Timing of the decision to remain voluntarily childless: evidence for continuous socialization

This study contrasts different types of voluntary childlessness. Women who decided to remain childless relatively early in life, before marriage ( early articulators) were compared with women who did not decide until after they had married and developed a preferred life style that did not include children ( postponers). The comparison centered on a previously formulated model that explained the decision to remain childless in terms of family background factors, autonomy and achievement orientation in adulthood, and reference group support. The major difference disclosed by this research was with respect to family background factors. In addition to the early versus later decision to remain childless, socialization patterns in the family of orientation differentiate the two types of voluntarily childless women.

Evaluating the computer as a data camera in family planning research

"This chapter explores both the potential and limitations of the micro-computer as a research tool for unobtrusive data collection in the area of population and family planning.... To provide concrete examples of the computer's potential usefulness as well as its limitations, two research projects undertaken [in the United States] by the author and colleagues will be discussed.... Each program offers different applications of how the computer can be used to: (1) evaluate programs; (2) collect descriptive data about users' values, decisions, and previous behaviors regarding sexual issues, and (3) develop and test cognitive and behavior models. Each application also offers examples of the limitations of the computer in terms of external validity issues (i.e., how representative are samples of persons who use the computer voluntarily), the need to check the validity of responses typed by computer users, and ethical issues involved in using the computer to collect data."

Self-esteem, spiritual well-being, and intimacy: a comparison among couples using NFP and oral contraceptives

The purpose of this study was to compare the intimacy, spiritual well being (SWB), and self-esteem of couples using natural family planning (NFP) with those couples using oral contraceptives (OCs). 22 couples who were using the Creighton Model Ovulation Method of NFP for 1 year to avoid pregnancy were matched with 22 couples who were using OCs for a least a 1-year period and administered a SWB, self-esteem, and intimacy inventory. Student t-tests were calculated to determine differences in the mean scores of the 3 inventories between the 2 groups. The results showed that the NFP couples had statistically higher self-esteem (T=3.15, p0.01), SWB (T=4.25. p0.001), and intellectual intimacy (T=2.53, p0.05) than the OC couples. There were no differences in emotional, social, recreational, and sexual intimacy between the groups. Although the results provide some evidence that NFP can enhance a couple's relationship, other factors such as a sampling bias and educational levels could explain the difference.

Contraception and culture: the use of yuyos in Paraguay

The use of herbs (yuyos) as contraception is common practice in Paraguay. This report analyzes data from the 1995-1996 Paraguayan Reproductive Health Survey. The analysis reveals that women are more familiar with yuyos (88%) than any other method of family planning. Modeling the determinants of ever having relied on yuyos as contraception demonstrates that older women (OR = 1.043) and women with more children (OR = 2.283) are significantly more likely to have used yuyos, but an interaction between older women with more children shows they are less likely to have used this method (OR = .982). Women living in rural areas (OR = .664) and those with more education (OR = .883) are less likely to have used the method. These findings show widespread acceptance and use of yuyos for contraception in Paraguay. More research into the chemical properties of yuyos is needed to determine their contraceptive efficacy and to prevent harmful effects from their misuse.

What nurses should know about natural family planning

Two common natural family planning (NFP) methods are the ovulation method based on characteristics of cervical mucus and the symptothermal method based on changes in cervical mucus, basal body temperature, and the cervix. Both methods are effective when used correctly. Nurses should understand the principles of NFP and introduce these methods in discussions of family planning options. Interested clients should be referred to a certified NFP instructor for education and supervision.

Sterilization for family planning in a Third World country

Outpatient laparoscopy procedures have made sterilization possible for millions of women in developing countries. This report describes the experience of a team of doctors, nurses, and support staff that performed 107 laparoscopic tubal sterilizations during on eight-day sojourn in a remote north-central area of Nicaragua. Minimal analgesia (oral ibuprofen) and anesthesia (1% lidocaine) were used since most of the patients walked to and from the hospital-some up to 15 miles. Because the Nicaraguan government's support for birth-control programs is unreliable and because illegal abortion is the leading cause of maternal mortality in Nicaragua, this safe, minimally invasive surgical method is the favored means of birth control.

Long-acting hormonal contraception

For 30 years, the combined oral contraceptive pill has been an almost automatic choice for effective contraception in sexually active adolescent women. Nevertheless, consideration of the criteria of a hypothetical "ideal" contraceptive suggests that long-acting progestogen-only methods may have considerable advantages for some adolescents. These would include greater efficacy, easier compliance, avoidance of estrogenic side effects, and potentially greater privacy. The disadvantages of menstrual irregularity, progestogenic side effects including weight gain, and the initial greater medicalization of the method, particularly implants, must be weighed against the wishes and preferences of the adolescent. A number of studies of the uptake and utilization of these methods in adolescence have arisen, particularly from the United States. These are reviewed together with experience from programs in the United Kingdom.

