According to official Swedish epidemiological figures, during 1996 the number of abortions increased for the first time in the 1990s, breaking a declining trend, especially among women under 24 years of age. In several European countries a similar increase was reported. The number of induced abortions declined by 16.1% during 1990-95, whereas it increased by 2.3% in 1996 compared to the previous year. The corresponding increase was 4.1% for teenagers and 2.5% for women in the 20-24 age group. In Norway, a 7.2% increase was reported in the first half of 1996 compared to the first half of 1995, although there, too, there had been a declining trend during the 1990s. Preliminary figures from Denmark indicate an increase of abortions to 18,022 for 1996 vs. 17,720 for 1995. Similarly, in Great Britain, in the first half of 1996, the figure increased by 10% compared with the same period in 1995. More than 90% of women in Sweden use or have used oral contraceptives (OCs); about 50% of women up to age 24 use them, and for women up to age 29 OCs also continue to be the most frequently used contraceptive. In October 1995, the World Health Organization published an extensive epidemiological study, which showed that low-dose OCs containing third-generation gestagens pose double the risk of deep venous thrombosis compared to low-dose OCs containing second-generation gestagens. Immediately after this alarming report the trend of declining abortions stopped and the users of OCs dropped from 440,000 before the report to 370,000 in 1996 in Sweden.
Two-hundred-and-forty healthy women, ages 18 to 40 years, were randomized in a ratio of 2:5 to use NORPLANT implants or NORPLANT-2 implants. Through three years of use, no pregnancies were recorded among women using NORPLANT implants and two pregnancies were noted among women using NORPLANT-2 implants resulting in a cumulative net pregnancy rate of 1.3 +/- 0.9 per 100 acceptors (mean +/- SE) by the end of year three. This difference was not statistically significant. During the fourth year, no pregnancies were observed in the NORPLANT group, but 4 pregnancies occurred in the NORPLANT-2 group. The most common reason for terminating the study was bleeding disturbances. During the first year there were significantly more terminations due to bleeding problems in the NORPLANT group than in the NORPLANT-2 group. However, during the second year of use the proportion of women discontinuing for bleeding problems dropped considerably among NORPLANT users and during the third year very few women in either group discontinued because of bleeding problems. The continuation rates after one year were for NORPLANT users 59.4% and for NORPLANT-2 users 77.2%. Corresponding figures after three years of use were 46.1% and 51.7%, respectively. The second most common reason for discontinuation was depression and other mood changes. In both groups we noted a slight increase in weight during the study and a slight decrease in blood pressure and hemoglobin levels with time. In conclusion, both NORPLANT and NORPLANT-2 implants are very effective methods for contraception. The efficacy of NORPLANT-2 implants, however, was not acceptable during the fourth year of use in this study. The latter system could, however, become a suitable three-year contraceptive method, possibly with less bleeding disturbances than NORPLANT in the first year.
OBJECTIVES: This study was undertaken to investigate contraceptive practices and factors behind contraceptive preferences among Ukrainian women attending for abortion or gynecological health check-up. METHODS: Women attending for abortion (n = 919) and healthy non-pregnant women (n = 297) were studied by an anonymous 192-item self-questionnaire in a hospital-based unmatched case-control design. RESULTS: The average number of abortions per woman rose with age to 4.6 in the abortion group and 2.4 abortions in the non-pregnant group. In the abortion and non-pregnant groups, no contraceptive use during the past year was reported by 27% and 20% and at the time of conception or during the previous month, by 61% and 51%, respectively. Nevertheless, no intention to use contraception in the future was reported by 15% and 8% of women, respectively. A history of previous childbirth (odds ratio (OR) = 1.8), at least two induced abortions (OR = 1.7) and sexual education obtained from literature (OR = 1.8) were associated with preference to use modern contraceptives. Intention to use no contraception in the future was associated with giving no answer about acceptance of abortion as a birth control method (OR = 5.4), uncertainty whether to use abortion or an intrauterine device in a situation of choice (OR = 1.8), low income (OR = 1.9) and no answer about housing situation (OR = 3.9). Lack of experience with contraception reduced the intention to use any method in the future. CONCLUSIONS: Better reproductive education/information and economic incentives could contribute to a change from abortion to use of contraception.
