects of modern contraceptive methods appeared to be common among men. Family planning services in Uganda could be significantly strengthened by renewed efforts to focus on men's knowledge, fears, and misconceptions.

Examining trends in family planning among harder-to-reach women in Senegal 1992-2014

Recent increases in family planning (FP) use have been reported among women of reproductive age in union (WRAU) in Senegal. However, trends have not been monitored among harder-to-reach groups (including adolescents, unmarried and rural poor women), key to understanding whether FP progress is equitable. We combined data from six Demographic and Health Surveys conducted in Senegal between 1992/93 and 2014. We examined FP trends over time among WRAU and subgroups, and trends in knowledge of FP and intention to use among women with unmet need for FP. Our results show that percent demand satisfied is lower among rural poor women and adolescents than WRAU, although higher among unmarried women. Marked recent increases have been observed in all subgroups, however fewer than 50% of women in need of FP use modern contraception in Senegal. Knowledge of FP has risen steadily among women with unmet need; however, intention to use FP has remained stable at around 40% since 2005 for all groups except unmarried women (75% of whom intend to use). Significant progress in meeting the need for FP has been achieved in Senegal, but more needs to be done particularly to improve acceptability of FP, and to strategically target interventions toward adolescents and rural poor women.

A Qualitative Study of Young Women's Beliefs About Intrauterine Devices: Fear of Infertility

INTRODUCTION

Approximately 80% of college-aged women are at risk of unintended pregnancy. The American College of Obstetricians and Gynecologists recommends long-acting reversible contraceptive (LARC) methods, including intrauterine devices (IUDs), as first-line pregnancy prevention for adolescents and young women. Yet, less than 5% of 15- to 19-year-old women using a method of contraception use LARC. Limited research explores young women's concerns about IUDs.

METHODS

As part of a larger women's health research study, researchers conducted 53 in-depth interviews with women, aged 18 to 24 years enrolled in a midsized liberal arts college in the southeastern United States. Analytical techniques from the grounded theory approach were used to code line-by-line and identify themes emerging from these data.

RESULTS

Fear of causing harm or infertility through IUD use emerged as a significant barrier to uptake. Negative and often unfounded beliefs about IUDs led to silence and limited observability of IUDs in daily life and health care contexts. Identity as a fertile woman emerged as an antecedent factor to the compatibility of IUDs with participants' values and beliefs.

DISCUSSION

The link between fear of infertility and perceived identity was found to be a major factor in young women's contraceptive decision making. In order to increase uptake of IUDs, the beliefs of women must be addressed.

Provider counseling to young women seeking family planning services

CONTEXT

Contraceptive nonuse and misuse contribute to rates of unintended pregnancy and STDs among young women in the United States. Clinical providers assume an important role in guiding youths' contraceptive method choices.

METHODS

Sixty-seven women aged 16-21 were recruited as part of a cohort study, conducted in 2009-2012, that examined provider-patient interactions during family planning visits at six San Francisco clinics. Interactions between patients and providers were audio-recorded. Participants completed questionnaires about method preference immediately before seeing the provider; they reported on method choice immediately after the visit and by telephone three and six months later. Transcripts were analyzed to examine providers' strategies for guiding decision making and addressing youths' contraceptive concerns. Missed opportunities for promoting young women's reproductive health were identified.

RESULTS

Twenty-one percent of young women who did not report desiring a hormonal or long-acting reversible method (IUD or implant) before seeing their provider chose one after counseling. Use of a hormonal or long-acting reversible contraceptive method at follow-up was more common among women who had received interactive counseling by providers who guided them to consider contextual influences than among those who had not received such counseling. Attention to relationship characteristics, sexual behavior patterns and STD risk was largely absent from contraceptive counseling.

CONCLUSION

High-quality strategies used by providers to guide contraceptive decision making were tailored to adolescents' developmental and environmental needs. Several areas of counseling require increased attention and seem vital to providing comprehensive reproductive health care to adolescents.

