<p><strong>Introduction: </strong>Studies have shown that women are not always satisfied with the effects of contraception and that contraceptive advice is perceived as non-specific. <strong>Aim: </strong>The purpose of this study was to investigate what contraceptive women have chosen to use in the different phases of their reproductive lives, and what they felt had influenced their choice.<strong> </strong> <strong>Method: </strong>A retrospective cross-sectional comparative study with a quantitative approach. A survey with fixed and multiple-choice options was sent to five hundred 45-year old women. <strong>Result: </strong>The study shows that various birth controls are different in the normal reproductive life. The birth control pills , condoms and hormone coil were the contraceptive which women were most satisfied with through the reproductive life cycle, partially supported in previous research. The study also shows that the pill and condoms were most common contraceptives before pregnancy. Copper coil and hormone coil was the most common contraception after pregnancy. Condom was the most common contraceptive during several contraceptive reproductive phases. The women stated that the most common reason to discontinue a contraceptive was pregnancy desire followed by concerns about side effects. The study also shows that women have great integrity in the choice of contraception.<strong> Conclusion: </strong>The  practical significance of this study is that it can be used for counseling on contraceptive use through the life cycle. The scientific significance of the study is to promote women`s reproductive health by being able to provide such specific advice as possible.</p>

ABSTRACT Selective progesterone receptor modulators (SPRM) represent a new class of synthetic steroids which can interact with the progesterone receptor (PR) and can exert agonist, antagonist or mixed effects on various progesterone target tissues in vivo. VA-2914 is a selective progesterone receptor modulator with potential contraceptive activity. We evaluated VA 2914 for ovulation inhibition in women, using three experimental doses ( 2,5 mg/d, 5 mg/d, 10 mg/d ) given continuously for three months. We examined the endometrial impact in each group. Anovulation (defined by absence of progesterone above 3 ng/ml ) was obtained in nearly 80% women in the 5 and 10 mg/d groups with a great rate of amenorrhea ( 81.2 and 90% cases in the 5 and 10 mg/d groups ). Estradiol levels remained in the physiological follicular phase range. Endometrial histological analysis show predominantly usual patterns of secretory phase. Some cystic glandular dilatations are observed in rare cases ; any hyperplasia was detected. VA-2914 induces amenorrhea while progestins cause endometrial spotting and bleeding. This abnormal bleeding due to progestins is a consequence of focal stromal proteolysis by increase in naked vessel size and density. We quantified the effects of VA 2914 on endometrial vascularisation, fibrillar matrix and VEGF-A expression in endometrial biopsies from 41 women before and after 12 weeks daily treatment (2,5 , 5 or 10 mg/d VA 2914 versus placebo). We did not observed changes in endometrial vessels, collagen network and VEGF-A distribution between the luteal phase at baseline and under VA 2914. From these observations, we can assess that VA 2914 does not behave like a progestin since it does not alter the endometrial matrix nor the pattern of endometrial vessels. Résumé : Les modulateurs sélectifs du récepteur de la progestérone ( SPRMs) constituent une nouvelle famille de stéroïdes présentant des propriétés mixtes agonistes ou antagonistes en fonction des gènes cibles, du contexte cellulaire, de la présence simultanée dautres ligands du récepteur de la progestérone (Spitz 2003). Le chef de file de cette famille, la mifépristone, est utilisé depuis plusieurs décennies pour ses propriétés abortives. Son intérêt dans la contraception post coïtale a été démontré. Des molécules aux propriétés abortives réduites sont à létude ou en cours de développement dans les domaines de la contraception, du cancer du sein, du traitement médical de lendométriose et des fibromes utérins (Pintiaux et al. 2009). Le VA2914 que nous étudions, fait partie de ces SPRMs en cours de développement. Nous avons démontré sa capacité à inhiber lovulation à partir de 5 mg administrés par voie orale