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In this study, the determinants of contraceptive use and method choice are examined based on various variables, classified as individual, cultural, fertility and contextual. The data used came from the 1993 Turkish Demographic and Health Survey. The main finding is that there exists a positive association between the educational level of both spouses and the use of contraceptive methods in Turkey. After all individual, cultural, fertility and contextual variables are controlled, a woman's education is a stronger predictor of method use and method choice than that of her husband. Increasing the educational level of women may be the most effective means of advancing family planning acceptance and increasing the demand for contraceptive services in Turkey. The study also shows that, to a great extent, contraceptive use and choice of modern method depend on the sex of a couple's living children, implying some preference for sons, although generally women prefer to have children of both sexes.

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CONTEXT: Despite widespread efforts to increase contraceptive use to prevent both pregnancy and sexually transmitted diseases among sexually active adolescents, most prior work examining adolescent contraceptive use does not explicitly recognize that sexual decision-making inherently involves both partners in a couple. METHODS: An analytic sample of 1,593 females who first had intercourse during adolescence (prior to age 18) was drawn from the 1995 National Survey of Family Growth. Logistic regression and multinomial logistic regression techniques were used to model the effects of sexual partners' characteristics and relationship type on contraceptive use at first intercourse and contraceptive method selected at first intercourse. RESULTS: Approximately 31% of respondents used no contraceptive method at first intercourse. Roughly half (52%) of adolescents who had just met their sexual partner used no method, compared with 24% of those who were going steady. Whereas 75% of teenagers who practiced contraception at first intercourse used a condom, 17% relied on the pill. In multivariate models, net of other variables, adolescents who had just met their partner had 66% lower odds than those who were going steady of practicing contraception at first intercourse. Individual-level factors that influenced contraceptive use at first intercourse were age at first intercourse, race or ethnicity family type, parents' education, grades in school and receipt of birth control education prior to first intercourse. Differences between respondents and their partner in age and race or ethnicity mostly were not significantly related to method use at first intercourse. One exception was that adolescents who first had sex with a man six or more years older had reduced odds of practicing contraception. Type of relationship was significantly associated with method selection only among adolescents who were just friends with their first partner, who had higher odds of using "other" methods rather than the condom. Variables associated with pill use rather than condom use were age at first sex, race, family type, mother's education and school grades. CONCLUSIONS: Further efforts to understand contraceptive choice among adolescents should focus on relationship features. Research on the decision-making process surrounding contraceptive use may benefit from treating this as a partner decision and not just as a decision made by one member of the couple. Further research examining the qualities of the relationship may provide important clues for understanding adolescent contraceptive choice.

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CONTEXT: In every country, contraceptive behavior has important implications for fertility and the prevalence of sexually transmitted diseases (STDs). There has been relatively little attention to contraceptive practices in Canada, however, particularly how patterns of method use may have changed. METHODS: Data on contraceptive use were collected from 5,315 women in the 1984 Canadian Fertility Survey, and from 3,220 women and 3,449 men in the 1995 General Social Survey. RESULTS: Among Canadian women aged 15-49, current contraceptive use declined from 69% to 60% between 1984 and 1995. Pill use dropped from 19% to 17%, and IUD use declined from 6% to 3%. However, during the same period, condom use increased from 6% to 10%; tubal ligation declined from 24% to 17%, while vasectomy increased. In addition, the proportion of women sterilized for reasons other than contraception rose between 1984 and 1995. Men were less likely to rely on sterilization than were women (31 % vs. 40%). Men reported higher levels of condom use (22%), but lower levels of pill use among their partners (9%), than did women (10% and 17%, respectively). CONCLUSIONS: Contraceptive behavior in Canada is unique: The decline in contraceptive use over the last decade has left Canada's overall contraceptive prevalence among the lowest in the industrialized world, and the rate of sterilization among the highest These changes in contraceptive behavior complicate efforts to plan for social and health needs, particularly policy decisions focusing on reducing infections with STDs.

