History of unintended pregnancy and patterns of contraceptive use among racial and ethnic minority women veterans.

BACKGROUND: Nearly half of all pregnancies in the United States each year are unintended, with the highest rates observed among non-Hispanic black and Hispanic women. Little is known about whether variations in unintended pregnancy and contraceptive use across racial and ethnic groups persist among women veteran Veterans Affairs users who have more universal access than other populations to health care and contraceptive services. OBJECTIVES: The objectives of this study were to identify a history of unintended pregnancy and describe patterns of contraceptive use across racial and ethnic groups among women veterans accessing Veterans Affairs primary care. STUDY DESIGN: Cross-sectional data from a national random sample of women veterans (n = 2302) aged 18-44 years who had accessed Veterans Affairs primary care in the previous 12 month were used to assess a history of unintended pregnancy (pregnancies reported as either unwanted or having occurred too soon). Any contraceptive use at last sex (both prescription and nonprescription methods) and prescription contraceptive use at last sex were assessed in the subset of women (n = 1341) identified as being at risk for unintended pregnancy. Prescription contraceptive methods include long-acting reversible contraceptive methods (intrauterine devices and subdermal implants), hormonal methods (pill, patch, ring, and injection), and female or male sterilization; nonprescription methods include barrier methods (eg, condoms, diaphragm), fertility-awareness methods, and withdrawal. Multivariable logistic regression models were used to examine the relationship between race/ethnicity with unintended pregnancy and contraceptive use at last sex. RESULTS: Overall, 94.4% of women veterans at risk of unintended pregnancy used any method of contraception at last sex. Intrauterine devices (18.9%), female surgical sterilization (16.9%), and birth control pills (15.9%) were the 3 most frequently used methods across the sample. Intrauterine devices were the most frequently used method for Hispanic, non-Hispanic white, and other non-Hispanic women, while female surgical sterilization was the most frequently used method among non-Hispanic black women. In adjusted models, Hispanic women (adjusted odds ratio, 1.60, 95% confidence interval, 1.15-2.21) and non-Hispanic black women (adjusted odds ratio, 1.84, 95% confidence interval, 1.44-2.36) were significantly more likely than non-Hispanic white women to report any history of unintended pregnancy. In the subcohort of 1341 women at risk of unintended pregnancy, there were no significant racial/ethnic differences in use of any contraception at last sex. However, significant differences were observed in the use of prescription methods at last sex. Hispanic women (adjusted odds ratio, 0.51, 95% confidence interval, 0.35-0.75) and non-Hispanic black women (adjusted odds ratio, 0.69, 95% confidence interval, 0.51-0.95) were significantly less likely than non-Hispanic white women to have used prescription contraception at last sex. CONCLUSION: Significant racial and ethnic differences exist in unintended pregnancy and contraceptive use among women veterans using Veterans Affairs care, suggesting the need for interventions to address potential disparities. Improving access to and delivery of patient-centered reproductive goals assessment and contraceptive counseling that can address knowledge gaps while respectfully considering individual patient preferences is needed to support women veterans' decision making and ensure equitable reproductive health services across Veterans Affairs.

Dropout and Abstinence Outcomes in a National Text Messaging Smoking Cessation Intervention for Pregnant Women, SmokefreeMOM: Observational Study.