Disparities in abortion rates: a public health approach

Women of lower socioeconomic status and women of color in the United States have higher rates of abortion than women of higher socioeconomic status and White women. Opponents of abortion use these statistics to argue that abortion providers are exploiting women of color and low socioeconomic status, and thus, regulations are needed to protect women. This argument ignores the underlying causes of the disparities. As efforts to restrict abortion will have no effect on these underlying factors, and instead will only result in more women experiencing later abortions or having an unintended childbirth, they are likely to result in worsening health disparities. We provide a review of the causes of abortion disparities and argue for a multifaceted public health approach to address them.

Misunderstanding the risk of conception from unprotected and protected sex

BACKGROUND

Recent research suggests that lack of knowledge about the risks of conception from engaging in unprotected and protected sex is associated with not using contraception. A deeper understanding of women's knowledge of the risk of conception and the factors associated with such knowledge is needed.

METHODS

Women with no history of abortion (n=1,472) at 13 family planning clinics were surveyed regarding their knowledge of the risk of conception from engaging in unprotected sex and while using condoms, oral contraceptive (OCs) pills, and intrauterine contraception (IUC).

FINDINGS

Very few women (8%) accurately estimated the risk of conception from engaging in one act of unprotected sex. About one quarter (26%) of women correctly rated the effectiveness of condoms and over half correctly rated the effectiveness of OCs (61%) and IUCs (56%). Women who were African American or Latina, living in poverty, and had less than a college degree were more likely to overestimate the failure rate of condoms, OCS, and IUCs. Other factors associated with underestimating the effectiveness of these methods were being pregnant or seeking pregnancy and having recently engaged in unprotected sex. Women were significantly more likely to accurately assess the effectiveness of the method they planned to use.

CONCLUSION

These findings suggest that improving women's knowledge of the effectiveness of various methods may encourage more effective and consistent contraceptive use.

Race-Ethnic Differences in Sexual Health Knowledge

Despite extensive research examining the correlates of unintended fertility, it remains a puzzle as to why racial and ethnic minorities are more likely to experience an unintended birth than non-Hispanic whites. This paper focuses on sexual literacy, a potential precursor of unintended fertility. Analyses use a unique dataset of unmarried young adults aged 18-29, the 2009 Survey of Unmarried Young Adults' Contraceptive Knowledge and Practices, to examine beliefs regarding pregnancy risks, pregnancy fatalism, and contraceptive side effects. At the bivariate level, foreign-born Hispanics hold more erroneous beliefs about the risk of pregnancy than other groups, and non-Hispanic blacks are more likely to believe in contraceptive side effects than non-Hispanic whites. Both foreign-born Hispanics and non-Hispanic blacks are more likely than non-Hispanic whites to hold a fatalistic view towards pregnancy. Race-ethnic differences are attenuated for pregnancy misperceptions and fatalism in multivariate models controlling for sources of health information, sexual and fertility experiences, and sociodemographic characteristics. However, non-Hispanic blacks remain more likely than non-Hispanic whites to believe there is a high chance of reduced sexual desire and serious health consequences when using hormonal contraceptives. These differences may contribute to race-ethnic variation in contraceptive use and, ultimately, unintended fertility.

Predictors of unprotected intercourse for female adolescents measured at their request for a pregnancy test

The purpose of this study was to identify predictors of unprotected intercourse in a sample of female adolescents requesting pregnancy testing. A survey was completed by 305 adolescents at a clinic visit. The dependent variable, unprotected sexual intercourse, was measured by self-reported frequency of condom use. Significant variables in the final regression model predicting condom nonuse included current partner's age, frequency of sexual activity, race, age at menarche, time dating, resiliency, reproductive knowledge, and fertility fear. Fertility fears were identified as a possible motivator for unprotected intercourse, an important finding for health care professionals providing care to adolescents.

Contraceptive experiences among adolescents who experience unintended birth

BACKGROUND

Adolescents are at high risk of unintended pregnancy due to contraceptive nonuse and inconsistent use.

STUDY DESIGN

We examined associations between contraception and mistimed/unwanted birth among adolescents. For contraceptive nonusers, we analyzed factors contributing to unintended birth.

