Introduction

Bajos N., Leridon Henri, Job-Spira N. Introduction. In: Population (English edition), 59ᵉ année, n°3-4, 2004. pp. 347-356

Introduction au dossier

Bajos N., Leridon Henri, Job-Spira N. Introduction au dossier. In: Population, 59ᵉ année, n°3-4, 2004. pp. 409-418

Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases.

BACKGROUND: Several risk factors for ectopic pregnancy (EP) have been identified, but the site of implantation of EP has been little studied. METHODS: A total of 1800 surgically treated EP was registered between January 1992 and December 2001 in the Auvergne EP register and the women concerned were followed up. In this large population-based sample, we studied the distribution of EP sites, immediate complications, determining factors, and subsequent fertility. RESULTS: EP sites were interstitial (2.4%), isthmic (12.0%), ampullary (70.0%), fimbrial (11.1%), ovarian (3.2%) or abdominal (1.3%). No cervical pregnancies were observed. Complications and treatment depended on the site of EP. In multivariate analysis, the only risk factor associated with EP site was current use of an intrauterine device (IUD), which was more frequent in distal EP. The 2 year cumulative rate of subsequent spontaneous intrauterine pregnancy (IUP) increased progressively from interstitial to ovarian EP. Fair concordance (weighted kappa = 0.31) was observed between the sites of two successive EP if they were homolateral. CONCLUSION: In addition to providing an accurate description of the sites of implantation of EP, this study shows that current IUD use 'protects' against interstitial pregnancies, which are the most difficult to manage. It shows that subsequent fertility tends to be higher in women with distal EP

[Fertility after ectopic pregnancy: 10-year results in the Auvergne Registry]

OBJECTIVES: The purpose of this work was to study the fertility after ectopic pregnancy (EP) according to the type of contraception at the time of EP (none, IUD, other) and treatment (medical, conservative surgical, radical). MATERIAL AND METHODS: Ten-year Auvergne EP registry data were analyzed (1626 women, among whom 741 tried to become pregnant again). Fertility was characterized by the time to a new pregnancy and its outcome (EP recurrence, intrauterine pregnancy (IUP)). The censored data methodology was used. RESULTS: The rate of recurrence was much higher in women who had a IUD at the time of EP than in women without contraception. The opposite trend was observed for IUP (the rate of IUP was 1.7-fold higher in women who had a IUD at the time of EP). The rate of recurrence doubled in women treated medically. The rate of IUP was significantly lower in women given conservative treatment than in women given radical treatment. CONCLUSION: Contraception at the time of EP must be considered when studying subsequent fertility. The increase in rate of recurrence following medical treatment observed in the present study should be confirmed by others in search for an explanation. Our results point out the need for control trials on EP treatment, and provide data for planning such trials

[Comparison of fertility rates after ectopic pregnancy in Auvergne and Lille regions]

OBJECTIVES: Fertility rates after ectopic pregnancy (EP) were compared between the Auvergne region (central France) and the Lille region (northern France) in order to determine whether fertility factors are similar. We also wanted to determine whether regional differences persist if known fertility factors are taken into account. MATERIAL AND METHODS: Data from the Auvergne EP register 1992-1998 (1.285 women, among whom 552 tried to become pregnant again) and from Lille register 1994-1997 (678 women, among whom 343 tried to become pregnant again) were analyzed. Fertility was characterized by the time to a new pregnancy and its outcome (EP recurrence, intrauterine pregnancy (IUP)). Censored data methodology was used. RESULTS: Despite differences in general fertility characteristics between regions, fertility factors were the same with similar relative risks for age, history of infertility, previous tubal damage, use of an intrauterine device at the time of EP and EP treatment. When these factors were taken into account, fertility rate after EP remained significantly better in Auvergne than in the Lille region. CONCLUSION: This common analysis of data from two registers confirms, from a quantitative point of view, the role of the main factors associated with fertility after EP. However, other factors such as EP management or the surgical technique may intervene

Contraceptive failures and determinants of emergency contraception use.

The Cocon Group includes Jean Bouyer, Beatrice Ducot, Michèle Ferrand, Danielle Hassoun, Nadine Job-Spira, Monique Kaminski, Nathalie Lelong, Henri Leridon, Nicolas Razafindratsima and Josiane Warszawski.International audienceOBJECTIVES: Two years after emergency contraceptive pills (ECPs) were made available without prescription in France, we investigated the determinants of ECP use in a representative sample of women at risk for unintended pregnancy. STUDY DESIGN: This study is based on data collected from a population-based cohort exploring contraceptive practices and abortion (N=2863). RESULTS: Among the 706 women at risk for unintended pregnancy during the first year of follow-up (2001), only 11.1% used ECPs. Women in stable relationships or using the same contraceptive method during the year were less likely to use ECPs than other women. The study also demonstrates that detailed knowledge of ECPs increases the probability of its subsequent use. CONCLUSIONS: Given the low frequency of ECP use in cases of unintended pregnancy risk, these results suggest that information campaigns should be targeted not only at women with irregular contraceptive practices but also at women who experience errors in the use of their regular contraceptive method