BACKGROUND: Population-level text messaging smoking cessation interventions may reduce racial and ethnic differences in smoking among pregnant women. OBJECTIVE: Our objective was to examine racial and ethnic differences in dropout, response, and abstinence rates among users of a US national, publicly available text messaging cessation intervention targeting pregnant women, SmokefreeMOM. METHODS: Participants were online subscribers to SmokefreeMOM who set a prospective quit date within the 9 months before their due date. We examined demographics, smoking frequency, number of cigarettes smoked per day, and prequit time (up to 14 days of preparation time before quit date) as correlates of response rate and abstinence at 8 time points: quit date, day 7, day 14, day 21, day 28, day 35, day 42 (intervention end), and day 72 (1-month follow-up). We conducted survival analysis of time from quit date to dropout by race and ethnicity. RESULTS: The mean age of the analytic sample of 1288 users was 29.46 (SD 7.11) years. Of these, 65.81% (848/1288) were white, 16.04% (207/1288) were black, 8.86% (114/1288) were Latina, and 9.29% (120/1288) were multiracial, American Indian/Alaska Native, Native Hawaiian Pacific Islander, or other; 82.68% (1065/1288) had some college education or less. Point-prevalence abstinence was 14.51% (157/1082) on quit day, 3.51% (38/1082) at intervention end, and 1.99% (21/1053) at 1-month follow-up. Black users (hazard ratio 0.68, 95% CI 0.51-0.91) and those with a high school degree or less (hazard ratio 0.66, 95% CI 0.49-0.89) or some college education (hazard ratio 0.75, 95% CI 0.57-0.99) were less likely to drop out than whites or users with a bachelor's degree or higher. Response and abstinence rates were similar across race, ethnicity, and education. CONCLUSIONS: Enrollment was low among racial and ethnic minority women but high among less-educated women. Abstinence at intervention end and 1-month follow-up was lower than that in controlled trials of text messaging cessation interventions for pregnant women (range 7%-20%). Increasing the reach, engagement, and effectiveness of SmokefreeMOM, especially among women with high rates of smoking during pregnancy, must be prioritized.

Global Contraceptive Failure Rates: Who Is Most at Risk?

Contraceptive failure is a major contributor to unintended pregnancy worldwide. DHS retrospective calendars, which are the most widely used data source for estimating contraceptive failure in low-income countries, vary in quality across countries and surveys. We identified surveys with the most reliable calendar data and analyzed 105,322 episodes of contraceptive use from 15 DHSs conducted between 1992 and 2014. We estimate contraceptive method-specific 12-month failure rates. We also examined how failure rates vary by age, education, socioeconomic status, contraceptive intention, residence, and marital status using multilevel piecewise exponential hazard models. Our failure rate estimates are significantly lower than results from the United States and slightly higher than previous studies that included more DHS surveys, including some with lower-quality data. We estimate age-specific global contraceptive failure rates and find strong, consistent age patterns with the youngest users experiencing failure rates up to ten times higher than older women for certain methods. Failure also varies by socioeconomic status, with the poorest, and youngest, women at highest risk of experiencing unintended pregnancy due to failure.

Contraceptive use in Latin America and the Caribbean with a focus on long-acting reversible contraceptives: prevalence and inequalities in 23 countries.

BACKGROUND: The rise in contraceptive use has largely been driven by short-acting methods of contraception, despite the high effectiveness of long-acting reversible contraceptives. Several countries in Latin America and the Caribbean have made important progress increasing the use of modern contraceptives, but important inequalities remain. We assessed the prevalence and demand for modern contraceptive use in Latin America and the Caribbean with data from national health surveys. METHODS: Our data sources included demographic and health surveys, multiple indicator cluster surveys, and reproductive health surveys carried out since 2004 in 23 countries of Latin America and the Caribbean. Analyses were based on sexually active women aged 15-49 years irrespective of marital status, except in Argentina and Brazil, where analyses were restricted to women who were married or in a union. We calculated contraceptive prevalence and demand for family planning satisfied. Contraceptive prevalence was defined as the percentage of sexually active women aged 15-49 years who (or whose partners) were using a contraceptive method at the time of the survey. Demand for family planning satisfied was defined as the proportion of women in need of contraception who were using a contraceptive method at the time of the survey. We separated survey data for modern contraceptive use by type of contraception used (long-acting, short-acting, or permanent). We also stratified survey data by wealth, area of residence, education, ethnicity, age, and a combination of wealth and area of residence. Wealth-related absolute and relative inequalities were estimated both for contraceptive prevalence and demand for family planning satisfied. FINDINGS: We report on surveys from 23 countries in Latin America and the Caribbean, analysing a sample of 212 573 women. The lowest modern contraceptive prevalence was observed in Haiti (31·3%) and Bolivia (34·6%); inequalities were wide in Bolivia, but almost non-existent in Haiti. Brazil, Colombia, Costa Rica, Cuba, and Paraguay had over 70% of modern contraceptive prevalence with low absolute inequalities. Use of long-acting reversible contraceptives was below 10% in 17 of the 23 countries. Only Cuba, Colombia, Mexico, Ecuador, Paraguay, and Trinidad and Tobago had more than 10% of women adopting long-acting contraceptive methods. Mexico was the only country in which long-acting contraceptive methods were more frequently used than short-acting methods. Young women aged 15-17 years, indigenous women, those in lower wealth quintiles, those living in rural areas, and those without education showed particularly low use of long-acting reversible contraceptives. INTERPRETATION: Long-acting reversible contraceptives are seldom used in Latin America and the Caribbean. Because of their high effectiveness, convenience, and ease of continuation, availability of long-acting reversible contraceptives should be expanded and their use promoted, including among young and nulliparous women. In addition to suitable family planning services, information and counselling should be provided to women on a personal basis. FUNDING: Wellcome Trust, Pan American Health Organization.