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PIP: This paper reports the findings of the Contraceptive Technology Update 2000 Contraception Survey, which monitors contraceptive trends and family planning issues among 275 health care workers in the US. It is noted that oral contraceptives (OCs) maintain the top spot as the leading choice for birth control for both young and older women. OrthoTri-Cyclen from Ortho-McNeil Pharmaceuticals of Raritan, New Jersey, remains the top provider choice for young nonsmoking women; however, 20 mcg pills are making their mark as preferred selections for young and older women. 50% of the survey respondents named Alesse from Wyeth-Ayerst Laboratories of Philadelphia as their leading OC choice for older nonsmoking women. Overall, it is noted that while providers generally inform patients of the pill's benefits including the protection against ovarian cancer, 71.6% are unwilling to recommend access over the counter and say that pills should remain prescription-only.^ieng

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The primary purpose of this paper is to explore the relationship between religiosity and contraceptive method choice among users of contraception. The authors analyze a representative sample of 1751 married urban Israeli Jewish women interviewed in 1987-88. The authors' findings indicate that the contraceptive choices of religious women are determined largely by considerations unrelated to religious doctrine. A combination of factors, including the suitability of specific methods to fertility control needs, peer influences, and other cultural effects, appear to modify the acceptance and application of a particular religious theology.

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In-depth interviews were conducted with married Asian women from Indian, Pakistani and Bangladeshi backgrounds, to investigate patterns of contraceptive use and influences on contraceptive decision making. The results show two distinctively different contraceptive 'lifecycles'. Non-professional women typically have little knowledge about contraception until after their marriage or first birth. Their patterns of contraceptive behaviour show low levels of contraceptive use until after their first birth, when condom use is most prevalent. Non-professional women are influenced by their extended family, religion and cultural expectations on their fertility and family planning decisions. Professional women show an entirely different pattern of contraceptive behaviour. They are more likely to have knowledge about contraception before marriage, use some method of contraception throughout their childbearing years (typically the pill) and cite personal, practical or economic considerations in their fertility decisions rather than religious, cultural or extended family influences.

PIP: In-depth interviews on the patterns of contraceptive use and influences on contraceptive decision making were conducted among married Asian women from an Indian, Pakistani and Bangladeshi background. The data collected showed that there are significant variations in Asian women's reproductive strategies. Variations are evident in knowledge about family planning methods, timing of a first birth and timing of first use of contraception, birth spacing, and fertility. There are two distinctively different patterns of contraceptive use among Asian women: those of professional and nonprofessional women. Nonprofessional women usually have little knowledge about contraception until after their marriage or first birth. This is evident in their patterns of contraceptive behavior, which show low levels of contraceptive use until after their first birth. In contrast, professional women are more likely to have significant knowledge about contraceptive options before marriage and are able to make informed choices on their contraceptive needs. Unlike nonprofessional women, their fertility and family planning decision are not influenced by family, religion, or cultural expectations, but rather cites personal, practical, and economic considerations on their fertility decisions.

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PIP: The Chad Demographic and Health Survey (DHS), or Enquete Demographique et de Sante (EDS) Tchad 1996-97, was conducted by the Bureau Central du Recensement, Direction de la Statisque, des Etudes Economiques et Demographiques, Ministere du Plan et de l'Amenagement du Territoire N'Djamena, Chad, within the framework of the DHS Program of Macro International. Data for the EDS were collected from 6840 households, and complete interviews were conducted with 7454 women aged 15-49 and 2320 men aged 15-59. The interviews took place between December 1996 and July 1997. The summary statistics presented were taken from the Chad country report, with exceptions as noted. Included in this article are table and charts presenting valuable data on the general characteristics of the Chad population, fertility, fertility preferences, contraceptive use, knowledge about contraception, marital and contraceptive status, postpartum variables, infant mortality, health, and nutritional status.^ieng

