Family Planning and Contraception

  • Barbara S. Apgar


Contraceptive agents provide both irreversible and nonreversible methods of protection from unwanted pregnancy. Decisions about the selection of methods affecting human sexuality must be made with full informed consent with a respect for each individual’s personal sexual practices and beliefs. Although no method or agent provides absolute protection, current agents offer high effectiveness, minimal side effects, and convenience. It is necessary to balance these components with cost data. Trussell et al. developed an economic model to compare the effectiveness and costs per person of 15 contraceptive methods and found that the up-front acquisition costs of contraceptives are inaccurate predictors of the economic value of competing contraceptive methods, and that investments in contraception provide substantial economic savings and societal benefits.1 Regardless of payment mechanism, contraception saves money by preventing unwanted pregnancy, and improved cost savings can be achieved by optimizing appropriate and consistent use.


Oral Contraceptive Obstet Gynecol Emergency Contraception Female Condom Ethinyl Estradiol 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Trussell J, Leveque JA, Koenig JD, et al. The economic value of contraception: a comparison of 15 methods. Am J Public Health 1995;85:494–503.PubMedCrossRefGoogle Scholar
  2. 2.
    Alvarez F, Brache V, Fernandez E, et al. New insights on the mode of action of intrauterine contraceptive devices in women. Fertil Steril 1988;49:768–73.PubMedGoogle Scholar
  3. 3.
    Larsson B, Ljung B, Hamberger L. The influence of copper on the in vitro motility of the human fallopian tube. Am J Obstet Gynecol 1976;125:682–90.PubMedGoogle Scholar
  4. 4.
    Segal SJ, Sanchez FA, Adejuivon LA, Mejia VB, Leon P, Faundes A. Absence of chorionic gonadotropin in sera of women who use intrauterine devices. Fértil Steril 1985; 44:214–18.PubMedGoogle Scholar
  5. 5.
    Moyer DL, Mishell DR. Reactions of human endometrium to the intrauterine foreign body. Am J Obstet Gynecol 1971; 111:66–79.PubMedGoogle Scholar
  6. 6.
    Kjos SL, Ballagh SA, La Cour M, Xiang A, Mishell DR. The copper T380A intrauterine device in women with type II diabetes mellitus. Obstet Gynecol 1994;84:1006–9.PubMedGoogle Scholar
  7. 7.
    Sivin I. Dose and age-dependent ectopic pregnancy risks with intrauterine contraception. Obstet Gynecol 1991 ;78: 291–8.Google Scholar
  8. 8.
    Cramer DW, Goldman MB, Schiff I, et al. The relationship of tubal infertility to barrier method and oral contraceptive use. JAMA 1987;257:2446–50.PubMedCrossRefGoogle Scholar
  9. 9.
    Kessel E. Pelvic inflammatory disease with intrauterine device use: a reassessment. Fértil Steril 1989;51:1–11.PubMedGoogle Scholar
  10. 10.
    Sinei SKA, Schulz KF, Lamprey PR, et al. Preventing IUCD-related pelvic infection: the efficacy of prophylactic doxycy-cline at insertion. Br J Obstet Gynaecol 1990;97:412–19.PubMedCrossRefGoogle Scholar
  11. 11.
    Darling JR, Weiss NS, Metch BJ, et al. Primary tubal infertility in relation to the use of the intrauterine device. N Engl J Med 1985;312:937–41.CrossRefGoogle Scholar
  12. 12.
    Evans DTP. Actinomyces israelii in the female genital tract. Genitourin Med 1993;69:54–9.PubMedGoogle Scholar
  13. 13.
    Firorino AS. Intrauterine contraceptive device-associated actinomycotic abscess and Actinomyces detection on cervical smear. Obstet Gynecol 1996;87:142–9.CrossRefGoogle Scholar
  14. 14.
    Larsson G, Milsom I, Jonasson K, Lindstedt G, Rybo G. The long-term effects of copper surface area on menstrual blood loss and iron status in women fitted with an IUD. Contraception 1993;48:471–80.PubMedCrossRefGoogle Scholar
  15. 15.
    Zhang J. Factors associated with copper T IUD removal for bleeding/pain: a multivariate analysis. Contraception 1993; 48:13–21.PubMedCrossRefGoogle Scholar
  16. 16.
    Ben-Rafael Z, Bider D. A new procedure for removal of a “lost” intrauterine device. Obstet Gynecol 1996;87:785–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Taturn HJ, Schmidt FH, Jain AK. Management and outcome of pregnancies associated with the copper T intrauterine device. Am J Obstet Gynecol 1976;126:869–79.Google Scholar
  18. 18.
