Contraceptive use at first intercourse among Jewish women in Israel, 1962–1988

Using data from the 1987–1988 Study of Fertility and Family Formation,this study examines the family planning practices of Jewish Israeli womenwho first had intercourse between 1962 and 1988. The overwhelming majorityof women reported using no contraception at first intercourse, and among those who did practice birth control approximately half relied on modern techniques. While the likelihood that Israeli women used contraception at first sex changed little between 1962 and 1988, there has been a marked shift towards the adoption of efficient methods of birth control. Moreover, factors which promote female empowerment, including education and military service, have been positively associated with contraceptive use at first intercourse. Among those women who practiced contraception at first intercourse, those from Africa and Asia have been especially likely to make use of inefficient methods such as withdrawal.     

The initiation of contraception

Using data from the 1970 National Fertility Study, the trend in the initiation of contraception prior to the first pregnancy is examined. This trend is of interest because of its relationship to the tempo of familybuilding. Using data from a recent marriage cohort, it is shown that use before the first pregnancy is related to age at marriage, age at termination of first pregnancy and the probability of having a premarital conception. For women first married during the decade of the 1960’s, there was a substantial increase in the proportion using contraception before the first pregnancy. This trend is found among both white Catholics and white non-Catholics, but not among blacks. An examination of the specific method used by women using contraception before the first pregnancy reveals a shift from reliance on the traditional methods of diaphragm, condom and douche by the earlier birth cohorts to the use of the pill by the more recent cohorts. An appendix examines the reliability of various measures of the interval of first use of contraception.     

Natural family planning: A comparison of continuers and discontinuers

Little research has been done on social-psychological variables related to the use of natural family planning. The objective of this study was to analyze variables that differentiated between continuers and discontinuers of natural family planning (NFP). Questionnaires were obtained from couples who had received instruction in the sympto-thermal method of natural family planning at a large urban hospital. Subjects who were attempting to become pregnant or who were using other methods of contraception in conjunction with NFP were deleted from the analysis, leaving N of 74. With Pearson correlation, variables significantly related (p<.05) to NFP continuance were: religiosity, planning more children, perceived severity of pregnancy, support from spouse and relatives, dissatisfaction with other contraceptive methods, attitudes toward NFP, perceived effectiveness of NFP, attitudes toward abstinence, and importance of intercourse.     

Age-old methods of contraception

Folk methods of contraception have been used in Philippines from immemorial times, especially in the rural areas. Some methods seem to be practical while others are mystical. The popularity of methods are due to their low cost and the trust women in the community feel for the traditional healer. Herbs are the most commonly method used. For external application, pounded and heated leaves are placed inside a bag. Traditional practitioners believe that when the "charm" is worn during intercourse, the semen will "dropout" of the vagina. For internal application a beverage is prepared with seeds of the plant and drunk before sexual intercourse. For contraceptive purposes other herbs used in rural communities could induce abortion, which is illegal in Philippines. A projected study by the University of the Philippines' College of Medicine will try to establish the pharmacological effectiveness of local plants to determine the validity of some methods of family planning reported by medical students who have talked to rural herbalists and patients. The one which seems most relevant for this study is the herb Kibatalia Gitingesis, which is supposed to contain "progesteronal-like principles." Other methods of contraception are abdominal massage, which involves manual manipulation of the uterus, chemicals, like asoge (mercury), salt, and tablets, and the use of inanimate objects, such as the bato-balani or magnetic stone. If herbs and other folk methods of contraception are proven to be effective, the possibility to have them incorporated into the National Population Program has to be considered. The untrained hilots (nurse midwives) could become trained program workers, and because of their influence in the community the number of acceptors would increase.     

