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RHO archives : Topics : Contraceptive Methods

Annotated Bibliography

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Lactational amenorrhea method

Pathfinder International. Comprehensive Reproductive Health and Family Planning Training Curriculum: Module 8—Lactational Amenorrhea and Breastfeeding Support (1997). Available at:
This is one of a series of training modules developed by Pathfinder International. It is available on-line at the web address above. The modules are designed to train family planning service providers. The module provides an overview of breastfeeding and the lactational amenorrhea method, and includes master copies handouts and transparencies. There are pre- and post-tests to evaluate participant comprehension of the material presented.

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Drennan, M. Reproductive health: new perspectives on men's participation. Population Reports Series J, No. 46. Baltimore: Johns Hopkins School of Public Health, Population Information Program (October 1998). Available at:
This issue of Population Reports explores the shift in family planning programs toward including men as partners and participants in reproductive health programs. The issue includes a table on the "Use of Family Planning Methods Involving Men's Cooperation" based on selected survey among married women, 1980-1997. Withdrawal use is reported in all regions; in some areas up to 26 percent of women surveyed rely on withdrawal.

Rogow, D. and Horowitz, S. Withdrawal: a review of the literature and an agenda for research. Studies in Family Planning 26(3):140-53 (May-June 1995).
This article reviews that available literature about the use of withdrawal as a contraceptive method. The authors conclude there is a lack of definitive research on the prevalence, acceptability effectiveness, safety, and relationship to sexually transmitted infections of this methods. Population and family planning programs have largely ignored the method, focusing on modern women-controlled methods. The authors question the validity of existing data and offer an agenda for future research.

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Family Health International (FHI). Expert Consultation on Vasectomy. Report on an interagency workshop organized by Family Health International, EngenderHealth, and the ACQUIRE Project, December 3-5, 2003; Washington, D.C. Available at:
This report presents an excellent summary of clinical research findings (2002-2004) on vasectomy techniques, discusses the strengths and limitations of these studies, and includes a (draft) consensus statement on the effectiveness of different techniques for vas occlusion. The report also includes programmatic implications of the research and key steps needed to improve vasectomy services regionally and globally.

FHI. Male and female sterilization. Network 18(1) (Fall 1997). Available at:
Voluntary female sterilization is highly effective and convenient, and is the most widely used contraceptive method worldwide with more than 150 million users. Vasectomy is even safer and easier, and recovery is quicker than with female surgical sterilization. Vasectomy can be performed in an office setting with a local anesthetic and without an incision. Yet, because sterilization is permanent, it is not appropriate for every client. Clients interested in sterilization should compare this permanent method with reversible options and be encouraged to select the most appropriate method for their circumstances from a range of contraceptive choices. Articles in this issue provide an important understanding of male and female sterilization, the search for new nonsurgical  techniques that are safe and effective, and the importance of counseling.

International Planned Parenthood Federation (IPPF). IMAP statement on voluntary surgical contraception. IPPF Medical Bulletin 33(4) (August 1999). Available at:
This Bulletin reflects statements agreed upon at the IMAP meeting in June 1999. Surgical sterilization is a well-established method of contraception that is highly effective and carries low risk of complications when performed according to accepted medical standards. This issue reviews both male and female sterilization, and provides a review of operative techniques, efficacy, complications, health benefits, and eligibility criteria. Additionally, issues such as the importance of appropriate counseling for informed choice before the procedure, service management, and provision of services to special populations are addressed.

PATH. Quinacrine sterilization: the controversy heightens. Outlook. 1999;17(1)4-5,8. Available at:
This article summarizes the background and current research on the use of quinacrine pellets for nonsurgical female sterilization. Although the availability of a safe and effective method of nonsurgical sterilization would benefit millions of women (particularly in rural or remote regions), concern over the drug's side effects and effectiveness has been raised. This article describes recent events related to quinacrine sterilization and discusses future prospects for the method.

World Health Organization (WHO). Female sterilization: what health workers need to know. Geneva: WHO (1999).
Female sterilization is the most widely used family planning method in the world and one of the most effective. Female sterilization is one of the options available to couples who have decided to end childbearing. This booklet provides health workers with answers to the most common questions about female sterilization: what female sterilization is and how it works; its advantages and disadvantages; its risks and benefits; and how to help women make well-considered choices. 

