New Frontiers in Contraceptive Research A Blueprint for Action (2004) / Chapter Skim
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4 Improving Contraceptive Use and Acceptability
4 Improving Contraceptive Use and Acceptability
Pages 108-133
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From page 108... ...
couples who do use methods of contraception, largely because of the inconsistent and incorrect use of effective methods (Alan Guttmacher Institute, 2000; Henshaw, 1998~. The same trend has been observed in other developed countries (Larsson et al., 2002; Rasch, 2002~.
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From page 109... ...
. Surveys of women using oral contraceptives in developing countries indicate that the unintended pregnancy rate is at least 7 percent.
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From page 110... ...
TABLE 4.1 The Most Commonly Used Contraceptive Methods Among All Couples, Those Seeking to Delay and Space Childbearing, and Those Who Want No Further Births, by Region of the Developing World, Late l990s and Early 2000s Couples Seeking to Delay and Space Couples Who Want Region All Couples Childbearing No Further Births Africa Eastern Africa Injectable or implant Oral contraceptives Injectable or implant Middle Africa Periodic abstinence Periodic abstinence Periodic abstinence Southern Africa Injectable or implant Injectable or implant Injectable or implant Western Africa Periodic abstinence Periodic abstinence Periodic abstinence Northern Africa IUDa IUD IUD Asia Eastern Asia-China China Female sterilization IUD Female sterilization Female sterilization IUD Female sterilization South-central Asia Female sterilization Condom Female sterilization Southeastern Asia Injectable or implant Injectable or implant IUD Oceania-Micronesia Injectable or implant Injectable or implant Injectable or implant Western Asia Withdrawal Withdrawal Withdrawal Latin America and the Caribbean Caribbean Central America South America Female sterilization Female sterilization Female sterilization Oral contraceptives Oral contraceptives Oral contraceptives Female sterilization Female sterilization Female sterilization aIUD = intrauterine device.
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From page 111... ...
Because those trying to delay and space future births were much more likely to be using no method and because the methods that they did use are typically less effective than contraceptive sterilization, they accounted for 51 percent of all unintended pregnancies in developing countries (Singh et al., 2003~. Thus, although the inherent effectiveness of a contraceptive method is important, the effectiveness of a contraceptive method is ultimately determined largely by whether couples use the method consistently and correctly.
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From page 112... ...
However, the services of family planning providers are oriented primarily toward women and such providers have little experience with providing contraceptive services for men (Alan Guttmacher Institute, 2002, 2003~. Moreover, specific safety and biological issues must be taken into account when new methods of contraception are developed for men.
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From page 113... ...
Increased attention is being paid to the behavioral vulnerability of adolescents; but, like women approaching menopause, adolescents have certain biological vulnerabilities that present some special challenges, and opportunities, in the development of contraceptive methods for this group. For example, because of their age and stage of physical development, there may be concerns about an increased prevalence of cervical ectopy and its possible relationship to HIV infection.
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From page 114... ...
, inconsistent condom use was associated with alcohol use, the intention to abort if pregnant, and the belief that a pregnancy would not be upsetting. The scientific evidence on the effects of contraceptive methods on HIV transmission is limited at present: condom use has been shown to be at least 85 percent effective in preventing HIV infection (National Institutes of Health, 2001)
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From page 115... ...
of HIV infection must be examined in future studies. Finally, to reduce the risk of unplanned and unsafe pregnancies as well as the burden of HIV disease, direct links need to be established between family planning providers and health care providers for those infected with HIV as well as others with expertise with STIs.
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From page 116... ...
People's views of the consequences (costs and benefits) of contraceptive method use are affected not only by their goals regarding pregnancy prevention and their perceptions of side effects and other characteristics of a particular method but also by social factors, including attitudes and beliefs tied to a particular social environment, such as religious upbringing and the expectations of partners, peers, or family members (Raine et
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From page 117... ...