Determinants for contraceptive use in young, single, Danish women from the general population

Determinants for contraceptive use were studied in 5031, non-pregnant women aged 20-29 years from the general population in Denmark. Most women (72%) had never been pregnant, 34% had a history of a sexually transmitted disease, and 22% had ever had a legal abortion. Current contraception was most frequently condoms (60%) or oral contraceptives (33%). Among the women who used OCs or IUD, 32% reported additional condom use (double contraception). Important predictors of using one contraceptive method were lifetime number of sexual partners, parity, and age at first sexual intercourse for condoms and age for oral contraceptives. Also, women with a previous legal abortion were more likely to use condoms currently and women with a history of STDs were less likely to use condoms, but more likely to use OCs. Lifetime number of sexual partners was the only predictor of double contraception. Our data suggest a potential for reducing the number of unintended pregnancies and STDs in single women by increasing the information about the double principle in contraception.

Consistency of condom use among users of injectable contraceptives

Use of condoms for protection against sexually transmitted diseases (STDs) was examined over a nine-month period among 536 women from 17 clinics in southeastern Texas who had selected the injectable depot-medroxyprogesterone acetate (DMPA) as a contraceptive. Among women who were using condoms prior to receiving DMPA, nearly half said they never or rarely did so after initiating DMPA use; only 18% of all women in the study used condoms consistently while relying on DMPA. Factors associated with consistent condom use were being black (odds ratio of 2.0), being unmarried (odds ratio of 2.2), having a history of STD infection (odds ratio of 1.8), having previously used condoms (odds ratio of 2.7) and having no interest in future childbearing (odds ratio of 1.8). Our data suggest that the majority of users of injectables may not be protected from exposure to the human immunodeficiency virus and other STDs.

Voluntary female sterilisation via minilaparotomy: report from Burkina Faso

We present the first study of voluntary female sterilisation in Burkina Faso. The average woman undergoing tubal ligation was a 37 year old, married, house wife para 8 with five living children. The main reasons for TL were: achieved desired family size (45.9%) and medical reason (29.5%). The TL was usually performed (77.8%) in the postpartum, using the Pomeroy technique. With a follow up of three to fifteen months, no pregnancy has been reported and no request for reversal expressed. The authors make some suggestions to increase the prevalence of TL in Burkina Faso.

The provision of public-sector services by family planning agencies in 1995

Results from a 1995 survey of a nationally representative sample of 603 publicly funded family planning agencies reveal that 96% rely on federal funding, 60% on state funding and 40% on local funding to provide family planning and other services. Although only 25% of the contraceptive clients served by these publicly funded agencies--including health departments, hospitals, Planned Parenthood affiliates, independent agencies and community and migrant health centers--are Medicaid recipients, 57% have incomes below the federal poverty level and an additional 33% have incomes of 100-250% of the poverty level. Some 40% of the recipients of family planning services are black, Hispanic or from other minority groups, and 30% are younger than 20. Each agency employs an average of three physicians who together provide approximately seven hours of care per week and seven midlevel clinicians who provide 71 hours of care per week. The pill is the only contraceptive method provided by all agencies, but 96% provide the injectable; at least 90% spermicide, the condom and the diaphragm; 78% periodic abstinence; and 59% the implant. The remaining methods are provided by fewer than 50% of agencies. Almost 70% of agencies have at least one special program of outreach, education or services to meet the needs of teenagers, but far fewer have special programs for such hard-to-reach groups as the homeless, the disabled or substance users.

Intention to use contraceptives and subsequent contraceptive behavior in Morocco

In this article, the relationship between stated intention to use contraceptives and subsequent use during a three-year period in Morocco is examined. Longitudinal data are drawn from two Demographic and Health Surveys: the 1992 Morocco DHS and the 1995 Morocco Panel Survey. Reported contraceptive intentions in 1992 have a strong predictive effect on subsequent contraceptive use even after controlling for other characteristics of respondents, and the strength of the effect is second only to that of previous contraceptive use. Women who in 1992 said they intended to use contraceptives in the future but did not do so are the most likely to have had an unmet need for contraception in 1995. Weakly held fertility preferences reported by some of the women surveyed in 1992 appear to have been a contributing factor in the subsequent failure of these women to act upon their intention to practice contraception.

