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The Pop Reporter®

Volume 7, Number 1
22 January 2007

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Guest Editorials (free with every subscription)

Expanding services for injectable contraceptives: How family planning programs and providers can meet clients’ needs


Author: Lande R | Richey C

rlande@jhsph.edu

The increasing demand for injectable contraceptives challenges programs to expand access to good-quality services. Counseling is crucial -- especially about changes in monthly bleeding caused by injectables. Providers need to give injections safely and avoid contributing to the estimated 64 million injections for all purposes each year in developing countries that risk transmitting infection (3). Communication programs need to provide accurate information about injectables and correct common misinformation, such as the false idea that injectables make women permanently infertile. Community distribution of injectables offers another contraceptive choice to women in isolated rural areas. These are some of the components of a comprehensive strategy for injectables that meets clients’ needs.

More Women Are Choosing Injectables

In 2005 an estimated 32 million married women were using injectables, 20 million more than in 1995. By 2015, 40 million women may be using injectables (5). Most women are choosing DMPA (depot medroxyprotesterone acetate), which is injected every three months. Programs also offer NET-EN (norethisterone enanthate), injected every two months, and some stock a combined injectable (progestin + estrogen) injected monthly.

Convenience and side effects influence women’s decision to use injectables. Women choose injectables because they are highly effective, long-acting, reversible, and private. About half of women stop using injectables within a year, however, mainly because of side effects (see Population Reports, "When Contraceptives Change Monthly Bleeding" (http://www.populationreports.org/j54/)). Some women stop because they have trouble returning for repeat injections or because the nearest clinic has run out of injectables. Good-quality services help women be satisfied continuing users of injectables.

A Strategy for Quality

To offer well-run injectables services, program managers need to:

• Maintain adequate supplies. Forecasting enables programs to anticipate increases in demand. For unexpected increases in demand, emergency shipments are available.

• Provide training. With comprehensive or focused training, a range of health care providers can learn to give injections safely. Training auxiliary nurses to give injections in Honduras increased use of injectables among women attending the rural clinics where the nurses were posted (4).

• Provide safe injections. The spread of infection can be avoided by ensuring that all injections are given with sterile equipment, placing disposable syringes in sharps disposal containers immediately after use, and burying or burning used equipment.

• Hold down costs. Program managers can expand injectables services without greatly increasing costs by shortening client waiting times, buying supplies in bulk to get low prices, and increasing the number of service sites without building more clinics--for example, by offering injectables in the homes of providers and clients. Providers in some programs can increase efficiency by spending more time with clients and less time on administrative tasks (2).

• Consider community distribution. Community services for injectables can be comparable in quality to clinic services (6). A new formulation of DMPA that is injected under the skin rather than in the muscle promises easier injections and the choice of self-injection at home for clients.

• Tailor communication messages. Communication programs can address women who know about injectables but hesitate to try them. Television spots in Egypt and radio spots in some sub-Saharan African countries have offered information about injectables. To address concerns about side effects, some women need to talk with a trusted source of information via a telephone hotline or in face-to-face meetings (1).

• Help women make an informed choice and be informed users. Good counseling can be the difference between successful and unsuccessful efforts to increase access to injectables. Vietnam used the introduction of injectables to train providers in a client-oriented approach and strengthen their counseling skills (7).

Developing an overall strategy for improving the quality of injectables services can be an opportunity for programs to improve counseling and the quality of care for all contraceptive methods.

Based on Population Reports, "Expanding Services for Injectables" (http://www.populationreports.org/k6/), and INFO Reports, "Injectable Contraceptives: Tools for Providers" (http://www.infoforhealth.org/inforeports/injectable/index.shtml). Both reports are available online. For printed copies of the reports, send an e-mail message to orders@jhuccp.org, go online to our order form (http://www.jhuccp.org/cgi-bin/orders/orderform.cgi) or write to Orders, Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, 111 Market Place, Suite 310, Baltimore, MD 21202, USA.

Would you like to comment on this editorial? Visit the Injectables blog (http://www.infoforhealth.org/injectables/blog/). For up-to-date evidence, best practices, and resources on injectables contraceptives, see the Injectables Toolkit (http://www.injectablestoolkit.org).

References:

1. Berg, R., Kanesathasan, N., and Bollinger, L. Getting from awareness to use: Lessons learned from SOMARC III about marketing hormonal contraceptives. Washington, D.C., Futures Group International, Social Marketing for Change (SOMARC), Sep. 1998. (SOMARC III Special Study No. 6) 21 p.