[Current knowledge on contraceptive knowledge in France: CNGOF Contraception Guidelines]. / Contexte de la contraception en France. RPC Contraception CNGOF.

OBJECTIVE: To summarize current knowledge on contraceptive coverage in France and worldwide, describe the effectiveness of different types of contraceptives, describe the characteristics of women using contraception, contraceptive failure situations and describe the different medical risks associated with contraceptive methods. METHODS: Consultation of the Medline database and of national or international reports on contraception. RESULTS: Contraceptive coverage in France is high: 97% of women in 2013 use a contraceptive method (among fertile, sexually active women without a desire for pregnancy), with a majority using medical methods (72% using pills and other hormonal contraceptives, intrauterine devices and 25% using natural and traditional barrier methods). The 2013 pill scare called into question the use of estrogen-progestogenic contraception and the information provided by doctors, but the pill remains the first contraceptive method followed by the intrauterine device, condoms and the traditional and natural methods. Lifetime contraceptive coverage changes according to a defined standard in France: condoms for the teen-agers, pills before pregnancy and then intrauterine devices after childbirth. Sterilization is very rarely chosen and offered. Contraception in France remains a predominantly female domain. Women and couples should be informed about all contraceptive methods, allowing them to choose the method that best suits their health, living conditions and sexuality.

[Natural Family Planning methods and Barrier: CNGOF Contraception Guidelines]. / Méthodes de contraception naturelle et méthodes barrières. RPC contraception CNGOF.

OBJECTIVE: To develop clinical practice recommendations for the use of natural contraception and female and male barrier methods. MATERIALS AND METHODS: A systematic review of English and French literatures related to the safety and effectiveness of natural contraceptive methods based on PubMed, Cochrane Library, practice recommendations issued by international scientific societies and guidelines provided by the World Health Organization (WHO) as well as updates from the Center for Disease Control and Prevention (CDC). RESULTS: Natural contraceptives methods include fertility awareness-based methods, lactational amenorrhea method (LAM) and withdrawal method. The prevalence is low (4.6% of users) and remains stable over the years. Identification of the fertile period can be symptom-based cervical mucus (Billings), two-day method, basal body temperature, symptom-thermal method or based on calendar calculation (Ogino-Knauss, standard day method). Pregnancy rate after one-year utilization varies from 0.4% to 5% in perfect use but 8% in common practice. Effectiveness increases with absence of vaginal sex and decreases when combined to barriers method inadequately implemented. Data is scarce on reliability and effectiveness of ovulation predictor kits readily available on internet. Lactational amenorrhea method (LAM) can be very effective (98%) provided three conditions are fulfilled: within 6 months after birth, amenorrhea is effective, and breastfeeding is exclusive or quasi exclusive (day/night). Withdrawal method is constraining and of limited effectiveness. Male and female condom, diaphragm, cervical cap and spermicides are mechanical and chemical barrier methods, preventing spermatozoids from passing through the cervix into the uterus and therefore preventing fecundation. Female and male condoms offer a double protection to avoid pregnancy and prevent STD's. They are effective provided strict conditions of use are fulfilled. Male condom is favored by teenagers (45.6% among 15 to 19 years old), sometimes in combination with contraceptive pill (16% of cases). Women on the pill decreases according to their age. Pregnancy rates within the first year of consistent and correct use of these methods vary between 5 to 26% and reach 20 to 32% in practical use. Diaphragm and cervical cap need to be used in combination with spermicides. Spermicides have limited effectiveness when used alone. CONCLUSION: In common practice, natural and barrier contraceptive methods are more constraining and less effective than modern contraceptive method. They can be an alternative at given time and/or in situations where the women or the couple accept the possibility of an unexpected pregnancy which might be terminated or not. Women/couples need to be properly informed on how to use such methods, on their disadvantages and possible failures in common practice. Reminders are to be given on emergency contraceptive methods (IUD, hormonal) after unprotected sex.