RESULTS

Half of adolescents with unintended births did not use contraception at conception. Those ambivalent about pregnancy reported fewer unwanted [relative risk (RR)=0.06] compared to wanted births. Amongst contraceptive nonusers, difficulty accessing birth control was the only factor associated with more unwanted birth (RR=3.05). For Black adolescents, concerns of side effects (RR=7.03), access issues (RR=10.95) and perceived sterility (RR=3.20) were associated with unwanted birth. For younger teens, falsely perceived subfertility increased unwanted birth (RR=2.74), whereas access issues were significant for older teens (RR=3.97).

CONCLUSIONS

Access issues and misconceptions around contraceptive side effects and fertility place adolescents at higher risk for unintended pregnancy, especially among younger and Black teens. Ambivalence represents an additional area for intervention.

Studying the use of oral contraception: a review of measurement approaches

BACKGROUND

Although oral contraception (OC) misuse is presumed to play an important role in unwanted pregnancy, research findings have often been equivocal, perhaps reflecting unaddressed inconsistencies in methodological approaches.

METHODS

Using established databases, we performed a systematic review of measurement methods for OC use using primary research reports published from January 1965 to December 2009.

RESULTS

Terminology used to describe OC use, which included "continuation," "compliance," and "adherence," differed across studies and was rarely defined. The majority of studies (n = 27 of 38, 71%) relied solely on self-report measures of OC use. Only two reports described survey or interview questions, and reliability and validity data were seldom described. More rigorous measurement methods, such as pill counts (electronic or manual), serum and urinary biomarkers, and pharmacy records, were infrequently employed. Nineteen studies simultaneously used more than one method, but only three studies compared direct and indirect methods.

CONCLUSIONS

The lack of a consistent, well-defined measurement of OC use limits our understanding of contraceptive misuse and related negative outcomes. Future research should clarify terminology, develop standardized measures, incorporate multimethod approaches with innovative methods, and publish details of measurement methods.

Family discussions about contraception and family planning: a qualitative exploration of black parent and adolescent perspectives

CONTEXT

Parent-adolescent communication is associated with increased adolescent contraceptive use. However, studies of this association are limited by their lack of examination of the communication process, reliance on cross-sectional designs and infrequent comparison of parent and adolescent perspectives. Examining communication in black families is particularly important, given the high pregnancy rate among black adolescents.

METHODS

Between December 2007 and March 2008, a total of 21 focus groups were conducted with 53 black families (68 parents and 57 adolescents) in Pennsylvania. Separate groups were held for males and females, and for parents and adolescents. The discussion guide explored family communication about sexual health topics, including contraception, family planning and abortion. Sessions were audio-recorded; data were transcribed and analyzed using a grounded theory approach to content analysis and the constant comparison method.

RESULTS

Five key themes emerged among both parents and adolescents. First, discussions about contraception were indirect and framed in terms of the need to avoid negative consequences of sex. Second, contraceptive knowledge was low. Third, parents more often reported helping male adolescents get condoms than helping females get contraceptives. Fourth, discussions emphasized planning for the future over contraception. Finally, negative attitudes toward abortion were prevalent.

CONCLUSIONS

Parent-adolescent communication interventions should improve contraceptive knowledge, help parents understand the harmful effects of gender biases in information dissemination, and provide mothers and fathers with communication skills tailored to enhance the role they play in their adolescents' sexual development.

Contraception for adolescents with lupus

Sexually active adolescents, including young women with lupus, are at high risk for unplanned pregnancy. Unplanned pregnancy among teens with lupus is associated with an elevated risk of poor maternal and fetal outcomes. The provision of effective contraception is a crucial element of care for a sexually-active young woman with lupus. Unfortunately, providers may be hesitant to prescribe contraception to this group due to concerns about increasing the risk of lupus complications. This article reviews the risks and benefits of currently-available contraceptives for young women with lupus. Providers are encouraged to consider long-term, highly-effective contraception, such as implantables and intrauterine devices, for appropriately selected adolescents with lupus.

