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Continuation and compliance of contraceptive use

Continuation and compliance of contraceptive use. Bojana Pinter, MD, PhD Department of Ob/Gyn University Medical Center Ljubljana, Slovenia. How to choose a method ?. Effectiveness Safety Acceptability Health care benefits Continuation - acceptability

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Continuation and compliance of contraceptive use

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  1. Continuation and compliance of contraceptive use Bojana Pinter, MD, PhD Department of Ob/Gyn University Medical Center Ljubljana, Slovenia

  2. How to choose a method? • Effectiveness • Safety • Acceptability • Health care benefits • Continuation - acceptability • Compliance- method:use effectiveness

  3. Continuation ratesSource: Hatcher RA, Trussell J, Stewart F, et al, eds. Contraceptive Technology. 17th revised edition. New York: Ardent Media, Inc. 1998.

  4. Continuation rates, Slovenia Fertility Survey, Slovenia 1990. Source: Pinter B. Continuation of contraceptive use in Slovenia – life-table analysis. Eur J Obstet Gynecol Reprod Biol 1994; 55: 54.

  5. Discontinuation rates, Slovenia Fertility Survey, Slovenia 1990. Source: Pinter B. Continuation of contraceptive use in Slovenia – life-table analysis. Eur J Obstet Gynecol Reprod Biol 1994; 55: 54.

  6. Components of continuation • The highest continuation rates: methods not affected by compliance • The highest use-effectiveness: coitus-independent methods • Other method related reasons: the pill, coitus-dependent methods

  7. Compliance rates • Poor compliance • Inconsistent use • Irregular – sporadic use • Not using a backup method • Discontinuing the method but failing to substitute another

  8. Consequences of noncompliance • Unintended pregnancy • Side effects • Diminished noncontraceptive benefits

  9. The rate of unintended pregnancySource: Hatcher RA, Trussell J, Stewart F, et al, eds. Contraceptive Technology. 17th revised edition. New York: Ardent Media, Inc. 1998.

  10. Components of compliance • Contraceptive efficacy • Contraceptive safety • Side effects • Patient comprehension of use • Personal characteristics • Noncontraceptive benefits • Health care provider preferences

  11. Health Belief Model • Patient’s perceptions of susceptibility to consequences • Severity of consequences • Costs versus benefits • Barriers

  12. How to improve contraceptive use? • Unique needs of each patient • Do you accept the need for using a pill daily? Are you willing to take a pill daily? Are you willing to return for follow–up? Are you willing to report side effects? • Use of contraceptives with high compliance

  13. Development of new contraceptive methods • Monthly injectables • Vaginal ring • Transdermal patches • Biodegradable capsule implants

  14. Conclusions • To empower patients to realise their own responsibility for their reproductive health • To work individually with the patient • To develop and promote the use of new contraceptive methods

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