Bakgrund: Preventivmedel är metoder som i huvudsyfte används för att förhindra graviditet, de kan dock påverka mycket mer än fertiliteten i form av biverkningar. Det fanns sedan tidigare studier som beskrev kvinnors erfarenheter av reversibla preventivmedel men för att ge en bredare bild av kvinnors upplevelser valde författarna att sammanfatta dessa i en litteraturstudie. Syfte: Att beskriva kvinnors erfarenheter av att använda reversibla preventivmedel. Metod: En deskriptiv litteraturstudie av 16 artiklar, 13 med kvantitativ ansats och tre med kvalitativ ansats. Huvudresultat: Kvinnor upplevde att de påverkades av sin omgivning när det gällde valet av preventivmedel, ofta handlade det om vänners tidigare erfarenheter och attityder. P-piller är den metod som flest kvinnor i omgivningen använde och metoden valdes därför många gånger av bekvämlighetsskäl. P-piller kan dock vara besvärliga eftersom de ska tas varje dag, något som många kvinnor upplevde var svårt. Detta kunde påverka metodens säkerhet och ge oro, denna oro upplevde inte kvinnor som valde mer långsiktiga metoder som spiraler, p-ring eller p-stav vilket resulterade i att kvinnorna upplevde en större trygghet. Trygghet upplevdes vara en viktig faktor för den sexuella hälsan. Hur kvinnan blev bemött av sin vårdgivare samt metodens påverkan på menstruationen hade också betydelse för kvinnans välmående. Slutsats:Kvinnors upplevelser av användningen av reversibla preventivmedel är väldigt individuell och komplicerad och därför är det viktigt att belysa kvinnors upplevelser och eventuella problem. / Background: The main purpose of contraceptives is to prevent pregnancy, but they might also affect more than just fertility due to side effects. There is previous research that describes women's experiences of reversible contraceptives, the authors aim was therefore to provide a broad view of these experiences by summarizing them into a literature review. Aim: To describe women’s experiences with using reversible contraceptives. Method: A descriptive literature review of 16 articles, 13 with a quantitative approach and three with a qualitative approach. Main result: Women often experienced an impact from their surroundings when it came to their choice of contraceptives, usually the experiences and attitudes of friends. Oral contraceptives were the most commonly used method and often chosen because of convenience. However, oral contraceptives need to be taken every day and to some women that was a problem leading to nervousness which affected the security of the method. Women that choose long-acting reversible contraceptives like intrauterine devices, vaginalring or implant, usually experienced a greater security. Security was an important factor for the sexual health of women. How the women were being treated by her caregiver and how the method impacted on her menstruation also had significance on her wellbeing. Conclusion: Women's experiences of the use of reversible contraceptives was very individual and complicated and that is why it is important to make aware of women's experiences and any problems they might have.

Despite the availability of contraception in Canada, almost half of pregnancies are unintended and account for approximately 95% of elective, induced abortions. Nearly one-third of Canadian women will access an elective abortion in their lifetime and 30-40% of these women will access at least one further termination. Although contraceptive counselling is generally provided as part of abortion care, there is a paucity of research about the effectiveness of peri-abortive counselling methods or women’s experiences with this care. This research was designed to better understand peri-abortive contraceptive decision-making through the lens of the Ottawa Decision Support Framework and addressed gaps in previous research. The thesis was completed in two parts, a literature review and the first Canadian qualitative study on this topic. Unlike most of the available research that focused on typical outcomes such as contraceptive uptake or continuation, the data from the interpretive descriptive study described women’s informational needs, desired supports, and preferences for peri-abortive contraceptive care. The literature review described the current research and the findings from the qualitative study demonstrated that Canadian women’s experiences with peri-abortive contraceptive care are similar to those in studies published in other countries. This thesis contributes to the limited body of knowledge in understanding what women need and want when receiving contraceptive care as part of abortion services.

Unintended pregnancy is a global public health threat that affects the lives of women, families, communities, and society. In 2008, the rate of unintended pregnancy in Ethiopia was 101 per 1,000 women aged 14 to 44 years. Although Ethiopia has experienced a steady increase in modern contraceptive use since 2004, this increase did not result in a proportional decline in unintended pregnancy, total fertility rates, or rapid population growth. In this cross-sectional study, associations between individual, interpersonal, community, and societal factors and contraceptive uptake were tested using a sample of 3,863 women aged 15 to 49 years who participated in the 2016 Ethiopian Demographic and Health Surveys. Statistically significant predictors of contraceptive use were included in the logistic regression model. Findings showed that age, education, marital status, type of residence, and wealth index reliably predicted contraceptive use. Increase in age, highest level of education, and wealth index were associated with 13%, 15%, and 65% increase in the odds of contraceptive use, respectively. Being married was associated with 85% decrease in the odds of contraceptive use and being from an urban residence was associated with 56% increase in the odds of contraceptive use. Results of the study can be used to develop targeted family planning interventions to increase contraceptive use and reduce unintended pregnancy, child and maternal mortality, total fertility rates, and rapid population growth in Ethiopia.

