Education and counseling for Norplant users

Characteristics of Norplant users

OBJECTIVE

To determine whether a profile can be developed to indicate which clients are the best candidates for Norplant by describing the characteristics of clients who use this contraceptive for 5 years and those who have it removed early.

DESIGN

A descriptive study of data collected from a convenience sample. SELLING: A state-supported university hospital's obstetric and gynecology outpatient clinic serving primarily indigent clients in the southern United States.

PARTICIPANTS

Women (N = 256), primarily with low incomes, being seen for removal of Norplant contraceptive capsules. Of these, 166 women had completed the recommended 5 years.

MAIN OUTCOME MEASURES

Characteristics of the clients who retained the contraceptive for the recommended 5 years and characteristics of clients who came for early removal.

RESULTS

Clients who retained the contraceptive for 5 years differed from those who did not on only three characteristics: race, age, and parity. No significant differences were found in education or marital status.

CONCLUSIONS

No clear profile of successful Norplant users emerged. Instead, thorough counseling of each individual is essential to the client's completion of 5 years with Norplant. Advantages and disadvantages must be explained and the client's tolerance of possible side effects must be assessed, thereby helping the client to make an informed choice.

Reproductive decision-making and determinants of contraceptive use in HIV-infected women

Perinatal transmission and reproductive decisions of HIV-infected women can be categorized in statistical and epidemiological terms. These reports and figures, however, do little to fully explain the complexities of human relationships, life experiences, personal and cultural influences, and situational and environmental variables that impact on the HIV-infected woman regarding reproductive decision-making. It is only with genuine attempts to understand the woman's perspective and the dynamic and unique variables that influence reproductive decision-making, as well as maintaining a non-judgmental and culturally sensitive perspective, can we hope to assist women, and society as a whole, in coming to terms with the complexities of HIV and reproductive decision-making. Further study is needed to identify factors that influence reproductive decision-making in HIV-infected women. The determinants of contraceptive use regarding demographic factors, barriers to contraceptive use, and factors that contribute to successful contraceptive use in this population must be understood if efforts to reduce the number of unplanned pregnancies are to be successful. More conclusive data are needed on the safety and efficacy of oral contraceptives in HIV-infected women as well as data that describe the effects of longer acting hormonal contraceptives such as levonorgestrel implants (Norplant; Wyeth-Ayerst, Philadelphia, PA) and injectable medroxyprogesterone acetate (Depo Provera; Upjohn Company, Kalamazoo, MI). More research is needed to determine the effects of patient education and counseling and closer follow-up on effective long-term contraception in HIV-infected women.