Thesis (Ph. D.)--Oregon State University, 2005. / Includes bibliographical references.

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Background: Unintended pregnancy is a major problem among sexually active women and occurs due to a number of reasons, such as inconsistent use of short term contraceptive methods or non-use of modern contraception. Recent scientific findings indicate that long acting reversible contraceptives (LARC) methods, which are cost effective and highly effective in pregnancy prevention, are a possible solution to the problem of unintended pregnancies. Therefore, the aim of the study is to identify the demographic, socio-economic and reproductive health factors associated with the use of long acting reversible contraceptive methods among sexually active women aged 15-49 in Malawi. Methods: The study used the Malawi Demographic and Health Survey 2010 data. The sample comprised of 17 744 sexually active women aged 15-49 years. LARC methods were defined as Norplant, Intra-uterine device (IUD) and Depo-Provera. Descriptive analysis was done to describe the study sample, while binomial logistic regression modeling was done to identify demographic, socio-economic and reproductive health factors that influence LARC method use. Data analysis was done using Stata 12. Results: The results suggest that prevalence of LARC methods is 26%. At multivariate level, the results indicate that younger women (15-24) are more likely to use LARC methods than older women (35+). There is distinct regional variation of LARC use, with women in the Southern region being more likely to use the methods. Additionally, being married, with a secondary education or higher, having been visited by a family planning worker, staying in urban areas and wanting children after 2 years, increased the odds of using the LARC methods among the women. Conclusion: Increasing the prevalence of LARC methods is very crucial as a solution to the challenge of unintended pregnancy. Measures need to be put in place to ensure that there is no distinct variation in LARC use in women found in the three regions of the country. Formal education and mobile family planning workers are crucial in increasing LARC methods use.

King Cheung-lam. / Thesis (M. Ph.)--Chinese University of Hong Kong. / Bibliography: leaves 81-91.

The most common method of birth control used since 3000 B.C., is the condom. It has been used continuously in the 21st century, but several other forms have been added. Due to reformers like Marie Stopes, Margret Sanger, Katharine McCormick and Gregory Pincus contraceptive usage has become popularized in today's society. New forms of contraceptive include, but are not limited to intrauterine devices (IUDs), shots, pill, patch, and vaginal rings. These devices have been developed as both hormonal and nonhormonal products. Hormonal birth control delivers hormones such as estrogen and progestin, which affect the joining of the sperm and egg. Products that are non-hormonal are a viable alternative for women who cannot tolerate hormonal regulation. Estrogen and progestin function as contraceptives by changing various areas in the vaginal tract by changes such as the thickening of cervical mucus, thinning the uterus lining, or increasing the vagina acidity. Researchers are also trying to develop other options such as a male contraceptive option to expand and reach a target population that is not currently reached. There are also government policies currently in Congress that address the issue of the uninsured; thereby reaching those who may need contraceptives the most. The Affordable Care Act also known as Obama care is trying to provide Medicaid to people who do not and would not ever be able to afford adequate health care, including contraceptives on their own. With the passing of the Affordable Care Act more women will be able to go to a medical provider to be informed and educated on the various contraceptive methods, enabling them to make an informed decision.

The objective of the research comprising this thesis was to characterize ovarian follicular development in healthy women of reproductive age undergoing natural menstrual cycles and oral contraception (OC) cycles. We quantified changes in the numbers and diameters of follicles, detected ovulation and assessed changes in the growth and regression of corpora lutea using high-resolution transvaginal ultrasonography. Changes in follicular and luteal development were then correlated with changes in concentrations of reproductively-active hormones and endometrial growth to provide a comprehensive approach to ovarian and uterine function.<p>We documented, for the first time, that women exhibited waves of antral follicular development during the menstrual cycle. Two and three waves of follicle growth were observed. Major and minor waves of follicle development were characterized. Major waves were those in which a dominant follicle was selected for preferential growth; minor waves were those in which dominance was not manifest. Luteal progesterone production appeared to have a negative effect on the emergence and development of follicle waves in women. The ovarian follicular wave phenomenon has provided a new model for studying the growth and regression of ovarian follicles during the human menstrual cycle. Documentation of ovarian follicular waves in women has implications for the development of new strategies to manipulate ovarian follicular development, in particular hormonal contraceptive regimens and infertility therapies. <P>We further documented that ovarian follicular development occurred during the compliant use of oral contraception. Follicles developed to ostensibly ovulatory diameters and either regressed, ovulated, or formed follicular cysts under the suppressive effects of OC. The majority of follicles that developed during OC use emerged during the hormone-free interval (HFI). We interpreted our findings to mean that ovarian follicular development during OC use was associated with loss of endocrine suppression during the HFI, rather than user non-compliance as previously speculated. The number and maximum diameter of follicles that developed during OC use were greater in women administered OC containing 20 g versus 30--35 g Ethinyl -- Estradiol formulations. Our results provided rationale for a reduction or complete elimination of the HFI in OC regimens, and the judicious use of low EE dose OC regimens (i.e., ? 20 g EE). Ovarian follicular development and circulating concentrations of estradiol and LH were not suppressed effectively when OC use was initiated at mid to late stages of follicle development (i.e., ? 10 mm). Our findings demonstrated that dominant follicles secrete estradiol and become increasingly responsive to LH as they acquire functional dominance after becoming physiologically selected for preferential growth during the follicular phase of the menstrual cycle.

The objective of the research comprising this thesis was to characterize ovarian follicular development in healthy women of reproductive age undergoing natural menstrual cycles and oral contraception (OC) cycles. We quantified changes in the numbers and diameters of follicles, detected ovulation and assessed changes in the growth and regression of corpora lutea using high-resolution transvaginal ultrasonography. Changes in follicular and luteal development were then correlated with changes in concentrations of reproductively-active hormones and endometrial growth to provide a comprehensive approach to ovarian and uterine function.<p>We documented, for the first time, that women exhibited waves of antral follicular development during the menstrual cycle. Two and three waves of follicle growth were observed. Major and minor waves of follicle development were characterized. Major waves were those in which a dominant follicle was selected for preferential growth; minor waves were those in which dominance was not manifest. Luteal progesterone production appeared to have a negative effect on the emergence and development of follicle waves in women. The ovarian follicular wave phenomenon has provided a new model for studying the growth and regression of ovarian follicles during the human menstrual cycle. Documentation of ovarian follicular waves in women has implications for the development of new strategies to manipulate ovarian follicular development, in particular hormonal contraceptive regimens and infertility therapies. <P>We further documented that ovarian follicular development occurred during the compliant use of oral contraception. Follicles developed to ostensibly ovulatory diameters and either regressed, ovulated, or formed follicular cysts under the suppressive effects of OC. The majority of follicles that developed during OC use emerged during the hormone-free interval (HFI). We interpreted our findings to mean that ovarian follicular development during OC use was associated with loss of endocrine suppression during the HFI, rather than user non-compliance as previously speculated. The number and maximum diameter of follicles that developed during OC use were greater in women administered OC containing 20 g versus 30--35 g Ethinyl -- Estradiol formulations. Our results provided rationale for a reduction or complete elimination of the HFI in OC regimens, and the judicious use of low EE dose OC regimens (i.e., ? 20 g EE). Ovarian follicular development and circulating concentrations of estradiol and LH were not suppressed effectively when OC use was initiated at mid to late stages of follicle development (i.e., ? 10 mm). Our findings demonstrated that dominant follicles secrete estradiol and become increasingly responsive to LH as they acquire functional dominance after becoming physiologically selected for preferential growth during the follicular phase of the menstrual cycle.