'I wanted to enjoy our marriage first but I got pregnant right away': a qualitative study of family planning understandings and decisions of women in urban Yogyakarta, Indonesia.

BACKGROUND: Despite several decades of investment into family planning and maternal health systems strengthening, Indonesia's maternal mortality ratio remains among the highest in Southeast Asia. Among postpartum women unmet need for family planning is greater than at any other time, thus there is great potential to improve the reproductive health outcomes of Indonesian women through enhanced postpartum family planning access. This article explores the socially embedded nature of family planning choices in the Indonesian context, drawing on the experiences of a sample of urban dwelling and predominantly middle class women. METHODS: This was an ethnographic study which explored the reproductive experiences of women residing in Yogyakarta City, and Sleman and Bantul regencies. Fieldwork was undertaken over 18 months from September 2014 to March 2016. This article draws on 31 in-depth interviews (IDIs) conducted with 20 women aged 21 to 38 years who had given birth less than two years prior. RESULTS: Though there was great variance across women's reproductive trajectories, the majority had limited understandings of family planning, especially in relation to contraception. Societal norms pertaining to women's fertility and reproduction underpinned women's desires to become pregnant soon after marriage. Normative ideals concerning family size and the composition of families underpinned women's desires for a maximum of two to three children, with at least one child of each sex. Negotiations concerning timing of pregnancies and family size occurred within spousal relationships. The majority of women were using some form of fertility control to prevent or space pregnancies, with method choice decisions often informed by family members, friends and family planning providers. Quality of care among family planning providers was often lacking, perpetuating misinformation, and women's choices were not always respected. CONCLUSIONS: Our analysis reveals the socially embedded nature of women's postpartum family planning understandings and choices, and the ways in which social and relational factors sometimes constrain and at other times support women's reproductive agency. We identify key areas for health sector reform to enhance women's understandings of postpartum family planning and improve family planning quality of care.

Multiple contraceptive method use and prevalence of fertility awareness based method use in the United States, 2013-2015.

OBJECTIVES: Contraceptive prevalence in the United States is typically calculated according to the most effective method of contraception reported. This could theoretically underestimate the number of women using fertility-awareness based methods (FABMs), including those who use other methods (e.g., condoms) during the fertile window, but the extent of any such underestimation has not been assessed. STUDY DESIGN: We used data from the 2013-2015 National Survey of Family Growth to examine the extent to which women report use of an FABM alone or with other methods. We investigated FABM use patterns and compared demographic profiles of FABM users versus other contraceptive users. We considered how to most appropriately define FABM prevalence. RESULTS: One in six (16.5%) female contraceptors 15-44 reported use of multiple contraceptive methods in their month of interview. Among women reporting current FABM use, 67% used it alone or with withdrawal, 24% also used condoms or emergency contraception, and 9% also used hormonal contraception or sterilization. An FABM was the most effective method reported for 2.2% of current contraceptive users; while 3.2% of contraceptors reported any current FABM use. We posit an FABM prevalence of 3% (1,113,000 users) among US female contraceptors (2013-2015). FABM users had similar sociodemographic characteristics as other method users, but were more likely married. CONCLUSIONS: Currently, consideration of multiple method use has modest implications for estimation of FABM prevalence among contraceptors (i.e., an increase from 2.2% to 3%). However, multiple method use patterns with FABMs may merit special consideration if FABM use continues to increase. IMPLICATIONS: Researchers and providers need to be familiar with the unique patterns of use among FABM users in order to more effectively measure and counsel about these methods.

