The dynamics of oral contraceptive use in The Netherlands 1990-1993.

Data from an ongoing series of surveys on contraceptive use in the Netherlands were analyzed with respect to the percentages of oral contraceptive (OC) users who annually started use, discontinued use or switched to another OC type. The surveys had been conducted between 1990 and 1993 among samples of women aged 15-49 who belonged to a survey panel. Response rates of the surveys were 89-90% and the sample sizes ranged from 4560 to 4621 women. The assessed OC use rates reflected those of the Dutch population reasonably well. Of all respondents who had used OCs during the 12 months prior to the surveys, 12-15% discontinued use within this period, mainly in order to get pregnant, 12-16% were starters and 9-14% switchers. Of all starters 37% switched to another OC type within the first 12 months after starting. Switching was mainly related to the experience of perceived side-effects and wishes for better cycle control. The results highlighted the relevance of closely monitoring the individual woman's satisfaction with her OC. Since OC use appeared in many cases to be characterized by an active seeking for the most acceptable OC type, a wide range of OC types available and the development and introduction of new types is highly relevant for tailoring contraceptive use to individual needs.

Choices and changes in contraceptive behaviour; the role of information sources.

One of the factors contributing to the fact that contraceptive behaviour in The Netherlands is more effective then in most other countries seems to be that Dutch women are very well informed about all aspects of contraception as a result of formal and informal education at school, in the families and by the media. In a population based survey more than 4500 women were followed during 5 consecutive years by means of a yearly questionnaire about contraceptive behaviour, choices and trends. With regards to information sources it is concluded that the general practitioner, who plays a central role as provider of contraceptive services, is viewed as the most important and reliable source of information. On the other hand Dutch women in general view their contraceptive choices as their own, they do not feel that they are very much influenced by the opinions of their physicians, who in general do not have a normative, patronizing and/or moralizing attitude regarding sexuality and contraception.

PIP: Between 1989 and 1993, a cohort of more than 4500 women, 15-49 years old, living in the Netherlands were interviewed on family planning, contraceptive use, sexual behavior, attitudes, use of services, sources of information, and reasons for changes in behavior and/or contraceptive status. The media, public opinions, and attitudes of health care authorities have affected contraceptive behavior. For example, IUD use fell during the 1980s and early 1990s (1980-1993, from about 14 to 2.8%) due to adverse publicity and the continued belief by women and health care providers that IUDs increase the risk of pelvic inflammatory disease and ectopic pregnancy. 86-89% of women believed that they themselves decided which contraceptive to use. The leading information source for all contraceptive methods but condoms was the general practitioner (66-80%). In fact, the women rated the information from the general practitioner to be the best for all methods (92-98%). The general practitioner was perceived not to have a normative, patronizing, or moralizing attitude towards sexuality and contraception. More and more women, particularly teenagers, were adopting the Dutch method of simultaneous contraceptive and condom use to prevent unwanted pregnancy and transmission of sexually transmitted diseases, including HIV. The female condom, Femidom, was introduced in the Netherlands in January 1993. By March-April 1993, just 22% of the women had never heard of Femidom. 86% of condom users had heard of it, while just 74% of women who used no contraception had heard of it. Just 3 women used it regularly and 8 women used it sometimes.