Les inégalités sociales d'accès à la contraception en France

Bajos Nathalie, Oustry Pascale, Leridon Henri, Bouyer Jean, Job-Spira Nadine, Hassoun Danielle and the COCON group.- Social inequalities in access to contraception in France Since contraception was legalized in France in 1967, there has been a sustained increase in use of medical contraception, notably third generation contraceptive pills that are not reimbursed by the social security. This change in contraceptive behaviour may well have generated new forms of inequality. This article shows that social inequalities in contraceptive use in France have changed in recent decades. At the beginning of the 1 980s, access to the pill and the intrauterine device (IUD) was characterized by large inequalities. These inequalities subsequently declined sharply, for the pill in the 1990s and for the IUD at the end of the 1990s. COCON data show for the first time that such inequalities now affect access to third generation oral contraceptives. In addition to the financial obstacle of high price, the inequalities in access to these non-refundable products seem to result from women's expectations, which are related to their social class, and from the behaviour of the prescribing doctors, which also varies with the woman's social class. However, women seem not to prefer these new productsBajos Nathalie, Oustry Pascale, Leridon Henri, Bouyer Jean, Job-Spira Nadine, Hassoun Danielle et l'équipe Cocon,- Les inégalités sociales d'accès à la contraception en France Depuis la légalisation de la contraception en 1967, le recours à la contraception médicalisée, et notamment aux pilules de troisième génération non remboursées, ne cesse d'augmenter. Cette modification du paysage contraceptif a pu générer de nouvelles formes d'inégalités. L'article montre que les inégalités sociales en matière de contraception en France se sont déplacées de décennie en décennie. Au début des années 1980, l'accès à la pilule et au stérilet était marqué par de fortes disparités. Ces disparités se sont par la suite fortement réduites, pour la pilule dans les années 1990, puis pour le stérilet à la fin des années 1990. Pour la première fois, les données de l'enquête Cocon montrent qu'elles concernent désormais l'accès aux pilules de troisième génération. Ces inégalités d'accès à des produits non remboursés par la Sécurité sociale semblent résulter, outre du frein financier que représente leur prix élevé, d'attentes différentes des femmes, liées à leur appartenance sociale, ainsi que des comportements des prescripteurs qui varient aussi selon l'appartenance sociale des femmes. Ces nouveaux produits ne semblent toutefois pas être plus appréciés des femmes.Bajos Nathalie, Oustry Pascale, Leridon Henri, Bouyer Jean, Job-Spira Nadine, Hassoun Danielle y el equipo Cocon.- Las desigualdades sociales en el acceso a la anticoncepción en Francia Desde que se legisló el uso de anticonceptivos, en 1967, el acceso médico a éstos, y en particular a las pildoras no reembolsables de tercera generación, sigue aumentando. Es posible que taies cambios en el paisaje anticonceptivo hayan generado nuevas formas de desigualdad. Este articulo muestra que las desigualdades sociales en el uso de anticonceptivos en Francia se han ido desplazando década tras década. A principios de los aňos ochenta había fuertes dis- paridades de acceso a la pildora y al DIU. Estas disparidades se fueron reduciendo durante los aňos noventa, en el caso de la pildora, y hacia finales de los noventa, en el caso del DIU. Por primera vez, los datos de la encuesta Cocon muestran que taies desigualdades se manifiestan actualmente en el uso de las pildoras de tercera generación. Además del obstáculo financiero que supone el precio elevado de estas pildoras, tales desigualdades de acceso a productos no reembolsables por la Seguridad Social parecen derivarse de diferentes expectativas por parte de las mujeres segun su nivel social y a comportamientos también variables según nivel social de la mujer por parte de quienes las prescriben. Sin embargo, estos nuevos productos no parecen gozar de mayor apreciación entre las mujeres.Bajos N., Oustry P., Leridon Henri, Bouyer J., Job-Spira N., Hassoun D. Les inégalités sociales d'accès à la contraception en France. In: Population, 59ᵉ année, n°3-4, 2004. pp. 479-502

Contraception: from accessibility to efficiency.

