'Age alone is not a contraceptive' experts warn

Experts fear older women are ditching contraception in the mistaken belief that they cannot get pregnant past a certain age.
The [UK] Family Planning Association (FPA) believes the message on infertility and age has gone "too far".
Although fertility does wane, women can still get pregnant well into their thirties, forties and even fifties.
Abortion rates for women aged 40 to 44 match those for the under 16s, figures for England and Wales show.
In 2008, both of these groups had an abortion rate of four per 1,000 women.
There are many reasons why some women opt for an abortion - including birth abnormalities in the baby, which are more common when the mothers are older.
But FPA says its anecdotal evidence suggests some of the abortions are because women wrongly assumed they could not get pregnant because they were too old.
Aimed at women aged 35 and over, the FPA's new campaign 'Conceivable?' reminds women to stay vigilant about unplanned pregnancy and to keep using contraception until after the menopause if they do not wish to become pregnant.
Chief executive of the FPA Julie Bentley said: "Whilst the message about fertility declining with age is an important one, it is often overplayed, alongside disproportionate messaging about unplanned teenage pregnancies.
"It sends an inaccurate message to women and society that only the young fall pregnant and is leading older women to believe their fertility has gone long before it actually has."
She said women should realise it is entirely conceivable that just one night of unprotected sex in your late 30s, 40s and even 50s can end in an unplanned pregnancy.
"Our helpline receives calls from such women, shocked this has happened to them. They thought their age would protect them from becoming pregnant."
She said in general all methods of contraception were suitable for the over-35s.
Women aged 30 to 34 continue to have the highest fertility rate - 113.1 live births per 1,000 women.
But the rate among women aged 40 and over has more than doubled since 1988, from 5.1 to 12.6 per 1,000 women, and there were more than 26,000 live births to women in this age group in 2008, figures from the Office for National Statistics show.
Emily James of Marie Stopes International said: "Many older women facing an unplanned pregnancy are completely shocked to find themselves in this position - many assume that their irregular periods are due to menopause, and are surprised to learn that they are in fact pregnant.
"It is vital that women of all ages are provided with the information, support and advice they need when deciding whether or not to continue with an unplanned pregnancy."

Source: BBC News online, 11 May 2010

The Best Intentions:

Unintended Pregnancy and the Well-Being of Children and Families


Description
Experts estimate that nearly 60 percent of all U.S. pregnancies--and 81 percent of pregnancies among adolescents--are unintended. Yet the topic of preventing these unintended pregnancies has long been treated gingerly because of personal sensitivities and public controversies, especially the angry debate over abortion. Additionally, child welfare advocates long have overlooked the connection between pregnancy planning and the improved well-being of families and communities that results when children are wanted.
Now, current issues--health care and welfare reform, and the new international focus on population--are drawing attention to the consequences of unintended pregnancy. In this climate The Best Intentions offers a timely exploration of family planning issues from a distinguished panel of experts.
This committee sheds much-needed light on the questions and controversies surrounding unintended pregnancy. The book offers specific recommendations to put the United States on par with other developed nations in terms of contraceptive attitudes and policies, and it considers the effectiveness of over 20 pregnancy prevention programs.
The Best Intentions explores problematic definitions--"unintended" versus "unwanted" versus "mistimed"--and presents data on pregnancy rates and trends. The book also summarizes the health and social consequences of unintended pregnancies, for both men and women, and for the children they bear.
Why does unintended pregnancy occur? In discussions of "reasons behind the rates," the book examines Americans' ambivalence about sexuality and the many other social, cultural, religious, and economic factors that affect our approach to contraception. The committee explores the complicated web of peer pressure, life aspirations, and notions of romance that shape an individual's decisions about sex, contraception, and pregnancy. And the book looks at such practical issues as the attitudes of doctors toward birth control and the place of contraception in both health insurance and "managed care."
The Best Intentions offers frank discussion, synthesis of data, and policy recommendations on one of today's most sensitive social topics. This book will be important to policymakers, health and social service personnel, foundation executives, opinion leaders, researchers, and concerned individuals. May

Reviews

"Anyone who cares for women and children or delivers prenatal care should spend time reading, examining, and dipping into this book. It is fascinating, eye-opening, and distressing. It should be on all family physicians' bookshelves.";--IT;Family Medicine;RO

from this page one coul start reading

Lambeth Conference

all mainline churches opposed contraception until the Anglicans broke with tradition at the Lambeth Conference of 1930. Only then did others follow suit.

