Continuation and compliance of contraceptive use

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 - methoduse effectiveness

3
Continuation rates Source 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

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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

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Health Belief Model

• Patients 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 followup? Are you willing
  to report side effects?
• Use of contraceptives with high compliance

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

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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