BACKGROUND

Norplant is a method of long-term contraception that was introduced in the United States in January 1991. This study was designed to explore the extent to which family physicians currently offer and insert Norplant.

METHODS

A cross-sectional descriptive survey design was used to elicit information from a random sample of family physicians belonging to the Ohio Academy of Family Physicians.

RESULTS

Of the 242 (69% response rate) physicians responding to the questionnaire, 130 (54%) were offering Norplant to their patients and 60 (25%) were inserting the devices themselves. Physicians offering Norplant were more likely to be women, younger, board certified, and currently practicing obstetrics. The most common reasons cited by the 112 (46%) physicians who did not offer Norplant were concerns about side effects, lack of familiarity with the procedure, expense, and personal or religious reasons. Overall, 88% of physicians who offered Norplant to their patients were satisfied with the product's performance.

CONCLUSIONS

Over one half of the physician participants were offering Norplant as a contraceptive option for their patients. Physicians who offered the system were satisfied with its performance, and many expressed the belief that this form of contraception might be particularly well suited to certain patient groups.

Norplant is a subdermal implant providing contraceptive protection over a five-year period. After worldwide trials, it has been available in the UK since September 1993. The author discusses the mode of action of this contraceptive method, its efficacy, advantages and disadvantages and describes the procedure for insertion of the implants.

The objectives of this study are to determine whether Norplant would be an acceptable contraceptive method for Cambodian women, given its technology and the socio-cultural context, and whether it can be delivered by a private sector clinic with good quality care. This is a prospective cohort study of the first 966 acceptors. It was found the one-year continuation rate was 90.5%, there were no pregnancies and client satisfaction was high. In general, Norplant was delivered with high quality of care. Findings indicate that Norplant suits the contraceptive needs of many Cambodian women and is appropriate for their socio-cultural context. Norplant can be introduced, with high quality care, in a private clinic in a developing country.

OBJECTIVE

To determine the effect of contraception given immediately postpartum on coagulation as measured by antithrombin III.

METHODS

In this prospective study, parturients (n = 85) self selected three means of postpartum contraception: levenorgesterol implants, oral contraceptives, or a barrier method.

RESULTS

Baseline coagulation was assessed by antithrombin-III levels in each of the 85 women within 48 hours of delivery (100.35 +/- 1.61%) and at one (109.1 +/- 1.89%) and six (105.51 +/- 1.71%) weeks postpartum. There was a rise in antithrombin-III after delivery but there were no significant differences between the groups.

CONCLUSIONS

The levenorgesterol implant system did not cause a decrease in antithrombin-III in normal parturients.

Norplant-2 contraceptive implants consist of two silastic rods in which levonorgestrel has been incorporated with the polymer. This study describes our experience with 100 acceptors of the Norplant-2 rods in Singapore. No pregnancies occurred during the first year of use. Menstrual irregularities was the main complaint associated with the use of Norplant-2. However, the incidence of menstrual irregularities appeared to diminish with time and the continuation rate at the end of one year was 95.0 per cent. Thus, it appears that the Norplant-2 rod systems offer a highly effective, convenient means of contraception which should be well accepted in future.

The principal objective of this 5-year clinical study of Norplant implants was to introduce these implants into the family planning program in Senegal and to determine their overall acceptability and safety in Senegalese acceptors. A total of 300 subjects were enrolled into the trial from August 1986 to July 1991. All the women were followed-up for 5 years or until the implants were removed. The pooled cumulative discontinuation rate was 40.8 +/- 2.91 per 100 women resulting in a continuation rate of 59.2 +/- 2.91 per 100 women. Thirteen subjects (4.3%) were lost during the follow-up. Seven pregnancies were reported throughout the 5 years leading to a cumulative pregnancy rate of 3.3 +/- 1.25 per 100 women. Menstrual problems were the reason most often given for early removal during the first 2 years. After year 2, desire for another pregnancy was the main reason for implant removal. The results presented in this study show that the Norplant implant system is a safe, effective, and acceptable method that meets the needs of the Senegalese family planning program.

A total of 189 women volunteered to accept subdermal implants for contraception. The implants were "covered rods", consisting of a core rod containing equal parts by weight of levonorgestrel and polydimethylsiloxane and sealed inside a thin-walled tube of Silastic tubing with medical adhesive. In one study 78 women used 4 3cm rods (study 07) and in the other 111 women used 6 3cm rods. In 5 years of use there were no pregnancies in either group. Terminations because of menstrual problems were twice as frequent among the 4-rod users than among users of the 6 rods. Menstrual pattern analysis is presented for the two rod regimens and compared with the previously reported patterns for the 6-capsule regimen (NORPLANT). Long--term in vivo release rates are also presented.