Once developed, these measures would be most valuable when applied early in the research and development process so that a "go" or "no go" decision about continued development is made before the expenditure of resources for a method that lacks consumer and provider appeal. Moreover, if a "go" decision for continued drug or device development ensues on the basis of a predicted level of acceptability, the characteristics of a method can be market tested with diverse populations when phase II and phase III trials are being conducted.
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From page 118... ...
These include the strong role of social and economic disadvantage in promoting risk taking, not only because of barriers that limit access to care but also because of the lack of assurance that avoiding outcomes such as unintended pregnancy will be effective toward bettering lives (Darroch et al., 2001~. Research regarding contraceptive use and risk taking should pay attention not only to personal factors but also to influences within the relationship, family, and community.
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From page 119... ...
While "side effects" are commonly cited as reasons for using no method or for not using certain methods, especially hormonal methods and IUDs, little information is available about what specific effects are most salient to users (Forrest and Frost, 1996~. Because of the focus on the prevention of STIs and HIV infection in the last decade, contraceptive decisions involve not only balancing the benefits and risk of pregnancy but also the potential protection from STIs (see the section on the added health benefits of contraceptive methods on page 122)
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From page 120... ...
Certain contraceptive methods require more detailed planning and service delivery adjustments than others. New products or services, such as emergency contraception, sterilization techniques, or the contraceptive vaginal ring, require more than just teaching clinicians about the product or teaching clinicians how to perform the procedure.
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From page 121... ...
Research that determines which service delivery practices are important in combating consumer and client biases against vaginally administered methods and that determines the optimal way to increase consumer use of a product is especially important since microbicides (e.g., Buffergel, Savvy, and Ushercell) will probably come to market first as a vaginally administered contraceptive method.
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From page 122... ...
Formative, qualitative, and quantitative research methodologies are all integral to the operations research needed to inform the service delivery changes that enhance product use. DEVELOPMENT OF CONTRACEPTIVE PRODUCTS WITH OTHER BENEFITS For many individuals and couples, the benefits of contraception beyond pregnancy prevention might influence uptake and encourage more consistent and effective use.
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From page 123... ...
Although the same sexual behaviors put individuals at risk for both STIs (including HIV infection) and unintended pregnancy, a challenge arises because the most effective methods of pregnancy prevention (Swahn et al., 1996)
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, the committee clearly spelled out the obvious: unprotected intercourse can result in both unintended pregnancy and HIV infection and other STIs. At that time, the committee recommended that family planning services be integrated into comprehensive programs for reproductive health.
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From page 125... ...
Although a number of reversible methods of contraception are available, modern methods fall into only three categories: barrier methods, hormonal methods, and IUDs. All have their drawbacks.
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From page 126... ...
Thus, contraceptives that reduced the risk of other diseases such as breast or prostate cancer would likely have wide appeal. A contraceptive method that also conferred protection against HIV infection and other STIs is likely to have widespread benefit as well.
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From page 127... ...
Providers play a vital role in influencing both uptake rates and continuation rates of contraceptive method use. Thus, research that determines which service delivery practices are effective for increasing acceptance and use of contraceptives would be useful as well.
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From page 128... ...
2002. Dual protection against unintended pregnancy and sexually transmitted infections: what is the best contraceptive approach?
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From page 129... ...
1995. Vaginal bleeding patterns of women using different contraceptive methods (implants, injectables, IUDs, oral pills)
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From page 130... ...
Stud Fam Plann 22~1~:31-38. McCormack S
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2003. Determinants of contraceptive method among young women at risk for unintended pregnancy and sexually transmitted infections.
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From page 132... ...
Fam Plann Perspect 32~4~:176-183, 191. Tanis BC, van den Bosch MA, Kemmeren JM, Cats VM, Helmerhorst FM, Algra A, van der Graaf Y
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From page 133... ...
1992. Oral Contraceptives and Neoplasia.
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