Information

22.11: Contraception - Biology

22.11: Contraception - Biology


We are searching data for your request:

Forums and discussions:
Manuals and reference books:
Data from registers:
Wait the end of the search in all databases.
Upon completion, a link will appear to access the found materials.

Family Planning Pioneer

Her name was Marie Stopes, and she was a British author and paleobotanist who lived from 1880 to 1958. She is pictured here in her lab next to her microscope. Stopes made significant contributions to science and was the first woman on the faculty of the University of Manchester in England. Her primary claim to fame was her work as a family planning pioneer.

Along with her husband, Stopes founded the first birth control clinic in Britain. She also edited a newsletter called Birth Control News, which gave explicit practical advice on how to avoid unwanted pregnancies. In 1918, she published a sex manual titled Married Love. The book was controversial and influential, bringing the subject of contraception into wide public discourse for the first time.

What is Contraception?

About a century after Married Love, more than half of all fertile married couples worldwide use some form of contraception. Contraception, also known as birth control, is any method or device used to prevent pregnancy. Birth control methods have been used for centuries, but safe and effective methods only became available in the 20th century, in part because of the work of people like Marie Stopes.

Many different birth control methods are currently available, but they differ considerably in their effectiveness at preventing pregnancy. The effectiveness of contraception is generally expressed as the failure rate, which is the percentage of women who become pregnant using a given method during the first year of use. Virtually no one uses any method of birth control perfectly, so the failure rate with typical use is almost always higher — and often much higher — than the failure rate with perfect use. For example, with perfect use, a birth control method might have a failure rate of just one percent, whereas, with typical use, the failure rate might be 25 percent. For comparison, there is an average one-year pregnancy rate of 85 percent if no contraception is used.

All methods of birth control have potential adverse effects, but their health risks are less than the health risks associated with pregnancy. Using contraception to space the children in a family is also good for the children’s health and development, as well as for the health of the mother.

Types of Contraception and Their Effectiveness

Types of birth control methods include barrier methods, hormonal methods, intrauterine devices, behavioral methods, and sterilization. With the exception of sterilization, all of these methods are reversible. Examples of each type of birth control method and their failure rates with typical use are described below.

Barrier Methods

Barrier methods are devices that are used to physically block sperm from entering the uterus. They include condoms and diaphragms. Eighteen out of 100 individuals who use this method may get pregnant.

Condoms

Condoms are the most commonly used method of birth control globally. There are condoms for vaginas and penises, but penis condoms are more widely used, less expensive, and more readily available. Both types of condoms are pictured in Figure (PageIndex{2}).

Whichever type of condom is used, it must be put in place before sexual intercourse occurs. Condoms work by physically blocking ejaculated sperm from entering the vagina of the sexual partner. With typical use, penis condoms have an 18 percent failure rate, and vagina condoms have a 21 percent failure rate. Unlike virtually all other birth control methods, condoms also help prevent the spread of sexually transmitted infections (STIs), in addition to helping to prevent pregnancy.

Diaphragms

Diaphragms, like the one in Figure (PageIndex{3}), ideally prevent sperm from passing through the cervical canal and into the uterus. A diaphragm is inserted vaginally before sexual intercourse occurs and must be placed over the cervix to be effective. It is usually recommended that a diaphragm be covered with spermicide before insertion for extra protection. It is also recommended that the diaphragm be left in place for at least six hours after intercourse. The failure rate of diaphragms with typical use is about 12 percent, which is about half that of condoms. However, diaphragms do not help prevent the spread of STIs, and their use is also associated with an increased frequency of urinary tract infections.

Hormonal Methods

Hormonal contraception is the administration of hormones to prevent ovulation. Hormones can be taken orally in birth control pills, implanted under the skin, injected into a muscle, or received transdermally from a skin patch. Six to twelve pregnancies in hundred individuals who use this method may occur.

Hormonal methods are currently available only for individuals with uterus and ovaries. Birth control pills are the most common form of hormonal contraception. There are two types of pills: the combined pill (which contains both estrogen and progesterone) and the progesterone-only pill. Both types of pills inhibit ovulation and thicken cervical mucus. The failure rate of birth control pills is only about one percent or less if used perfectly. However, the failure rate rises to about ten percent with typical use, because individuals do not always remember to take the pill at the same time every day. The combined pill is associated with a slightly increased risk of blood clots, but a reduced risk of ovarian and endometrial cancers. The progesterone-only pill does not increase the risk of blood clots, but it may cause irregular menstrual periods. It may take a few weeks or even months for fertility to return to normal after the long-term use of birth control pills.

Intrauterine Devices

An intrauterine device (IUD) is a T-shaped or coiled plastic structure that is inserted into the uterus via the vagina and cervix that contains either copper or a hormone. You can see an IUD in the uterus in the drawing in Figure (PageIndex{4}). An IUD is inserted by a physician and may be left in place for months or even years. A physician also must remove an IUD, using the strings attached to the device. The copper in copper IUDs prevents pregnancy by interfering with the movement of sperm so they cannot reach and fertilize an egg. The copper may also prevent implantation in the unlikely circumstance of a sperm managing to reach and fertilize an egg. Almost no one gets pregnant who uses this method.

The hormones in hormonal IUDs prevent pregnancy by thickening cervical mucus and trapping sperm. The hormones may also interfere with ovulation, so there is no egg to fertilize. For both types of IUDs, the failure rates are less than one percent, and failure rates with typical use are virtually the same as failure rates with perfect use. Their effectiveness is one reason that IUDs are among the most widely used forms of reversible contraception. Once removed, even after long-term use, fertility returns to normal immediately. On the other hand, IUDs do have a risk of complications, including increased menstrual bleeding and more painful menstrual cramps. IUDs are also occasionally expelled from the uterus, and there is a slight risk of perforation of the uterus by the IUD.

Behavioral Methods

The least effective methods of contraception are behavioral methods. They involve regulating the timing or method of intercourse to prevent the introduction of sperm into the uterus, either altogether or when an egg may be present. Behavioral methods include fertility awareness methods and withdrawal. Abstinence from sexual activity, or at least from vaginal intercourse, is sometimes considered a behavioral method, as well — but it is unlikely to be practiced consistently enough by most people to prevent pregnancy. Even teens who receive abstinence-only sex education do not have reduced rates of pregnancy. Abstinence is also ineffective in cases of non-consensual sex.

Fertility Awareness Methods

Fertility awareness methods involve estimating the most fertile days of the menstrual cycle and then avoiding unprotected vaginal intercourse on those days. The most fertile days are generally a few days before ovulation occurs, the day of ovulation, and another day or two after that. Unless unprotected sex occurs on those days, pregnancy is unlikely. Techniques for estimating the most fertile days include monitoring and detecting minor changes in basal body temperature or cervical secretions. This requires daily motivation and diligence, so it is not surprising that typical-use failure rates of these methods are at least 20 to 25 percent, and for some individuals may be as high as using no contraception at all (85 percent).

Basal body temperature is the lowest body temperature when the body is at rest (usually during sleep). It is most often estimated by a temperature measurement taken immediately upon awakening in the morning and before any physical activity has occurred. Basal body temperature normally rises after ovulation occurs, as shown in Figure (PageIndex{5}). The increase in temperature is small but consistent and may be used to determine when ovulation occurs, around which time unprotected intercourse should be avoided to prevent pregnancy. However, basal body temperature only shows when ovulation has already occurred, and it cannot predict in advance when ovulation will occur. Sperm can live for up to a week in the female reproductive tract, so determining the occurrence of ovulation only after the fact is a major drawback of this method.