Norplant removal may be complicated if deep insertion causes difficulty in localization with palpation. Various methods have been used to locate these deeply seated implants. Soft tissue X-ray films (standard anteroposterior and lateral views) with a paper clip placed as a marker by the clinician provide a simple method of locating deep implants.

In the present study Norplant(R) and IUD acceptors who attended the same counseling sessions have been compared on their perception of the information received at the family planning clinic. The study covered 100 acceptors of each method quota matched by parity and years of schooling. Data were obtained through home interviews. The two groups presented no significant differences when selected socio-demographic characteristics were analyzed. Norplant users recalled more information on this method than did IUD acceptors, and the content of what they remembered was different. This included concepts as important as risk of pregnancy, menstrual and health effects, and method of removal. The results suggest that the intrinsic qualities of the new method and the presence of a group of women motivated to use one with its general characteristics, are not sufficient conditions for its acceptance.

Plasma thyroxin (T4), triiodothyronine (T3), T3-uptake and thyroid stimulating hormone (TSH) were measured in 18 women using Norplant implants or Norplant-2 implants for six months. Free T4-index and free T3-index were also calculated. All women had used non-hormonal contraceptives before insertion of the implants. T4 decreased and T3-uptake increased, indicating a lower level of thyroid binding proteins during treatment. Free T4-index remained unchanged, indicating that the free concentration of thyroxin was unaltered. All women were euthyroid and TSH was unchanged. It is concluded that treatment with Norplant implants does not result in a change in thyroid function.

A total of 265 women who had the Norplant system inserted were followed for 5 years. The present study is based on 11,435 women-months of use, describing the continuation rates and efficacy of Norplant among these women. The 5-year cumulative continuation rate was 45.7 per 100 continuing users. The continuation rates were age-dependent. The women>> or = 35 years of age consistently maintained higher continuation rates at all time intervals as compared with those of younger women. During 5 years of follow-up, five women became pregnant. Three pregnancies occurred in year 2, one in year 3, and one in year 5. The 5-year cumulative pregnancy rate was 2.5 per 100 continuing users. The weight of the user did not influence the pregnancy rate. The continuation rates, as well as the pregnancy rates, are comparable to those reported from other countries in the region.

This article describes the first two years of Norplant implants use among 1560 acceptors in four counties of rural north China. Continuation of use was high, 88.4% after two years. Disruption of the menstrual cycle was the predominant side effect and the predominant reason for termination. Clinical performance among the four counties was diverse, with two-year continuation rates ranging from 73.9% to 95.3%. Factors that may contribute to the diversity among study sites and the overall high continuation rate are discussed in the context of Chinese family planning.

The United States has the highest rate of teen pregnancy in the Western world. Although abstinence may be the ideal solution for the prevention of this problem, one half of adolescents in the United States are sexually active. This article reviews the epidemiology of contraception among adolescents, barriers to effective use of contraception, and ways to improve efficacy. Major methods of contraception, including oral contraceptive pills, Norplant, Depo-Provera, condoms, spermicide, sponge, intrauterine device (IUD), diaphragm, and rhythm/periodic abstinence, are discussed along with method-specific issues related to adolescents.

OBJECTIVE

To evaluate the factors that may affect the selection of a reversible or an irreversible contraceptive method.

METHODS

In an urban area of a developing country, demographic characteristics, educational and income levels, and previously used contraceptive methods were retrospectively reviewed for 3 years from the files of women who had chosen reversible or irreversible contraceptive methods. Student's t test and the chi2 test were used to analyze the data obtained from the two groups of women.

RESULTS

Out of a total of 8078 women, 595 (7.4%) selected surgical sterilization, while 7483 (92.6%) preferred reversible methods such as intrauterine devices (38.1%), combined oral contraceptives (13.9%), condoms (40%) and Norplant (0.6%). Compared to those who preferred reversible methods, the women with surgical sterilization had a higher mean age (33.9 +/- 4.2 years versus 29.6 +/- 3.9 years), mean gravidity (3.8 +/- 0.9 versus 2.3 +/- 1.2) and mean number of living children (2.6 +/- 0.8 versus 2.1 +/- 1.1) (p < 0.01). These women had also higher rates of high-school education (37.3% versus 30.1%) and previous modern contraceptive use (78.1% versus 71.2%) (p < 0.01). None of the women with surgical sterilization, but 1770 (33.0%) of those who chose reversible methods, had fewer than two living children.

CONCLUSIONS

These data suggest that irreversible contraceptive methods tend to be chosen by older women with higher educational levels, who have decided that their family is complete and who have at least two children.