In 1987 the Swedish social and health service issued advice about contraception with factual recommendations about the available contraceptive methods. Since 1987 a new copper IUD and a hormonal IUD have been introduced, and a number of reports have been published about the short- and long-term effects of combined oral contraceptives (OCs). Therefore, the pharmaceutical bureau issued new recommendations. For postcoital contraception, the effectiveness of 4 high-dose OCs has been convincingly proven when given in 2 doses within 72 hours after intercourse; also the insertion of an IUD postcoitally has been mentioned. Another method is the hormonal IUD, Levonova, which has been recommended for women who need long-term and safe contraception. The new copper IUD with a large copper surface (Gyne-T- Slimline) can even be recommended to women who face an increased risk of ectopic pregnancy on the basis of documented high contraceptive effectiveness. A new recommendation concerning the use of the IUD is that women who had a copper or hormonal IUD inserted at around age 40 do not have to exchange the well-functioning IUD after the prescribed duration of use of 5-8 years. The use of combined OCs had also been contraindicated in women aged 35-40 because of the risk of cardiovascular complications with earlier high-dose preparations. However, new studies have not been able to confirm that women of this age group who do not smoke and have no cardiovascular risk factors run any kind of increased risk of cardiovascular complications. Thus, even after 40 women could use OCs. The net effect of comparing the advantages and disadvantages of OCs is positive. This overwhelming positive effect has even led to suggestions about the sale of OCs without a prescription.
A 23-year old patient became pregnant in spite of using an IUD and underwent legal abortion with vacuum aspiration. The IUD was not found even after repeated follow-up scrapings with a curet. A new IUD inserted at the request of the patient worked satisfactorily for 5 years. The IUD was removed because of the patient's desire to have a child; however, the patient did not became pregnant. 6 years after the extraction of the IUD, an investigation was started concerning the inability to conceive . It was found that the husband had a poor sperm test with a suspicion of infection. After antibiotic treatment, his sperm test improved. Still no pregnancy ensued, and at age 38 the patient underwent a hysterosalpingographic X-ray test during which the old copper IUD was found in the uterus. It was removed during hysteroscopy which also revealed exceptionally uneven and mucous synechiae in the uterus. The patient felt very bitter towards the doctor who had left the IUD in her uterus 15 years earlier. If a patient gets pregnant while wearing an IUD, ultrasound or pelvic overview X-ray can be used to locate it. It has to be removed as soon as possible, because the risk of miscarriage or prematurity is considerable. Also, the safest IUDs are recommended for use to avoid such a problem.
In independent surveys concerning sexual behavior among university students in Uppsala, Sweden, in 1989 and 1990, we found that condoms were infrequently used and that up to 25% of the sexually experienced students had a history of having had at least one sexually transmitted disease (STD). We targeted an information campaign toward the same students (approximately 20,000) in 1990. Our aims were (1) to increase the knowledge of STDs and alert the students to the high frequency of STDs in the student population, (2) to encourage students to have an STD checkup at the local STD clinic, and (3) to induce a positive attitude toward condoms. We evaluated the effects of the campaign, using before and after classroom surveys, a separate survey of students who attended the STD clinic, and a focus group analysis. Although the information campaign was successful, in that students became more aware of STDs and showed increased knowledge about the high frequency of STDs in their own population, fewer than 1% of the target population went for an STD checkup at the local STD clinic. Overall, the campaign was well received by the students but failed to induce any measurable changes in attitudes during the short observation period.
Emergency contraception (EC) has recently become available, accepted and widely used in Sweden but little is known about the characteristics and background factors of women requesting EC. METHODS: During a four-month period, consecutive women (n = 762) visiting family planning clinics to request emergency contraception filled out a questionnaire about their current need for EC. RESULTS: The user of emergency contraception was typically a nulligravid young woman (83%) but 13% had a previous history of at least one induced abortion and 41% had given birth in the past. One out of four had used EC before, and of these 20% more than once. Condom breakage was the major reason for the current need for EC but as many as 37% had not discussed the need for contraception prior to intercourse. Friends were the most important source of knowledge about EC. CONCLUSION: Women requesting emergency contraception could be anyone and emergency contraception is used to compensate for contraceptive failure in order to prevent unwanted pregnancies.
The authors evaluated a sexually transmitted disease (STD)-prevention program that combined a mass media campaign with peer education. The program was designed to increase Swedish university students' knowledge about STDs, improve attitudes toward condom use, and tell students where to get an STD checkup. Preintervention and postintervention postal questionnaires wer used with an intervention group and two types of control groups. Responses ranged from 32% to 67% for the randomly selected students and from 93% to 99% for classroom and clinic participants. The intervention was noticed by a majority of the students (85-98%) and discussed by 43% to 57%; more women than men observed and discussed the campaign. Knowledge about STDs, where to turn for STD checkups, and the intention of having an STD checkup increased. Attitudes toward condom use were equally positive before and after the intervention. Although it was successful in attracting attention and leading to discussion of STD prevention, the campaign did not encourage students to have an STD checkup.