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PIP: The Indonesia Demographic and Health Survey (DHS) was conducted by the Central Bureau of Statistics, State Ministry of Population/National Family Planning Coordinating Board, and Ministry of Health, Jakarta, Indonesia, within the framework of the DHS Program of Macro International. Data from the DHS were collected from 34,255 households and complete interviews were conducted with 28,810 women aged 15-49. The interviews took place between September 1, 1997 and December 31, 1997. The summary statistics presented were taken from the Indonesia country report with exception as noted. Included in this article are table and charts presenting valuable data on Indonesia general characteristics of the population, fertility, contraceptive use, and knowledge about contraception, marital and contraceptive status, infant mortality, and health.^ieng

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OBJECTIVE: To determine the knowledge of women about lactational amenorrhoea and contraceptive properties of breastfeeding. DESIGN: A prospective, randomised descriptive study. SETTING: Kocaeli University School of Medicine, Department of Obstetrics and Gynecology. SUBJECTS OR PARTICIPANTS: Nine hundred and twenty-two women in their reproductive ages. INTERVENTION: A questionnaire was filled by doctors or nurses during face to face interview. MAIN OUTCOME MEASURES: There was significantly less knowledge for the importance of frequency and duration of suckling (p < 0.0001). The education increases the knowledge of lactational amenorrhoea as a interruptus contraceptive method. RESULTS: More than fifty-three per cent of women were using one of the modern contraceptive methods, 23.86% were using natural methods and 22.78% not using any family planning method. Intrauterine devices (30.15%), coitus interuptus (21.69%) and condom (16.48%) were the most common contraceptive methods. Nearly fifty-two per cent of women were not aware of the contraceptive property of breastfeeding, 25.68% of women knew lactation had a protective effect from pregnancy, 48.16%, did not know the importance of frequency and duration of suckling on fertility reducing effect of lactation. CONCLUSION: The level of knowledge on lactational amenorrhoea and frequency of suckling was significantly low in our study, especially in the illiterate group. Since efficacy of natural family planning depends on the compliance of women, education of women about lactation is very important. Family planning programmes should be focussed on breastfeeding and type of breastfeeding practices used, especially where there are no contraceptive alternatives.

PIP: This prospective, randomized, descriptive study examined the contraceptive choices and knowledge of women about lactational amenorrhea and contraceptive properties of breast-feeding in Kocaeli, India. A total of 922 women of reproductive age were surveyed, and a Chi-square test was used for data analysis. Results showed that 53.36% of the women used modern contraceptive methods, 23.86% preferred natural methods, and 22.78% were not using fertility control methods. The most commonly used contraceptive methods included IUDs (30.15%), coitus interruptus (21.69%), and condoms (16.48%). Almost 52% of the women were not aware of the contraceptive effect of breast-feeding; 25.68% knew that lactation had a contraceptive effect. Lactation was accepted as a contraceptive method by 48.16% of the women, while 51.8% of the women did not accept this type of method. Overall, the level of knowledge on lactational amenorrhea and suckling frequency was significantly low, particularly among illiterate women. Family planning programs should focus on breast-feeding as a fertility control method, especially when no contraceptive alternatives are available.

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CONTEXT: Despite the fact that choosing a contraceptive method is often a decision made by couples, little is known about how men and women differ in their perceptions of the characteristics of various method types, and in the importance that they attach to those characteristics when choosing a contraceptive method. METHODS: The data analyzed here are subsets from two companion surveys conducted in 1991--1,189 men aged 20-27 who were surveyed in the National Survey of Men and 740 women aged 20-27 who were surveyed in the National Survey of Women. Multivariate ordered logit analysis is used to examine how gender is related to both the importance that individuals assign to seven specific contraceptive characteristics when choosing a method, and to perceptions about the extent to which five common method types possess each of these characteristics. RESULTS: Women rank pregnancy prevention as the single most important contraceptive characteristic when choosing a method, with 90% citing it as "very important." The health risks associated with particular methods and protection from sexually transmitted diseases (STDs) are rated as the second most important characteristics by women (each mentioned as "very important" by 77%). In contrast, men consider STD prevention for themselves and their partner to be just as important as pregnancy protection (each mentioned as "very important" by 84-86%), and they rank STD prevention as more important than other health risks (by 72%). Women, but not men, rank both ease of use and the need to plan ahead as being more important characteristics than a method's interference with sexual pleasure. Both men and women have an accurate understanding of the strengths and weaknesses of particular methods, but differ enough in their perceptions to alter the relative attractiveness of each method. In particular, women have more favorable perceptions than men about the pill, being somewhat more likely than men to believe that the pill is "very good" at preventing pregnancy (75% vs. 67%) and to say that it is very good at not interfering with sexual pleasure (82% vs. 76%). In contrast, women have generally less favorable perceptions than men about other reversible methods, including the condom: Women were less likely than men to consider the condom very good at pregnancy prevention (29% vs. 46%) or at having no need for advance planning (22% vs. 38%). Gender differences in perceptions about the specific characteristics of contraceptive methods often vary by marital status. CONCLUSIONS: Men and women have somewhat different priorities when choosing a contraceptive method. Despite many similarities between women and men in their perceptions about the characteristics of each method type, numerous differences between them may have an important influence on how couples make their method choices.