Monitoring cervical mucus has the potential for being more effective than monitoring basal body temperature because it can predict ovulation ahead of time. As ovulation approaches, cervical secretions usually increase in the amount and become thinner (which helps sperm swim through the cervical canal). By recognizing the changing characteristics of cervical mucus, ovulation timing can be predicted. From this information, it can be determined when to avoid unprotected sex to prevent pregnancy.

Withdrawal

Withdrawal (also called coitus interruptus) is the practice of withdrawing the penis from the vagina before ejaculation occurs. The main risk of the withdrawal method is that penis is not withdrawn in a timely manner. The fluid typically released from the penis before ejaculation occurs may also contain some sperm. In addition, if sperms are ejaculated just outside of the vagina, there is a chance they will be able to enter the vagina and travel up to fertilize an egg. For all these reasons, the withdrawal method has a relatively high failure rate of about 22 percent with typical use.

Sterilization

The most effective contraceptive method is sterilization. In both sexes, sterilization generally involves surgical procedures that are considered irreversible. Additional surgery may be able to reverse a sterilization procedure, but there are no guarantees. Male sterilization is generally less invasive and less risky than female sterilization.

Male Sterilization

Male sterilization is usually achieved with a vasectomy. In this surgery, the vas deferens from each testis is clamped, cut, or otherwise sealed (Figure (PageIndex{6})). This prevents sperm from traveling from the epididymis to the ejaculatory ducts and being ejaculated from the penis. The same amount of semen will still be ejaculated, but it will not contain any sperm, making fertilization impossible. After a vasectomy, the testes continue to produce sperm, but the sperms are reabsorbed. It usually takes several months after a vasectomy for all remaining sperm to be ejaculated or reabsorbed. In the meantime, another method of birth control should be used.

Female Sterilization

The procedure undertaken for female sterilization is usually tubal ligation. The Fallopian tubes may be tied or cut in a surgical procedure, which permanently blocks the tubes. Alternatively, tiny metal implants may be inserted into the Fallopian tubes in a nonsurgical procedure. Over time, scar tissue grows around the implants and permanently blocks the tubes. Either method stops eggs from traveling from the ovaries through the Fallopian tubes, where fertilization usually takes place.

Emergency Contraception

Emergency contraception is any form of contraception that is used after unprotected vaginal intercourse. One method is the so-called “morning-after” pill. This is essentially a high-dose birth control pill that helps prevent pregnancy by temporarily preventing ovulation. It works only if ovulation has not already occurred, and when taken within five days after unprotected sex. The sooner the pill is taken, the more likely it is to work. Another method of emergency contraception is the IUD. An IUD that is inserted up to five days after unprotected sex can prevent nearly 100 percent of pregnancies. It keeps sperm from reaching and fertilizing an egg or inhibits implantation if an egg has already been fertilized. The IUD can then be left in place to prevent future pregnancies.

Review

  1. Define contraception. Globally, how prevalent is the use of contraception by fertile married couples?
  2. How is the effectiveness of contraceptive methods typically measured?
  3. List five different types of birth control methods. Which (if any) methods are reversible? Which (if any) methods can prevent the spread of sexually transmitted infections, as well as pregnancies?
  4. What are barrier methods? Give two examples.
  5. Describe hormonal contraception. What is the most commonly used form of hormonal contraception?
  6. What is an IUD?
  7. Generally, describe behavioral methods of contraception, and identify two specific behavioral methods.
  8. Discuss sterilization as a birth control method. How is sterilization typically achieved in males? In females?
  9. What is emergency contraception? When is it used? What are the two forms of emergency contraception?
  10. How does the thickness of cervical mucus relate to fertility? How do two methods of contraception take advantage of this relationship?
  11. Arrange the following methods of contraception in order of typical effectiveness, from the least effective to most effective: birth control pill; fertility awareness method; IUD; male condom
  12. If a newly developed method of contraception had a 35 percent failure rate, would you consider this to be an effective method? Explain your answer.
  13. Which method of contraception prevents ovulation?
    1. female condom
    2. tubal ligation
    3. birth control pill
    4. fertility awareness method
  14. True or False: A vasectomy prevents the production of sperm.
  15. True or False: If a man and woman have unprotected intercourse four days before ovulation occurs, the woman cannot get pregnant.

Explore More

bio.libretexts.org/link?17799#Explore_More


Norethisterone

Norethisterone, also known as norethindrone and sold under many brand names, is a progestin medication used in birth control pills, menopausal hormone therapy, and for the treatment of gynecological disorders. [3] [5] The medication is available in both low-dose and high-dose formulations and both alone and in combination with an estrogen. [5] [6] It is used by mouth or, as norethisterone enanthate, by injection into muscle. [3] [5] [7]

  • 68-22-4 Y
  • DB00717 Y
  • 5994 Y
  • D00182 Y
  • CHEBI:7627 Y
  • ChEMBL1162 Y
InChI=1S/C20H26O2/c1-3-20(22)11-9-18-17-6-4-13-12-14(21)5-7-15(13)16(17)8-10-19(18,20)2/h1,12,15-18,22H,4-11H2,2H3/t15-,16+,17+,18-,19-,20-/m0/s1 Y Key:VIKNJXKGJWUCNN-XGXHKTLJSA-N Y

Side effects of norethisterone include menstrual irregularities, headaches, nausea, breast tenderness, mood changes, acne, increased hair growth. [8] [9] Norethisterone is a progestin, or a synthetic progestogen, and hence is an agonist of the progesterone receptor, the biological target of progestogens like progesterone. [3] [5] It has weak androgenic and estrogenic activity, mostly at high dosages, and no other important hormonal activity. [3] [10]

Norethisterone was discovered in 1951 and was one of the first progestins to be developed. [11] [12] [13] It was first introduced for medical use on its own in 1957 and was introduced in combination with an estrogen for use as a birth control pill in 1963. [13] [14] It is sometimes referred to as a "first-generation" progestin. [15] [16] Along with desogestrel, it is one of the only progestins that is widely available as a progestogen-only "mini pill" for birth control. [17] [18] Norethisterone is marketed widely throughout the world. [19] It is available as a generic medication. [20] In 2018, it was the 138th most commonly prescribed medication in the United States, with more than 5 million prescriptions. [21] [22]


An Introduction to the Male reproductive system

As earlier mentioned the purpose of my blogs are to let the non science readers understand the science in an easy and interesting way .During my live radio shows at Awaz Fm 107.2 (www.awazfm.co.uk/gullalaii.html). I have came across the male listeners who would call and request if I could explain the male reproductive issues in an easy language. I tried to refer them to the websites that I have found easy and interesting. To my surprise they refused and insisted that they like the way I explain the scientific terminologies thus, helps them to understand the phenomena easily even on air. This made me think to write a blog for my male listeners whom feel shame to ask anyone or their kids at home if they want to know about any reproductive related issues. My blogs focus on the Asian ethnic minorities where to get awareness about issues such as reproductive systems, sexual organs, infertility, sexually transmitted diseases contraception is a taboo and considered a shame to be discussed.