Disparities in family planning

Prominent racial/ethnic and socioeconomic disparities in rates of unintended pregnancy, abortion, and unintended births exist in the United States. These disparities can contribute to the cycle of disadvantage experienced by specific demographic groups when women are unable to control their fertility as desired. In this review we consider 3 factors that contribute to disparities in family planning outcomes: patient preferences and behaviors, health care system factors, and provider-related factors. Through addressing barriers to access to family planning services, including abortion and contraception, and working to ensure that all women receive patient-centered reproductive health care, health care providers and policy makers can substantially improve the ability of women from all racial/ethnic and socioeconomic backgrounds to make informed decisions about their fertility.

Do perceived health risks outweigh the benefits of modern contraceptives? A qualitative study in a suburban population in Istanbul, Turkey

OBJECTIVES

To evaluate the health concerns and the perceived non-contraceptive benefits of modern contraceptive methods through utilizing qualitative methods.

METHODS

Six focus group discussions were carried out with a total of 53 married women in a socio-economically disadvantaged community in Istanbul, Turkey.

RESULTS

Women had a vague knowledge of the mechanism of menstruation. Some women believed that the uterus was filled with blood -- termed 'dirty blood' -- which should be eliminated during menstruation in order to stay healthy. For this reason, amenorrhoea was recognized as the important disadvantage of the progestin-only injectable contraceptives. While the participants mentioned fallacious and exaggerated side effects related to modern methods they did not recognize their non-contraceptive benefits. Most women gained the information concerning side effects through their social networks. Sometimes the information acquired was based on rumours that biased women against the modern contraceptives.

CONCLUSIONS

Women outweighed the risks, some of which were fallacious and exaggerated, against the benefits of modern contraceptives. It is crucial to address health concerns of women and what they 'heard' from their peers during counselling sessions. Also the non-contraceptive health benefits of modern methods should be well emphasized. Since informal sources are prevalent, the effectiveness of peer education should be studied in this community.

The resistance to contraceptive use in young Italian women

OBJECTIVE

To investigate the personal relationship and social factors that influence young women not to use contraceptives.

METHODS

A total of 104 young women aged 14-23 years were studied using a 26-item questionnaire which was to be filled out individually. The questionnaire addressed use of contraceptives at the first intercourse and current use, together with various items related to age, educational level, self-image, fantasy about parenthood, and characteristics of the relationships with the partner and the family. A descriptive analysis and a multivariate logistic regression model investigated the relationship between contraceptive non-use and selected variables.

RESULTS

Twenty-four percent of the girls did not use any effective contraceptive method at the first sexual intercourse and 21% were current non-users. The study of characteristics associated with inconsistent contraceptive use shows a complex picture where young age, poor knowledge of the partner, an older partner and living in a incomplete family nucleus or outside the family represent significant risk factors. Considering our results as a whole, contraceptive non-use is not only a marker of risk-taking behavior, but sometimes expresses irrational feelings which emerge when facing new sexual experience.

La contraception des adolescentes en France en 2007

The two main objectives of adolescence contraception are the eviction of involuntary pregnancies and the prevention of sexually transmitted infections. In France, in spite of our rich contraceptive arsenal and a widely spread information, the rate of voluntary termination of pregnancy keeps growing among the teenagers population--and this, probably because the gap between theoretical effectiveness and practice of contraception is particularly wide among the young people. Every contraceptive means can be used by teenagers; the best option being, it seems, the "double DUTCH", which consists of concomitant use of condoms and hormonal contraception. Most often, the consultation for contraception is the first gynaecological consultation. That is the reason why it is usually stressful for teenagers who dread undergoing a gynaecological examination. If this examination is not necessary for most of young patients, it is essential to create a trustful relationship and to make explicit the several contraceptive methods. During this consultation it is interesting to look for common teenage troubles like addiction to smoking and eating disorders. For any prescription of hormonal contraception, it is important to explain the benefits and the possible side effects, to stress the observance and to tell the teenager about the recommendations in case of forgetting. Concerning condom - the only efficient way of preventing sexually transmitted infections--, it is useful to talk about it in concrete and straightforward terms, to show its handling and to inform about risks of tearing. With this state of mind, an emergency contraception can be prescribed straightaway in order to make its use easier. Also, without any moralizing speech, the need for maturity must be emphasized as well as taking care of one's body with the aim of avoiding a premature pregnancy or any sexually transmitted infection. This consultation must be coupled with a close follow-up, availability and mutual confidence which are the main elements vouching for a good observance and consequently an efficient contraception.