Traditional and Modern Contraceptive Method Use in the Philippines: Trends and Determinants 2003-2013.

This study examines recent levels, patterns, and determinants of traditional contraceptive method use, based on pooled data from the 2003, 2008, and 2013 Philippines Demographic and Health Surveys. Most contraceptive users in the Philippines rely on modern methods, but over the past ten years traditional method use has continued to account for about a third of all contraceptive use. Results show women in 2003 and 2008 were more likely to use periodic abstinence (rhythm) over modern methods compared with women in 2013, while withdrawal rather than modern methods was preferred more by women in 2013 than in 2003. The characteristics of women who use traditional methods have changed little over the past decade. Knowing the characteristics of traditional contraceptive method users can help establish policies and programs that promote more effective contraceptive use, including encouraging users of traditional contraceptive methods to switch to the more effective modern methods.

Use of non-medical contraceptive methods: a survey of women in western Sweden.

OBJECTIVES: To describe women's self-reported use of non-medical contraceptive methods (including barrier methods, fertility awareness-based methods and withdrawal), explore reasons for and satisfaction with choice of contraceptive methods and examine women's fertility awareness. METHODS: A cross-sectional survey was conducted among women consulting at primary healthcare clinics not using medical contraceptives. RESULTS: Most of the 648 participants (67%) reported using a mix of condom use, withdrawal and a calendar method, while 23% used only condoms. Eleven percent reported using the Billings ovulation method, diaphragm/cap or fertility monitor and found these methods highly satisfactory. A majority of the women who primarily used condoms also reported being satisfied. Most women actively chose non-medical contraception because it was perceived as without adverse effects, uncomplicated and effective. Fertility awareness was generally poor. CONCLUSION: Frequent use of withdrawal and a calendar method, as well as poor fertility awareness, suggests a need for improved counselling at contraceptive clinics on fertility awareness and more effective non-medical contraceptive methods to assist women in making an informed contraceptive choice.

Trends of contraception use among married reproductive age women: Tehran lipid and glucose cohort study 2002-2011.

OBJECTIVES: This study aimed to examine the trends of contraception use among married reproductive age women in Tehran Lipid and Glucose study between 2002 and 2011. METHODS: This analysis investigated a proportion of women users and non-users of family planning, using data from 10year population-based Tehran Lipid Glucose Study from surveys conducted in 2002, 2005, 2008, and 2011. Of the 6813, 6993, 7077, and 6789 women in the four phases mentioned, 34.1%, 33.9%, 33.5% and 35% of participants in each phase preferred to use contraception. Number of participants studied were 2506 women in 2002, 2529 women in 2005, 2594 women in 2008 and 2525 women in 2011. RESULTS: Types of methods and patterns of change in contraception differed across time. The percentage of women using traditional methods increased significantly from 25.7% in 2002 to 34.6% in 2011 (p value for trend=0.001). Accordingly, modern contraception use showed a reverse trend. From 2002 to 2011, 61.4%, 61%, 57.7%, and 51% of married women reported currently using various modern contraceptives, respectively (p value for trend=0.001). The proportion of users relying on condoms showed a significant increase during this decade, being 10.9% in 2002, 15.2% in 2005, 20% in 2008 and 21.9% in 2011. The prevalence of non-users for contraception was generally low; 12.7%, 8.2%, 8% and 14.3%, respectively from 2002 to 2011, but increased significantly across time (p=0.005) CONCLUSION: Relying on less effective contraceptive methods has increased rapidly among women in the Tehran Lipid and Glucose cohort study, a trend that could be a warning to policy makers about the possibility of higher unsafe abortion and maternal mortality/morbidity rates in the near future.

Effects of male literacy on family size: A cross sectional study conducted in Chakwal city.