Surely Sanger must have remembered how Pope Pius XI wrote the famous Encyclical Castii Connubii (On Christian Marriage) four months after the Lambeth Conference of 1930, wherein he states that the teaching against contraception was “uninterrupted Christian tradition” (see paragraph 56 in the document).

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Dr. Gerard M. Nadal: Science in Service of the Pro-Life Movement

• the official website for the Lambeth Conference
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• What is the Lambeth Conference?

fc

AP

Advocates of the FC2, a female condom approved by the FDA, say the new version is less costly and more user friendly. They hope the female condom will be used to protect against AIDS and other sexually transmitted diseases.

c4p

Call for Papers on Family Planning and HIV

With partial support from USAID, Family Health International and the Imperial College London are collaborating with the journal AIDS to produce a supplemental issue dedicated to family planning and HIV. We are pleased to issue a call for papers for this special issue. Manuscripts are due May 1, 2009.

Submissions may include but are not limited to biomedical research on the safety and effectiveness of contraceptive methods for women with HIV, behavioral research on the contraceptive practices and fertility desires of women and couples with HIV, evaluations of service-delivery approaches for integrating family planning and HIV services, and policy and programmatic case studies of efforts to integrate these services.

AIDS publishes the latest research on HIV and AIDS and has the highest impact of all AIDS-related journals. This special issue will increase attention to evidence-based strategies for integrating services and meeting the unique reproductive health needs of women and couples with HIV.

For more information about the supplement and how you can contribute, see:

http://tinyurl.com/ah46mt.

Contraception is An Economic Issue

Every dollar spent on family planning saves taxpayers $4 dollars, according to a new report by the Guttmacher Institute. “The national family planning program is smart government at its best,” said Rachel Benson Gold, lead author of the study, Next Steps for America’s Family Planning Program.

The report comes after Republicans ridiculed the inclusion of what they falsely claimed was $200 million in the stimulus package for family planning. “Democrats capitulated and contraception was gone. Now, it turns out there never was a $200 million budget request for contraception” said blogger Cristina Page.

Page first uncovered the facts about Republican Rep. John Boehner, who, she reported, “made a ‘huge mistake,’ one that conveniently served his interests, and that he didn't step up to correct.”

The contraception provision that was stripped out of the House economic stimulus bill (signed by President Obama last week) would have given states additional flexibility to provide more family planning services to those who qualify for Medicaid.

In addition to highlighting that every dollar invested in helping women avoid an unintended pregnancy saves $4.02 in Medicaid expenditures that otherwise would have been needed for pregnancy-related care, the

Guttmacher Institute report notes that:

• By providing millions of young and low-income women access to voluntary contraceptive services, the national family planning program prevents 1.94 million unintended pregnancies, including almost 400,000 teen pregnancies, each year. These pregnancies would result in 860,000 unintended births, 810,000 abortions and 270,000 miscarriages.

• Public expenditures for family planning in 2006 totaled $1.85 billion, with 71% of those funds coming from the joint federal-state Medicaid program. The role of Medicaid in funding family planning has risen dramatically since the 1980s. The increase was driven by efforts in 21 states to expand eligibility specifically for family planning for low-income women who otherwise would not qualify for Medicaid.

The findings and proposed next steps of the Guttmacher Institute report are supported by voter opinion. An Election Day poll of voters by Lake Research Partners, for the Women Donors Network, found that 72 percent of voters believed the federal government should provide funding for birth control for low-income women.

Fully 86 percent thought couples should have access to all birth control options, including emergency contraception, and that it is their decision whether to use birth control and it should be safe and available.

Eighty percent believed that for women to achieve equality, they must have access to family planning services, including birth control and contraception. These strong findings were consistent throughout the Bush administration as well.