Correlates of oral contraceptive use in Italian women, 1991-93

In order to understand the determinants of oral contraceptive (OC) use in Italy, we analyzed data on 1577 women aged under age 60 (median age 50 years) admitted as controls in a case-control study of breast cancer. Included in this group were women with acute, non-neoplastic, non-gynecologic, non-hormone-related diseases, admitted between 1991 and 1994 to a network of hospitals in six Italian centres. A total of 275 (17.4%) women reported ever OC use. Oral contraceptive use was strongly related to the level of education: in comparison with women reporting < 7 years of schooling, the multivariate odds ratios (OR) of ever OC use were 2.2 and 3.5, respectively, in women reporting 7-11 and > or = 12 years of schooling (chi 1(2) trend 40.87 p < 0.001). OC use was inversely related to body mass index (BMI): in comparison with leaner women (BMI, Kg/m2, < 25), the OR of being an ever OC user was 0.8 and 0.7, respectively, in women with BMI 25-< 30 and > or = 30 (chi 1(2) trend 3.36, p = 0.07). Parous women more frequently tended to be OC users than nulliparous ones, the estimated OR being 2.4 and 2.3, respectively, in women reporting 1 or 2 and 3 or more births in comparison with nulliparae. Likewise, women with history of induced abortions were more frequently ever OC users (OR for > or = 1 induced abortions vs no induced abortion, 1.8, 95% Cl 1.2-2.6). However, no relationship emerged between OC use and history of spontaneous abortions. Finally, there was no relation between pill use and history of hypertension, cholelithiasis, thyroid diseases, hyperlipidemia, family history of breast cancer, uterine fibroids and benign breast disease. Women with a history of diabetes were less likely to be OC users (OR 0.6), but the finding was not significant. The results of this analysis are comparable with those of a study conducted in the same population in the early 1980's, and suggest that sociodemographic and reproductive factors, rather than medical history, are major determinants of OC use in this population.

Early experience with the contraceptive use of depot medroxyprogesterone acetate in an inner-city clinic population

There are few data on the experience of American women with the injectable depot medroxyprogesterone acetate (DMPA) since its recent approval by the Food and Drug Administration for contraceptive use in the United States. An exploratory study was conducted using chart reviews and telephone interviews of 261 women who initiated DMPA use between December 1992 and June 1994 at either a hospital-based (48%) or community-based (49%) clinic in New York City. Most DMPA users were single (70%), had had at least one birth (88%), had had at least one abortion (67%) and had ever practiced contraception (75% of those with available data). Life-table DMPA continuation rates were 63% at six months and 42% at 12 months and were not affected by the users' age, marital status, pregnancy history, clinic site or proximity of residence to the clinic. Among adults, the risk of DMPA discontinuation was highest during the three-month period following the second injection, while among adolescents, this risk increased throughout the duration of use. The most commonly reported reasons for method discontinuation were side effects, primarily menstrual irregularities (30%) and weight gain (24%).

Characteristics of injectable contraceptive users in a low-income population in Texas

Among 600 women at 17 family planning clinics in Texas who expressed interest in using the hormonal injectable depot medroxyprogesterone acetate (DMPA), 536 (89%) actually received the injectable. Thirty percent of the DMPA recipients were younger than 21 and 77% were not married. The average numbers of pregnancies and births were 1.9 and 1.2 per woman; one-third of the women had had at least one abortion. The majority of women receiving DMPA (66%) were using it to space births. Their main sources of information about the method were friends (42%) and health care providers (37%), and the most commonly reported reason for its use was dissatisfaction with previous contraceptive methods.

Health belief and self-efficacy models: their utility in explaining college student condom use

This investigation tested the ability of the Health Belief Model (HBM), dimensions of self-efficacy, various behavioral variables (i.e., number of sex partners in the past 12 months, frequency of drunkenness during sexual intercourse, and number of diagnosed sexually transmitted diseases), and demographic measures to distinguish between three condom user groups (i.e., nonusers, sporadic users, and consistent users). The usable sample consisted of 366 college students, ages 18 to 24. The study operationalized the following HBM components: perceived susceptibility, perceived benefits, and perceived barriers. The multidimensional Condom Use Self-Efficacy Scale (CUSES) was also used in this investigation. Results from a discriminant analysis indicated that sporadic users were best distinguished from both consistent and nonusers by number of sex partners in the past year, frequency of drunkenness during sexual intercourse, perceived susceptibility to HIV/AIDS and other STDs, and a self-efficacy factor labeled Assertive. The sporadic users had significantly more sex partners, were drunk more often when engaging in sexual intercourse, perceived themselves as more susceptible to HIV/AIDS and other STDs, and were less confident in their ability to discuss and insist on condom use with a partner. It was also discovered that each condom user group was best defined by different subsets of discriminating variables. Implications of these findings for campus-based prevention programs and future research are discussed.