    Craig S, Hepburn S. The effectiveness of barrier methods with and without spermicide. Contraception 1982;26:347–59.PubMedCrossRefGoogle Scholar
  19. 19.
    Hooton TM, Hillier S, Johnson C, Roberts PL, Stamm WE. Escherichia coli bacteriuria and contraceptive method. JAMA 1991;265:64–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Baehler EA, Dillon WP, Cumbo TJ, Lee RV. Prolonged use of a diaphragm and toxic shock syndrome. Fértil Steril 1982; 38:248–50.PubMedGoogle Scholar
  21. 21.
    Powell MG, Mears BJ, Deber RB. Contraception with the cervical cap: effectiveness, safety, continuity of use and user satisfaction. Contraception 1986;33:215–32.PubMedCrossRefGoogle Scholar
  22. 22.
    Moran JS, Janes HR, Peterman TA, Stone KM. Increase in condom sales following AIDS education and publicity, United States. Am J Public Health 1990;80:607–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Schechter MT, Craib KJ, Willoughby B, et al. Patterns of sexual behavior and condom use in a cohort of homosexual men. Am J Public Health 1988;78:1535–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Trussel J, Kost K. Contraceptive failure in the United States: a critical review of the literature. Stud Fam Plan 1987; 18:237–83.CrossRefGoogle Scholar
  25. 25.
    Gerofi J, Shelley G, Donovan B. A study of the relationship between tensile testing of condoms and breakage in use. Contraception 1991;43:177–85.PubMedCrossRefGoogle Scholar
  26. 26.
    Albert AE, Hatcher RA, Graves W. Condom use and breakage among women in a municipal hospital family planning clinic. Contraception 1991;43:167–76.PubMedCrossRefGoogle Scholar
  27. 27.
    DeVincenzi I, for the European Study Group on Heterosexual Transmission of HIV. A longitudinal study of human immunodeficiency virus transmission by heterosexual partners. N Engl J Med 1994;31:341–6.CrossRefGoogle Scholar
  28. 28.
    Diaz T, Schable B, Chu SY, Supplement to HIV and AIDS Surveillance Project Group. Obstet Gynecol 1995;86:277–82.PubMedCrossRefGoogle Scholar
  29. 29.
    Trussell J, Sturgen K, Strickler J, et al. Comparative contraceptive efficacy of the female condom and other barrier methods. Fam Plann Perspect 1994;26:66–72.PubMedCrossRefGoogle Scholar
  30. 30.
    Louv WC, Austin H, Alexander WJ, Stagno S, Cheeks J. A clinical trial of nonoxynol-9 for preventing gonococcal and chlamydial infections. J Infect Dis 1988;158:518–23.PubMedCrossRefGoogle Scholar
  31. 31.
    Fischl MA, Dickinson GM, Scott GB, Klimas N, Fletcher MA, Parks W. Evaluation of heterosexual partners, children and household contacts of adults with AIDS. JAMA 1987;257: 640–4.PubMedCrossRefGoogle Scholar
  32. 32.
    Louik C, Mitchell AA, Werler MM. Maternal exposure to spermicides in relation to certain birth defects. N Engl J Med 1987;317:474–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Hemrika DJ, Slaats EH, Schoemaker J. The response of the pituitary-ovarian axis to pulsatile administration of gonado-tropin-releasing hormone in long-term oral contraceptive users. Am J Obstet Gynecol 1994;170:462–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Vessey MP, Villard-Mackintosh L, Jacobs HS. Antiestrogenic effect of cigarette smoking [letter]. N Engl J Med 1987;317:769.PubMedCrossRefGoogle Scholar
  35. 35.
    Baron JA, La Vecchia C, Levi F. The antiestrogenic effect of cigarette smoking in women. Am J Obstet Gynecol 1990; 162:502–14.PubMedCrossRefGoogle Scholar
  36. 36.
    Rosenberg MJ, Waugh MS, Long S. Unintended pregnancies and use, misuse and discontinuation of oral contraceptives. J Reprod Med 1995;40:355–60.PubMedGoogle Scholar
  37. 37.
    Rosenberg MJ, Waugh MS, Stevens CM. Smoking and cycle control among oral contraceptive users. Am J Obstet Gynecol 1996;174:628–32.PubMedCrossRefGoogle Scholar
  38. 38.