There are three main functions of the male reproductive system

  1. The production of the male germs cells or sperm along with the protective fluid called semen.
  2. The transfer of sperms inside the vagina of the female during sexual intercourse.
  3. The production of hormones for the function of the male reproductive system.

The male reproductive system consists of three parts, penis, scrotum and testicles.

Penis: The penis has three parts the bottom or root attached to the wall of the abdomen, the main shaft and the head or glans.

The shaft has three circular chambers all have soft tissue and sacs. The blood supply to the soft tissue or sac fill them up thus, makes the penis erect and stiff that enables it to penetrate the vagina during the intercourse. The head or glan of the penis has loose skin that is called foreskin. Sometime the skin has been removed during a process called circumcision. The skin of the shaft is flexible so when the penis gets erected and the skin can get stretched. The head has an opening called urethra for the discharge of urine and sperms. When the penis gets erected as a reflex action, the urine gets blocked means that urine is not released at the same time as semen. There are more than 20 million sperms per ml in an ejaculation of average 2.5 -5 ml volume.

Scrotum: It is a sac that is located outside the body hanging down. There are muscles and blood supply to these sacs. It contains the testes also called testicles. The scrotum has a special temperature control mechanism therefore, if the development of testes needs warmth then the muscles contracts thus keeping the testicles nearer to the body. While if need to be kept cooler the sacs muscles gets relax, keeping them away from the body.

Testicles: The scrotum contains two testicles almost an olive size attached by a spermatic cord .The testes produces testosterone hormone ( a male sex hormone) and sperms. There is a coiled mass of tubes known as seminiferous tubes which are responsible for the production of the sperm cells.

This You Tube video would enable the readers to understand the system v well.

Beside main parts of the reproductive system there are other structures that are seen in the above figures such as:

Epididymis: It is a coiled tube that is found behind the testis. The immature sperms are released by the testes in to the epididymis and they get matures there before fertilization. During the sexual desire the force pushes the mature sperms in to the vas deferens.

Vas deferens: These are muscular tubes whose function is to transfer the mature sperms from the epididymis to the urethra from where the sperms are ejaculated outside the penis through the tiny hole.

Ejaculatory Ducts: They are formed by the fusion of vas deferens and the seminal vesicles .They transfer sperms to the urethra.

Seminal vesicles: These are sacs attached to the vas deferens. The main function is to produce the sugar rich fluid that provides energy to the sperms for the movement. The fluid from seminal vesicles constitutes the major portion of the ejaculate i.e 60-70 %.

Prostate gland: It is walnut sized gland that provides additional fluid for the nourishment of the sperms. The fluid also contributes to the volume of the ejaculate. The urethra that contains the sperms runs through the centre of the prostate gland.

Bulbourethral glands: also known as Cowper’s glands situated below the prostate glands. They secrete a fluid that empties in to the urethra. This fluid lubricates the urethra and neutralizes the acidity of the urethra if any urine drops are left over.

Function of male reproductive system: The main function is controlled by the chemicals known as hormones. The main hormones that are responsible for the function of male reproductive system are: The follicle stimulating hormone that is responsible for the formation of the sperms (spermatogenesis). The luteinizing hormone is responsible for the production of the testosterone which is involved in the sperm production. The testosterone is also responsible for the secondary male characters such as facial hair growth, voice change at puberty, sex desire, fats growth and bone growth or mass.


Does the oral contraceptive pill &ldquoage&rdquo a woman's cervix prematurely?

Well, I heard an interesting one tonight. My wife passed on that on a blog discussing contraceptive use, someone posted a link to a site stating that taking Ortho Tri Cyclen, an oral contraceptive, "ages" the cervix prematurely.

The implication was that if a younger woman takes the pill, her cervix could end up being of an "age" of an older woman, thus preventing pregnancy when desired (and when taking oral contraceptives is stopped).

I had a heck of a time trying to research this on my own.

  • I started with googling "ortho tri cyclen" to find out more and examine side effects. I could only find it mentioned on the Wikipedia page for oral contraceptive formulations but no main site with side effects.
  • I looked at the pages for the two types of birth control pill (progestogen-only and combined) and didn't see anything like this listed in the side effects.

In googling "the pill ages the cervix", the top link directed me to the potential source of this claim, a page on a site called WOOMB, World Organization Ovulation Method Billings (emphasis mine):

The cervix undergoes a natural process of development and ageing. The area of the cervix given over to the mucus secreting crypts gradually diminishes from maturity. The number of S crypts decreases from teenage. They are first replaced by L crypts starting at the base of the cervix. Later G crypts replace the L crypts.

"The L replaces S and G replaces L transformations are partially reversed by changes during pregnancy, but they are partially accelerated by the Pill. These circumstances may be simply stated by the expression: a pregancy rejuvenates the cervix by 2-3 years, but for each year the Pill is taken, the cervix ages by an extra year." ("The Discovery of Different Types of Cervical Mucus and the Billings Ovulation Method", Professor Erik Odeblad, Bulletin of the Natural Family Council of Victoria, ISSN 0321-7567, Vol 21 No 3 September 1994, pp3-35).

Following the link to Professor Erik Odeblad's work, I was surprised to find what I considered a much more modest statement (emphasis mine):

The study of the effects of contraceptive pills on the cervix is a difficult task. A considerable amount of work is required for each patient and the time required spans many years, up to 10 years or more. Many women also want to change to other pills or to other methods of contraception, or perhaps now want to become pregnant. It also happens that some pills are withdrawn from the market. To these difficulties are added the normal age changes in the cervix and the dynamic processes which are of constant occurrence. After 3 and up to 15 months of contraceptive pill use, there is a greater loss of the S crypt cells than can be replaced.

Read the quote yourself, but there seems to be no obvious connection (at least in that quote, which is what Woomb itself chose to reproduce) made between S crypt cells, the "age" of the cervix, or the ability to become/stay pregnant.

Lastly, here's a blog post that reiterates the above and might be something similar to what caused my wife to bring this up.

Is there evidence supporting the claim that the oral contraceptive pill (or some specific formulation) "age" the cervix prematurely such that the chances for pregnancy are reduced or eliminated even when no longer taking contraceptives?

As an aside, I'm a former Catholic and very familiar with natural family planning (NFP), of which the Billings method is a type. I find it intriguing that this claim would originate with a natural family planning researcher, as these methods tend to be associated with Catholics/Christians who want to avoid pregnancy while not disobeying the doctrine to which they subscribe.

In Catholic culture, natural family planning is not often pitched as simply that -- avoid pregnancy while not sinning there tends to be a lot of preaching against other forms of contraception to make them less appealing, probably because NFP involves long(er) periods of abstinence.

I simply add this to shed light on what I think might be a side agenda of various natural family planning groups: to downplay alternative methods (condoms reduce sensation, the pill ages the cervix, etc.) to keep enticement down as much as possible for religious populations.