PIP: This paper focuses on the effects of gender on the importance of contraceptive characteristics and on how specific contraceptive methods are evaluated by men and women. In particular, the study examines how gender is related to both the importance that individuals assign to seven specific contraceptive characteristics when choosing a method, and to perceptions on the extent to which the five common method types possess each of these characteristics. The data used were derived from two companion surveys conducted in 1991, which included a sample of 1189 men and 740 women who belong to the 20-27 age group. Findings revealed that 90% of women rank pregnancy prevention as the first and single most important contraceptive characteristic when choosing a method, followed by sexually transmitted disease (STD) protection. Among men, STD prevention for themselves and their partner and pregnancy protection were of equal importance. Furthermore, both men and women have a correct understanding of the strengths and weaknesses of a particular method but differ significantly with their perceptions on the relative attractiveness of each method. Gender differences in perceptions on the specific characteristics of contraceptive methods often vary by marital status. These results clearly indicate that gender greatly affects contraceptive method perceptions and priorities.

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The objective of the present survey was to assess the contraceptive status and sexual function of climacteric Chinese women. One cross-sectional study randomly recruited 742 premenopausal, perimenopausal, and naturally menopausal women aged 45-55 years from Beijing. Contraceptive methods were used by 75.6% of premenopausal and 54.2% of perimenopausal women. The primary methods were the IUD and barrier method. The women's choices of methods were related to parity and frequency of sexual activities. Sexual activity was related to the satisfaction of contraceptive methods. Perimenopausal and postmenopausal women were about half as likely to enjoy sexual activity and to experience orgasms than premenopausal women. Women of higher socioeconomic status had a lower risk for decreased sexual functioning. The IUD was the most popular and the most appropriate contraceptive method for perimenopausal women. Sexual function was associated with the women's satisfaction with the contraceptive method used, their menopausal status, and their socioeconomic class.

PIP: A cross-sectional survey about contraception and sexuality in climacteric Chinese women was evaluated. Women aged 45-55 years were randomly sampled from the urban area of Beijing using a three-stage cluster sampling procedure. The sample was composed of 742 pre-, peri-, and naturally menopausal women. Results showed that contraceptive methods were used by 75.6% of 242 premenopausal women and 54.2% of 240 perimenopausal women. IUDs and barrier methods were the primary methods used. A comparison of IUD users by age at insertion, removal, or last clinic visit showed that women over age 40 tolerated IUDs better than did younger women. IUDs were commonly used because the barrier method (condom) caused vaginal dryness and even pain, especially among middle-aged women. The women of higher socioeconomic status had a lower risk of decreased sexual functioning. A higher level of educational attainment was associated with a lower risk of decreased sexual functioning among women aged 45-55 years. Women of higher class differed in several sexual variables from those of the lower class due to differences in level and quality of sexual education, awareness, and attitudes. In conclusion, the IUD was the most popular and appropriate method of contraception for perimenopausal women, and sexual function was associated with a woman's satisfaction with her contraceptive method together with her menopausal status and socioeconomic class.