2. Hubacher, D., Holtman, M., Fuentes, M., Perez-Palacios, G., and Janowitz, B. Increasing efficiency to meet future demand: Family planning services provided by the Mexican Ministry of Health. International Family Planning Perspectives 25(3): 119-124, 138. Sep. 1999.

3. Hutin, Y.J., Hauri, A.M., and Armstrong, G.L. Use of injections in healthcare settings worldwide, 2000: Literature review and regional estimates. British Medical Journal 327(7423): 1075. Nov. 8, 2003.

4. Mendoza, I. and Vernon, R. Promoting reproductive health services in rural communities in Honduras. Population Council, Frontiers in Reproductive Health, Jun. 15, 2001. 11 p. (http://www.popcouncil.org/pdfs/frontiers/FR_FinalReports/Honduras_Nurse_roles.pdf)

5. Ross, J., Stover, J., and Adelaja, D. Profiles for family planning and reproductive health programs: 116 countries. Futures Group, 2005. 182 p. (http://www.constellafutures.com/Documents/Profiles116FP2ed.pdf)

6. Stanback, J., Mbonye, A., Lemelle, J., Bekiita, M., Ssekito, G., and Kajura, N.J. Safety and feasibility of community-based distribution of Depo-Provera in Nakasongola, Uganda. Final Report. Research Triangle Park, North Carolina, Family Health International, Uganda Ministry of Health, Save the Children, Nakasongola Local Government, Jun. 2005. 20 p.

7. Thorn, N.T., Hieu, D.T., Nhan, V.Q., Nhan, D.T., Whittaker, M., Fajans, P., and Satia, J. The strategic approach to the introduction of DMPA as an opportunity to improve quality of care for all contraceptive methods in Viet Nam. Asia-Pacific Population Journal 15(4): 63-88. Dec. 2000.

FAMILY PLANNING/REPRODUCTIVE HEALTH RESEARCH

Syphilis in China: results of a national surveillance programme
(Abstract; subscription needed for full text; Asia)
Lancet. 2007 Jan 11;Online access January 11, 2007. 369(9556):132-138.
Chen ZQ | Zhang GC | Gong XD | Lin C | Gao X | Liang GJ | et al
After a massive syphilis epidemic in the first half of the 20th century, China was able to eliminate this infection for 20 years. Substantial changes in Chinese society have been followed by a resurgent epidemic of sexually transmitted diseases. Sporadic reports have provided clues to the magnitude of the spread of syphilis, but a national surveillance effort is needed to provide data for planning and intervention. This study collected and assessed case report data from China's national sexually transmitted disease surveillance system and sentinel site network.



Awareness of hormonal emergency contraception among married women in a Kuwaiti family social network
(Abstract; subscription needed for full text; Middle East)
European Journal of Obstetrics & Gynecology and Reproductive Biology . 2007 Feb;130(2):216-222.
Marafiea N| Ball D| Abahussaina E
Awareness and use of hormonal emergency contraception are not known in the Arab world. This study investigated awareness and perceptions of hormonal emergency contraception among women within a Kuwaiti extended family and their social contacts. It was found that most respondents would not use or inform a friend about hormonal emergency contraception; however, they wanted hormonal emergency contraception to be available.



Population effect of increased access to emergency contraceptive pills: a systematic review
(Abstract; subscription needed for full text; North America)
Obstetrics & Gynecology . 2007 Jan;109:181-188.
Raymond EG | Trussell J | Polis CB
The authors systematically reviewed data on effects of increased access (including different levels of access) to emergency contraceptive pills on pregnancy rates and use of the pills. Of the 717 articles identified, the authors selected 23 for review. The studies included randomized trials, cohort studies, and evaluations of community interventions. Increased access to emergency contraceptive pills enhances use, but has not been shown to reduce unintended pregnancy rates.

FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS

Girls should receive cervical cancer vaccine: experts
(News Article; North America)
19 Jan 2007
Yahoo/HealthDay News
New American Cancer Society guidelines recommend that females should be vaccinated against human papillomavirus (HPV) when they are 11 to 12 years old in order to prevent cervical cancer. The new guidelines emphasize that the full potential of the HPV vaccine will be reached only if widespread vaccination is achieved in groups of women who do not get regular cervical screenings.