Depo Now: preventing unintended pregnancies among adolescents and young adults

PURPOSE

We compared the immediate administration of DMPA (Depo Now) to the immediate use of short-term hormonal methods that served as a "bridge method" until later DMPA initiation. We examined whether Depo Now, as compared to initiating with a bridge method (pills, transdermal patch, or vaginal ring), resulted in greater DMPA continuation at six months.

METHODS

Young women aged 14 to 26 years seeking to use DMPA were randomized (nonblinded) after meeting eligibility criteria to either the Depo Now (n = 101) or bridge method (n = 232) group. Depo Now subjects received their first injection of DMPA at the conclusion of their first visit provided each was medically suitable and had a negative urine pregnancy test regardless of menstrual cycle day. Those assigned to the bridge method group were allowed to choose their starting contraceptive method and it was provided at the first visit. All subjects were told to return to the clinic in 21 days to repeat the urine pregnancy test, and among those who were assigned to use a bridge method, to receive their first injection of DMPA. All subjects were followed to their third injection, or about 6 months later.

RESULTS

Those randomized to a bridge method were 1.8 (1.1, 2.9) times more likely than Depo Now subjects to return for their 21-day repeat pregnancy test, but only 55% (n = 125) of these young women actually received their first DMPA injection. Continuation rates at the third injection were 29.7% (n = 30) for those in the Depo Now group and 21.1% (n = 49) for those assigned to the bridge method (p = .09). Three factors were significantly associated with adherence to the third injection: randomized to Depo Now group, knowing more women who use DMPA, and returning to clinic for the 21-day repeat pregnancy test visit. Finally, 28 pregnancies were diagnosed during the study period, and those in the bridge method group were almost 4.0 (1.2, 13.4) times more likely to be diagnosed with a pregnancy than those in the Depo Now group.

CONCLUSIONS

Immediate administration of DMPA is associated with improved adherence to DMPA continuation and fewer pregnancies.

Menstrual irregularity from hormonal contraception: a cause of reproductive health concerns in minority adolescent young women

CONTEXT

Adolescents are frequent users of hormonal contraception (HC), yet their adherence to these methods is often poor. Concerns about side effects, especially those affecting the menstrual system, are often given as reasons for contraceptive nonadherence or discontinuation. We sought to identify teens' concerns and misperceptions about the menstrual-related side effects of HC.

METHODS

Open focus groups were conducted with both sexually active and virgin adolescent women aged 12-18 years who were recruited from the Philadelphia area. The adolescents did not have to be contraceptive users in order to participate. The question put to each group was, "What are the things you have heard about the birth control pill, Depo-Provera and Norplant?" Groups were audio-recorded, transcribed and analyzed using qualitative software.

RESULTS

We conducted 13 female-only groups. Participants raised frequent concerns about menstrual-related side effects, believing that these side effects were evidence of possible negative effects of HC on their reproductive health. Four themes related to hormonal contraceptive-induced menstrual irregularity emerged from the groups. Theme 1: Menstruation is natural and should not be altered in any way. Theme 2: The menstrual period is necessary for cleansing of the body. Theme 3: "Spotting," intermenstrual bleeding and amenorrhea cause doubts about the method's effectiveness and worries about pregnancy. Theme 4: All menstrual irregularity, from intermenstrual bleeding to amenorrhea, causes worry about the effects on fertility and on physical health.

CONCLUSIONS

Teens have concerns about the menstrual irregularity caused by HC. Providers understand that these side effects are minor and of little medical consequence. Yet, adolescent patients may be ascribing great significance to these effects and may be declining these methods because of fear and misperceptions.

Factors influencing young women's decision making regarding hormonal contraceptives: a qualitative study

INTRODUCTION

Discontinuation of hormonal contraceptives is correlated with the experience of unwanted effects and is an important cause of unwanted pregnancy. Previous studies have not identified the factors that influence whether a woman will switch to another hormonal contraceptive, switch back to condom use or stop contraception altogether when side effects are experienced.