BACKGROUND: Despite the widespread use of medical contraception in France, the prevalence of abortion remains stable. A cross-sectional population-based survey was designed to study the characteristics of current contraceptive use in France, the different types of contraceptive failure, and the reasons reported for not using contraception. METHODS: A representative sample of 14 704 French households was randomly selected from the telephone directory. All women who in the last 5 years had had an abortion or whose last pregnancy was unintended were selected (n = 1034), whilst a fraction (n = 1829) of the other women were randomly selected. Altogether, 2863 women answered the questionnaire. RESULTS: Only 2.7% of the women aged 18-44 years who did not wish to conceive and were sexually active did not use any contraception. However, 33% of pregnancies were estimated to be unplanned, of which 50% ended in an abortion. A total of 65% of the reported unplanned pregnancies occurred among women using contraception (21% the pill, 9% IUD, 12% condoms, 23% other method). The main reasons given for these contraceptive failures were the misuse of the methods or the failure of the partner to withdraw. Reasons for not using any contraception go beyond a simple lack of information. CONCLUSIONS: The importance of-and the reasons mentioned for-contraceptive failure show a misadaptation between women's contraceptive needs and the method they use. Improving the training of family planning providers remains a major goal to ensure that women use a contraceptive method that fits their social and sexual lifestyle

Social Inequalities in Access to Contraception in France

Bajos Nathalie, Oustry Pascale, Leridon Henri, Bouyer Jean, Job-Spira Nadine, Hassoun Danielle and the COCON group.- Social Inequalities in Access to Contraception in France Since contraception was legalized in France in 1967, there has been a sustained increase in use of medical contraception, notably third generation contraceptive pills that are not reimbursed by the social security. This change in contraceptive behaviour may well have generated new forms of inequality. This article shows that social inequalities in contraceptive use in France have changed in recent decades. At the beginning of the 1980s, access to the pill and the intrauterine device (IUD) was characterized by large inequalities. These inequalities subsequently declined sharply, for the pill in the 1990s and for the IUD at the end of the 1990s. COCON data show for the first time that such inequalities now affect access to third generation oral contraceptives. In addition to the financial obstacle of high price, the inequalities in access to these non-refundable products seem to result from women's expectations, which are related to their social class, and from the behaviour of the prescribing doctors, which also varies with the woman's social class. However, women seem not to prefer these new products.Bajos Nathalie, Oustry Pascale, Leridon Henri, Bouyer Jean, Job-Spira Nadine, Hassoun Danielle et l'équipe Cocon.- Les inégalités sociales d'accès à la contraception en France Depuis la légalisation de la contraception en 1967, le recours à la contraception médicalisée, et notamment aux pilules de troisième génération non remboursées, ne cesse d'augmenter. Cette modification du paysage contraceptif a pu générer de nouvelles formes d'inégalités. L'article montre que les inégalités sociales en matière de contraception en France se sont déplacées de décennie en décennie. Au début des années 1980, l'accès à la pilule et au stérilet était marqué par de fortes disparités. Ces disparités se sont par la suite fortement réduites, pour la pilule dans les années 1990, puis pour le stérilet à la fin des années 1990. Pour la première fois, les données de l'enquête Cocon montrent qu'elles concernent désormais l'accès aux pilules de troisième génération. Ces inégalités d'accès à des produits non remboursés par la Sécurité sociale semblent résulter, outre du frein financier que représente leur prix élevé, d'attentes différentes des femmes, liées à leur appartenance sociale, ainsi que des comportements des prescripteurs qui varient aussi selon l'appartenance sociale des femmes. Ces nouveaux produits ne semblent toutefois pas être plus appréciés des femmes.Bajos Nathalie, Oustry Pascale, Leridon Henri, Bouyer Jean, Job-Spira Nadine, Hassoun Danielle y el equipo Cocon.- Las desigualdades sociales en el acceso a la anticoncepción en Francia Desde que se legisló el uso de anticonceptivos, en 1967, el acceso médico a éstos, y en particular a las pildoras no reembolsables de tercera generación, sigue aumentando. Es posible que taies cambios en el paisaje anticonceptivo hayan generado nuevas formas de desigualdad. Este articulo muestra que las desigualdades sociales en el uso de anticonceptivos en Francia se han ido desplazando década tras década. A principios de los aňos ochenta había fuertes dis- paridades de acceso a la píldora y al DIU. Estas disparidades se fueron reduciendo durante los aňos noventa, en el caso de la píldora, y hacia finales de los noventa, en el caso del DIU. Por primera vez, los datos de la encuesta Cocon muestran que taies desigualdades se manifiestan actualmente en el uso de las pildoras de tercera generación. Además del obstáculo financiero que supone el precio elevado de estas pildoras, tales desigualdades de acceso a productos no reembolsables por la Seguridad Social parecen derivarse de diferentes expectativas por parte de las mujeres según su nivel social y a comportamientos también variables según nivel social de la mujer por parte de quienes las prescriben. Sin embargo, estos nuevos productos no parecen gozar de mayor apreciación entre las mujeres.Bajos N., Oustry P., Leridon Henri, Bouyer J., Job-Spira N., Hassoun D. Social Inequalities in Access to Contraception in France. In: Population (English edition), 59ᵉ année, n°3-4, 2004. pp. 415-437