Tuesday 9 August 2005
Contraception use by obese women
Issue 16: 8 Aug 2005
Source: Women’s Health Issues 2005; 15: 167-73
A major study has uncovered high levels of non-use of contraception among women of reproductive age who have chronic medical conditions such as obesity and diabetes.
The researchers present possible reasons for such women not using contraception, and say that addressing this non-use is a “critical step” towards improving pregnancy-related health outcomes.
Chronic medical conditions are known risk factors for pregnancy-related complications. Research has found that obesity increases the risk of pregnancy-related morbidity such as induction of labor, emergency cesarean section, excessive birth weight, gestational diabetes, and pregnancy-induced hypertension. Diabetes has been linked with an increased risk of congenital malformations, and higher rates of spontaneous abortion and perinatal mortality.
In a new paper in the journal Women’s Health Issues, researchers from Pennsylvania State College of Medicine, in Hershey, USA, describe their analysis of contraceptive use among 7,943 sexually active women of reproductive age (18-44 years) who were not trying to conceive. The data came from a telephone survey of women from 11 states, conducted in 2000.
Using contraception?
Overall, 18.9 percent of the women reported not using any form of contraception. This included 23.4 percent of obese women (with a body mass index of 30 kg/m2 or more), 20 percent of overweight women (with a body mass index of 25 to less than 30 kg/m2), and 25.8 percent of women with diabetes.
Statistical analyses showed that obesity was significantly associated with not using contraception. Obese women were 1.34 times as likely not to use contraception as women of normal weight (with a body mass index of less than 25 kg/m2).
Non-use of contraception was also significantly higher among women who were:
Older (aged 35-44 years, compared with women aged 18-24).
Black or Hispanic (compared with white).
Less educated (to less than high school level, compared with at least some college education).
Without health insurance.
The researchers suggest several reasons why women with a chronic medical condition such as obesity may be less likely to use contraception.
They say the women may perceive themselves as having a decreased fertility, or have negative views on the effectiveness of contraception in the context of the chronic condition. During health visits, management of the chronic condition may dominate, and preventive measures such as contraception may not be discussed. The women themselves may prioritize the condition and be less concerned with pregnancy planning or avoidance, the researchers add. The costs of treatment of the chronic condition may also be sufficiently high that some women do not want to take on additional costs associated with contraception.
Concluding, the researchers write: “Because women with chronic conditions like obesity are at higher risk of pregnancy-related complications and adverse pregnancy outcomes, proper contraceptive use and unintended pregnancy avoidance is a priority.”
http://www.obgynworld.com/international/webzine/2005/Issue_16/Contraception_use_by.asp 
Contraception use by obese women 