HIV/AIDS RESEARCH

Rapid point-of-care HIV testing in pregnant women: a systematic review and meta-analysis
(Abstract; subscription needed for full text; Global)
Tropical Medicine and International Health. 2007 Feb;Online Access January 11, 2007. 12(2):1-12.
Pai N | Tulsky J | Cohan D | Colford J | Reingold A
Rapid, point-of-care human immunodeficiency virus testing has the potential to enhance strategies to prevent mother-to-child transmission of HIV infection. Rapid tests need minimal laboratory infrastructure and can be performed by health workers with minimal training. This systematic review and meta-analysis summarized the overall diagnostic accuracy of rapid HIV tests in pregnancy, and outcomes such as acceptability, patient preference, feasibility and impact of rapid testing.



Experience with the use of a first-line regimen of stavudine, lamivudine and nevirapine in patients in the TREAT Asia HIV observational database
(Abstract; subscription needed for full text; Asia)
HIV Medicine. 15 Jan 2007;8(1):8-16.
Zhou J | Paton N | Ditangco R | Chen Y | Kamarulzaman A | Kumarasamy N | et al
The antiretroviral treatment combination of stavudine, lamivudine and nevirapine is the most frequently used initial regimen in many Asian countries. There are few data on the outcome of this treatment in clinic cohorts in this region. This study selected patients from the TREAT Asia HIV Observational Database and looked at their success rates, providing insight into clinical practice in Asia and the Pacific region, concluding there is a need to develop affordable second-line antiretroviral treatment options for patients with HIV infection in developing countries.

HIV/AIDS NEWS

Brazilians find gel to combat HIV/AIDS
(News Article; Global)
17 Jan 2007
Mmegi Online Botswana
Brazilian scientists have developed a new type of anti-HIV drug, which could possibly be put on the market in a few years. The drug was extracted from a type of algae found on the Brazilian coast. The first-phase testing shows that the gel is 95 percent efficient in blocking the sexual transmission of HIV. The team hopes the gel, one of a new generation of microbicides, would be key to preventing HIV infection in women.



Africa: First ladies call for new HIV/AIDS initiatives
(News Article; Sub-Saharan Africa)
16 Jan 2007
AllAfrica
Three African first ladies, Azeb Mesfin of Ethiopia, Jeanette Kagame of Rwanda, and Maureen Mwanawasa of Zambia, called for new and further-reaching approaches to combating HIV/AIDS in Africa at the World Bank Headquarters in Washington, DC. They spoke on behalf of the Organization of African First Ladies Against HIV/AIDS, formed in 2002.

MATERNAL AND CHILD HEALTH RESEARCH

Two-year morbidity–mortality and alternatives to prolonged breast-feeding among children born to HIV-infected mothers in Côte d'Ivoire
(Research Article; Sub-Saharan Africa)
PLoS Medicine. 2007 Jan;Online access January 18, 2007. 4(1):e17.
Becquet R | Bequet L | Ekouevi DK | Ida Viho I | Sakarovitch C | Fassinou P | Bedikou G | Timite-Konan M | Dabis F | Leroy V
Related News Article: Safety of short-term breastfeeding among children born to HIV-infected mothers in Cote d’Ivoire: lessons for urban Africa?
HIV-infected pregnant women in Abidjan, Côte d'Ivoire received a peripartum antiretroviral prophylaxis and were presented antenatally with infant feeding interventions: either artificial feeding, or exclusive breast-feeding and then early cessation from 4 mo of age. The primary outcome was the occurrence of adverse health outcomes in children or severe events such as hospitalization or death. The two year rates of adverse health outcomes were similar among short term breastfed and formula-fed children. Mortality rates did not differ significantly between these two groups.



Simple antenatal preparation to improve breastfeeding practice
(Abstract; subscription needed for full text; Asia)
Obstetrics & Gynecology . 2007 Jan;109:73-80.
Mattar CN | Chong YS | Chan YS | Chew A | Tan P | Chan YH | How-Jing Rauff M
This study addressed the impact of simple antenatal educational interventions on breastfeeding practice in Singapore. Women in group A received educational material and individual coaching from a lactation counselor. Group B received educational material with no counseling. Group C received routine antenatal care only. Where breastfeeding practices are suboptimal, simple one-encounter antenatal education and counseling improve breastfeeding practice up to 3 months after delivery. Provision of printed or audiovisual educational material is not enough.