Dynamics of contraceptive use and breastfeeding during the post-partum period in Peru and Indonesia

This paper examines the interaction between contraceptive use and breastfeeding in relation to resumption of intercourse and duration of amenorrhea post-partum. We used data from the month-by-month calendar of reproductive events from Demographic and Health Surveys (DHS) in Peru and Indonesia. The analyses show that breastfeeding women were less likely than non-breastfeeding women to have resumed sexual intercourse in the early months post-partum in both countries. In Peru, but not in Indonesia, breastfeeding women had a significantly lower odds than non-breastfeeding women of adopting contraception. Although the likelihood of contraceptive adoption was highest in the month women resumed menstruation in both countries, about ten per cent of subsequent pregnancies occurred to women before they resumed menses. These results emphasize the importance of integrating breastfeeding counselling and family planning services in programmes serving post-partum women, as a means of enabling those who wish to space their next birth to avoid exposure to the risk of a pregnancy that may precede the return of menses.     

A meta-analysis of research on adolescent contraceptive use

Meta-analysis was used to summarize the results of 134 studies of adolescent contraceptive use in relation to two major explanatory models, the career model and the decision model. There was evidence in support of both models, although there has been less research conducted on variables related to the decision model. The major variables found to affect young women's contraceptive use were partner influence to use contraception, acceptance of one's sexuality, future orientation, positive attitudes toward contraception, an exclusive sexual relationship, and frequency of intercourse. The major variables affecting young men's contraceptive use were partner influence, frequency of intercourse, and positive attitudes toward contraception; however, there was relatively little research on young men compared to young women. A number of possible future directions for research are noted.We would like to thank Nancy Adler and Catherine Chilman for their comments on an earlier version of this article. Portions of this research were presented at the 1984 meeting of the American Psychological Association.Requests for reprints should be addressed to Bernard E. Whitley, Jr., Department of Psychological Science, Ball State University, Muncie, Indiana, 47306.     

Advantages and disadvantages of pregnancy and contraception: Teenagers' perceptions

Research has shown that teenagers' perceptions of the advantages and disadvantages of pregnancy and contraception are significant predictors of pregnancy risk taking. This analysis examines the content and determinants of these cost-benefit sets, using data from 425 sexually active adolescents. The results indicate that teens' perceptions of the advantages and disadvantages of pregnancy and contraception are neither strongly nor systematically related to each other. Moreover, the determinants of the four cost-benefit sets are varied, although there is some overlap between sets. Explanations of these findings and implications for future research and for the delivery of family planning services to teenagers are suggested.The authors names are listed alphabetically. The work reported herein was supported by an NICHD grant No. 1 R01-HD-1485-01. Direct all communication to Debra Kalmuss, Center for Population and Family Health, Columbia University, 60 Haven Avenue, New York, N.Y. 10032.     

Non-Heterosexuality,Relationships, and Young Women’s Contraceptive Behavior

Non-heterosexual young women have a higher rate of unintended pregnancy than their heterosexual peers, but their fertility behaviors are understudied. We use longitudinal data from the Relationship Dynamics and Social Life study to investigate mechanisms contributing to non-heterosexual women’s higher pregnancy risk. These data include weekly reports of relationships, sex, and contraceptive use over 30 months. We compare the relationships and fertility behaviors of three groups: exclusively heterosexual (consistent heterosexual behavior, identity, and attraction); mostly heterosexual (heterosexual identity with same-sex behavior and/or same-sex attraction); and LGBTQ (any non-heterosexual identity). We find that mostly heterosexual and LGBTQ women behave differently from exclusively heterosexual women in ways likely to elevate their risk of unintended pregnancy: more distinct partners during the study period, more sexual intercourse with men, less frequent contraceptive use, less use of a dual method (condom plus hormonal method), and more gaps in contraceptive coverage. Mostly heterosexual women resemble LGBTQ women in their contraceptive behavior but have significantly more intercourse with men, which may increase their pregnancy risk relative to both LGBTQ and exclusively heterosexual women. We conclude by considering implications for LGBTQ health and the measurement of sexual minority populations.     