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Contraceptive research and development

Committee on Contraceptive Development, National Research Council and Division of International Health, Institute of Medicine. Developing New Contraceptives: Obstacles and Opportunities. Mastroianni, L. et al., eds. Washington, DC : National Academy Press (1990).
This report analyzes the process by which contraceptives are developed and approved for use. Limited contraceptive options have a greater negative impact in developing countries than in the United States because the health risks of pregnancy and childbirth are higher and the social benefits of contraceptive use can be much greater than in the United States. Obstacles to the development of contraceptive methods detailed in the report include lack of support for research by large pharmaceutical companies because of liability issues and the political climate. Nonprofit organizations and small firms have become more active in the development process. They have encountered funding constraints, limitations of technology, and a lack of experienced personnel. If political and financial support were mobilized, new methods would likely become available.

CONRAD. Mechanical and Chemical Barriers for Women (Bienniel report). Available at: Accessed April 2004).
The key objective of the Contraceptive Research and Development Program (CONRAD) is to expand the range, availability, and use of safe, effective, and acceptable technologies for the prevention of pregnancy and STIs. This web page, hosted through Reproline, provides highlights from CONRAD's contraceptive development activities in 2001-2002. It provides updates on the status of research and evaluation of several new female mechanical and chemical barrier contraceptive products (see page 5 of the report). It also describes current research on male methods.

Global Reproductive Health Forum. Contraception: New Methods for Men. Available at: Accessed November 2000).
This site contains both information and links to other sites of groups involved in research of new male contraceptive methods. Of particular interest is the full text article by Karin Ringheim, Whither Methods for Men? Emerging Gender Issues in Contraception, which examines why the development of an effective, reversible, nonbarrier contraceptive method for men is an important gender issue.

National Academy of Sciences/Institute of Medicine (NAS/IOM). Summary of Proceedings: Workshop on Contraceptive Research and Development and the Frontiers of Contemporary Science. Washington, DC (December 9-10, 1994).
These proceedings report on an NAS/IOM meeting aimed at mobilizing top scientists involved in reproductive system research to address projects related to contraceptive development. The proceedings include overviews of the status of contraceptive development; reports from scientists involved in contraceptive research; and reports from selected reproductive biologists, biochemists, and others about their work, and how it may relate to new approaches for contraception.

PATH. Contraceptive research and development: progress toward a woman-centered agenda. Outlook. 1995;13(2):1-8.
This article reports on current research in vaginal methods, menses inducers, and methods for men. It describes the challenges facing researchers working in these areas and outlines some future research priorities. Roles of the public and private sector in contraceptive research and development also are examined.

Population Council and International Family Health. The Case for Microbicides: A Global Priority.  The Population Council and International Family Health (2000). Available for download from:, or contact the Population Council email: [email protected]; fax: 001 212-755-6052.
This publication provides a concise explanation of the role that female-controlled microbicides can play in the HIV/AIDS epidemic, an overview of the main approaches to microbicide research, and the status of recent developments. Challenges that need to be addressed, such as increasing public-sector investment and attracting private-sector investment, as well as scientific and research challenges also are discussed.  

Reproductive Health Technologies Project (RHTP). Microbicides. Available at: Accessed November 2000.
This site contains a brief overview of the need for microbicide development, frequently asked questions about how microbicides work and what they do, news, advocacy information, and a table of experimental microbicides in or nearing human trials.

ReproLine. Contraceptive Advances: Centchroman. Available at: Accessed April 2004).
Centchroman is a nonsteroidal chemical that was developed and marketed in India as a once-a-week contraceptive pill. Centchroman appears to be an effective, safe, and easy-to-use oral contraceptive, although only limited studies in humans are available. Centchroman could become an important oral contraceptive in India. Since it is nonsteroidal, women do not experience side effects common to estrogen and progestin. Centchroman is marketed under the trade names Centron and Saheli.  This web page provides an overview of information available about Centchroman including the mode of action, efficacy, teratogenicity, pharmacokinetic studies, and return to fertility after use.