OBJECTIVE: To determine the effects of male education on family size, the desired family size, knowledge and use of contraception and opinion about female education. METHODS: The cross-sectional study was carried out in Chakwal city, Punjab, Pakistan, from June to October 2009. A pre-tested questionnaire was used for data collection. The respondents were males and data on their demographics, age at marriage, actual and desired family size, knowledge about methods of contraception, and opinion about female education was collected. SPSS 15 was used for statistical analysis. RESULTS: Out of the 178 respondents, 52(29.2%) were illiterate and 126(70.8%) were educated. Among the educated, 97(77%) were in favour of small families compared to only 10(19.2%) of the uneducated males (p< 0.001). Besides, 118 (93.6%) educated males were aware of any method of contraception. The most important source of awareness was television 45(37.8%) followed by lady health visitors 40(33.9%). Among the respondents, 38(21.3%) were not using any contraceptive method because they considered it unIslamic, 16(9.1%) had fear of side effects, 57(32.0%) were desirous of large families, while 67(37.6%) had other reasons, like trying to conceive. Among the uneducated males, 17(32.7%) didn't discuss any family planning issue with their wives compared to 14(11.3%) of educated males (p< 0.001). CONCLUSIONS: Educational status of the males had an effect on the desired family size, contraceptive use and views in favour of female education.

Does the evidence support global promotion of the calendar-based Standard Days Method® of contraception?

OBJECTIVES: To scrutinise claims about the effectiveness of the Standard Days Method® (SDM). The SDM is a calendar method with similarities to the rhythm method that has now been reclassified and is marketed as a modern contraceptive method. As promoted, it requires users to avoid unprotected intercourse on days 8-19 of the menstrual cycle. It is used in at least 100 countries. SDM has been researched, developed, and is marketed by the Institute of Reproductive Health (IRH) at Georgetown University, USA, and a for-profit company Cycle Technologies. SDM proponents say it is a major advance on traditional periodic abstinence, claiming that it is 95% effective when used correctly - rivalling pills and condoms. The effectiveness claim is repeated in recent documents from the World Health Organization. STUDY DESIGN: Evaluation of evidence obtained via literature review of published and unpublished reports. RESULTS: Claims made for SDM effectiveness appear to rely on a single efficacy study where "correct use" of SDM was defined as total abstinence from intercourse in cycle days 8-19. It may therefore be misleading to apply a 95% effectiveness figure from the study to SDM as promoted, where abstinence is not required. Moreover, "typical use" effectiveness figures, cited as 88%, are based on an unrepresentative sample of women using SDM in ways likely to vary from how SDM is used in practice. CONCLUSION: Existing evidence does not support claims that the effectiveness of SDM as promoted is comparable to the best short-acting modern contraceptive methods. SDM is promoted in ways that may mislead users, by quoting overestimates of effectiveness and providing efficacy comparisons only with selected methods of contraception. Users should be provided with full and accurate information to make contraceptive choices. IMPLICATIONS: Use, delivery and promotion of SDM should be reevaluated. Meanwhile, SDM should only be offered to family planning clients as an adaptation of traditional periodic abstinence methods, requiring total abstinence in fertile days - reflecting "correct use" in the efficacy study - to achieve high effectiveness. Delivery of any form of SDM should include presentation of the full range of other contraceptive methods, including the most effective options.

A hospital-based comparative study of the knowledge, attitudes and practices of family planning among women belonging to different socio-economic status.

OBJECTIVE: To assess the knowledge, attitudes and practices of family planning among women belonging to different socio-economic status. METHODS: A cross sectional study was conducted in the outpatient department of three hospitals of Ziauddin University based on the socioeconomic divide. Total 351 married females of reproductive age group with at least one child were selected after informed consent through non probability convenience sampling. Data was analyzed by using SPSS version 21. RESULTS: The preferred method of contraception in all three groups was a male condom30.9%. The upper socioeconomic group relied more on the modern methods of contraception 92% while the middle socioeconomic group relied on modern 71.7% as well as natural methods of contraception 28.3%. Use of contraceptives was comparatively lower in the low socioeconomic group 19.5%. Lower socioeconomic group also had the most children per family with mean and standard deviation of 3.6±2.3 and also had the highest number of desired children with mean and standard deviation of 4±1.4. The general reasons for avoiding contraceptives were difficulty in getting pregnant (11.1%), the want for more children (10.2%), infrequent sexual intercourse (10.0%) and fear of side effects (6.9%). CONCLUSIONS: Awareness of contraception was found lowest in the lower socioeconomic class, with the elite class using a high percentage of contraceptives.