A second look at natural family planning

There is renewed interest in natural family planning (NFP) as the Philippine Population Program enters the 1980s. Much of this interest is due to the realization that, properly practiced, NFP can be a highly effective means of birth spacing. In 1978 the Special Committee to Review the Philippine Population Program recommended that more efforts be made to promote NFP. The different methods of NFP are reviewed. Sex without intercourse, coitus interruptus, and prolonged nursing are not officially recognized as NFP methods by the Program. The rhythm method was first described independently by Drs. Hermann Knaus of Austria and Kyusaku Ogino of Japan in the 1930s. Ogino's method of calculating a woman's fertile period is based on the lengths of the last 12 menstrual cycles which she recorded on a calendar. The advantages of rhythm are that it is inexpensive, it requires only the cost of charts which may be homemade, there are no physical side effects, control is in the woman's hands, and it is acceptable to people who consider it their duty to follow religious teachings. Disadvantages include: keeping constant, accurate records of cycles for long periods of time; the need for perseverance and correct interpretation of the chart; the possible need for medical advice and help; and the fear that something might upset a woman's cycle and change the time of ovulation. The continuation rates of rhythm acceptors in the Philippines are unimpressive. A study of 142 women revealed a high pregnancy/failure rate--25% for a 12-month period compared to 0 with oral contraception (OC) and the IUD's 2%. The basal body temperature method helps determine the unsafe period with some accuracy. Its premise is that there are slight but detectable changes in a woman's body temperature during her cycle. These changes herald ovulation. A special thermometer must record temperature changes of 0.1 degree Farenheit. This instrument and the charts are the only expenses involved. The reviewers of the Philippine Population Program noted that since the end of the unsafe period can be indicated only by the temperature, the total period of abstinence becomes long, although the basal body temperature method gives more or less 10 successive days for intercourse. The cervical mucus method, also known as the Billings method, takes into account the cervical secretions during the menstrual cycle. Appearance of this mucus is an indication of fertility. All that is required of a practitioner is to learn to distinguish the different sensations of wetness and dryness. The disadvantage is that the method becomes ineffective in areas where there is cervicitis or infection of the cervix. The symptom thermal method is the basal body temperature method combined with other NFP techniques and is widely used. With this method an accurate record of the 6 immediately preceding menstrual cycles is established. The start of the fertile period is set by substracting 20 days plus 1. The woman watches for symptoms like pelvic heaviness, breast softness, and mucus discharge.     

Metal ring - a safe,effective, economical and convenient approach of fertility regulation

A survey of 25,000 women from 1450 villages in China has indicated that the metal ring is a safe, effective, and convenient method of contraception. The continuation rate was 79.3% after 1 year of use and 55.2% after 5 years of use. Factors that were most influential in continuation included insertion after menstruation, insertion during breastfeeding, age at 1st birth, insertion after abortion, level of the health care system, age at insertion, intensity of labor, number of births before insertion, and number of abortions before insertion. The expulsion rate ranged from 11.4-20.7%. The accidental pregnancy rate was 2.4-6.8%. Events such as expulsion and unintended pregnancy showed an association with parity, number of abortions, level of the health care system, and insertion during the breastfeeding period. No serious complications were noted in any of the women fitted wih metal rings.     

Barriers to contraceptive use among Pakistani couples

Despite the existence of a family planning program in Pakistan since 1965 and widespread knowledge among Pakistanis about contraception, there is a high level of unmet need for family planning. One recent survey found that while 53% of married women express the desire to avoid pregnancy, less than 20% use contraception. A recent Population Council study conducted in urban and rural areas of Punjab province investigated personal beliefs, family circumstances, social norms, and gender relations among 1310 married women and 554 of their husbands. The unmet need for contraception was highest among women over age 30 years, those with more living children, less educated women, and women living in rural areas. The study found that while most Pakistanis approve of family planning, obstacles to contraceptive use exist in most marriages. 97% of respondents who wanted another child wished for a boy. That preference for sons influences contraceptive use behavior. The fear of social disapproval of contraceptive use, perceived opposition from in-laws and husbands, and fear of health side effects and divine punishment were major reasons identified against contraceptive use. Female contraceptive users were more autonomous and likely to make domestic decisions without consulting their husbands, while husbands defer to social and cultural norms.     