Hormonal Contraception and Depression: Updated Evidence and Implications in Clinical Practice

Hormonal contraceptives are used worldwide by more than 100 million women. Some studies have been published about the possible appearance of depressive symptoms when using hormonal contraceptives, but this link is still a matter of debate. The purpose of this review is to provide an update of the literature on this issue, and to investigate the possible explanations of this problem based on animal and human studies. The main pathway responsible for menstrual cycle-related mood changes is the γ-aminobutyric acid pathway, which is sensitive to changes in the levels of progesterone and of its metabolites, the neurosteroids. In particular, allopregnanolone is a potentiating neurosteroid with anxiolytic and anti-convulsant effects whose levels change during a normal menstrual cycle together with progesterone levels. Progestins have different effects on allopregnanolone, mainly owing to their diverse androgenicity. Moreover, they might affect brain structure and function, even though the meaning of these changes has yet to be clarified. It is important to define the groups of women in which negative mood disorders are more likely to occur. Adolescence is a critical period and this age-specific vulnerability is complex and likely bidirectional. Moreover, women with a history of mood affective disorders or premenstrual dysphoric syndrome are at a higher risk when taking contraceptives. In this review, we aim to provide clinicians with advice on how to approach these difficult situations.


Knowledge, Attitude and Practices of Contraception among the Married Women of Reproductive Age Group in Selected Wards of Dharan Sub-Metropolitan City

Citation: Thapa P, Pokharel N, Shrestha M (2018) Knowledge, Attitude and Practices of Contraception among the Married Women of Reproductive Age Group in Selected Wards of Dharan Sub-Metropolitan City. J Contracept Stud Vol.3 No.3:18

Abstract

Background: It is very critical to understand that awareness of family planning and proper utilization of contraceptives is an important indicator for reducing maternal and neonatal mortality and morbidity. It also plays an important role in promoting reproductive health of the women in an underdeveloped country. According to NDHS 2011 the knowledge of at least one contraceptive method was universal in Nepal but only 49.7% of the married women aged 15-49 years were currently using any method. Materials and Methods: A cross sectional descriptive study was conducted among 209 married women of reproductive age in selected wards of Dharan Sub-Metropolitan City. Simple random sampling was used to select the wards and population proportionate sampling for selecting the sample numbers from each ward. Semi-structured self-prepared questionnaire was used to collect data. Descriptive and inferential statistics were used to interpret the data considering p-value 0.05. Results: Most (53.1%) of the respondents were of the age group 20-34 years. Majority (92.3%) of the respondents had ever heard of contraception. Popular known method was Inj. Depo-provera (92.7%). Mass media (85.8%) was the major source of information. Mean percentage score of knowledge was 45.23%. Majority (90.4%) of the respondents had positive attitude and only (64.6%) were usingcontraceptives currently. Education, occupation and total income of the family was associated with knowledge regarding contraceptives. Logistic regression showed significant correlates of attitude with distance to the nearest health centre, education and age group whereas that of practice showed significant association with education, encouragement from husband, women&rsquos participation in decision making, distance to nearest health centre and type of family. A positive correlation was found among knowledge, attitude and practice of contraception. Conclusion: The study concludes that contraceptive practice is relatively low. Improved education on contraception and counselling are needed to solve these problems.

Keywords

Attitude Contraception Knowledge Practice

Introduction

Amongst the various challenges faced by human beings, the most important one today is not infectious disease but population. Over time, family planning program has been changed considerably. Globally Family Planning is promoted as a mechanism to address the reproductive health needs of men and women, as well as the crucial challenge of rapid population increase [1]. Family planning is a practice by which a couple space the number of years between each child they want to give birth to through the use of contraceptive methods [2].

Contraception is the deliberate use of artificial methods or other techniques to prevent pregnancy as a consequence of sexual intercourse. The major forms of artificial contraception are: barrier methods, of which the commonest is the condom or sheath the contraceptive pill, which contains synthetic sex hormones which prevent ovulation in the female intrauterine devices, such as the coil, which prevent the fertilized ovum from implanting in the uterus and male or female sterilization.

&ldquoThe truth is women use contraception not only as a way to prevent unintended pregnancies, but also to improve their health and health of their families. Increased access to contraception is directly linked to declines in maternal and infant mortality&rdquo.

Each year, more than 208 million pregnancies occur worldwide 185 million occur in the developing world alone. Worldwide, almost two in five women who become pregnant have either an abortion or an unplanned birth. More than 40% of pregnancies worldwide are unintended. An estimated 222 million women in developing countries would like to delay or stop child bearing but are not using any method of contraception. An estimated 18 million unsafe abortions take place each year in less developed countries contributing high rates of maternal deaths, and injuries in these regions. In addition, unwanted birth poses risks for children at health and wellbeing and contributes to rapid population growth. Family planning is one of the fundamental pillars of safe motherhood and a reproductive right [3].

Measuring the level of awareness of contraception provides a useful measure of the success of information, education and communication activities and help to identify the areas that need to be strengthened. Involvement of men regarding use of family planning is a must among the couples for consistent and effective result. Men are considered to be a neglected potential consumer of family planning method. Their involvement is found to be very low [4].

Materials and Methods

A descriptive cross-sectional study design was used for the study. A total of 209 married women of reproductive age group (15- 49) mothers were selected from randomly selected four wards of Daharan Sub-Metropolitan City by population proportionate sampling technique. Semi-structured self-prepared interview questionnaire was used to assess knowledge, five point Likert scale for attitude and interview checklist for practice regarding contraception. Data were collected from 16 th Dec to 15 th Jan, 2016 and entered IBM SPSS version 11.0 and analysis was done by using descriptive and inferential statistic. Logistic regression was used only among the variables which were significantly associated in univariate analysis with attitude and practice.

Above Table 1 depicts that most (53.1%) of the respondents belong to the age group 20-34 years. The mean ± SD age of the respondents was 30.01 ± 8.124 years. Majority (81.3%) of the respondents were Hindu. Most (64.1%) of the respondents belonged to disadvantaged janajati followed by (26.8%) upper caste and few (9.1%) Dalit. Most (72.7%) of the respondents were literate. Regarding the occupation, majority (80.3%) of the respondents were housewives. Two-third (64.1%) of the respondents was from nuclear family. Most (64.5%) of the respondents had a family income of less than Rs. 15,000 per month. Most (67.5%) of the respondents were married for more than five years and few (11.0%) were married for less than 2 years. About (58.4%) had parity less than 3. Regarding age of the last child, (55.9%) of the respondents had children of less than 5 years. Most (54.9%) of the respondents had age gap of the last two children in the range of 2-4 years. Only few (5.7%) respondents had a history of abortion. Regarding the distance, majority (77%) had walking distance of less than 30 minutes from their home to the nearest health centre.

Table 1: Socio-demographic Characteristics of Respondents (n=209).

Characteristics Category Frequency Percent (%)
Age in years 15-19 14 6.7
20-34 111 53.1
35-49 84 40.2
Religion Hindu 170 81.3
Buddhist 17 8.2
Kirant 22 10.5
Education Illiterate 57 27.3
Primary 72 34.4
Secondary 55 26.3
Higher 25 12
Occupation Agriculture 16 7.7
Service holder 25 12
Housewives 168 80.3
Type of family Nuclear 134 64.1
Joint 75 35.9
Income of the family/Month <15000 135 64.5
&ge15000 74 35.5
Parity Nulliparous 29 13.8
<3 122 58.4
&ge3 58 27.8
Age of the last child <5 years 100 55.9
&ge5 years 79 44.1
Gap between 2 last children 1-2 years 13 11.5
2-4 years 62 54.9
4 or more 38 33.6
History of abortion Yes 12 5.7
No 196 94.3
Distance of health care centre < 30 minutes 161 77
&ge 30 minutes 48 23

Table 2 reveals that majority of the respondents (92.3%) had heard about the contraception while (7.70%) had not. Injection Depo-Provera was the most (92.7%) known method of contraception, 91.7%, 89.6% had heard about pills and condom respectively.