World Health Organization (WHO). HIV/AIDS topics: Microbicides [fact sheet] (2003). Available in English, French, and Spanish at:
This brief fact sheet from the HIV-AIDS division of the WHO provides a concise overview of why microbicides are important, and reviews the key mechanisms of action of the leading microbicide candidates. The overview also contains an estimate of the health impact that could be achieved by a moderately successful microbicide, and provides key references for further reading in this area.

WHO. Challenges in Reproductive Health Research: Biennial Report 1992-1993. Geneva: WHO (1994).
This biennial report provides an excellent overview of recent trends in development of contraceptive and reproductive health technologies, as well as background information to understand how interested parties at all levels have brought greater clarity and consensus to the shift from fertility regulation to reproductive health. It describes recent advances in each of the major reproductive health research areas.

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Hormonal contraception, IUDs, and HIV risk

Allen, S. et al. Human immunodeficiency virus infection in urban Rwanda: demographic and behavioral correlates in a representative sample of child-bearing women. Journal of the American Medical Association 266(12):1657-1663 (1991).
This article presents the findings of a study which examined the incidence and predictors of HIV disease in prospective cohorts of HIV-1infected and HIV-1uninfected women in urban Rwanda. A cross-sectional analysis of the responses to questionnaires administered to 3,702 women aged 18 to 35 years was performed, and the relationships between three demographic predictors of HIV infection—marital status, partner income, and duration of union—were evaluated. Infection rates were higher in women who were single, among women in steady relationships that began after 1981, and in 33 percent of the women reporting more than one lifetime sexual partner. Having a male partner who drank alcohol or who had a higher income were significant risk factors, but use of oral contraceptives and having an uncircumcised partner were not. The article concludes that in Rwanda the epidemic of AIDS has spread beyond the high-risk groups to the general populations of women without known risk factors. For most of the women studied, a steady male partner was the source of their HIV risk and therefore a key target for intervention efforts.

Costello Daly, C. et al. Contraceptive methods and the transmission of HIV: implications for family planning. Genitourinary Medicine 70:110-117 (1994).
This article reviews published evidence for associations between HIV and individual contraceptive methods including oral contraceptives (OCs), injectable hormonal contraceptives, IUDs, spermicidal preparations, and the female condom. The authors discuss the program and policy implications of associations between specific contraceptive methods and HIV transmission. They also state that many unanswered questions remain, and that additional studies are needed to determine whether there is an association between individual contraceptive methods and HIV infection. The article recommends that large-scale studies involving low-risk women using contraceptives for extended periods be conducted to evaluate the impact of contraceptive use among the majority of users. The possibility of behavioral differentials between users of different contraceptives should be carefully evaluated. The study notes that additional research about the sites of virus entry, infectivity, and local defense mechanisms in the female genital track also is needed. Given that contraceptive use is being promoted worldwide (including areas where HIV incidence is increasing), additional knowledge about the effect of individual contraceptives on HIV transmission is needed.

Family Health Interational. Do hormonals affect STI risk? Network. 2001;20(4):30-33. Available in English, French, and Spanish at:
This article discusses findings from research studies looking at the relationship between use of hormonal methods (primarily oral contraceptives and injectable contraceptives) and STIs (including HIV). Research results are conflicting for a variety of reasons.

Martin, H.L. et al. Hormonal contraception, sexually transmitted diseases, and the risk of heterosexual transmission of human immunodeficiency virus type 1. Journal of Infectious Diseases 178:1053-1059 (1998).
This study examines the associations between methods of contraception, sexually transmitted diseases (STDs), and incidence of HIV-1 infection among female sex workers attending a municipal STD clinic in Mombasa, Kenya. Data presented include demographic and behavioral characteristics, prevalence and incidence of STDs and other genital tract conditions, and univariate associations between demographic characteristics and sexual behavior during follow-up and HIV-1 seroconversion. The study reports that demographic and behavioral factors significantly associated with HIV-1 infection include type of workplace (such as a bar or dance club), condom use, and parity. In multivariate models, vulvitis, genital ulcer disease, vaginal discharge, and Candida vaginitis were significantly associated with HIV-1 seroconversion. Women using depo medroxyprogesterone acetate (Depo, "the shot") were found to have an increased incidence of HIV-1 infection, and the article explores several possible reasons for this finding.

