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The study is based on data from the 1978 Manawatu Family Growth Study concerning use, user satisfaction, and experience of side effects and fears among oral contraceptive (OC) users. 1085 (78%) of the 1390 women aged 16-44 interviewed had ever used OCs, 411 were current users. The proportion ever using OCs varied by age from 48.3% of women 16-19 to around 90% for those 25-34, 75.9% of current and 43.3% of former users were aged 16-29. 21.5% of previous users discontinued to become pregnant, and 65.6% switched to another method. 45.2% of current users admitted to sometimes forgetting to take the pill. 50% reported they were not entirely happy with the pill, with dissatisfaction lowest among current users aged 16-19 and 35-39 and greatest among those 25-34. Substantial proportions of dissatisfied current users and of previous users reported various side effects, among which swelling or weight gain, dizziness, headache, or feeling weak were among the most common; nausea, bleeding, and changes in skin or hair were reported also by many. Fears of permanent damage to their health were reported by over 1/2 of dissatisfied current users and of previous users, and 46.9% of ever users reported that publicity about possible side effects had caused them concern. Subgroup variation was found in use and experience, as illustrated by greater incidence among Maori women of both forgetting and satisfaction among current users. Study findings suggest a need for instruction, guidance, and counseling for OC users.
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PMID:The oral contraceptive pill: use, user satisfaction, side effects and fears among Manawatu women. 695 20

This work uses clinical examples to explore sources of conflict and denial of patients and physicians during contraception consultations. The discovery of oral contraceptives (OCs) and improvements in mechanical contraception raised hopes that couples could achieve total control of their fertility. But continued high abortion rates and the persistence of sexual problems and maladjustments have demonstrated that contraception alone is not a panacea. Conflicts about contraception may be conscious and quickly expressed during a consultation, even if a medical pretext is given. The resentment when 1 partner desires a child and the other does not for example can translate into a conflict about contraception. Some women are fully aware of their own ambivalence about pregnancy and contraception and able to express it openly, but very often the woman's concerns are expressed by questions, fears, and verbal slips. The fear that pills are unnatural or will cause congenital defects can be interpreted as an expression of guilt over the pleasure that pills permit. Sterility is the ultimate fear caused by this unlimited possibility for pleasure. In the majority of cases, physical complaints are the means by which contraception clients address their physicians. In some cases, intolerance to OCs may actually be a hysterical manifestation that is not understood. Such symptoms as nausea, breast swelling, dizziness, vomiting, nervousness, and insomnia may be signs of early pregnancy as well as of intolerance for pills. Intolerance to pills may be caused by intolerance of a sexuality in which all things seem possible but in which the individual feels unrecognized by the partner. The resulting aggression may be turned inward in the form of a morbid symptom or of forgetting or stopping pill use, recourse to abortion, and demand for recognition. Acting out, especially by adolescents, is common in the area of contraception. In some cases the psychological or emotional needs of the patient might be better met by contraception that leaves some risk of failure, such as low-dose progestins or local methods. Their relative efficacy may allow the ambivalent desire for a child not to be completely stifled. Cases also arise in which patients use contraceptives to mask problems and to give the illusion of a normally functioning body. The possibility of having a child is very seldom raised during contraceptive consultations, perhaps because for the physician contraception subconsciously evokes the forces of death. The doctor can take refuge in the technical aspects of contraception, ignoring the emotional needs of the client.
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PMID:[The difficulties of contraception: conflicts and paradoxes]. 1231 42