Source: PlanetWire.org, 24 February 2009

commercial sex workers in Tallinn

http://dx.doi.org/10.1136/sti.2007.027664
Sexually Transmitted Infections. 2008 Jun;84(3):189-191.
Uuskula A | Fischer K | Raudne R | Kilgi H | Krylov R

Estonia is confronted by a dramatic expansion of the initially injection drug use-driven HIV epidemic. Little is known about HIV occurrence in population groups at high risk other than injection drug users. The objective was to obtain data on the prevalence of HIV and hepatitis C virus (HCV) among female sex workers (FSW) in Tallinn. The design was an unlinked, anonymous, cross-sectional survey of FSW recruited in Tallinn from October 2005 to May 2006. 227 FSW were recruited for the survey and biological sample collection (HIV, HCV antibodies detection) using a combination of time-location, community and respondent-driven sampling. Among 227 women the HIV and HCV prevalences were 7.6% (95% CI 4.6% to 12.5%) and 7.9% (95% CI 4.5% to 12.6%), respectively. HIV prevalence was higher among FSW working in the street (odds ratio (OR) 6.4; 95% CI 1.1 to 35.6) and at the brothels and apartments
supervised by the organised sex industry (OR 5.0; 95% CI 1.3 to 18.4). The duration of sex work was negatively associated with HIV prevalence (OR 0.78; 95% CI 0.63 to 0.97). Prevention needs of FSW in this area include increasing rates of HIV testing and putting in place effective programmes that can help extend HIV prevention behaviours across a range of sexual and drug use risk behaviours.

CC in Serbia

a significant number of Serbian gynaecologists neither use modern methods of contraception themselves nor have adequate knowledge to advise their patients. Thus, education and training of gynaecologists in all methods of available contraception is a priority in Serbia.

compatibility

Comparability of contraceptive prevalence estimates for women from the 2002 Behavioral Risk Factor Surveillance System
http://www.publichealthreports.org/archives/issuecontents.cfm?Volume=123&Issue=2
Public Health Reports. 2008 Mar-Apr;123(2):147-154.
Santelli J | Lindberg LD | Finer LB | Rickert VI | Bensyl D | Posner S | Makleff S | Kost K | Singh S

This article assesses the comparability of contraceptive use estimates for adult women obtained from the 2002 Behavioral Risk Factor Surveillance System (BRFSS), using the 2002 National Survey of Family Growth (NSFG) as a benchmark. The 2002 BRFSS uses data collection methods that are considerably different from the NSFG. We compared demographic differences and national estimates of current contraceptive methods being used and reasons for nonuse. Variables were recoded in the BRFSS and NSFG systems to make the two samples comparable. Women in the NSFG and BRFSS were similar in age and race/ethnicity. Compared with the NSFG, the BRFSS sample was more educated and of higher income, less likely to be cohabiting, and more likely to be married. After adjusting for differences in the coding of hysterectomy, many BRFSS estimates for current contraceptive use were statistically similar to those
from the NSFG. Small but statistically significant differences were found for vasectomy (7.7% and 6.3%), the pill (21.9% and 19.6%), rhythm (1.5% and 1.0%), the diaphragm (0.5% and 0.2%), and withdrawal (0.3% and 2.7%) for the BRFSS and NSFG, respectively. Major reasons for nonuse were similar: seeking pregnancy and currently pregnant. The percentage of women who were not currently sexually active was higher in the BRFSS (16.0%) compared with the NSFG (12.5%). The BRFSS is a useful source of population-based data on contraceptive use for reproductive health program planning; however, planners should be cognizant that lower-income women are not fully represented in telephone surveys.

emco

REVIEW

Advance Provision of Emergency Contraception for Pregnancy Prevention

A Meta-Analysis

Chelsea B. Polis¹, Kate Schaffer, MSc², Kelly Blanchard, MS³, Anna Glasier, MD, FRCOG⁴, Cynthia C. Harper, PhD⁵ and David A. Grimes, MD⁶

From the ¹Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; ²Pathfinder International, Watertown, Massachusetts; ³Ibis Reproductive Health, Cambridge, Massachusetts; ⁴Family Planning and Well Women Services, Lothian Primary Care NHS Trust, Edinburgh Scotland; ⁵Bixby Center for Reproductive Health Research and Policy, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California; and ⁶Family Health International, Research Triangle Park, North Carolina.