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CONTEXT: Unintended pregnancy remains a major public health concern in the United States. Information on pregnancy rates among contraceptive users is needed to guide medical professionals' recommendations and individuals' choices of contraceptive methods. METHODS: Data were taken from the 1995 National Survey of Family Growth (NSFG) and the 1994-1995 Abortion Patient Survey (APS). Hazards models were used to estimate method-specific contraceptive failure rates during the first six months and during the first year of contraceptive use for all U.S. women. In addition, rates were corrected to take into account the underreporting of induced abortion in the NSFG. Corrected 12-month failure rates were also estimated for subgroups of women by age, union status, poverty level, race or ethnicity, and religion. RESULTS: When contraceptive methods are ranked by effectiveness over the first 12 months of use (corrected for abortion underreporting), the implant and injectables have the lowest failure rates (2-3%), followed by the pill (8%), the diaphragm and the cervical cap (12%), the male condom (14%), periodic abstinence (21%), withdrawal (24%) and spermicides (26%). In general, failure rates are highest among cohabiting and other unmarried women, among those with an annual family income below 200% of the federal poverty level, among black and Hispanic women, among adolescents and among women in their 20s. For example, adolescent women who are not married but are cohabiting experience a failure rate of about 31% in the first year of contraceptive use, while the 12-month failure rate among married women aged 30 and older is only 7%. Black women have a contraceptive failure rate of about 19%, and this rate does not vary by family income; in contrast, overall 12-month rates are lower among Hispanic women (15%) and white women (10%), but vary by income, with poorer women having substantially greater failure rates than more affluent women. CONCLUSIONS: Levels of contraceptive failure vary widely by method, as well as by personal and background characteristics. Income's strong influence on contraceptive failure suggests that access barriers and the general disadvantage associated with poverty seriously impede effective contraceptive practice in the United States.

PIP: This study estimated method-specific contraceptive failure rates in the US. Estimates were adjusted for underreporting of induced abortion in the main survey. The correction made a sizeable impact, as 25% of the 2,157,473 conceptions due to contraceptive failure were aborted. Data were obtained from the 1995 National Survey of Family Growth and the 1994-95 Abortion Patient Survey. Analysis was based on hazard models for failure in the first 6 and 12 months. Data include 7276 contraceptive use segments. The mean duration was 9.6 months. The pill and condom had the largest shares of use segments. The lowest failure rates were for implants and injectables (2-3%). Failure rates were as follows: oral pills (8%), diaphragm and cervical cap (12%), male condom (14%), periodic abstinence (21%), withdrawal (24%), and spermicides (26%). Failure rates were highest among cohabiting and other unmarried women; women with an annual family income below 200% of the federal poverty level; among Black and Hispanic women; and among adolescents and women in their 20s. The failure rate among low income women declined during 1988-95. Women above the 200% of poverty level had stable rates. Poverty continued to have a negative impact on effective contraceptive use. Four models were used to examine the effects of socioeconomic factors on contraceptive failure.

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CONTEXT: Measures of contraceptive use at one point in time do not account for its changing nature. A measure that addresses the pattern of method use over time may better predict the cumulative risk of unintended pregnancy. METHODS: Women at risk of unintended pregnancy were selected from the 1995 National Survey of Family Growth, and their contraceptive use patterns were compared across age-groups. Survival analysis was used to validate women's long-term use pattern as an indicator of pregnancy risk, and multivariate regression analyses were used to explore potential covariates of current patterns of contraceptive use. RESULTS: More than two-thirds of women aged 15-19 report long-term uninterrupted contraceptive use, but they are more likely to report sporadic use and less likely to report uninterrupted use of a very effective method than are women aged 25-34. Compared with women aged 25-34, women aged 20-24 have higher rates of sporadic use and lower rates of effective uninterrupted use. Among teenagers, nonusers are 12 times as likely as uninterrupted effective users to experience an unintended pregnancy within 12 months at risk. Women in less stable relationships, those having more infrequent intercourse and women who have recently experienced nonvoluntary intercourse for the first time are more likely than others to have a high-risk contraceptive pattern. Women aged 17 and younger whose current partner is more than three years older are significantly less likely to practice contraception than are their peers whose partner is closer in age. CONCLUSIONS: Long-term contraceptive use pattern is a valid predictor of unintended pregnancy risk. Policies aimed at reducing unintended pregnancies should target women who do not practice contraception and those who are sporadic users. Women in unstable relationships, those having infrequent sex and women who experience sexual coercion need access to methods, such as emergency contraception, that can be used sporadically or after unprotected intercourse.

