Purpose
To review currently available choices for non-daily hormonal contraception, considering efficacy, safety, patient counseling issues, and appropriate patient selection.

Data Sources
Worldwide medical literature and the individual products' prescribing information.

Conclusions
Patients and clinicians have many nondaily hormonal contraceptive options available—from Depo-Provera quarterly injection, which has been available in the United States for over 10 years, to several new entries (Mirena 5-year intrauterine system, Lunelle monthly injection, NuvaRing monthly intravaginal ring, and Ortho Evra weekly transdermal patch). All these options offer high efficacy and enhanced convenience for many patients over daily oral contraceptives (OCs). Barriers to use of these agents may include patients’ lack of information as well as fear or misconceptions regarding the hormones and methods. All of these can be addressed with adequate patient counseling and open dialogue. The clinician and patient need to be well-informed regarding these options so that they can work together and identify the best contraceptive fit for the patient—with the ultimate goal being to increase patient satisfaction and adherence and, thus, avoid unintended pregnancy.

Implications for Practice
Despite the efficacy of OCs, missed pills are quite common and contribute to unintended pregnancy. Many women in all population categories would benefit from the convenience and reliability of nondaily hormonal contraceptives. The highest efficacy rates with typical use are associated with agents that require minimal user participation (i.e., Depo-Provera, Mirena).Compared to daily regimens, all nondaily options offer increased convenience and may contribute to improved patient adherence.However, barriers to use may exist.Patient fears regarding use of hormones can be minimized by discussing the long-term safety of hormonal contraceptives. (The data are predominantly derived from Depo-Provera and OCs because these agents have been available in the United States and in the rest of the world for much longer than the newer nondaily options.) Patient counseling and appropriate expectations regarding changes in menstrual pattern have been demonstrated to further enhance patient adherence to therapy. Finally, patient lifestyle preferences must be considered. The finding that many women are comfortable with or even prefer amenorrhea, which is associated with options such as Depo-Provera, highlights how important it is for clinicians to avoid making assumptions about a patient's contraceptive preferences. Rather, clinicians and patients should exchange information through an open dialogue. For the majority of patients, nondaily hormonal contraceptives should be considered and offered as first-line options.

Nondaily hormonal contraception: considerations in contraceptive choice and patient counseling.

This study is an investigation into the status and trends of family planning (FP) and reproductive health (RH) programs within the context of Ethiopia’s heightening HIV/AIDS epidemic. By helping individuals and couples control the number and timing of pregnancies family planning provides far-reaching benefits. In addition by reducing unintended and high-risk pregnancies family planning can lower the instances of maternal and child injury illness and death associated with childbirth and unsafe abortions. Ethiopia has not been able to expand FP services to satisfy the increasing unmet need in the country and its maternal mortality ratio (MMR) ranks as one of the world’s highest. At the same time Ethiopia is among the countries that have been hardest hit by the HIV/AIDS epidemic. The findings of this study are expected to inform policy and program managers about the various dimensions of HIV/AIDS and family planning in Ethiopia. (excerpt)

Country analysis of family planning and HIV / AIDS: Ethiopia.

The effects of skilled health attendants on reducing maternal deaths in developing countries: testing the medical model

Reproductive health is a crucial part of general health and a central feature of human development. It is a reflection of health during childhood and crucial during adolescence and adulthood, sets and stage for health beyond the reproductive years for both women and men, and affects the health of the next generation. The extent and severity of the problems that adolescents encounter during this phase of their life include many reproductive health issues. Hence the present study was undertaken to know awareness of Reproductive Health among school going and school dropout adolescent girls of Jammu City. The results of the study revealed that majority of both school going girls and school drop out girls scored well in the identification of reproductive system. The areas where both school going girls and school dropout girls scored low were-Female reproductive organs, conceivable age and reproductive age of men, Unsafe abortion, legal and illegal abortion and its harmful effects, Clinical symptoms and biological symptoms of AIDS and the relationship between AIDS/HIV/STD's. Knowledge of teenage pregnancy and mode of pregnancy was lower in school going girls than dropout girls. The difference in the knowledge level of reproductive system, teenage pregnancy STD's, HIV in the two groups were insignificant but the knowledge level related to mode of pregnancy AIDS/HIV in the two settings was significant. The Results of the study revealed that the School Dropout Girls had more scientific information, than the School Going Girls. It was due to the fact that teachers hesitated to discuss such topics in the school.

Awareness of Reproductive Health among Rural Adolescent Girls (A Comparative Study of School Going Girls and Dropout Girls of Jammu)

On 12 October world population will reach 6 billion. It is just 12 years since the five billion mark was passed. In another 12 years we will approach seven billion. On the front line of reproductive health provision there is optimism, tempered with frustration. The good news is that a revolution in reproductive behaviour is sweeping the developing world; the bad, that we are failing to meet the needs of millions of couples who want to plan their families but cannot access contraceptive services.

In the 1960s 10% of couples in developing countries used contraception. Today 50% do. Total fertility has fallen from six children per couple to just over three. The principal cause of this decline has been the rapid and widespread adoption of contraception.1 The number of couples practising contraception is approaching western levels of use (75%). In Latin America it has reached 68%, in Asia 60%, and in the Middle …

https://www.bmj.com/content/bmj/319/7215/932.full.pdf

Impediments to effective fertility reduction. Contraception should be moved out of the hands of doctors.

\n Amid attempts by anti-abortionists to reinstate the Mexico City policy restricting US population and family planning financial assistance to agencies which do not provide abortion services, even with other funds, the US Congress, in 1996, cut funds for international family planning programs by 35% and froze funding for 5-9 months under a complex compromise. Some population organizations issued reports on the benefits of family planning programs overseas just as Congress prepared to vote on whether to release fiscal 1997 international family planning funds in March. The Population Reference Bureau (PRB) released the revised and expanded third edition of Family Planning Saves Lives, which explores how family planning prevents maternal and child mortality; a new Rockefeller Foundation report described the success of family planning programs since the 1960s and charged the US government with backing away from its 30-year commitment; and a US Agency for International Development study examined family planning's role in preventing abortion.\n

Family planning saves lives, prevents abortion.

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Family planning saves lives, prevents abortion.