OBJECTIVE: Advance provision of emergency contraception can circumvent some obstacles to timely use. We performed a meta-analysis to summarize randomized controlled trials evaluating advance provision of emergency contraception to explore effects on pregnancy rates, sexually transmitted infections, and sexual and contraceptive behaviors.

DATA SOURCES: In August 2006, we searched CENTRAL, EMBASE, POPLINE, MEDLINE, a specialized emergency contraception article database, and contacted experts to identify published or unpublished trials.

METHODS OF STUDY SELECTION: We included randomized controlled trials comparing advance provision to standard access, defined as any of the following: counseling (with or without information about emergency contraception) or provision of emergency contraception on request at a clinic or pharmacy.

TABULATION, INTEGRATION AND RESULTS: Two reviewers independently assessed study quality. We performed a meta-analysis using Review Manager software. Eight randomized controlled trials met inclusion criteria, representing 6,389 patients in the United States, China, and India. Advance provision did not decrease pregnancy rates, despite increased use (single use, odds ratio [OR] 2.52, 95% confidence interval [CI] 1.72–3.70; multiple use: OR 4.13, 95% CI 1.77–9.63) and faster use (weighted mean difference –14.6 hours, 95% CI –16.77 to –12.4 hours). Advance provision did not increase rates of sexually transmitted infections (OR 0.99, 95% CI 0.73–1.34), unprotected intercourse, or changes in contraceptive methods. Women who received emergency contraception in advance were as likely to use condoms as other women.

CONCLUSION: Advance provision of emergency contraception did not reduce pregnancy rates and did not negatively affect sexual and reproductive health behaviors and outcomes compared with conventional provision.

LEVEL OF EVIDENCE: III

reminder

Contraception and adolescents
(Abstract; subscription needed for full text; North America) http://dx.doi.org/10.1542/peds.2007-2535
Pediatrics. 2007 Nov;120(5):1135-1148.
Committee on Adolescence

Although adolescent pregnancy rates in the United States have decreased significantly over the past decade, births to adolescents remain both an individual and public health issue. As advocates for the health and well-being of all young people, the American Academy of Pediatrics strongly supports the recommendation that adolescents postpone consensual sexual activity until they are fully ready for the emotional, physical, and financial consequences of sex. The academy recognizes, however, that some young people will choose not to postpone sexual activity, and as health care providers, the responsibility of pediatricians includes helping teens reduce risks and negative health consequences associated with adolescent sexual behaviors, including unintended pregnancies and sexually transmitted infections. This policy statement provides the pediatrician with updated information on contraception methods and guidelines for counseling adolescents.

remainder

Contraceptive discontinuation attributed to method dissatisfaction in the United States
(Abstract; subscription needed for full text; North America) http://tinyurl.com/345uda
Contraception. 2007 Oct;76(4):267-272.
Moreau C | Cleland K | Trussell J
This study examines contraceptive discontinuation due to method dissatisfaction among women in the United States. The study population, drawn from the 2002 National Survey of Family Growth, consisted of 6724 women (15-44 years of age) who had ever used a reversible contraceptive method. We first estimated the overall proportion of women who had ever discontinued their contraceptive due to dissatisfaction. We then calculated method-specific discontinuation risks due to dissatisfaction and analyzed the reasons for dissatisfaction given by women who had ever stopped using Norplant, Depo-Provera, oral contraceptives or condoms. Overall, 46% of women had ever discontinued at least one method because they were unsatisfied with it. Dissatisfaction-related discontinuation risks varied widely by method: the diaphragm and cervical cap showed the highest proportions of such discontinuation (52%),
followed by long-acting hormonal methods (42%). Oral contraceptives were associated with an intermediate risk of dissatisfaction-related discontinuation (29%), while condoms had the lowest risk (12%). A broader understanding of women's concerns and experiences using contraception could help health care providers redesign counseling strategies to improve contraceptive continuation.