PIP: This study examined determinants of unintended pregnancy in the US. Data were obtained from the 1995 National Survey of Family Growth among 7221 women 15-44 years old at risk of unintended pregnancy. Findings indicate that adolescents were not mainly sporadic method users in 1995. Most used a method without interruption for an extended period. Teenagers were more likely to report sporadic contraceptive use and were less likely to be uninterrupted users of effective methods. Women 20-24 years old were no more likely than 18-19 year old women to report long-term sporadic use and were more likely than women 25-34 years old to report long-term sporadic use. Nonusers and sporadic users contributed significantly to the high rate of unintended pregnancies. Logistic models reveal that women who were married or cohabiting were more likely to be uninterrupted effective contraceptive users than those not in long-term relationships. Frequency of intercourse had a consistent, strong positive relationship with contraceptive use. Women who had nonvoluntary intercourse and teenagers with significantly older partners were less likely to use contraceptives. Condoms are appropriate for infrequent intercourse, but couples must know the risks of pregnancy even with infrequent intercourse and know about postcoital methods of pregnancy prevention.

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This paper analyses the patterns of contraceptive use among Australian women, using data from the 1995 National Health Survey. More than 44% of all women aged 18-49 years reported using a method of contraception. Among users, the 2 most commonly reported methods were the pill (60%) and condom (27%); IUD and natural methods accounted for less than 5% each. Sterilizing operations of the women/partner were the most frequently reported reasons for nonuse of contraception in women aged over 35 years, while among the younger women the most reported reasons were pregnancy or trying to get pregnant and not being sexually active. Among pill-users about a quarter were smokers, 20% overweight and 13% reported heart or circulatory disease. These figures were generally lower than in the general population but indicate a need for regular monitoring. The survey demonstrates the continuing evolution in the use of contraception among Australian women.

PIP: This paper presents an analysis of the patterns of contraceptive use among Australian women using the 1995 National Health Survey data. Among the 4.1 million women aged 18-49, 44% were reported to be contraceptive users. The two most commonly used contraceptive methods were pills and condoms, which were used by 60% and 27% of the respondents, respectively. This was followed by the use of IUDs and other methods, which accounted for less than 5% of the subjects. An increasing rate of sterilizations was noted among women aged 45-49, which was nearly twice the rate of vasectomy among their partners. On the other hand, reasons for not obtaining a sterilization among younger subjects included a desire for pregnancy and not being sexually active. Among the women who used oral contraceptives, 25% were smokers, 20% were overweight, and 13% reported heart and circulatory diseases. In a comparison of the 1983 and 1995 health surveys, an increase in oral contraceptive use from 23.2% to 26.7% was noted among women aged 18-49 years. The survey demonstrated the continuing evolution of contraceptive use among Australian women.

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PIP: A Norwegian investigation from 1987-88 indicated that 25% of the women who were interviewed at a maternity ward stated that their pregnancy had not been planned. That means that 15,000 of the annual total of 60,000 births in Norway are not planned. This is roughly the same figure as the number of abortions (14,000 per year). 93% of women who carry out an unplanned pregnancy have not used contraception according to a 1991 study, but even a 1999 study showed that half of women seeking abortion had not used contraception. A 1994 investigation revealed that only 8% of women in the 20-24 age group did not use contraception and 5% used unsafe methods (coitus interruptus, safe periods, spermicides), while the rest used effective contraceptives (60% used OCs). There are 144,000 women in this age group in Norway, of which 12,000 give birth within a year. In theory the remaining 132,000 would have 2600 pregnancies. In 1996 there were 3883 abortions in this same age group; half of them would originate from that 8% of women who did not use contraception and the other half owing to contraceptive failure. Two studies among students in Oslo in 1997 demonstrated that even if a young woman started using OCs it did not mean that she would continue using them. A number of them discontinued because their relationship with their partner ended, they neglected to visit their doctor, forgot to take their pills, or thought that they could not get pregnant right after stopping OC use.^ieng