This study aimed to explore perceptions and experiences concerning sexuality, contraceptives, unwanted pregnancy and unsafe abortion among young people in Kisumu, Kenya. The design of the study was inductive with a qualitative approach using personal in-depth interviews. Eight participants (four female and four male) were asked to describe their perceptions and experience concerning sexuality, contraceptives, unwanted pregnancies and unsafe abortion. The result showed that culture and norms, misconceptions and gender based power in sexuality are factors that impact Sexual Reproductive Health among young people in Kisumu today. Unwanted pregnancy was described as a shame, a burden and a destroyed life which lead to many unsafely induced abortions. The findings indicate that youth interventions are important, such as engaging young men in unwanted pregnancy and thus unsafe abortions and to empower young women.

Despite its widespread use, little research has been undertaken on the use of progestogen-only injectable contraceptives by South African women. This thesis is comprised of two sections. Section 1 provides the first comprehensive description of injectable contraceptive use among rural South African women. It includes an analysis of the contraceptive method mix, prevalence of injectable contraceptive use, discontinuation patterns and reported side effects. A comparison of depot medroxyprogesterone acetate (DMPA) versus norethisterone oenanthate (NET-EN) focuses on utilization patterns and costs. The second section gives an account of the pharmacokinetics of DMPA including the first ever population analysis. A cross-sectional, community-based household survey was undertaken in the Hlabisa sub-district of KwaZulu-Natal, South Africa. Interviews were held during 1998 and 1999, with 848 randomly selected women (aged 15-49 years) and with 14 focus groups. There was a heavy reliance on injectable contraceptives which were used by 74% of women practising contraception. By contrast, the condom was the current method of only 4%. The injectable method was the most commonly used method among teenagers. However, in most cases, contraceptive use appeared to commence only after the first pregnancy. Slightly more NET-EN (54%) than DMPA (46%) was used, with younger women more likely to use NET-EN than DMPA (p=0.001). No significant differences in self-reported side effects were found between current users of the two injectables. Health workers played an important role in women's decisions to use the injectable, and in product selection, with NET-EN being recommended for younger women on the basis of concerns about method reversibility. While some women used injectables for long periods of time, discontinuation rates at two years were high, most commonly due to menstrual disturbances. Many side effects were reported by users of both DMPA and NET-EN, with amenorrhoea the most common, experienced by 63% of current injectable users. Heavy bleeding was most commonly reported by previous users (38%). Vaginal wetness was also common, mentioned by 18% and 29% of current and previous users respectively. Utilisation patterns of the two injectable products (DMPA and NET-EN) were analysed by means of a Pareto analysis of injectables issued from four South African provincial pharmaceutical depots over three financial years (1997/8, 1998/9 and 1999/2000). Injectables accounted for a substantial share of total state expenditure on drugs. While more DMPA than NET-EN was issued, NET-EN distribution from two depots increased over the period of analysis, even though DMPA was the cheaper option. The pharmacokinetic analysis was undertaken amongst DMPA users routinely attending family planning services in three Durban clinics in 1996. Medroxyprogesterone acetate levels at the end of the dosing interval were analysed for 94 women. In addition a population pharmacokinetic analysis of 291 serum levels from 111 DMPA users was undertaken. This involved the use of Non Linear Mixed Effect Modelling (NONMEM) to fit the data and determine the pharmacokinetic parameters, apparent clearance (CLIP) and apparent volume of distribution (VIP), and to estimate the influence of covariates on CLIP and VIP (where P is the bioavailability). The final model estimates for CLIP and VIP were 1080 (95% confidence interval: 994, 1166) litres/day and 86200 litres (95% confidence interval: 68246, 104154) respectively. No significant relationships were found between the covariates tested and CLIP and VIP. Concerns raised in the literature about the influence of weight or ethnicity on the pharmacokinetics of DMPA were shown to be unfounded. In the context of South Africa's HIV epidemic, the heavy reliance on injectable contraceptives, which offer no protection against HIV, should be addressed by expanding the contraceptive method mix to include barrier methods such as the female condom. Health providers are influential in contraceptive decision-making and should be encouraged and supported to redress the dependence on the injectable method alone, taking into account the need of many for dual protection against HIV and unwanted pregnancy. Provider counseling should also focus on adherence to dosing regimens, improving continuation rates, and should provide appropriate advice for women complaining about vaginal wetness with injectable use. Promotion of one injectable product over another to younger women is not appropriate. Since DMPA is the cheaper product, provider training about the rational use of injectable contraceptives should include cost considerations. / Thesis (Ph.D.)-University of Natal, 2003.

Thesis (M.S.)--University of Michigan, 1989.