    Hatcher RA, Trussel J, Stewart F, et al. The pill: combined contraception. In: Hatcher RA, Trussel J, Stewart F, et al, editors. Contraceptive technology. New York: Irvington, 1994:230–1.Google Scholar
  39. 39.
    Louv WC, Austin H, Perlman J, Alexander WJ. Oral contraceptive use and the risk of chlamydial and gonococcal infections. Am J Obstet Gynecol 1989;160:396–402.PubMedCrossRefGoogle Scholar
  40. 40.
    Mishell DR. Oral contraception 1990: taking stock. Dialog Contraception 1990;3:1–7.Google Scholar
  41. 41.
    Parazzini F, Negri E, Vecchi CL, Fedele L, Rabaiotti M, Luchini L. Oral contraceptive use and risk of uterine fibroids. Obstet Gynecol 1992;79:430–3.PubMedCrossRefGoogle Scholar
  42. 42.
    Vessey M, Metcalfe A, Wells C, McPherson K, Westhoff C, Yeates D. Ovarian neoplasms, functional ovarian cysts, and oral contraceptives. BMJ 1987;294:1518–20.PubMedCrossRefGoogle Scholar
  43. 43.
    Grimes DA, Godwin AJ, Rubin A, Smith JA, Lacarra M. Ovulation and follicular development with three low-dose oral contraceptives: a randomized controlled trial. Obstet Gynecol 1994;83:29–34.PubMedGoogle Scholar
  44. 44.
    Frassinelli-Gunderson EP, Margen S, Brown JR. Iron stores in users of oral contraceptive agents. Am J Clin Nutr 1985; 41:703–12.PubMedGoogle Scholar
  45. 45.
    Hazes JMW, Dijkmans BAC, Vanderbroucke JP. Reduction of the risk of rheumatoid arthritis among women who take oral contraceptives. Arthritis Rheum 1990;33:173–9.PubMedCrossRefGoogle Scholar
  46. 46.
    Grodstein F, Colditz GA, Hunter DJ, et al. A prospective study of symptomatic gallstones in women: relation with oral contraceptives and other risk factors. Obstet Gynecol 1994;84:207–14.PubMedGoogle Scholar
  47. 47.
    Haenggi W, Casez JP, Birkharuser MH, et al. Bone mineral density in young women with long-standing amenorrhea: limited effects of hormone replacement therapy with ethinyl estradiol and desogestrel. Osteoporos Int 1994;4:99–103.PubMedCrossRefGoogle Scholar
  48. 48.
    Woods ER, Grace E, Havens KK, Merola JL, Emans SJ. Contraceptive compliance with a levonorgestrel triphasic and a norethindrone oral contraceptive in adolescent patients. Am J Obstet Gynecol 1992;166:901–7.PubMedCrossRefGoogle Scholar
  49. 49.
    Casper RF, Powell AM. Evaluation and therapy of breakthrough bleeding in women using a triphasic oral contraceptive. Fértil Steril 1991;55:292–6.PubMedGoogle Scholar
  50. 50.
    Upton GV. Lipids, cardiovascular disease, and oral contraceptives: a practical perspective. Fértil Steril 1990;53:1–12.PubMedGoogle Scholar
  51. 51.
    Godsland IF, Crook D, Simpson R, et al. The effects of different formulations of oral contraceptive agents on lipid and carbohydrate metabolism. N Engl J Med 1990;323:1375–81.PubMedCrossRefGoogle Scholar
  52. 52.
    Croft P, Hannaford PC. Risk factors for acute myocardial infarct in women: evidence from the Royal College of General Practitioner’s oral contraceptive study. BMJ 1989;298: 165–8.PubMedCrossRefGoogle Scholar
  53. 53.
    Stampfer MJ, Willett WC, Colditz GA, Speizer FE, Hannekens CH. A prospective study of past use of oral contraceptive agents and risk of cardiovascular diseases. N Engl J Med 1988;319:1313–17.PubMedCrossRefGoogle Scholar
  54. 54.
    Skouby SO, Anderson O, Kühl C. Oral contraceptives and insulin receptor binding in normal women and those with previous gestational diabetes. Am J Obstet Gynecol 1986; 155:802–7.PubMedGoogle Scholar
  55. 55.
    Bracken MB. Oral contraception and congenital malformations in offspring: a review and meta-analysis of the prospective studies. Obstet Gynecol 1990;76:552–7.PubMedGoogle Scholar
  56. 56.