Systematic review of effects of low-moderate prenatal alcohol exposure on pregnancy outcome
(Abstract; subscription needed for full text; Global)
BJOG: An International Journal of Obstetrics and Gynaecology. 2007 Jan;Online access January 18, 2007.
Henderson J | Gray R | Brocklehurst P
The aim of this study was to review systematically the available evidence on studies in humans on the effects of low–moderate levels of prenatal alcohol consumption (up to 10.4 UK units or 83 g/week) compared with consumption of no alcohol on pregnancy outcome. The search resulted in 3630 titles and abstracts, which were narrowed down to 46 relevant articles. At low–moderate levels of consumption, there were no consistently significant effects of alcohol on any of the outcomes considered. Many of the reported studies had methodological weaknesses.

MATERNAL AND CHILD HEALTH NEWS

Pregnancy is a dangerous pursuit in Zambia
(News Article; Sub-Saharan Africa)
2007 Jan 17;
Chimangeni I, Inter Press Service News Agency
The maternal mortality ratio in Zambia is 728 per 100,000 live births. Although the government, in collaboration with UNFPA's Safe Motherhood Project, has been working at reducing maternal mortality by educating and involving communities, it is unlikely that the maternal health situation in Zambia will improve rapidly enough to meet the U.N. Millennium Development Goal of reducing the maternal mortality rate by three quarters before 2015.



Pakistan: Obstetric fistula - Grim reminder of unmet MDGs
(News Article; Asia)
17 Jan 2007
Ebrahim Z, Inter Press Service News Agency
Since the launch of UNFPA's first-ever national campaign to end fistula in Pakistan in 2006, seven regional centres have been set up where surgeries to repair fistula are carried out free of charge.



New York hospital moves to offer first uterus transplant in U.S. history
(News Article; Global)
15 Jan 2007
Fox News
A New York hospital is taking steps to offer the first uterus transplant in the United States. This radical experiment might allow women whose wombs were removed or are defective to bear children. The wombs would come from dead donors, just as most other organs do, and would be removed after the recipient gives birth so she would not need anti-rejection drugs her whole life. Several experts cautioned that much more research must be done, and one declared this bold concept "not really ready for prime time."

MEN'S HEALTH RESEARCH

Is smoking a risk factor for decreased semen quality? A cross-sectional analysis
(Abstract; subscription needed for full text; Global)
Human Reproduction. 2007 Jan;22(1):188-196.
Ramlau-Hansen CH | Thulstrup AM | Aggerholm AS | Jensen MS | Toft G | Bonde JP
This study investigated the association between current smoking and semen characteristics and hormonal levels in 2562 men. Adjusting for study, age and other covariates, an inverse dose–response relation between smoking and semen volume, total sperm count and percentage motile sperm was observed. Heavy smokers had a 19% lower sperm concentration than non-smokers.



The natural progression and remission of erectile dysfunction: results from the Massachusetts male aging study
(Abstract; subscription needed for full text; Global)
The Journal of Urology. 2007 Jan;177(1):241-246.
Travison TG | Shabsigh R | Araujo AB | Kupelian V | O’Donnell AB | McKinlay JB
This analysis estimates the frequency of erectile dysfunction progression and remission among aging men, and assesses the relation of progression/remission to demographics, socioeconomic factors, comorbidities and modifiable lifestyle characteristics. Natural remission and progression occur in a substantial number of men with erectile dysfunction. The association of body mass index with remission and progression, and the association of smoking and health status with progression, offer potential avenues for facilitating remission.



Demographic and clinical characteristics of chronic prostatitis: prospective comparison of the University of Sciences Malaysia cohort with the United States National Institutes of Health cohort
(Abstract; subscription needed for full text; Asia)
The Journal of Urology. 2007 Jan;177(1):153-157.
Lee SW | Cheah PY | Liong ML | Yuen KH | Schaeffer AJ | Propert K | Krieger JN
The authors compared demographic and clinical characteristics of the University of Sciences Malaysia Chronic Prostatitis Cohort to the United States National Institutes of Health Chronic Prostatitis Cohort. These diverse populations proved similar in most respects; both cohorts experienced major reduction in their quality of life from chronic pelvic pain and urinary symptoms.

MEN'S HEALTH NEWS

Age-related impotence may improve over time
(News Article; Global)
16 Jan 2007
About one third of older men who are impotent (men with erectile dysfunction) will experience natural remission, with symptoms becoming less severe but not necessarily going away completely, research suggests. However, they also estimated another third will experience a worsening of this condition over time.