quotidiennement. Il exerce une action endométriale participant vraisemblablement à leffet contraceptif . Il ninhibe pas le développement folliculaire et permet déviter la carence estrogénique observée sous progestatif antigonadotrope. A partir de la dose de 5 mg par jour, son utilisation saccompagne dun haut taux daménorrhée (Chabbert-Buffet et al. 2007). Lutilisation dun SPRM au long cours pose le problème dun endomètre soumis aux estrogènes endogènes sans opposition progestative. Limpact dun SPRM sur lendomètre varie en fonction de la molécule, de son dosage, de la présence concomitante dautres stéroïdes et de lespèce à laquelle ce SPRM est administré (Chwalisz et al. 2000). Des aspects histologiques particuliers sont décrits dans les endomètres soumis aux SPRMs. Il sagit de la coexistence daspects histologiques non présents de façon simultanée physiologiquement ( aspects sécrétoires et prolifératifs coexistant au sein du même endomètre, signes dapoptose et dactivité mitotique au sein dune même glande) (Mutter et al. 2008). La persistance dune activité mitotique est observée dans les glandes endométriales des patientes anovulatoires soumises au VA2914 (Chabbert-Buffet et al. 2007). Lutilisation de cette molécule quotidiennement et à long terme nest donc pas dactualité contrairement à son utilisation ponctuelle dans le cadre de la contraception postcoïtale (Creinin 2006). La place des SPRMs en contraception classique doit être définie. Différents schémas dadministration et différents dosages devront être évalués en termes defficacité et de sécurité. Lutilisation des SPRMs pourrait être utile pour contrer les saignements indésirables observés lors de la prise de progestatif seul. Contrairement aux patientes soumises aux progestatifs seuls, les patientes sous VA2914 présentent un haut taux d'aménorrhée. Lors du saignement physiologique menstruel comme lors de l'administration de progestatif seul, la dégradation locale du stroma endométrial et une lyse du réseau fibrillaire riche en collagène sont classiquement observées (Galant et al. 2000). Sous VA2914, nous nobservons pas de dégradation de la matrice extracellulaire (Ravet et al. 2009). Le rôle des métalloprotéases matricielles dans les saignements normaux et pathologiques de l'endomètre humain est bien connu . Le profil d'expression des métalloprotéases matricielles dans l'endomètre des patientes traitées par VA2914 à différents dosages peut contribuer à lintégrité endométriale observée. Une angiogenèse aberrante est observée sous progestatif. Une modification de la densité vasculaire endométriale et une altération de la maturation de la paroi des vaisseaux, déficitaire en péricytes et en cellules musculaires lisses ont été décrites (Hickey et al. 1999; Hickey et al. 2000; Jondet et al. 2005; Rogers et al. 1993; Stephanie et al. 2007). L'observation de la vascularisation de lendomètre exposé au dispositif intrautérin au lévonorgestrel durant 1 à 3 mois montre une augmentation très importante (11,5 fois) des petits vaisseaux non matures constitués exclusivement d'un endothélium. Le nombre de vaisseaux partiellement matures est augmenté de 6 fois. Au plus long cours, ces vaisseaux immatures ou partiellement matures restent néanmoins 4 fois plus fréquents que dans les endomètres non soumis à cette thérapeutique. La surface vasculaire et la densité augmentent au cours du temps sous ce dispositif hormonal (Stephanie et al. 2007). De telles modifications ne sont pas observées sous VA2914 et peuvent contribuer à l'absence de saignement. Au cours du cycle témoin, nous avons observé la présence de vaisseaux matures, représentant 80 % de la surface vasculaire totale. Après 3 mois de traitement sous VA2914 aux différentes doses, aucun changement vasculaire n'est observé. Sous VA2914, nous ne constatons pas de modification de l'expression du VEGFA ni de modification de sa distribution qui apparaît prédominante au niveau de la portion apicale des cellules épithéliales de surface et glandulaires. L'absence de modification de la distribution et de l'intensité du marquage du VEGFA (Vascular endothelial growth factor) et la stabilité du rapport Ang-1/Ang-2 avant et sous traitement par VA2914 n'est pas en faveur d'un remodelage vasculaire important (Ravet et al. 2009). Au niveau du réseau vasculaire endométrial, le VA2914 ne paraît donc pas se comporter comme un agoniste du récepteur de la progestérone.