Predictors of condom acquisition after an STD clinic visit

Data from a survey of 691 men and women who made patient visits to an inner-city, sexually transmitted disease (STD) clinic and were given coupons to redeem for condoms at a neighborhood pharmacy show that only 22% of the sample did so. Gender, ethnicity, marital status and education were not significant predictors of whether study participants redeemed their coupons. Factors that significantly predicted coupon redemption included the extent of acculturation and age, with those who were older and less acculturated more likely to do so. Other significant factors were having a primary sexual partner and having had more than one sexual partner in the last month; having ever had an STD was negatively associated with coupon redemption. A perception of being at high STD risk and a favorable attitude about condoms also significantly predicted condom acquisition. All these variables, except for attitude toward condoms and a history of an STD, remained significant when entered into a logistic regression controlling for the influence of all independently significant predictors.

Utilisation of family planning services at the teaching hospital in Blantyre, Malawi

In the whole of 1993, there were a total of 1533 new clients who attended the family planning clinic at the Queen Elizabeth Central Teaching Hospital in Blantyre, Malawi. They formed 23.0% of the total client-visits for the year. 305 women had surgical contraception (bilateral tubal ligation) for various reasons, but mainly on request for family limitation. The ages of the new clients ranged from 15 to 49 years. Adolescents (< 20 years old) formed only 9.0%, while those aged > 35 years formed 22.0%. Their parity ranged from 0 to 11, with 58.0% of them being para 1 to 4. The grandmultiparae (para > 5) formed 31.0%. The oral pill was the most favoured method (42.0%), followed by depo-provera (31.0%) and sterilisation (21.0%). Though the majority of the clients who chose the oral pill were aged less than 30 years, about 6.0% were aged > 35 years. Likewise about 15.0% of those who took oral pills were para > 5, i.e. grandmultiparae. These are women who should have either stopped producing a long time back or been counselled to have tubal ligation rather than these temporary methods, when seen in the clinic then. Amongst all the client-visits for the year, oral pill and depo-provera were the two most popular methods, 42.0% and 41.0%, respectively. The ratio, between the clients who discontinued the method they were on and the new clients was 1:6.8, and that of drop-out/new clients was 1:2.4, which are quite high. The rate of absenteeism was also high at 29.0% of the total client-visits.(ABSTRACT TRUNCATED AT 250 WORDS)

Norplant contraceptive acceptability among women in five Asian countries

An analysis of 1,882 Asian acceptors of Norplant implants indicates that method acceptability remained high among the 882 women who used the method for five years. Women who discontinued early from the study were, on average, younger than those who completed five years of use. Also, they had fewer live births and were more likely to desire additional children. Overall, about 70% of the women in these countries found the Norplant implant method to be very favorable. The majority (> 40%) of the women found the ease and duration of use of the method to be most attractive, while menstrual disturbances were the least-liked aspect of the method. Although it was apparent that there are still some potential obstacles to Norplant implant acceptance, most noticeably concerns about menstrual irregularities, interest in continuing the method after five years of use is high. Further research of issues related to Norplant implant acceptability may improve continuation rates and overall client satisfaction.

Who uses Norplant. A study from Finland

OBJECTIVE

Although Norplant implantable contraceptives were introduced first in Finland, their use has been infrequent. The objective of this study was to investigate what kind of women use Norplant in Finland, who suggested its use, and from what source women get their information on Norplant.

METHODS

A questionnaire was mailed to all women having had Norplant inserted one to two years before the study initiation (June 1992) in seven family-planning clinics in the Helsinki city area (n = 262). After one reminder, the response rate was 82%.

RESULTS

Most of the users were 25-34 years old, and many of them had had a previous abortion. Half of the women were still considering a (subsequent) child. All the women had used some birth control method before Norplant and reported several problems with it. Women reported that they themselves had chosen Norplant, but physicians and nursing staff in the family-planning clinic were their most important information sources. Most women considered that they had received sufficient information before insertion regarding both the good and bad aspects of the method.

CONCLUSIONS

Women with previous abortions are a special users' group for Norplant, even though most users are in no way exceptional women.

Effects of prebehavioral cognitive work on adolescents' acceptance of condoms

Two educational strategies designed to promote condom use for sexually transmitted disease protection were tested in a field experiment involving 291 female, adolescent family planning clinic clients. The 1st strategy was designed to enhance attitude-behavior correspondence by increasing direct experience with handling condoms. The 2nd, a contingency-planning exercise, induced clients to generate a mental representation of negotiating condom use with a sexual partner. Both strategies were compared with the standard education. The dependent measures were condom acceptance (operationalized by the number of condoms taken), attitudes, and knowledge. Clients in the contingency-planning condition accepted about 60% more condoms than did other clients. Condom attitudes followed the same pattern, and knowledge did not differ among conditions.