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Ethnic monitoring of all new and first attenders in the year to community family planning clinics was carried out by means of an anonymous questionnaire during April to June 1997 inclusive to ascertain whether ethnic minority women attend family planning clinics. A 73 per cent response rate (2664 questionnaires) was obtained. The results showed that women came from a wide variety of ethnic groups and from almost every country in the world. Those of UK European origin were underrepresented. For 28 per cent of women, English was not their first language. A total of 66 languages were recorded. Sixty two per cent (1673) of all the women were between 20 and 34 years. Overall half of all the women attending did not have children. Though in some ethnic groups most women were parous, less than 20 per cent of Caribbean (born Caribbean) West African and Turkish Cypriot women and only six per cent of Turkish/Kurdish women born in Turkey had not had children. Thirty three per cent of women admitted to having had one or more terminations although there was only a 90 per cent response rate to this question. While between 20 and 25 per cent of United Kingdom, EEC and non EEC European and black British women had had one or more abortions, 49 per cent of West African, 43 per cent of Kurdish and 40 per cent of Turkish Cypriot women had had one or more abortions. The lowest percentage of women admitting to a termination were Irish (12 per cent). The majority of women did choose a method or methods of contraception. The oral contraceptive pill and the condom were the most popular methods, often being used together The method used was influenced by age and ethnicity. Younger women opted for 'the pill' while older women chose the intrauterine device. The combined pill and condom were relatively equally popular with UK, Irish, EEC European, Caribbean (born Caribbean, born UK) and 'other' groups of women; while the intrauterine device was the favoured method of Kurdish/Turkish women born in Turkey. Depo-Provera was used principally by UK, European, Caribbean (born Caribbean, born UK) and African (West and East) women. Twelve per cent of women were recorded as not using a method. These women might have attended for a pregnancy test, cervical smear, advice about general health, gynaecological problems, though this was not specifically recorded. These women featured in all age groups. While a third were UK European, two thirds were of other ethnic groups. This would appear to illustrate that those women do seem to be aware that family planning clinics can provide services in addition to supplying contraceptive methods. It was noted that the Kurdish/Turkish women favoured one particular clinic sited in the ante natal department of the local hospital (the North Middlesex) where linkworkers are available. They accounted for 34 per cent of those who attended (128 out of 371). However at all but one of the clinic sites, which are spread around the borough, the UK European group was in a minority ranging from 20 to 47 per cent in attendance, compared to other ethnic groups. It is proposed that ethnic monitoring will be routinely recorded from April 1998 for new and first time attenders. It is also planned to work more closely with various ethnic minority groups in the community.

PIP: Ethnic monitoring was conducted of all new and first-time attenders in the financial year to Haringey Family Planning Clinics through an anonymous questionnaire during April-June 1997 to determine whether ethnic minority women attend family planning clinics. 2664 questionnaires were returned, for a response rate of 73%. The women came from a wide range of ethnic groups from the UK and Europe, Ireland, Caribbean, Africa, Greece, Turkey, India, southeastern Asia, and elsewhere. Women of UK European origin were under-represented. English was not the first language for 28% of the women, who reported 66 different first languages. 62% of the women were aged 20-34 years, and more than half of all women attending the clinics had no children. 33% of women admitted to having had at least one induced abortion, with the highest level of abortions being among women from West Africa (49%), and the lowest level being among Irish women (12%). Data on number of children, abortion, and choice of contraceptive method are reported with regard to ethnicity. The majority of women chose a method or methods of contraception, with the oral contraceptive pill and the condom being the most popular methods, and often used together. Contraceptive method used was influenced by age and ethnicity, with younger women choosing the pill and older women choosing IUDs. 12% of women were recorded as not using a contraceptive method. It is proposed that ethnic data be routinely recorded from April 1998 for first-time attenders, with efforts made to work more closely with various ethnic minority groups in the community.