    Peipert JF, Gutmann J. Oral contraceptive risk assessment: a survey of 247 educated women. Obstet Gynecol 1993;82: 112–17.PubMedGoogle Scholar
  57. 57.
    Cancer and Steroid Hormone Study of the Centers for Disease Control and the National Institute of Child Health and Human Development. Oral contraceptive use and the risk of breast cancer. N Engl J Med 1986;315:405–11.CrossRefGoogle Scholar
  58. 58.
    Williams JK. Oral contraceptives and reproductive system cancer. J Reprod Med 1991;36:247–52.PubMedGoogle Scholar
  59. 59.
    Schlesselman JJ. Net effect of oral contraceptive use on the risk of cancer in women in the United States. Obstet Gynecol 1995;85:793–801.PubMedCrossRefGoogle Scholar
  60. 60.
    Cancer and Steroid Hormone Study of the Centers for Disease Control and the National Institute of Child Health and Human Development. The reduction in risk of ovarian cancer associated with oral contraceptive use. N Engl J Med 1987;316:650–5.CrossRefGoogle Scholar
  61. 61.
    Gross TP, Schlesselman JJ. The estimated effect of oral contraceptive use on the cumulative risk of epithelial ovarian cancer. Obstet Gynecol 1994;83:419–24.PubMedGoogle Scholar
  62. 62.
    Cancer and Steroid Hormone Study of the Centers for Disease Control and the National Institute of Child Health and Human Development. Combination oral contraceptive use and the risk of endometrial cancer. JAMA 1987;257:796–800.CrossRefGoogle Scholar
  63. 63.
    Negrini BP, Schiffman MH, Kurman RJ, et al. Oral contraceptive use, human papillomavirus infection and risk of early cytological abnormalities of the cervix. Cancer Res 1990;50:4670–5.PubMedGoogle Scholar
  64. 64.
    Gerstman BB, Piper JM, Tomita DK, Ferguson WJ, Stadel BV, Lundin FE. Oral contraceptive estrogen dose and the risk of deep venous thromboembolic disease. Am J Epidemiol 1991; 133:32–7.PubMedGoogle Scholar
  65. 65.
    World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. Venous thromboembolic disease and combined oral contraceptives: results of international multicentre case-control study. Lancet 1995;346:1575–82.Google Scholar
  66. 66.
    Jick H, Hick SS, Gurewich V, et al. Risk of idiopathic cardiovascular death and nonfatal venous thromboembolism in women using oral contraceptives with differing progestogen components. Lancet 1995;346:1589–93.PubMedCrossRefGoogle Scholar
  67. 67.
    Spitzer WO, Lewis MA, Heinemann LAJ, et al On behalf of Transnational Research Group on Oral Contraceptives and the Health of Young Women. Third generation oral contraceptives and risk of venous thromboembolic disorders: an international case-control study. BMJ 1996;312:83–8.PubMedCrossRefGoogle Scholar
  68. 68.
    Farmer RDT, Preston TD. The risk of venous thromboembolism associated with low oestrogen oral contraceptives. J Obstet Gynaecol 1995;15:195–200.CrossRefGoogle Scholar
  69. 69.
    Mishell DR, Kaunitz AM, Sulak PJ, et al. Oral contraceptives and venous thromboembolism: consensus conference statement. Dialog Contraception 1996;spring:1–8.Google Scholar
  70. 70.
    Chi IC. The safety and efficacy issues of progestin-only oral contraceptives: an epidemiologic perspective. Contraception 1993;47:1–21.PubMedCrossRefGoogle Scholar
  71. 71.
    Smith RD, Cromer BA, Hayes JR, et al. Medroxyprogesterone acetate (Depo-Provera) use in adolescents: uterine bleeding and blood pressure patterns, patient satisfaction and continuation rates. Adolesc Pediatr Gynecol 1995;8: 24–8.Google Scholar
  72. 72.
    Cundy T, Cornish J, Evans MC, et al. Recovery of bone density in women who stop using medroxyprogesterone acetate. BMJ 1994;308:247–8.PubMedCrossRefGoogle Scholar
  73. 73.
    Sharma JB, Newman MRB, Smith RJ. Depot medroxyprogesterone acetate and osteoporosis: smoking may explain findings [letter]. BMJ 1994;308:1567.CrossRefGoogle Scholar
  74. 74.
    Su-Juan G, Ming-Kun M, Ling-De Z, et al. A 5-year evaluation of Norplant contraceptive implants in China. Obstet Gynecol 1994;83:673–8.Google Scholar
  75. 75.