Improvement of contraception during the course of marriage

Contraceptive effectiveness is conventionally measured by a pregnancy rate, which reveals little about the way in which pregnancy risks vary among couples. In this paper a technique is presented for estimating curves of pregnancy risk. The technique is applied to data from the Family Growth in Metropolitan America study for purposes of estimating how much these couples would have to Improve their initial contraception In order to realize, by contraception alone, the calibre of family limitation claimed by respondents late in their childbearing period. A very substantial improvement Is estimated as necessary.

It Is also argued that the notable increase In contraceptive effectiveness before and after second birth, observed for couples desiring only two children is attributable mainly to a more regular practice of contraception. Changes Iin method preference, decline in average fecundabillty and increased contraceptive skill are viewed as secondary factors.     

Can LARC Fulfill Its Potential to Reduce U.S. Women’s Unintended Pregnancy Risk? Examining Women’s Contraception and Childbearing in the Year Before Initiating LARC

Long-acting reversible contraceptives (LARCs) have received increased attention in recent decades for their potential to reduce the high level of unintended pregnancy. We know little about women’s contraceptive use and (unintended) childbearing prior to LARC initiation, even though it provides vital context to considering the extent to which increased LARC use could be expected to reduce the U.S. unintended pregnancy rate. Data from 849 women who initiated LARC in the 2–3 years prior to the 2006–2015 cycles of the National Survey of Family Growth were analyzed to describe U.S. women’s contraceptive use and (unintended) childbearing in the year before initiating LARC. Results show that more than half of women (55.4%) who initiated LARC did so within a year of giving birth, with 47.3% of these births resulting from an unintended pregnancy. Among women without a recent birth, 5.0% had last relied on sterilization, 54.7% had last used a moderately-effective method, 34.7% had last used a less-effective method, and 5.6% had not used contraception in the year prior to initiating LARC. These findings advance understanding of the extent to which increased LARC use could be expected to reduce the unintended pregnancy rate. Women initiating LARC after a recent birth are selective of those at high risk of unintended pregnancy. In contrast, the majority of LARC initiators without a recent birth last relied on a moderately-effective method or sterilization—a pattern that could reduce LARC’s impact on the unintended pregnancy rate.

     

The prediction of fertility among catholics: A longitudinal analysis

A longitudinal analysis of the reproductive behavior of a sample of Catholics who were participants in the 1965 NFS and reinterviewed in 1969 is reported in this paper. Fertility over the period studied varied systematically with the additional number of children intended in 1965. In addition, this study has documented a predictive role for method of contraception and the experience of premarital pregnancy. Women using less effective methods and those premaritally pregnant had higher fertility over the interval net of controls for other variables in the analysis, including life-cycle stage and 1965 intentions. Surprisingly, the planning status of the last pregnancy before 1965 was not found to have any independent association with subsequent fertility.     

Contraceptive overlap with post-partum anovularity

Contraceptive use in the early post-partum months is, for the majority of women, without any direct protective value because, whilst not ovulating, they are not exposed to the risk of pregnancy. This does not, of course, imply that contraception should be delayed until signs of the resumption of ovulation appear, as for many women the first sign of such resumption is pregnancy. There are, besides, logistic and psychological reasons which make early post-partum contraception advisable. It does, however, demand that any calculation of the demographic effects of contraceptive use should make due allowance for this null period of use.     