Die immunologische Kontrazeption mittels Zona pellucida (ZP) Proteinen gilt als vielversprechender Ansatz für die Reproduktionskontrolle verwilderter Haus- und Wildtierbestände. Da die Applikation von nativer ZP mit Nebenwirkungen verbunden ist, wird die Verwendung einzelner ZP Peptide als Bestandteil kontrazeptiver Vakzine als besonders aussichtsreich erachtet. Das Prinzip dieser nebenwirkungsfreien ZP Immunisierung ist die gezielte Trennung der Entzündungsreaktionen auslösenden T-Zell-Epitope der ZP von den kontrazeptiv wirkenden B-Zell-Epitopen.<br> Niedermolekulare synthetische oder rekombinante Peptide allein sind gering immunogen und können somit keine ausreichende Immunantwort induzieren. Die Verwendung von Peptiden für die immunologische Kontrazeption erfordert daher ein &bdquo;Vakzin-Design&ldquo;, d. h. die gezielte Kombination der Peptide mit immunstimulierenden Substanzen (Liposomen, Carrierproteinen, Adjuvantien). Zielstellung der vorliegenden Arbeit war die Untersuchung des Potentials synthetischer Peptide für die Immunokontrazeption von verwilderten Hauskatzen (Felis catus). Dazu wurden zunächst relevante B-Zell-Epitope des felinen Zona pellucida Proteins, ZPB2, identifiziert und synthetisiert. Zwei der synthetischen Peptide (P3, P6) wurden zur Herstellung von Antikörpern an BSA konjugiert und zusammen mit Freundschem Adjuvans in Ratten verimpft. Die kontrazeptive Relevanz beider Peptide sowie der Ratten Anti-Peptid Antiseren wurde im in vitro Befruchtungssystem der Hauskatze geprüft. Zur Untersuchung der Immunogenität der Peptide in der Zielspezies Hauskatze erfolgte die Entwicklung von Vakzin-Prototypen für die einmalige Applikation. Neben der Eruierung der Stärke und Dauer der Immunantwort wurde durch Verpaarung der Tiere auch das kontrazeptive Potential in vivo abgeschätzt. / Immunological contraception based on zona pellucida (ZP) proteins is regarded as a promising approach for the control of reproduction in feral domestic and wild animals. Because application of native ZP caused adverse reactions, utilization of single ZP peptides as elements of contraceptive vaccines were considered to bear good prospects. The principle of this ZP immunization is based upon a systematic separation of inflammation triggering T-cell epitopes from the contraceptive B-cell epitopes.<br> The present study evaluates the immunogenicity and contraceptive potential of synthetic feline ZPB2 peptides for immunocontraception in cats (Felis catus). First of all, relevant B-cell epitopes were identified and synthesized. In order to generate antipeptide antibodies two peptides (P3, P6) were chosen and coupled to BSA. Rats were immunized with the conjugation product combined with Freund&prime;s complete adjuvant.<br> The contraceptive efficacy of both peptides and of the anti-peptide antibodies generated were determined using in vitro fertilization of feline oocytes (IVF). To evaluate the peptides immunogenicity in the target species (cat), vaccine-prototypes were developed for a single application protocol. The strength and duration of the immune response was analyzed. Additionally, cats were mated to assess the contraceptive potential of the vaccines in vivo.

<p>Background: In Namibia, studies showed that HIV/AIDS affects youth, especially the under 24 years age group. At the same time the pregnancy rate is also high by age 19. Interestingly, in&nbsp / Andara district several reports from staff working in the reproductive services have indicated that adolescent girls, who would seem to be taking responsibility in one sphere of their sexual lives&nbsp / by protecting themselves against unwanted pregnancy, were however not using condoms to protect themselves from HIV infection. Study Aim and Objectives: To describe the knowledge, attitude and behaviour related to HIV/AIDS amongst female adolescents who are accessing the primary health care (PHC) services for contraception. Specific objectives were to describe the&nbsp / knowledge of female adolescents who are accessing the PHC services for contraception about the modes of transmission and prevention of HIV/AIDS, to assess their attitude with regards to&nbsp / condom use, abstinence and being faithful to one uninfected partner, also to determine the significance of association between age and knowledge, attitudes and behaviour, between their&nbsp / education level and knowledge, attitudes and behaviour and the significance of association between knowledge of HIV prevention strategies and&nbsp / behaviour of female adolescents accessing&nbsp / &nbsp / PHC services for contraception in the district. Setting: The study was conducted in Andara district, North East of Namibia. Methods: Descriptive cross-sectional KAB study. Sample: All female&nbsp / adolescents who are