POPULATION RESEARCH

Population Control in India: Prologue to the Emergency Period
(Abstract; subscription needed for full text; Asia)
Population and Development Review. 2006 Dec;32(4):629-667.
Connelly M
The Emergency Period of 1965-67 in India has become emblematic of everything that can go wrong in a program based on "population control" rather than on informed choice. Problems of the program included time-bound targets, incentive payments, and contravention of medical standards. These developments led to a disastrous campaign to induce 29 million women to accept IUDs. This article explores how and why such policies were developed.

POPULATION NEWS

Record number of countries contribute record amount to UN Population Fund
(News Article; Global)
15 Jan 2007
UN News Centre
One hundred and eighty countries contributed $360 million to the regular resources of the United Nations Population Fund (UNFPA) last year, the highest number of donors and the largest total since the organization began its operations in 1969 to promote a raft of activities from ensuring safe births to reducing poverty. UNFPA Executive Director Thoraya Ahmed Obaid said that this new record highlights the importance of sexual and reproductive health, as well as HIV prevention, for development.



Hong Kong: Pregnant Chinese face HK limits
(News Article; Asia)
17 Jan 2007
England V, BBC News
New rules are due to take effect on 1 February 2007 that will work toward reducing the number of Chinese women who give birth in Hong Kong, both in order to avoid China's one-child policy and to ensure their child is a citizen of Hong Kong. Hospitals in Hong Kong are setting up a centralised booking system to give priority to local women, and impose a quota on the number of mainland mothers allowed in after 1 February. After this date, any pregnant woman coming from China without a hospital booking will be turned back at the border.



China's men lack millions of brides
(News Article; Asia)
15 Jan 2007
The Australian
China will be short 30 million brides within 15 years because of its gender imbalance, according to an official report on the country's burgeoning population. About one in every 10 men aged between 20 and 45 -- equivalent to almost the entire population of Canada -- will be unable to find a wife. China's gender ratio for newborn babies in 2005 was 118 boys to 100 girls, compared with 110 to 100 in 2000.



Pakistan: Population burst causing problems
(News Article; Asia)
18 Jan 2007
The International News
Prime Minister Shaukat Aziz said that Pakistan was facing problems relating to the provision of health, education, food, energy and water due to the high population growth rate. The prime minister reported that the government was working on an agenda for lowering the population growth rate in order to overcome the problems emanating from the over-population. He warned, though, that dependence on the government efforts in this regard would not be enough and instead, the people would also have to behave sensibly and play their role.

WOMEN'S HEALTH RESEARCH

Female sexual dysfunction in Lower Egypt
(Abstract; subscription needed for full text; North Africa)
BJOG: An International Journal of Obstetrics and Gynaecology. 2007 Feb;Online access January 18, 2007. 114(2):201-206.
Elnashar AM | EL-Dien Ibrahim M | EL-Desoky MM | Ali OM | El-Sayd Mohamed Hassan M
The aim of this study was to assess the prevalence and associated factors of female sexual dysfunction in Lower Egypt. 68.9% of women had one or more sexual problems, though 23% of the women with sexual problems were not distressed by these issues. Marital disharmony, 'hate' and unfavorable socioeconomic circumstances were the most common aggravating factors for sexual dysfunction, followed by pregnancy-related events. 90.3% of the women were circumcised. Most women received no help for their sexual problems.

WOMEN'S HEALTH NEWS

Women and girls must be protected from violence, UN official tells rights committee
(News Article; Global)
15 Jan 2007
UN News Centre
The Committee on the Elimination of Discrimination against Women, a panel comprising 23 international experts on women’s issues, recently launched a two-week session at UN Headquarters in New York. During this session panel members will examine the reports of 15 countries regarding their implementation of measures to eliminate discrimination against women. Senior UN Official, Rachel Mayanja, notes that states who have signed on to the United Nations international bill of rights for women must continue to press for an end to gender-based violence.



Rural Ethiopia ignores law against child brides
(News Article; Sub-Saharan Africa)
15 Jan 2007
National Public Radio
The Ethiopian government is backing a series of new family planning policies, including a ban on the practice of marrying girls while they're still children. In rural villages, some women are indifferent to the change while others are welcoming it.

YOUTH HEALTH RESEARCH

A rather benign sexual culture: socio-sexual lifestyles of youth in urban Central Java, Indonesia
(Abstract; subscription needed for full text; Asia)
Population, Place and Space. 2007 Jan;13(1):59-76.
Ford N | Shaluhiyah Z | Suryoputro A
Sexuality is clearly a key dimension for both population and medical geography. The challenge of HIV prevention has given rise to research efforts to understand the pattern and dynamics of sexual lifestyles. This paper reports upon findings from a study undertaken upon the socio-sexual lifestyles of youth from low-income and middle class social environments in urban Central Java, Indonesia. The main part of the paper concerns a discussion of a range of young men and women's socio-sexual lifestyles.