Contraceptive overlap with post-partum anovularity

Abstract Contraceptive use in the early post-partum months is, for the majority of women, without any direct protective value because, whilst not ovulating, they are not exposed to the risk of pregnancy. This does not, of course, imply that contraception should be delayed until signs of the resumption of ovulation appear, as for many women the first sign of such resumption is pregnancy. There are, besides, logistic and psychological reasons which make early post-partum contraception advisable. It does, however, demand that any calculation of the demographic effects of contraceptive use should make due allowance for this null period of use.     

Why women who don't want to get pregnant don't use contraception

In the developing world about 120 million women have an unmet need for contraception. They want to postpone childbearing, yet they do not use contraception, often because of the unavailability of services and supplies. However, according to a recent article by John Bongaarts, the primary factors are lack of knowledge about a contraceptive method, concern about side effects, and the disapproval of the male partner in developing countries. Lack of knowledge means inability to describe the uses of a contraceptive, its side effects, and the locale of its availability. An approximate knowledge index was calculated for such women, which showed that knowledge level positively correlated with contraceptive prevalence. Countries where the index was below 50% had a contraceptive prevalence of 8% only. The determinant reasons why women were reluctant to use the pill, IUD, and sterilization had to do with health and the fear of side effects, such as nausea and increased bleeding. The contraceptive prevalence among these women was reduced by 71% for the pill, 86% for the IUD, and 52% for sterilization. In Sub-Saharan countries nearly 70% of women cited partner disapproval of contraception, although they had never discussed family planning with their partners. The central concept for reducing unmet need is access with quality, which means that services are voluntary, safe, and appropriate in delivery. Some of the recommendations to reduce the unmet need for contraception include: one-on-one same-sex discussions to increase contraceptive knowledge and acceptability; sensitive responses by programs to their client's health concerns; support by service providers to women negotiating with male partners in order to mitigate male disapproval; and sex education and family planning services to reduce unwanted and early sexual contact and pregnancy while girls develop identities apart from mothering roles.     

Changes in the use of birth control methods

Abstract Information on changes in the methods of contraception used was collected from women in a KAP Survey of Trinidad and Tobago in 1970-71. Using methods analagous to those used in the study of internal migration, it is found that 54% of contraceptors were still using the method they first used, and 46% had changed. In general, the net changes tended to be from less to more efficient methods. This is demonstrated with data showing: 1. the number of changes from one method to another; 2. the number of changes these women have made, considering the first and last methods only; and 3. the number of changes, including intermediate changes. Nevertheless, there is also an appreciable movement away from the more effective methods either to other methods, or out of contraceptive practice entirely. The rate of dropout from contraception has been increasing in recent years for all methods, and, apparently, for all ages of women. The principal reasons given for stopping the use of the various methods were: 1. pregnancy; 2. that the method was uncomfortable or too much trouble; 3. that the method made the user ill (in the case of the pill and the IUD); and 4. that the partner disliked the method (in the case of the condom and withdrawal). More positive reasons include: 1. that the woman wanted more children; and 2. that she no longer had a partner.     

Application of life table techniques to measurement of contraceptive effectiveness

Two problems are associated with the analysis of use-effectiveness of contraception. First, couples belonging to a sample of contraceptors typically vary in their monthly chances of contraceptive failure. Second, one does not observe for many, and perhaps a majority of the couples, how long they can remain protected with the contraceptive, because either they are stopping contraception to plan a pregnancy or else observation of them is being interrrupted by lost contact, by discontinuation of contraception for other reasons, or by the end of the study. It is argued that because of these two problems-namely, sample heterogeneity and incomplete histories-the Pearl pregnancy rate, which has been traditionally used to measure contraceptive effectiveness, is inadequate.A life table method is described that permits one to combine incomplete histories with complete ones for purposes of estimating the proportions of the sample that might have remained protected for specified periods if all members had remained under observation for these periods. The versatility of the techniques is illustrated in relation toa retrospective survey. A detailed account of procedure is given. Finally, it is shown that only under specialized conditions that are rarely met in practice is it possible to estimate the results of the new technique from knowledge of Pearl pregnancy rates alone.