METHODS

This qualitative study used in-depth interviews to explore factors influencing young women's decision making regarding highly effective hormonal contraceptives in 51 women aged 16-25 years living in or just outside London, UK.

RESULTS

Young women's decision making regarding hormonal contraceptives is not simply determined by the experience of unwanted effects but reflects the meaning of unwanted effects in relation to underlying beliefs regarding the nature of hormones in contraceptives, 'natural' menses, menstrual control and the importance of avoiding pregnancy. When unwanted effects were experienced, women with no concerns about the nature of hormones tended to switch to other highly effective hormonal contraceptives. Those with underlying concerns regarding the nature of hormones returned to (inconsistent) condom use or stopped using contraception altogether. This was linked to experiencing unwanted pregnancy.

CONCLUSIONS

Eliciting attitudes regarding the nature of hormones in contraceptives, menstrual control and natural menses could enable health care practitioners to offer more tailored advice, interventions and contraceptives to women.

Concerns about contraceptive side effects among young Latinas: a focus-group approach

To identify perceptions and attitudes about contraceptive side effects in young, low-income Latina adolescents through focus-group conversations. We conducted seven focus-group discussions with Latino females in an outpatient clinic and community setting. Qualitative methodology was used to analyze data. Participants were recruited from the outpatient gynecology clinic at the University of Illinois at Chicago, and from the Easter Seals Day Care Center. Women were recruited if they were Latino and between the ages of 18 and 26 years (N = 40). Participants cited both perceptions of side effects as well as personal experience with side effects as reasons for not using or discontinuing the use of contraception. Women also demonstrated incorrect knowledge about contraception, and tended to value anecdotal information over information from health professionals. These factors led to reliance on less-effective methods of contraception, placing participants at risk for unintended pregnancy. Concern about side effects, fear of health consequences and misinformation were identified as barriers to effective contraceptive use in young, low-income Latinas. Providers caring for this population should address potential concerns about side effects of contraception as well as assess patients' understanding in light of cultural and language barriers.

Tolerability of levonorgestrel emergency contraception in adolescents

OBJECTIVE

We evaluated the tolerability of emergency contraception in adolescents. Study design In this descriptive study, 1 0.75 mg levonorgestrel tablet was administered to 52 females aged 13-16 with instructions to take the second tablet 12 hours later (unprotected intercourse was not an entry requirement). Participants kept diaries of side effects and menstrual patterns. We assessed correct use, side effects caused by treatment, and impact on menstrual cycle.

RESULTS

Virtually all participants used the drug correctly, with no serious adverse events. Minor expected side effects occurred, including nausea, fatigue, and vomiting. There was no difference in reporting of side effects by age. Adolescents' mean duration of menses was comparable pre- and post-treatment (5.3 vs 5.0 days; P=.146), and onset of menses was within the expected range. Ninety percent of participants reported they would recommend emergency contraception to a friend or relative if needed.

CONCLUSION

Adolescents tolerated the medication well, experiencing transient side effects.

Canadian Contraception Consensus

This document has been archived because it contains outdated information. It should not be consulted for clinical use, but for historical research only. Please visit the journal website for the most recent guidelines.

Importance and knowledge of oral contraceptives in antepartum, low-income, African American adolescents

STUDY OBJECTIVE

To assess motivation, sense of self-efficacy and knowledge of oral contraceptives (OC) in antepartum, African-American Adolescents and young adults following OC counseling.

METHODS

Gravid African-American females, less than 25 years of age, receiving prenatal care at the Prentice Ambulatory Clinic at Northwestern Memorial Hospital were eligible for this study. Participants were enrolled after 34 weeks gestation, received one session of standardized OC counseling and then completed a series of questions regarding importance, confidence and knowledge of OCs.

RESULTS

Forty-three adolescents and young adults participated in this study. Almost all participants agreed that it was important to plan their next pregnancy and to avoid unplanned pregnancies. On average, participants were extremely confident they could take a pill each day. Yet, while most were confident that they knew what to do if they missed one pill, only 37% actually knew what to do if they missed one pill.