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To make an informed decision when choosing a contraceptive, women and couples need to know how effective different methods are when used perfectly, where perfect use is defined as following the directions for use. In this article, we show that unbiased estimates of pregnancy rates during perfect use can be guaranteed only if information on consistency and correctness of use is available for each menstrual cycle. The estimated probability of pregnancy during a year of perfect use among the subset of women who always used a method perfectly will be biased upward.

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PIP: Oral contraceptives (OCs) remain the leading choice of reversible contraception for American women. In the 1999 Contraceptive Technology Update Contraceptive survey, more than 60% of the providers say that 50 or more women leave their offices each month with pill prescriptions in hand. Of the available OCs in the market, a 20-mcg Alesse pill and 20- and 30-mcg Loestrin pills are the top choices among older nonsmoking women because they help them through the perimenopausal stage. Among younger nonsmoking women, the 35-mcg Ortho Tri-Cyclen pill is the top choice because it is effective, leads to few complications and side effects, and has easy-to-use packaging. Research has established that OCs protect women against dysmenorrhea and menorrhagia, menstrual cycle irregularities, iron deficiency anemia, ectopic pregnancy, pelvic inflammatory disease, ovarian cysts, benign breast cancer disease, endometrial cancer, and ovarian cancer. Aside from the noncontraceptive health benefits, OCs have proven valuable in the management of a variety of gynecologic disorders. Providers are moving toward prescription of OCs specifically for noncontraceptive benefits, but respondents are still unwilling to see OCs offered as over-the-counter drugs.^ieng

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PIP: Although the progestin-only oral contraceptive (OC) is a safe, effective method for women who cannot use agents that include estrogen because they are breast-feeding or for another reason, it accounts for only 1-26% of the OC market in the US. The progestin-only OC is less effective than combined OCs, and about 5% of women who use rely on the progestin-only formulation and use it correctly will become pregnant in the first year. However, the added contraceptive effect of breast-feeding makes the method nearly 100% effective in lactating women. The progestin-only OC does not interfere with the quality or quantity of breast milk and causes fewer and milder side effects or adverse effects than combined OCs, with irregular bleeding being the most troublesome. The doses of progestin are even lower in the progestin-only OCs than in combined OCs, and the progestin is metabolized within 24 hours, so a back-up method of contraception must be used until the regular schedule has been reinstated for 48 hours if a woman misses a dose by more than 3 hours unless she is fully breast-feeding. The pills are taken daily, and the regimen can be started at any time in the menstrual cycle. Shorter and simpler labeling for the progestin-only OCs was accepted in 1995. The OCs can be given to women immediately postpartum and are a good choice for women who smoke or are over age 35 but should be avoided by women taking hepatic enzyme-inducing medications or by women with a history of gestational diabetes.^ieng

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PIP: This study assessed the contraceptive method of choice and tendency of method switching of women after their first birth in Shanghai, China. The assessment was based on 15 months follow-up after the first delivery. Included in the study were 3701 primiparous women aged 18-43 years, with 1833 women living in an urban area and 1868 living in a rural area. Results showed that 15 months after delivery 95.46% had already used a contraceptive method. The leading first choice among urban women was the condom (50.72%), followed by the IUD (29.09%), while the leading first choice among rural women was the IUD (56.65%), followed by the condom (30.60%). Among women who had never used a contraceptive method, 33.77% of urban women and 18.52% of rural women switched method 15 months after delivery. The major reason for the contraceptive method switching was method failure attributed to improper use. Furthermore, the choice of contraceptive method after first birth varied significantly by women's characteristics. Urban, well-educated women, breast-feeding women and older women preferred the condom and the rhythm method over oral contraceptives. Family planning workers should increase women's awareness of the benefits and disadvantages of different contraceptive methods, dispel myths, and improve women's informed choice.^ieng

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