Table 2: Awareness regarding Contraception and Different Methods of Contraceptives among the Respondents (n=209).

Methods Yes No
Frequency Percent (%) Frequency Percent (%)
Heard about contraception 193 92.3 16 7.7
Methods heard (n=193)
Pills 177 84.68 32 8.3
IUCD 134 69.4 75 30.6
Injection Depo-Provera 179 92.7 30 7.3
Condom 173 89.6 36 10.4
Norplant 134 69.4 75 30.6
Female sterilization 121 62.7 88 37.3
Male sterilization 111 57.5 98 42.5
Abstinence 76 39.4 133 60.6
Withdrawal 68 35.2 141 64.8
Rhythm 22 11.4 187 88.6
Lactational Amenorrhea 17 8.8 192 91.2
Emergency contraception 45 23.3 164 76.7

Above Table 3 shows that majority (85.8%) of the respondents had got information of contraception through mass media and few (24.7%) through relatives.

Table 3: Sources of Information of Contraception among the Respondents (n=193).

Source of Information * Frequency Percent (%)
Health worker 138 72.6
Husband 70 36.8
Friends 72 37.9
Relatives 47 24.7
Mass media 163 85.8
* Multiple Responses

Table 4 shows that avoiding unwanted pregnancy was the most (79.3%) known benefit of contraception However, only (46.6%) respondents knew that it also decreases the economic burden of the family.

Table 4: Knowledge Regarding Benefits of Contraception (n=193).

Benefits of Contraceptives Frequency Percent (%)
Yes 193 92.3
No 16 7.7
If Yes *
Avoid unwanted pregnancy 153 79.3
Maintain birth spacing 138 71.5
Limit the number of births 133 68.9
Decrease the economic burden of family 90 46.6
Improve the health of mother and child 115 59.6
* Multiple Responses

Table 5 reveals that majority (90.4%) of the respondents had a positive attitude and few (9.6%) respondents had negative attitude regarding contraception.

Table 5: Overall Attitude of the Respondents towards Contraception (n=209).

Characteristics Response
Positive Attitude (&ge 60%) Negative Attitude (<60%)
Frequency Percent (%) Frequency Percent (%)
Attitude regarding contraception 189 90.4 20 9.6

Above Table 6 shows that 70.8% of the respondents had ever practiced contraception whereas only (64.6%) of the respondents were currently practicing it. Majority (35.6%) of the respondents were using Injection Depo-Provera followed by female sterilization (18.5%) Abstinence (0.7%). Male sterilization was found to be least (2.2%) practiced.

Table 6: Contraceptive Practice among the Respondents (n=209).

Practice of Contraceptive Frequency Percent (%)
Ever practiced
Yes 148 70.8
No 61 29.2
Currently using contraception
Yes 135 64.6
No 74 35.4
Methods used (n=135)
Pills 19 14.1
IUCD 8 6
Inj. Depo-Provera 48 35.6
Condom 19 14.1
Norplant 6 4.4
Female sterilization 25 18.5
Male sterilization 3 2.2
Abstinence 1 0.7
Withdrawal 6 4.4

Above Figure 1 shows that maximum (48.3%) respondents believed that use of contraception causes damage to the uterus, (41.7%) had a fear of side effects and (36.7%) believed that it causes infertility.

Figure 1: Reason for Not practicing Contraceptives by the Respondents (n=61).

Only (25.7%) of the respondents experienced side effects with the use of contraceptives. The commonest (31.8%) side effects experienced were weight gain and menstrual irregularities each followed by heavy bleeding (20.5%) and amenorrhea (18.2%) (Table 7).

Table 7: Side Effects of the Contraceptives Experienced by the Respondents (n=148).

Table 8 reveals that the mean percentage score of knowledge, attitude and practices of the respondents was 45.23, 77.40 and 71.15 respectively.

Table 8: Knowledge, Attitude and Practice of Contraception of the Respondents (n=209).

Characteristics Mean Standard Deviation 95% CI for Mean
Lower Bound Upper Bound
Knowledge Score 45.23 24.83 41.84 48.62
Attitude score 77.4 12.17 75.73 79.06
Practice Score 71.15 45.41 64.95 77.36

The above Table 9 illustrates that there was statistically significant association of knowledge with education, occupation, and total income of the family at p-value < 0.05. There was no statistically significant association of the knowledge with the other variables.

Table 9: Association of Knowledge with Selected Socio Demographic Variables (n=209).

Characteristics Category Mean ± SD Mean rank p value
Age in years ** 15-20 41.71± 28.31 94.64 0.162
20-35 48.47 ± 23.90 112.47
35-50 41.90 ± 25.28 96.85
Religion ** Hindu 45.11 ± 25.03 104.42 0.632
Buddhist 51.29 ± 28.15 117.56
Kirant 42.91 ± 20.99 99.7
Education ** Illiterate 27.44 ± 20.42 62.11 <0.001
Primary 46.56 ± 21.14 107.92
Secondary 53.67 ± 24.21 124.85
Higher 64.64 ± 20.52 150.7
Occupation ** Agriculture 60.50 ± 28.50 137.34 0.004
Business 54.88 ± 21.43 129.72
Household 42.52 ± 24.23 98.24
Type of family * Nuclear 46.75 ± 25.18 108.33 0.287
Joint 42.93 ± 24.25 99.05
Income of the family/month * <15000 42.13 ± 23.74 97.67 0.018
&ge15000 51.30 ± 25.90 118.38
Duration of marriage ** <2 years 53.04 ± 27.32 122.65 0.119
2-5 years 40.44 ± 24.06 91.58
&ge 5 years 45.70 ± 24.52 106.4
Parity ** Nulliparous 51.72 ± 29.43 120.07 0.287
< 3 45.31 ± 24.32 104.53
&ge 3 42.34 ± 23.32 98.46
History of abortion * Yes 42.67 ± 21.25 105.31 0.766
No 45.54 ± 25.10 99.96
Distance of health care center from home * < 30 min 46.81 ± 23.39 108.33 0.145
&ge 30 min 40.58 ± 29.02 93.84
* Mann-Whitney Test ** Kruskal-Wallis Test

Table 10 depicts that distance to the nearest health facility (OR=7.975, 95% CI=2.15-13.32, p=0.002), education (OR=0.24, 95% CI=0.06-22.55, p=0.034) and age group (20-34 years) (OR= 0.03. 95% CI=0.004-0.315, p=0.003) remained the significant correlates of attitude.

Table 10: Logistic Regression on Socio-Demographic Variables, having Significant Relationship with Attitude (n=209).

Variables B S. E Wald df Sig. Exp (&beta) 95% C.I.
Lower Upper
Age
15-19 years 15.15 2 0.001
20-34 years -3.3 1.09 9.08 1 0.003 0.03 0.004 0.31
35-49 years 1.35 0.89 2.26 1 0.132 3.87 0.66 22.55
Education -1.42 0.67 4.48 1 0.034 0.24 0.06 22.55
Age of the last child 1.07 0.77 1.92 1 0.166 2.92 0.64 0.9
Distance to the nearest health facility 2.08 0.67 9.69 1 0.002 7.97 2.15 13.32
Constant 1.03 0.75 1.89 1 0.168 2.8 29.48

Above Table 11 reveals that education (OR=5.98, 95% CI=2.41- 14.80, p<0.001), type of family (OR=4.96, 95% CI=2.05-12.00, p<0.001), distance to the nearest health facility (OR=3.34, 95% CI=1.30-8.56, p=0.012), women&rsquos participation in decision making (OR=5.23, 95% CI=2.01-13.63, p=0.001), and encouragement from husband (OR=9.05, 95% CI=3.69-22.21, p<0.001) remained the significant correlates of practice.