CONCLUSION

Despite high motivation and confidence in their ability to take OCs following pregnancy, many in this cohort did not fully understand the counseling that they had received. It is important for clinicians to bear in mind that patients may express motivation and confidence about using OCs, but still lack knowledge of the more complex and critical aspects of OC use. Additional education and support are needed in high-risk populations to ensure effective contraceptive knowledge.

Feasibility study of the use of a daily electronic mail reminder to improve oral contraceptive compliance

Women who ingest their oral contraceptive pill (OCP) as part of a daily routine are more likely use their OCPs correctly. This trial examines the feasibility of an electronic-mail (e-mail) reminder system to improve OCP compliance. An e-mail reminder was sent to 50 new OCP users daily for 3 months. Subjects sent an e-mail reply to confirm receipt. OCP compliance was recorded on diaries. Four subjects were discontinued for not checking their e-mail. Active participants missed a median of 18% of the e-mail reminders (range: 0-65%). A follow-up visit was scheduled after completion of three OCP cycles. Of the 40 subjects returning completed diaries, 50% missed no active pills at all and 20% missed at least one in each cycle. Most found the daily e-mail somewhat (65%) or very helpful (19%) for OCP compliance. Of those continuing OCPs, 64% wanted to continue receiving e-mail reminders at the completion of the study. Because inconsistent OCP use is a significant cause of unplanned conception, the use of e-mail to improve OCP compliance has the potential to decrease unintended pregnancies.

Adolescent beliefs about infertility

PURPOSE

Explore adolescents' definition of fertility and range of beliefs regarding causes of infertility.

METHODS

Qualitative study involving five focus groups that met between April 2001 and December 2001 at a hospital-based adolescent health center. All groups were led by one experienced moderator and observed by two investigators. Audiotapes of the group discussions were transcribed and reviewed independently by three investigators who met and reached consensus on underlying themes.

RESULTS

Most adolescents generally understood fertility as the ability to become pregnant. Ten themes emerged as causes of infertility. Anatomic/gynecologic causes generated the most responses and most detailed discussion (e.g., "The coating on the egg is too hard and the sperm can't get in to fertilize the egg."). Other commonly mentioned causes were male factors (e.g., "He cannot produce sperm."), sexually transmitted infections (e.g., "like chlamydia caused scarring in the fallopian tubes"), genetics (e.g.,"a birth defect") and substance use (e.g., "if a man smoke weed all day, the egg may not develop because of problems with his sperm"). Less commonly mentioned themes were stress, contraception, environmental toxins, violence and injury.

CONCLUSIONS

Most adolescents defined fertility as the ability to become pregnant and reported an extensive range of beliefs about the causes of infertility. Providers should consider eliciting adolescents' definitions of fertility and also exploring beliefs about causes of infertility with their patients when counseling about sexuality and contraception to determine if an adolescent has inaccurate beliefs about their fertility.

[Oral contraception in France in 2001: results of an opinion poll survey conducted on 3609 women between 15 and 45]

OBJECTIVES

The aim of this study concerning the taking of the pill in France in 2001 was threefold, i.e. to assess its rate as well as its characteristics of use, and to appraise the most frequent side effects as reported by women.

MATERIAL AND METHOD

Three thousand six hundred and nine women representative of the French female population between 15 and 45 years of age were recruited thanks to a survey, which took place in 2001. The data were collected from self-questionnaires.

RESULTS

Women on the whole have quite a good opinion of oral contraception and most of them are convinced of its efficiency. As far as pill tolerance is concerned, opinions do vary, more than half of the women judging that being on the pill is not without side-effects. Though, the rate of use of oral contraceptives has increased by 12% since 1994. Most women (48%) use first and second generation pills and this in all age brackets. Thirty per cent of women aged 30 to 45 keep loyal to the same patent medicine, which they keep using for more than 10 years. Among the side-effects that can be found, two of them--putting on weight (31%) and hydrosodium retention (26%)--are the most frequently quoted, in all age brackets. This accounts for the relatively low ratio of women who find their pill quite satisfactory (58% of the cases).

DISCUSSION AND CONCLUSION

Despite the diversity of all the different patented pills that are available, efforts are still to be made in order to reduce what side-effects are encountered when using them.