Social network- and community-level influences on contraceptive use: evidence from rural Poland.

The diffusion of 'modern' contraceptives-as a proxy for the spread of low-fertility norms-has long interested researchers wishing to understand global fertility decline. A fundamental question is how local cultural norms and other people's behaviour influence the probability of contraceptive use, independent of women's socioeconomic and life-history characteristics. However, few studies have combined data at individual, social network and community levels to simultaneously capture multiple levels of influence. Fewer still have tested if the same predictors matter for different contraceptive types. Here, we use new data from 22 high-fertility communities in Poland to compare predictors of the use of (i) any contraceptives-a proxy for the decision to control fertility-with those of (ii) 'artificial' contraceptives-a subset of more culturally taboo methods. We find that the contraceptive behaviour of friends and family is more influential than are women's own characteristics and that community level characteristics additionally influence contraceptive use. Highly educated neighbours accelerate women's contraceptive use overall, but not their artificial method use. Highly religious neighbours slow women's artificial method use, but not their contraceptive use overall. Our results highlight different dimensions of sociocultural influence on contraceptive diffusion and suggest that these may be more influential than are individual characteristics. A comparative multilevel framework is needed to understand these dynamics.

Examining quality of contraceptive services for adolescents in Oregon's family planning program.

OBJECTIVE: To assess the quality of care provided to adolescents (10-19 years old) compared to women (aged 20-25 years) who accessed services in Oregon's Contraceptive Care (CCare) program. STUDY DESIGN: We analyzed data routinely collected using the Clinic Visit Record form from women aged 25 years and younger who visited CCare clinics between January 1, 2004, and October 31, 2010. Modern methods were characterized into three tiers: Tier 1 is the intrauterine device, implant and sterilization; Tier 2, hormonal methods; and Tier 3, all barrier methods. Nonmodern methods included no method, withdrawal and natural family planning. We used multivariable logistic regression models to examine the effect of age on three indicators of quality of contraceptive care: transitioning from a nonmodern to a modern method, transitioning from Tier 3 methods to Tier 1 or Tier 2 methods, and initiation of long-acting reversible contraception (LARC). We then produced predicted probabilities to facilitate data interpretation. RESULTS: Adolescents accounted for 344,856 (41%) of the 848,221 clinic visits occurring in CCare among women under age 25. Compared with women (ages 20-25 years), young and older adolescents had decreased odds of LARC initiation [odds ratio (OR) 0.24 (95% confidence interval [CI] 0.16-0.35) and OR 0.44 (95% CI 0.38-0.52), respectively]. However, compared with women, both young and older adolescents had increased odds of leaving with any contraceptive method [OR 1.8 95% (CI 1.26-2.59) and OR 1.42 (95% CI 1.21-1.66)]. Among clients presenting with no method of contraception at the beginning of the visit, 78.7% of young adolescents (95% CI 73.84-83.03) compared with 81.44% (95% CI 77.02-85.52) of older adolescents, and 76.63% (95% CI 69.90-80.75) of young women left with a modern method, controlling for other covariates. CONCLUSION: Although adolescents served by CCare are more likely to initiate contraception, they are less likely to receive LARC than women aged 20-25 years. IMPLICATION: Efforts are needed to ensure that adolescents have access to highly effective reversible contraception.

Do natural methods count? underreporting of natural contraception in urban Burkina Faso.