Table 11: Logistic Regression on Socio-demographic Variables, having Significant relation with Practice (n=209).

Variables B S. E Wald df Sig. Exp(&beta) 95% C.I.
Lower Upper
Education 1.79 0.46 14.93 1 <0.001 5.98 2.41 14.8
Type of family 1.6 0.45 12.59 1 <0.001 4.96 2.05 12
Distance to the nearest health facility 1.21 0.48 6.3 1 0.012 3.34 1.3 8.56
Woman&rsquos participation in decision making 1.65 0.49 11.49 1 0.001 5.23 2.01 13.63
Encouragement from husband for using contraceptives 2.2 0.45 23.17 1 <0.001 9.05 3.69 22.21
Constant -4.45 0.81 30.02 1 <0.001 0.01

Above Table 12 reveals that there was statistically significant correlation of attitude and practice with knowledge of contraception at p-value <0.01.

Table 12: Correlation of Knowledge with Attitude and Practice (n=209).

Characteristics Knowledge of Contraception P-value *
Mean ± SD Mean Rank
Attitude
Positive attitude 48.87 ± 22.76 113.2 <0.001
Negative attitude 12.40 ± 19.33 27.48
Practice
Contraception practicing 52.03 ± 22.12 121.2 <0.001
Contraception not practicing 29.25 ± 23.88 65.69
*Mann-Whitney U Test

Table 13 depicts that there was statistically significant correlation between practice of contraception and attitude towards contraception at p value <0.01.

Table 13: Correlation between Attitude and Practice (n=209

Characteristics Positive Attitude Negative Attitude P-value *
Frequency % Frequency %
Practice
Yes 145 98 3 2 <0.001
No 44 72.1 17 27.9
*Chi-square Test

Discussion

Knowledge of the respondents regarding contraception

In the present study, information on knowledge of contraception was collected by asking respondents whether or not they have heard about different contraceptive methods including traditional as well as modern methods. The knowledge of contraception was widespread with the respondents and at least one contraceptive method was nearly universal in the study which is similar to the study finding of NDHS, 2011. The majority (92.3%) of the respondents had heard about contraception. Despite the wide social marketing of contraceptive method still 7.7% of the respondents had not heard about the contraception and the finding is similar to a study done in Dhankuta District of Nepal [4]. This clearly shows that the messages about the importance of contraceptives have not yet reached to the distant places though they have been already included in Sub-Metropolitan City. Concerning the methods known, most (92.7%) popular method known was Injection Depo-Provera followed by oral contraceptive pills and condom. Least (8.8%) known method was LAM. Emergency contraceptives was also least (23.3%) known by the respondents. The corresponding findings from NDHS 2011 shows Female sterilization (99%), Injection Depo (98%), male sterilization (95%), the pill (93%), condoms (98%) and emergency contraception is known by a relatively smaller (29%). percentage of women. With respect to abstinence and withdrawal, (39.4%) and (35.2%) of the respondents revealed to be hearing these methods in the present study which varies from the data of NDHS 2011 that states withdrawal and the rhythm method heard by 58% and 46% of the respondents respectively. NDHS report also states that overall women knew 7.9 contraceptive methods on average and a similar finding was found in the present study that showed 7 methods known on average by the respondents.

A question related to the benefits of contraceptives to the respondents, avoiding unwanted pregnancy (79.3%), maintaining birth spacing (71.5%), limiting number of births (68.9%), improving the health of mother and child (59.6%) and decreasing the economic burden of the family (46.6%) were identified as the main benefits of contraception. Similar findings were discovered in a study done in Sunsari, Nepal [3]. While the respondents of the study done in Bharatpur also revealed further benefits like anaemia can be reduced by using OCP and STDs can be prevented by using contraceptives like condoms [5]. Non contraceptive benefits were also identified in other studies.

In this study among the respondents who had heard about pills, only (91.0%) knew that pills must be taken on same time every day, only (68.4%) knew to take pill immediately as soon as possible if had missed a pill, whereas few (9.60%) knew that it also contains anaemia-preventing capsules. Only (59%) knew the exact duration of IUCD as 10 years, about one-third (32.9%) knew the best time for the insertion of IUCD (5th to 7th day of menstruation), and only (32.83%) could identify the major side effect of IUCD as heavy bleeding. Only (76.9%) of the respondents knew that Norplant is inserted under the skin of upper arm. About half (53.6%) of the respondents knew that condom prevents both STI and HIV. Only (47.2%) identified condom as the best method for newly married couple. Very few (17%) respondents knew about LAM and its protection duration as 6 months. Only (53.4%) knew that permanent sterilization prevents pregnancy forever and majority (95%) identified that it is not the cause for back pain. Majority (88%) identified that it is pill is an emergency contraceptive whereas only (16%) identified IUCD as emergency contraceptive. Only (84.4%) knew that it should be taken within 72 hours of unprotected sex whereas only (28.9%) knew the effective timing for getting IUCD for using it&rsquos as emergency contraceptive. These results shows that though the majority of the respondents had heard about the different methods of contraception, but the knowledge regarding specific methods were deficient among the respondents.

Attitude towards contraception

Attitudes are not gained by birth, they are learned and adopted by experiences and culturally gained during socialization. Attitude of women towards contraceptives are influenced by education and experiences such as pregnancy. In the present study, almost half (49.3%) of the respondents strongly agreed that contraceptive use is beneficial for women and its use can prevent unwanted pregnancy which is supported by the study conducted in India [6]. Almost two fifth (43.1%) of the respondents were neutral on advantage of modern contraceptives over traditional and natural methods. This may be due to inadequate dissemination of information regarding contraception among the respondents. More than 45% of the respondents were not sure about contraceptives causing malformation to the baby, which shows prevalence of ignorance among the respondents due to misinformation or misbeliefs. Only (11.5%) and (12%) strongly disagreed the statement that sexual pleasure is reduced on using contraceptives and it can cause infertility respectively. Only (22.5%) strongly agreed on the fact that contraceptive methods have more benefits than side effects. So there is still need of propagating the benefits of contraceptives that outweighs the negative side effects of contraception. Nearly half (47.8%) of the respondents agreed that men should share the equal responsibility of contraceptive use and (48.8%) agreed that standard of life is raised on using contraceptives. Nearly 50% of the respondents strongly disagreed the misbelief of pregnancy as the God gifted phenomena and having son as an important thing in a family. Most (52.2%) of the respondents agreed that they advise other women to use contraceptive methods. Only (21.5%) agreed that IUCD works a quite long time. This shows people have less knowledge regarding implants. Most (62.2%) of the respondents had neutral views regarding sterilization if they want to stop child bearing forever. Only (15.8%) disagreed the fact that sterilization is an unnecessary health burden. Approximately half (46.4%) of the respondents agreed on having appropriate gap between births, which is further supported by the study conducted in Kenya [7].