Mati, J.K.G. et al. Contraceptive use and the risk of HIV infection in Nairobi, Kenya. International Journal of Gynecology and Obstetrics 48:61-67 (1995).
Sexual exposure to HIV is a major determinant of a woman's risk of HIV infection. However, factors such as sexually transmitted disease have been shown to alter the probability of infection after exposure. The objective of this study was to determine the prevalence of HIV-1 infection among women attending family planning clinics in Nairobi, and the association between contraceptive use and HIV infections. Data for the study were collected through the use of history, clinical examinations, and laboratory tests for 4,404 women. Use of oral contraceptives (OCs), injectables, IUDs, and condoms were measured. The study found no significant association between past or current OC use and risk of HIV infection, suggesting that any independent association between OC use and HIV risk is not large. Prevalence of HIV was slightly elevated among women who had used OCs the longest (more than two years). However, the dose-response relationship was nonlinear and nonsignificant. The study also did not find a significant association between the use of injectables or IUDs and HIV. In spite of the high level of HIV/AIDS awareness in this population, the study found that condom use was low.

Morrison C, Best K. Hormonal Contraception and HIV: An Update. Research Triangle Park, NC: FHI; 2004. Available at:
There are biological and physiological reasons to believe that the use of hormonal contraception could facilitate HIV acquisition, transmission, or progression. In this research update available from FHI, Morrison reviews findings between 1999 and 2004. Results of the studies have been mixed. Current knowledge concerning a potential relationship between hormonal contraception and HIV is insufficient to change current family planning practices. The WHO Medical Eligibility Criteria for Contraceptive Use state that women at risk of HIV infection or those who are HIV-infected may use hormonal contraception with no restrictions. Hormonal contraception does not protect from HIV or STIs. Providers should counsel users who are at risk of HIV to reduce the number of sexual partners and use a condom correctly and consistently.

Mostad, S.B. et al. Hormonal Contraception, vitamin A deficiency, and other risk factors for shedding of HIV-1 infected cells from the cervix and vagina. Lancet 350(9082):922-927 (September 27, 1997).
This article investigates whether use of hormonal contraceptive (oral contraceptives and injectables), vitamin A deficiency, or other variables such as certain sexually transmitted diseases and immunosuppression were risk factors for cervical and vaginal shedding of HIV-infected cells. The study documents and presents data illustrating several positive correlates of HIV-1 shedding in cervical and vaginal secretions, most notably in women using hormonal contraceptives or with vitamin A deficiency. The article concludes that these factors may be important determinants of sexual or vertical transmission of HIV-1, and that they are important to public health because they are easily modified by simple interventions.

PATH. Hormonal contraception, IUDs, and HIV risk. Outlook. 1999;17(1)1-2,7. Available at:
This article summarizes several studies that have investigated whether hormonal contraceptives and IUDs increase a woman's risk of HIV infection. Some of the studies suggest that oral contraceptives and injectables, which contain high levels of progestins, may increase a woman's risk of HIV by promoting certain physiological changes. Other studies found no association or were inconclusive due to various statistical or methodological concerns. IUDs may be a concern because of their tendency to increase menstrual bleeding and upper genital tract infections, which may put users at higher risk of HIV transmission. Program implications also are discussed.

Plummer, F.A. et al. Cofactors in male-female sexual transmission of human immunodeficiency virus type 1. Journal of Infectious Diseases 163:233-239 (February 1991).
Facilitation of HIV-1 transmission by concomitant STDs, frequent heterosexual intercourse, and injections in STD clinics have all been postulated as explanations for the heterosexual epidemic of HIV-1 in Africa. The study examined demographic variables, contraceptive use, STDs, and sexual practices as possible factors causing seroconversion to HIV-1 in a group of African sex workers. Statistical analyses performed by the author confirm independent associations between HIV-1 infection and oral contraceptive use, condom use, genital ulcers, and C. trachomatis, thus concluding that, with the exception of condoms, all three factors appear to facilitate HIV-1 transmission. The study hypothesizes and discusses several potential mechanisms by which oral contraception could facilitate HIV-1 acquisition, either by direct effect on the genital tract or through systemic effect. The article concludes by arguing strongly for the inclusion of STD control in AIDS control programs.

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