Natural methods of contraception were widely used in developed countries until the late 1960s to space and limit childbirth. In France, when the first contraceptive surveys were conducted, researchers noticed that the use of natural methods was underreported, and questions to correct for this bias were subsequently added. The Demographic and Health Surveys do not currently include questions specific to natural methods. We added such questions to the standard DHS question regarding current contraceptive use when we conducted the Health and Demographic Surveillance System of Ouagadougou (2010 Ouaga HDSS) health survey in Burkina Faso among 758 women aged 15-49. Doing so enabled us to find a notable increase in the proportion of women in union who reported practicing contraception: 58 percent, compared with 38 percent in Ouagadougou in the 2010 Burkina Faso DHS. Thirty-two percent of women reported using modern medical methods or condoms in both surveys, but use of natural methods was much greater in the 2010 Ouaga HDSS health survey (26 percent) than in the 2010 Burkina Faso DHS (5 percent). Many women classified as having unmet need for family planning in Ouagadougou by the DHS data are in fact users of natural methods. Additional questions that would measure use of natural methods more completely should be tested in different settings.

The Standard Days Method(®): efficacy, satisfaction and demand at regular family planning service delivery settings in Turkey.

OBJECTIVES: To evaluate the demand, efficacy, and satisfaction concerning the Standard Days Method(®) (SDM; a fertility awareness method) as an option presented among other contraceptive methods at regular service delivery settings. METHODS: The survey group consisted of 993 women who presented at the primary care units in Umraniye District of Istanbul, Turkey, between 1 October 2006 and 31 March 2008, and started to use a new method. Women were enrolled until reaching a limit of 250 new users for each method, or expiration of the six-month registration period. Participants were followed for up to one year of method use. RESULTS: The characteristics of women who chose the SDM were similar to those of participants who opted for other methods. The most common reasons for selecting it were that it is natural and causes no side effects. Fifty-one percent used the SDM for the full year, compared to 71% who chose an intrauterine device (IUD). Continuation rates were significantly lower for all other methods. During the one-year follow-up period, 12% of SDM-, 7% of pill-, 7% of condom-, 3% of monthly injection-, 1% of quarterly injection-, and 0.5% of IUD users became pregnant. CONCLUSION: The SDM had relatively high continuation rates and relatively good levels of satisfaction among participants and their husbands. It should be mentioned among the routinely offered contraceptive methods.

Comparison of Abstinence and Coital Frequency Between 2 Natural Methods of Family Planning.

INTRODUCTION: The length of periodic abstinence, due to overestimation of the fertile phase of the menstrual cycle, is often a cause for dissatisfaction, discontinuation, and user error with natural family planning (NFP) methods. The objective of this research was to compare the length of required abstinence (ie, estimated fertility) and coital frequency between 2 NFP methods. METHODS: This was an analysis of data from a 12-month prospective comparison study in which participants were randomized into either an electronic hormonal fertility monitor (EHFM) group or a cervical mucus monitoring (CMM) group-both of which included a fertility algorithm as a double check for the beginning and end of the estimated fertile window. The number of days of estimated fertility and coitus was extracted from each menstrual cycle of data, and t tests were used to compare the means of these 2 variables between the 2 NFP methods. RESULTS: The study involved 197 women (mean [SD] age 29.7 [5.4]) who used the EHFM to estimate the fertile window and 160 women (mean [SD] age 30.4 [5.3]) who used CMM to estimate the fertile window. They produced 1,669 menstrual cycles of data. After 12 months of use, the EHFM group had statistically fewer days of estimated fertility than the CMM group (mean [SD] days, 13.25 [2.79] vs 13.68 [2.99], respectively; t = 2.07; P = .039) and significantly more coitus (mean [SD] coital acts, 4.22 [3.16] vs 4.05 [2.88], respectively; t = 1.17; P = .026). DISCUSSION: The use of the EHFM seems to provide more objectivity and confidence in self-estimating the fertile window and using nonfertile days for intercourse when avoiding pregnancy.

Guía nacional de planificación familiar / National Family Planning Guide

Esta guía, es una actualización de la edición del 2010, y es el resultado de una compilación de información basada en evidencia científica sobre los métodos anticonceptivos y el proceso de planificación familiar. Está dirigida a proveedores de salud en general y contiene lineamientos técnico normativos y científicos que deben tomarse en cuenta para la consejería balanceada en métodos de planificación familiar. Incluye una descripción detallada de métodos y dispositivos anticonceptivos.