Overall, majority (90.4%) of the respondents in the present study had a positive attitude which was similar to the findings of the study carried out in Ethiopia, whereas study carried out in Kathmandu Medical College Teaching hospital revealed only (68.50%) of the respondents with positive attitudes [8,9].

Practice of using contraception among the respondents

Importantly, it was found that 70.8% of the women reported of having ever used any type of contraceptives. Other studies have already described similar findings, i.e., high promotion but low utilization of contraceptives, making this situation a serious challenge in developing countries [10]. Annual report 2013/2014 reported (89.8%) contraceptive user in Eastern development region in which the finding of this study shows a lower (64.6%) percentage. Although there is a noticeable proportion of a respondent ever using contraceptive, however, there was a substantial drop-out from having ever used of contraception (70.8%) to (64.6%).

With respect to the methods specific, Injectable (Inj. Depo) (35.6%), female sterilization (18.5%), and pills and condom were the main methods used. Compared to NDHS 2011, a noteworthy finding in this study is the low use of implants, suggesting that health facilities in the study area are not being able to deliver the service. Injection Depo-Provera was most popular, as one shot of it worked for 3 months and most of the respondent&rsquos expressed that, it was easy to use and most of their circle friends were using it. Abstinence and male sterilization was found to be least practiced, 0.7% and 2.2%, respectively which is similar to the findings of many other studies which show a high rate of sexual activities and male dominance over female in regards of contraceptives [4].

Among the respondents, only (79.9%) of the respondents were participating in the decision making of the household and fertility related choices, whereas only (60.8%) got encouragement and support from their husband with regards to use of contraceptives. Most (56.0%) of the respondents were sharing information of contraception usage and its benefits with others.

Informed choice is an important tool for assessing, monitoring and evaluating the quality of family planning services. Informing about the side effects that might have with a method, what to do if they experienced side effect and informing about the other methods they could use are the components of informed choice. In the present study, among the users only (16.2%) told that they were informed about the side effects and only (14.2%) were informed about what to do if they ever experienced side effects. This is in contrast to the data obtained from NDHS, 2011 where 63% were informed about potential side effects of the methods they use and 59% were informed about what to do if they experienced side effects. It shows providers of the study area must know how to communicate and disseminate the full information with clients such that they are facilitating care rather than just prescribing the contraceptive methods.

Among the respondents with at least one child, only one-fourth (24.9%) of the respondents had a planned pregnancy previously which shows more knowledge regarding the benefits of planned pregnancy and benefits of contraceptives in it has been seen to be focused in the national family planning program. Only about two-third (67.9%) of the respondents knew that FCHV provide contraceptive services and information. This suggests that there is need of more energetic participation of the FCHVs to promote the information and services. Amongst the people aware of FCHVs, (96%) of the respondents said that FCHV do counselling about the contraception, (36%) said that they distribute condom, (32%) said that they distribute pills and (29.6%) said that they refer for family planning services. The rate of pills distribution by FCHV in Siraha District is (51.61%) as per Annual report 2013/2014.

Information on where women obtain their contraceptive method is important for program managers and implementers in designing family planning policies and programs. When asked the contraceptive users about the source of availability of contraceptive methods, health institution remained the major source of contraceptive methods as responded by majority (79.6%) of the respondents followed by medical shop/pharmacy to (31.3%), NGO (18.4%) and FCHV 15.6%. NGOs include FPAN, Bhotepool, Dharan. This result has similar findings from the study done in Tanzania with hospital being the major source. Furthermore, result of the present study shows that (25.7%) had ever experienced side effects, the commonest (31.8%) being the weight gain and menstrual irregularities each followed by heavy bleeding (20.5%) and amenorrhea (18.2%) which is similar to the findings of the study done in Kathmandu [11,12].

Respondents overall knowledge, attitude and practices of contraception

The overall mean percentage score for knowledge was nearly 45.23, which is much lower as compared to 81.0% in Karachi and 97.4% at Lahore. However similar score was found in an Indian study. Regarding attitude and practice, study revealed the mean percentage score as 77.40% and 71.15% respectively which is nearly similar to the study conducted in India [13]. Whereas in contrary to the findings, the findings of the study carried out in Gambia had more reduced scores [14].

Association between knowledge scores on contraception with the variables

In the present study, there was a significant association of knowledge scores with education (p<0.001), occupation (p=0.004), and total income of the family (p=0.018). Respondents with higher education had more knowledge (mean ± SD, 64.64 ± 20.52) than with the others reaffirming that access to education as an influential method in designing better habits. Women doing agriculture (mean ± SD, 60.50 ± 28.50) were more knowledgeable than other like business and house hold. Respondents of nuclear family had more knowledge score (mean ± SD, 46.75 ± 25.18) than the respondents belonging to a joint family joint. About the total income of the family, respondents with more than Rs.15,000 income per month had more knowledge scores (mean ± SD, 46.75 ± 25.18) and regarding the women&rsquos participation in decision making, women with decision making power had more knowledge scores (mean ± SD, 48.69 ± 23.18). This finding is in line with the findings of the study carried out in Udupi [15].

There was association between age of the respondents (p=0.022), education (p=0.008), age of the last child (p=0.021) and distance of health care centre from home (p <0.001) with attitude of the respondents towards contraception. Respondents of age group 20-34 years had more positive attitude than among the other age group, high education, having the last child less than 5 years and having less distance to the nearest health centre from home had increased chance of having positive attitude. Contradicting to this finding a study carried out in Karnataka revealed that there was no association between the attitude and the selected variables [15].

Significant variables in bivariate analysis were subjected to binary logistic regression analysis which showed that having less than 30 minutes walking distance from home to the near health centre (OR=7.975, 95% CI=2.158-13.318, p=0.002), being literate (OR=0.242, 95% CI=0.065-22.559, p=0.034) and age group (20-34 years) (OR=0.037. 95% CI=0.004-0.315, p=0.003) had significant correlation with attitude. Findings from the similar study done in Ethiopia showed that being literate was one of the factor associated with more positive attitude towards contraception (OR=1.89 p value= 0.002) [8].

Association between practices of contraception with the variables

In our present study, education (p=0.001), type of family (p=0.027), distance of health care centre (p=0.04), women&rsquos participation in decision making (p<0.001), encouragement from husband (p<0.001), FCHV providing contraceptive information and services (p<0.001), share of information about practice with others (p<0.001) and facing side effects (p<0.001) was found out to be statistically significant with the practice of contraception, whereas a study done in Kohat revealed that the practice was significant with only parity, age, occupation and education. However, study conducted in India showed that practice was significantly influenced by respondent&rsquos age and education level, distance to the near health facility, number of living children, husband wife communication on family planning, women&rsquos participation in decision making, husbands approval and encouragement, and if ever encountered side effects [11].

Being literate was associated with increased likelihood of being current user of contraceptives (OR=5.98, 95% CI=2.41-14.80, p<0.001). This finding is in accordance with the results from several previous studies conducted in other parts of Africa as well as Asian countries [16]. Some of these authors also argued that education provides new outlook and freedom from traditions and further that highly educated women have more decision making power within marriage, including decisions about reproductive health. Regarding type of the family, respondents with nuclear family had increased chances of using contraceptives (OR=4.96, 95% CI=2.05-12.00, p<0.001). Regarding distance from nearest health facility versus contraceptive use, results showed that decreased distance from nearest health facility was associated with increased likelihood of being current user of modern contraceptives (OR=3.34, 95% CI=1.30-8.56, p=0.012), which is similar to the findings of the study done in Tanzania [11].