accessing PHC services for contraception selected from multistage simple random sampling in 5 facilities and systematic sampling at facility level in Andara. All married&nbsp / women within this age range were excluded in the study. Data collection tool: An interviewer-administered standardised questionnaire was used to collect the data. Data analysis and&nbsp / Interpretations: Epi Info software 2002 was used for data analysis. The results were presented using descriptive statistics including means, 95% confidence intervals and percentages and&nbsp / this information was shown in tables, bar and pie charts. Cross-tabulations of knowledge, attitude and behaviour scores against demographic variables were performed. P-values &lt / 0.05 were&nbsp / &nbsp / considered statistically significant. Results: 76.5% knew that unprotected sexual intercourse was the main way of getting HIV/AIDS, 77.3% knew that people could protect themselves by&nbsp / abstaining from sexual intercourse and 64.5% knew that people could protect themselves by having one uninfected faithful sexual partner. Out of 192 respondents who stated that unprotected&nbsp / sexual intercourse was the main way of HIV/AIDS transmission, 25.5% used condom every time they had sexual intercourse, 10.9% used condom almost every time they had sex, 41.1% used&nbsp / condom sometimes and 22.4% never used condom. Older girls and those who were in higher grades at school had more knowledge that could protect them from HIV infection. Later sexual&nbsp / debut is associated with increased&nbsp / condom usage at sexual debut. Conclusions: The general HIV knowledge of respondents and their knowledge of how to&nbsp / protect themselves from HIV infection were disappointing given that this&nbsp / study was conducted in health facilities. In this study we also see that knowledge does not always translate into the appropriate behaviour. The health services need to evaluate the targeting and&nbsp / effectiveness of their HIV educational messages and develop skills that will support behaviour change.&nbsp / </p>

Background: Intimate partner violence (IPV) is a pervasive, worldwide public health problem and one of the most common violations of human rights. The aim of this thesis were twofold: (i) to study the process and factors related to ending of IPV of Nicaraguan women and (ii) to examine to what extent IPV exposure is associated with the child linear growth and women’s contraceptive use after pregnancy. Methods: Data were collected from a panel study which followed 398 women who were inquired about their IPV exposure during pregnancy and at follow-up a median of 43 months after delivery. Three hundred seventy five of their children were available for anthropometric assessment. Thirteen in-depth interviews were conducted with women exposed to physical/sexual IPV during pregnancy but not at follow-up. For analysis both quantitative and qualitative methodologies were used. Results: Women experienced four patterns of abuse: never abused, ending abuse, continued abuse, and new abuse. Of the women who experienced any IPV before or during pregnancy, 59% (95% CI 52-65%) reported no abuse at follow-up (135/229).  Women exposed to a continued abuse pattern and those exposed to any IPV, emotional or physical IPV at follow-up had higher odds of reversible contraceptive use. Further, exposure to any IPV and controlling behavior by a partner during pregnancy impaired the index child linear growth. Girls whose mothers had low social resources during pregnancy were the most affected. Women felt that being inquired about IPV while pregnant contributed to process of ending the abuse. Ending IPV was experienced as a process with three phases: “I came to a turning point,” “I changed,” and the “Relationship ended or changed.” Successful strategies to ending abuse mainly involved utilizing informal networks. Ending IPV did not always mean ending the relationship. IPV awareness, severity of the abuse, and economic independence were individual factors associated with ending of abuse. At the relationship level, diminishing or no exposure to controlling behavior by their partner was a key element. At the community level, a supportive and less tolerant to IPV environment as well as exposure to IPV inquiry during pregnancy facilitated the process of ending abuse. Conclusion: The study found that IPV exposure is associated with the children’s linear growth and women’s reversible contraceptive use. In addition, it is clear that gender norms regarding IPV are not static and that they play an important role in facilitating the process ending the abuse by increasing abused women’s access to emotional and material support. Our results emphasize the relevance of improving public services response to IPV.