    Konji JC, Otolorin EO, Lapido OA. The effect of continuous subdermal levonorgestrel (Norplant) on carbohydrate metabolism. Am J Obstet Gynecol 1992;166:15–19.CrossRefGoogle Scholar
  76. 76.
    Sivin I, Stern J, Diaz S, et al. Rates and outcomes of planned pregnancy after use of Norplant capsules, Norplant II rods, or levonorgestrel-releasing or copper TCU 380A intrauterine contraceptive devices. Am J Obstet Gynecol 1992;166:1208–13.PubMedCrossRefGoogle Scholar
  77. 77.
    Cullins VE, Remsburg RE, Blumenthal PD, Huggins GR. Comparison of adolescent and adult experiences with Norplant levonorgestrel contraceptive implants. Obstet Gynecol 1994; 83:1026–32.PubMedCrossRefGoogle Scholar
  78. 78.
    Van Amerongen D. Removal rates of subdermal levonorgestrel implants. J Reprod Med 1994;39:873–6.PubMedGoogle Scholar
  79. 79.
    Polaneczky M, Slap G, Forke E, et al. The use of levonorgestrel implants (Norplant) for contraception in adolescent mothers. N Engl J Med 1994;331:1201–6.PubMedCrossRefGoogle Scholar
  80. 80.
    Faundes A, Alvarez F, Braache V, Jimenez E, Tejada AS. Hormonal changes associated with bleeding during low dose progestogen contraception delivered by Norplant subdermal implants. Adv Contracept 1991;7:1–10.CrossRefGoogle Scholar
  81. 81.
    Diaz S, Croxatto NB, Pavez M, et al. Clinical assessment of treatments for prolonged bleeding in users of Norplant implants. Contraception 1990;42:97–109.PubMedCrossRefGoogle Scholar
  82. 82.
    Alvarez-Sanchez F, Brache MT, Thevenin F, Cocnon L, Faundes A. Hormonal treatment for bleeding irregularities in Norplant implant users. Am J Obstet Gynecol 1996;174:919–22.PubMedCrossRefGoogle Scholar
  83. 83.
    Archer DF. Management of bleeding in women using sub-dermal implants. Contemp Obstet Gynecol 1995;July: 11–25.Google Scholar
  84. 84.
    Trussell J, Stewart F. The effectiveness of postcoital hormonal contraception. Fam Plann Perspect 1992;24:262–4.PubMedCrossRefGoogle Scholar
  85. 85.
    Grou F, Rodriques I. The morning-after pill: how long after? Am J Obstet Gynecol 1994;171:1529–34.PubMedCrossRefGoogle Scholar
  86. 86.
    Young DC, Wiehle RD, Joshi SG, Poindexter AN. Emergency contraception alters progesterone-associated endometrial protein in serum and uterine luminal fluid. Obstet Gynecol 1994;84:266–71.PubMedGoogle Scholar
  87. 87.
    Harper CC, Ellertson CE. The emergency contraceptive pill: a survey of knowledge and attitudes among students at Princeton University. Am J Obstet Gynecol 1995;173:1438–45.PubMedCrossRefGoogle Scholar
  88. 88.
    Geerling JH. Natural family planning. Am Fam Physician 1995;52:1749–56.PubMedGoogle Scholar
  89. 89.
    Kambric RT. Natural family planning use—effectiveness and continuation. Am J Obstet Gynecol 1991;165:2046–8.CrossRefGoogle Scholar
  90. 90.
    Wade ME, McCarthy P, Braunstein GD, et al. A randomized prospective study of the use—effectiveness of two methods of natural family planning. Am J Obstet Gynecol 1981; 141:368–76.PubMedGoogle Scholar
  91. 91.
    Fehring RJ, Lawrence D, Philpot C. Use effectiveness of the Creighton model ovulation method of natural family planning. J Obstet Gynecol Neonat Nurs 1994;23:303–9.CrossRefGoogle Scholar
  92. 92.
    Shain RN, Miller WB, Mitchell GW, et al. Menstrual pattern change 1 year after sterilization: results of a controlled, prospective study. Fértil Steril 1989;52:192–203.PubMedGoogle Scholar
  93. 93.
    Shy KK, Sterrgachis A, Grothaus LG, et al. Tubal sterilization and risk of subsequent hospital admission for menstrual disorders. Am J Obstet Gynecol 1992;166:1698–706.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1998

Authors and Affiliations

  • Barbara S. Apgar

There are no affiliations available

Personalised recommendations