Women&rsquos participation in decision making has been indicated in several studies to be associated with practice of contraception [16]. Consistent with the results of these previous studies, result of this study indicate that women who reported participation in decision making were more likely to use contraceptives compared to the counterpart (OR=5.23, 95% CI=2.01-13.63, p=0.001). Likewise, women who had a support and encouragement from their husbands regarding contraceptives use were also more likely to be the current users of contraceptives (OR=9.05, 95% CI=3.69-22.21, p<0.001). These observations imply that campaign to empower women such emphasis on their education and encouraging gender balance by changing community attitude towards position/status of women in a household and in a society as a whole, as currently they are given lower position, specifically in patriarchal society could improve use of contraceptives in a study population [17].

Correlation among knowledge, attitude and practices of contraception

Present study shows statistically significant positive correlation of attitude regarding contraception and practice of contraception with knowledge of contraception at p-value <0.01. Attitude and practice were significantly associated (p value=0.05), and it was observed that majority of the people with positive attitude were practicing contraception and only a few with negative attitude were practicing contraception. This clearly confirms that if knowledge is improved then attitude will also be good and if there is improved knowledge and good attitude, practice will be good eventually.


The Ionization Constant of Lactic Acid, 0-50°, from Conductance Measurements

Article Views are the COUNTER-compliant sum of full text article downloads since November 2008 (both PDF and HTML) across all institutions and individuals. These metrics are regularly updated to reflect usage leading up to the last few days.

Citations are the number of other articles citing this article, calculated by Crossref and updated daily. Find more information about Crossref citation counts.

The Altmetric Attention Score is a quantitative measure of the attention that a research article has received online. Clicking on the donut icon will load a page at altmetric.com with additional details about the score and the social media presence for the given article. Find more information on the Altmetric Attention Score and how the score is calculated.

Note: In lieu of an abstract, this is the article's first page.


How long would it take for one hundred couples to have one million descendants?

Let's say an isolated colony is established in an ideal environment with the goal of growing the inhabited human population as quickly as possible. Health care is provided for them by managers, or those that own the colony, and is roughly up to twenty-first century standards with improvement on gene technology. Those in the colony are not allowed to develop technology beyond that used in the nineteenth century to quell any possibility of a successful uprise against their managers, but they are given the means to be self-sufficient. They can grow their own food, they are allowed to be educated enough to read and have a trade, and have laws enforced by their managers to kepp them 'in line'.

How long would it take for one hundred couples in the colony (one hundred men, one hundred women) - all of good genes, with no genetic diseases - to make one million descendants? That is, if Generation A had two hundred people in it and started having children at the age of sixteen (and were allowed to have as many children as possible), and every generation started having children at the same age (and are also allowed to have as many children as possible), how many generations would it take for a generation to be made up of one million individuals?

It is illegal to have sex outside of marriage, and marriages are preapproved by managers to ensure there are no genetic issues - rather, only couples with low chances producing sickly children are allowed to marry and reproduce with each other. Assuming they keep genetics records of every individual, and then get samples from all of their children to have their genetics as well so they have on record who the parents are, I assume inbreeding would still be an issue at some point. How long would it be before inbreeding became a problem? Could they hit the one million mark before that?


Question about Asari sex. (serious biology question)

Asari are MonoGendered, the terms male & female have no real meaning the them. physical contact isnt required for conception it is the spiritual connection, letting them mate with anyone.

damn could you imagine if liara & wrex mated. or samara & grunt.

User Info: moocha_locka

User Info: Arizona_Joe

She says physical contact may or may not be involved meaning they could have human style sex and since Shepard and Liara can get it on I'm assuming she has everything a human female has physically. Except she can't get pregnant from physical contact and only has a child if she decides to. Now that would be an awesome form of birth control. :P

A Krogan-Asari child would be just an aggressive Asari with maybe some distinct facial features.

User Info: mlchanges

User Info: Spennyworth

They would only have need for a birth cannel. There would be no benefit to them having general human like genitalia.
They did not evolve around other species, only their own and reproduce via mind melding.

So basically, they have a mindgasm and then a mini blue person pops out of a plain non-pleasure receiving hole possibly between there legs.
And if that&rsquos the case I very much doubt they would get any enjoyment out of you sticking something in there.

User Info: jeriausx

User Info: JAB991

I imagine they sorta just scissor. or is that not what the question is asking?

User Info: mikey_205

User Info: Deimir

From the Mass Effect Wiki:

Asari have a robust cellular regenerative system. While they do not heal faster than other species, asari are known to reach 1000 years of age.

Although asari have one gender, they are not asexual. An asari provides two copies of her own genes to her offspring, which - regardless of the species or sex of the 'father' - is always an asari and is always female. The second set is altered in a unique process called melding.

During melding, an asari consciously attunes her nervous system to her partner's, sending and receiving electrical impulses directly through the skin. A common phrase used before melding is "embrace eternity," presumably to help focus the partner's mind. Effectively, the asari and her partner briefly become one unified nervous system. This unique means of reproduction is the reason asari are talented biotics. Their evolved ability to consciously control nerve impulses is very similar to biotic training. The partner can be another asari, or an alien of any gender. However, since the asari began encountering other sentient species, non-asari mates have become preferred for the diversity they provide.
An asari's melding ability extends to a mental connection as well, which Liara describes as being the true union between an asari and her partner. It allows the asari to explore her partner's genetic heritage and pass desirable traits on to any offspring. During mating an asari and her partner share memories, thoughts, and feelings. It is also possible for an asari to use this ability outside of melding and share another's consciousness. This technique is used by both Liara and Shiala, with varying success Liara finds the ordeal extremely intense and debilitating.

Asari pass through three climacteric life stages, marked by biochemical and physiological changes:

The Maiden stage begins at birth and is marked by the drive to explore and experience. Most young asari are curious and restless.
The Matron stage of life begins around the age of 350, though it can be triggered earlier if the individual melds frequently. This period is marked by a desire to settle in one area and raise children.
The Matriarch stage begins around 700 years of age, or later if the individual melds rarely. Matriarchs become active in their community as sages and councilors, dispensing wisdom from centuries of experience. Their knowledge and guidance may be one reason why Matriarchs are rarely seen outside asari space.
However, it should be noted that, each stage can be started whenever an asari feels that she has reached the correct level of maturity. While each stage of life is marked by strong biological tendencies, individuals do make unexpected life choices. For example, there are Maidens who stay close to home rather than explore, Matrons who would rather work than build a family, and Matriarchs who have no interest in community affairs.


Speaker Bio

Shirley Tilghman

Shirley Tilghman is the President Emerita and Professor of Molecular Biology at Princeton University. Dr. Tilghman is a strong visionary and leader in academic research and higher-level education. As President of Princeton University for 13 years (2001-2013), she implemented policies and initiatives that supported better training of Princeton students and increased diversity in the faculty… Continue Reading

Daniel Rather

Dan Rather has a resume that reads like a history book. He has interviewed every American president since Eisenhower and personally covered almost every important global dateline of the last 60 years, from the Civil Rights Movement to Vietnam, to Watergate to the terrorist attacks of 9/11. Rather helped pioneer the very idea that television… Continue Reading


Watch the video: 9 Contraception 24102019 (May 2022).