Thesis (M.S.)--University of Michigan, 1989.

Thesis (M.A.)--Northern Kentucky University, 2006. / Made available through ProQuest. Publication number: AAT 1435883. ProQuest document ID: 1140194581. Includes bibliographical references (p. 22-24)

Background: Despite a wide range of contraceptive options available in the United Kingdom, the unplanned pregnancy rate remains high. Contraceptive services are currently delivered by general practitioners, sexual health clinics and pharmacies, but there may be scope to expand the places that these are offered, and increase the options available within each service. Doing so could increase the uptake of contraceptive methods, particularly the most effective methods, and therefore reduce the unplanned pregnancy rate. Aim and objectives: Research in this thesis aimed to investigate novel delivery models of contraception. The research had two main areas of focus. Firstly the capacity of the pharmacy to deliver regular contraception was examined, in the context of existing literature, and then through a pilot study. After that the expansion of contraception care to maternity services was investigated, first in the literature and then using an observational study. Methods: In undertaking this thesis I used a variety of methods. Two patient surveys were employed to investigate patients’ perspectives on proposed novel methods of contraceptive delivery. A pilot study investigated the feasibility and acceptability of delivery of the contraceptive injection at the pharmacy. Quantitative results about the numbers of injections given were collected, as were patient questionnaires. Qualitative one-to-one interviews were conducted with participating pharmacists, these were recorded, transcribed and analysed. An observational study was also undertaken to assess routine delivery of insertion of intra-uterine contraception at the time of caesarean section. Patients were seen at six weeks following insertion, and contacted by telephone at three, six and 12 months about satisfaction and continuation of the method. Results: 220 women completed a questionnaire about attending the community pharmacy to receive a contraception injection. 33% of current non-users indicated that they would consider using this method if it was available at the pharmacy. 50 established users of the contraceptive injection participated in a pilot project receiving up to three injections from the community pharmacy. Only 48 injections of a possible 150 were delivered at the community pharmacy. Only 7 participants received all three injections at the pharmacy, and participants reported mixed experiences accessing the pharmacy. The practical obstacles around pharmacy engagement and the challenges of retaining participants were significant, and more research is necessary before proceeding with a randomised controlled trial. 250 women on a postnatal ward completed questionnaires about their pregnancy intentions. 96.7% were not planning a baby in the next year, but only 23.6% were planning on using the most effective methods of contraception. One in three respondents described themselves as likely to use either an implant or intra-uterine contraception if it could be inserted before they left the hospital. In an observational study, 120/877 women opted to have intra-uterine contraception inserted at the time of caesarean section. Continuation rates at 12 months were 84.8% of those contacted, and 92.6% were either ‘very’ or ‘fairly’ happy with their contraception. Conclusion: Although patients are receptive to contraception being delivered using novel service models, alternatives to current practice need careful investigation. Contraceptive injections at the community pharmacy are not necessarily more convenient for patients, and therefore may not increase uptake of this method. However, offering intrauterine contraception to patients at the time of caesarean section is highly acceptable to patients, and results in a substantial majority continuing this highly effective method. Robust and careful research using a range of methods can help to identify which innovative approaches to contraceptive delivery offer the most promise.

abstract: Ethinyl estradiol, (EE) a synthetic, orally bio-available estrogen, is the most commonly prescribed form of estrogen in oral contraceptives (Shively, C., 1998), and is found in at least 30 different contraceptive formulations currently prescribed to women (Curtis et al., 2005). EE is also used in hormone therapies prescribed to menopausal women, such as FemhrtTM (Simon et al., 2003). Thus, EE is prescribed clinically to women at ages ranging from puberty through reproductive senescence. Here, in two separate studies, the cognitive effects of cyclic or tonic EE administration following ovariectomy (Ovx) were evaluated in young, female rats. Study I assessed the cognitive effects of low and high doses of EE, delivered tonically via a subcutaneous osmotic pump. Study II evaluated the cognitive effects of low, medium, and high doses of EE administered via a daily subcutaneous injection. For these studies, the low and medium doses correspond to the range of doses currently used in clinical formulations, and the high dose corresponds to the range of doses prescribed to a generation of women between 1960 and 1970, when oral contraceptives first became available. For each study, cognition was evaluated with a battery of maze tasks tapping several domains of spatial learning and memory. At the highest dose, EE treatment impaired multiple domains of spatial memory relative to vehicle treatment, regardless of administration method. When given cyclically at the low and medium doses, EE did not impact working memory, but transiently impaired reference memory during the learning phase of testing. Of the doses and regimens tested here, only EE at the highest dose impaired several domains of memory; this was seen for both cyclic and tonic regimens. Cyclic and tonic delivery of low EE, a dose that corresponds to doses used in the clinic today, resulted in transient and null impairments, respectively, on cognition. / Dissertation/Thesis / M.A. Psychology 2012