Introduction: Studies have shown that women are not always satisfied with the effects of contraception and that contraceptive advice is perceived as non-specific. Aim: The purpose of this study was to investigate what contraceptive women have chosen to use in the different phases of their reproductive lives, and what they felt had influenced their choice. Method: A retrospective cross-sectional comparative study with a quantitative approach. A survey with fixed and multiple-choice options was sent to five hundred 45-year old women. Result: The study shows that various birth controls are different in the normal reproductive life. The birth control pills , condoms and hormone coil were the contraceptive which women were most satisfied with through the reproductive life cycle, partially supported in previous research. The study also shows that the pill and condoms were most common contraceptives before pregnancy. Copper coil and hormone coil was the most common contraception after pregnancy. Condom was the most common contraceptive during several contraceptive reproductive phases. The women stated that the most common reason to discontinue a contraceptive was pregnancy desire followed by concerns about side effects. The study also shows that women have great integrity in the choice of contraception. Conclusion: The  practical significance of this study is that it can be used for counseling on contraceptive use through the life cycle. The scientific significance of the study is to promote women`s reproductive health by being able to provide such specific advice as possible.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009. / Härtill 4 uppsatser.

Background: Unintended pregnancy and sexually transmitted infections among young people are priority public health issues in the UK. Social marketing is the preferred Government approach to intervention despite limited evidence on efficacy. There is need to understand its applicability and effectiveness in addressing the specified sexual health issues. Methods: Three studies were carried out, of which the first was a systematic review of 12 studies assessing the effectiveness of social marketing in reducing unintended teenage pregnancies. The second and third were consumer research applications examining factors associated with Long Acting Reversible Contraceptive (LARC) use and Chlamydia screening respectively. The second study involved analysing five ONS Contraception survey datasets while the third involved analysing Havering PCT Chlamydia screening records and qualitative data from 28 participants. Data were analysed using Stata.10 and Framework statistical packages and maps drawn using MapInfo.10.5. Results: The systematic review showed that nine studies achieved significant effects on at least one of the specified outcomes (reduced pregnancy rates and related behaviour changes). The second study showed that the NICE guidelines published in 2005 successfully addressed the disparity in LARC uptake previously experienced by women aged below 20. The third study identified females and non-white participants as more likely to take Chlamydia tests. Motivating factors for testing included convenient access to kits and fear of infertility, while barriers included ignorance and fear of results. Conclusions: Social marketing appears to be effective in reducing unintended teenage pregnancies but evidence is limited to particular outcomes and context. Consumer research provides vital intelligence about target populations necessary for designing effective interventions and addressing inequalities. However to assess its influence on outcomes, studies that feature all social marketing components are required. Overall there is need for more studies that specifically utilize social marketing principles to enable more robust evaluations.

Not available / text

Immigrant women are frequently found to have higher fertility relative to women in the majority population. This is often attributed to their socioeconomic characteristics, cultural preferences and patterns of childbearing, and adaptation to the destination context. However, several limitations in the research to date may mask the associations and processes which shape women’s fertility: 1) frequently used indicators are not sensitive to the way in which fertility is shaped by the migration process 2) key proximate determinants of fertility are often not integrated into analyses and 3) non‐migrant women in sending countries are often excluded as a reference for immigrant women’s childbearing behavior. In order to assess how women’s migratory moves and social context affect fertility, I compare the risk of first birth and patterns of contraceptive use at higher‐order parities for non‐migrant, immigrant and native‐born women. For these analyses, I use data from nationally‐representative surveys of reproductive health and family formation from Mexico, the United States, Turkey and Germany. The results from these analyses demonstrate that both foreign‐born Mexican‐ and Turkish‐origin immigrant women experience first birth earlier than non-migrants, second generation immigrants, and native-born women at destination. However the underlying determinants of earlier birth are different for these two groups. There are also differences for second generation women; US-born Mexicans experience first birth at significantly younger ages than whites, whereas age at first birth is very similar for German-born Turkish women and ethnic Germans. Furthermore, patterns of contraceptive use among immigrant women who have at least one child are notably different than patterns observed for non-migrants. US-born women have similar contraceptive use compared to whites, but Mexican-born women are less likely to use permanent and highly effective methods, even after controlling for fertility intentions. Turkish-origin women in Germany exhibit large differences in contraceptive use relative to non-migrant women, particularly the very low reported use of withdrawal. These findings indicate that fertility determinants vary across origin and destination context. The observed differences between Mexican- and Turkish-origin women suggest that distinct processes of migration, socialization, and access to contraception lead to variation in the fertility outcomes for these two groups. / text