Contraceptive Failure Rates in the Developing World

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Effects of Intensive Longitudinal Data Collection on Pregnancy & Contraceptive Use

We use an experiment based on the Relationship Dynamics and Social Life (RDSL) study of sexual behavior, pregnancy, and contraceptive use to investigate whether participation in weekly self-reports over one year result in differential effects on related behaviors and attitudes, compared to participation in a one-time follow-up interview requiring retrospective self-reporting for the prior year. 

We randomly assigned 200 subjects to either a control group or a journal group. All subjects were interviewed at the beginning of the study (baseline interview) and 12 months later (closeout interview). Subjects in the journal group also completed a five-minute web- or phone-based survey every week during the 12-month study period. 

We found no statistically significant difference in pregnancy rates across the two groups at closeout. Contrary to our expectation, the control group experienced a slightly larger increase in having ever used a contraceptive method, although this was mainly due to increases in the least effective methods, such as condoms and withdrawal. 

Respondents in the weekly interview group became slightly more positive toward childbearing in terms of one specific attitude measure, but not for the vast majority of measures. 

We conclude that intensive longitudinal data collection does not appear to have a large or consistent impact on respondents' pregnancy, contraceptive use, or related attitudes, relative to the more standard longitudinal approach.

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By:  Barber JS1, Gatny HH1, Kusunoki Y1, Schulz P1.

• 1Institute for Social Research (http://home.isr.umich.edu/), University of Michigan, Ann Arbor, MI USA. 
• Int J Soc Res Methodol. 2016 Mar 1;19(2):205-222. Epub 2014 Dec 1.

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Brief Report: HIV Prevention by Australian Gay and Bisexual Men with Casual Partners: The Emergence of Undetectable Viral Load as One of a Range of Risk Reduction Strategies

We analyzed the HIV risk reduction strategies (RRS) used by Australian gay and bisexual men with casual partners. 

Among 1346 men who reported any condomless anal intercourse with casual partners, 75% frequently practiced at least one RRS. The most common RRS was serosorting, frequently practiced by 55% of HIV-positive and 47% of HIV-negative participants. 

Condoms were frequently (but inconsistently) used by 17% of HIV-positive, 41% of HIV-negative, and 30% of untested participants. Relying on an undetectable viral load was frequently practiced by 58% of HIV-positive participants. 

Strategic positioning, withdrawal, and non-HIV-positive men taking antiretroviral medication were less common strategies.

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By:  Holt M1, Lea T, Mao L, Zablotska I, Prestage G, de Wit J.

• 1*Centre for Social Research in Health, UNSW Australia, Sydney, Australia; †The Kirby Institute, UNSW Australia, Sydney, Australia; and ‡Social and Organizational Psychology, Utrecht University, Utrecht, the Netherlands. 

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"Is That A Method of Birth Control?" A Qualitative Exploration of Young Women's Use of Withdrawal

Despite its ubiquity, withdrawal is understudied as a family planning method. We investigated the context of and decision making around withdrawal use, drawing on in-depth, qualitative interviews with 38 Black and Latina women (ages 18 to 24). 

We examined contraceptive use histories to understand when and why participants used withdrawal. The majority of participants (n = 29; 76%) had used withdrawal in their lifetimes, though two-thirds of users mentioned withdrawal in their contraceptive histories only after interviewer prompts. 

Withdrawal was primarily used during transitions between contraceptive methods and when other methods were not desired. Relationship context was also an important factor, as many used withdrawal to increase intimacy with their partners; because they felt condoms were no longer necessary due to monogamy; or to fulfill their partners' preferences to increase sexual pleasure. Our findings indicate that decision making around withdrawal is embedded in situational and relational contexts. 

Future research should explore how health care providers and sex educators can engage young women in discussions of withdrawal's benefits and constraints. 

A harm reduction framework, which recognizes that optimal use of withdrawal is preferable to not using a pregnancy prevention method at all, may inform the ways that withdrawal can be addressed in clinical and educational settings.

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By: Arteaga S¹, Gomez AM².

¹a Department of Maternal and Child Health , School of Public Health, University of California , Berkeley.

²b School of Social Welfare , University of California , Berkeley.

  

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Withdrawal as Pregnancy Prevention and Associated Risk Factors among US High School Students

Among 4,793 currently sexually active students, 10.2% used withdrawal only, 12.4% used no method, 53.6% used a condom, and 23.8% used a more effective method as their primary form of pregnancy prevention during last sexual intercourse. Students who used withdrawal were less likely than those who used no method to have had sexual intercourse before age 13 years and currently use cocaine.

Among females, students who used withdrawal were more likely to engage in risky behaviors than those who used a condom and those who used a highly effective method of pregnancy prevention in a number of ways (e.g. having multiple sex partners during the past three months, current alcohol use, binge drinking, current marijuana use, drank alcohol or used drugs before last sexual intercourse).

Approximately 1 in 10 sexually active students used withdrawal only, about the same percentage as those who used no method. Health care providers and others who serve adolescents may want to discuss its pros and cons with their clients and help ensure they have information about and access to other contraceptive methods that are more effective at preventing pregnancy and sexually transmitted infections. Health care professionals should not consider young people who use withdrawal similar in risk to those that use no method.

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By: Liddon N1, O'Malley Olsen E2, Carter M3, Hatfield-Timajchy K4.

• 1Centers for Disease Control and Prevention, Division of Adolescent and School Health.
• 2Centers for Disease Control and Prevention, Division of Adolescent and School Health.
• 3Centers for Disease Control and Prevention, Division of STD Prevention.
• 4Centers for Disease Control and Prevention, Division of Reproductive Health.