YOUTH HEALTH NEWS

India: Students roped in for crusade against AIDS
(News Article; Asia)
15 Jan 2007
Telegraph India
A district administration in the Indian state of Assam has taken the fight against HIV/AIDS into the classroom. The district resource center recently launched the School AIDS Education program in the district with financial assistance from the Assam State AIDS Control Society. Students trained at workshops will be required to pass on the information given to them to other students in their respective schools.



Nigeria: genital mutilation...what the youth should know
(News Article; Sub-Saharan Africa)
All Africa
The Inter African Committee (IAC) Nigeria has insisted that it will continue to champion the course of eliminating harmful practices affecting the lives of not only women and children, but of mankind generally. The IAC recently organized a capacity-building workshop for youth from four states in Nigeria. The theme of the event was, "Catching the Youth: Young to Think, Talk and Act Against Harmful Traditional Practices." The organisers of the event focused on female genital mutilation.



India: Child nutrition campaign 'fails'
(News Article; Asia)
16 Jan 2007
BBC
India's Prime Minister warned that malnutrition rates for children in his country remain among the highest in the world. Following a UN report that said that half of the world's under-nourished children live in South Asia, with most in India, the prime minister sent a strongly worded letter to state chief ministers stating that a massive program to improve health and nutrition had been poorly implemented and had not sufficiently reduced child malnourishment levels.

SPECIAL REPORTS/PROFILES/RESOURCES

Children and AIDS: A stocktaking report
(Progress Report; Global)
(You need Adobe Acrobat Reader to access this document)
2007 Jan 16;
UNAIDS/UNICEF/WHO
This UNAIDS/UNICEF/WHO report summarizes progress on children and AIDS since the Unite for Children, Unite against AIDS initiative was launched in October 2005 and highlights important breakthroughs and progress noted in the global response to Children and AIDS since the campaign launch. Such achievements include real progress noted in some countries in preventing HIV transmission from mothers to children and providing treatment for children living with AIDS (44p PDF 3.49 MB).



Time to talk: A guide to family life in the age of AIDS
(Teaching and Training Material; Sub-Saharan Africa)
Tengatenga J | Bayley A
This training resource is designed to enable churches to discuss family life and sex in the context of the global AIDS epidemic. Intended for use by pastors, deacons and religious sisters, as well as catechists and lay church leaders. The book contains guidelines for running group activities - role plays, games, quizzes, discussions, Bible readings and other participatory exercises. These are all designed to help men and women examine the attitudes, beliefs and behaviours that can spread HIV and, if necessary, make changes in their own lives.

Continuous Identification of Research Evidence (CIRE) Related to Family Planning Guidance

Nappi C, Di Spiezio Sardo A, Greco E, Tommaselli GA, and Giordano E. Effects of an oral contraceptive containing drospirenone on bone turnover and bone mineral density. Obstetrics and Gynecology. 2005 Jan;105(1):53-60
This study compared the effects of a new 21-day combined oral contraceptive containing 30 micrograms ethinyl/estradiol plus 3 milligrams drospirenone with a 21-day preparation containing 30 micrograms ethinyl/estradiol plus 75 micrograms gestodene on bone turnover and bone mineral density in young fertile women. At 12 months, no significant difference was detected in lumbar bone mineral density values among the 3 groups and in comparison with basal values.


Link to CIRE evidence: http://www.infoforhealth.org/cire_pub.pl?cire_input=COC.Age..2666.3549.Y



Beksinska ME, Smit JA, Kleinschmidt I, Farley TM, and Mbatha F. Bone mineral density in women aged 40-49 years using depot-medroxyprogesterone acetate, norethisterone enanthate or combined oral contraceptives for contraception. Contraception. 2005;71:170-175
This study investigated bone mineral density in older women (40-49 years) in relation to use of depot-medroxyprogesterone acetate (DMPA), norethisterone enanthate (NET-EN) and combined oral contraceptives (COCs) for at least 12 months preceding recruitment into the study. There was no significant difference in BMD between the four contraceptive user groups (p=.26) with and without adjustment for age.


Link to CIRE evidence: http://www.infoforhealth.org/cire_pub.pl?cire_input=COC.Age..2651.3521.Y

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