Women’s Views and Experiences of Hormonal

Contraceptives: What We Know and

What We Need to Find Out
Anita Hardon

This paper is a review of studies on the acceptability of the hormonal contraceptive methods used
most extensively in family planning programmes worldwide: the pill, injectables and implants. It
aims to elucidate women’s views and experiences with these methods, and how they use them.
Studies show that women dislike taking a pill every day and fear the effects of hormonal methods
on their health. Given the high discontinuation rates found for the oral pill and three-month
injectables, there appears to be a demand for further development of new and existing methods,
so that they need not be taken daily and will cause minimal menstrual disturbances, such as once-
a-month injectables and pills, and early abortifacients. To better understand users’ views of
hormonal contraceptives, more studies are needed that focus on women and their changing
needs for fertility regulation, shedding light on their preferences, experiences and practices.

T
HE pill was the first effective hormonal ceptive practices. Ultimately, I am interested in
contraceptive method to come on the finding out from existing data how fertility
market and soon became a very popular regulating technology can be modified to fit
means of fertility control. Researchers and people’s diverse needs better.3
manufacturers have since developed new
delivery systems for hormones: injectables,
implants, IUDs and rings. This paper is a review Limitations of existing user perspective
of studies on the acceptability of the hormonal studies
methods that have been used most extensively in Available data on women’s views on and
family planning programmes worldwide, based experiences with hormonal methods are limited
on a systematic search in the Popline and for various methodological reasons. First,
Medline databases and a review of women’s studies generally focus on users’ views of the
health literature.1 methods, and not on the views of non-users.
Only women’s views and experiences are Second, most studies rely on surveys. There is a
covered, not those of men or health workers, lack of qualitative studies that aim at generating
because I chose to focus on the people who more in-depth understanding of how people use
actually take the pills or have the injections and or do not use hormonal contraceptives, what
implants. To date, only a prototype hormonal their views of the methods are and their
contraceptive for men exists, and there was only experience using these methods.
one acceptability study on men’s experiences Third, very few measures of contraceptive use
with that method.2 In their role as husbands and have been developed. Most studies relate
partners of women users, men of course acceptability of methods to (dis)continuation
condition the acceptability of hormonal methods, rates, defined as the percentage of users who
as do health workers who inform women of their continue or stop using a method after six
contraceptive options, prescribe the methods or months, or one or more years of use. Where
administer them. While not focusing on these users’ experiences with methods are described,
actors, I will draw attention to any findings on they usually concern perceived side effects and
how they affect women’s views and contra- reasons for discontinuation. For contraceptive

68
 Beyond Acceptability

pills, patterns of non-compliant use are com-

monly described. However the reasons for non- Table 1. Percentage women who intended to use
compliance are rarely studied systematically. selected hormonal methods in the next 12 months.4
Fourth, studies rarely describe how women
choose between the different contraceptive Region Number of Intention to Use
options, what they see as the relative advantages Countries Oral Pill Injectables
and disadvantages of each method, and how Africa 21 39 per cent 27 per cent
their preferences are related to socio-economic
Asia and Near East 10 30 per cent 15 per cent
and demographic variables such as their
educational status, age and actual vs. desired Latin America and
number of children. Caribbean 9 27 per cent 11 per cent
Lastly, existing studies rarely deal with the way
in which the health service context of a study
shapes women’s experience with and views on
the methods. Studies report on the effects of different ages liked the pill because it was easy to
methods, but not on what women were told about use, highly effective, and could be used to
the methods in the first place. They report extent regulate menstruation.
of non-compliance but not whether users were More studies provide information on what
told how to use the methods adequately. Most of women see as advantages of the longer-acting
these studies have been done in settings where hormonal injections and implants. An intro-
quality of care is relatively good, eg. in university ductory trial in Singapore, for example, com-
clinics or health centres located in urban areas. pared attitudes towards contraceptive implants
This is especially true for implants and injec- and injectables7 and found that current and
tables, which went through pre-introductory former users perceived the long duration of
trials before being included in family planning implants positively as compared to the shorter
programmes. As a consequence, comparatively three-month duration of injectables. A qualita-
little is known about acceptability of the methods tive study in Mexico revealed that women
in less adequate health care conditions. considered once-a-month injectables ‘less
troublesome’ than oral contraceptives and more
convenient than three-monthly injectables.
Women’s preferences among hormonal Features most often cited in favour of injectables
methods were their effectiveness, lack of rumours about
Although many new contraceptives have been side effects, the possibility of secrecy and ease of
developed in recent decades, demographic and correct use.8
health surveys (DHS) conducted worldwide In Bangladesh and Thailand three-monthly
show that the hormonal pill is still the most injectables have been widely used in the family
popular contraceptive method. In 21 African planning programme. An early evaluation of the
countries, 10 countries in Asia and the Near East, Bangladesh programme in 1979, stated that
and 9 Latin American and Caribbean countries, people like injections better than pills, and that
the contraceptive pill was the most preferred convenience, effectiveness and suitability for
method followed by injectables as the second lactating mothers were factors contributing to
most preferred method, though injectables were their popularity. In Thailand, the ‘freedom from
preferred by more women in Africa than in the fear of forgetting’ pills, the ease, convenience
other two regions (Table 1).4,5 and high effectiveness were the attributes
These aggregated data ignore differences considered positive, that explained its popularity.
between countries and within countries, but they In Indonesia, where the largest number of
do draw our attention to the continuing impor- implant users worldwide are found, the main
tance of the contraceptive pill. It is therefore reasons reported for selecting implants were
strange that few studies have examined qualita- that they were long-lasting and convenient.9
tively why women opt for the contraceptive pill (Table 2)
in such large numbers. One exception was in St
Vincent in the Caribbean6 where women of

69
Hardon

children and a higher educational level than oral

Table 2. Reported Reasons for Preferring Selected contraceptive users. The authors suggest that
Hormonal Methods Norplant was being used as an alternative to
sterilisation, while women who still wanted more
Pill Injectables Implants children were choosing the pill.13
• ease of use • convenience • convenience Furthermore, the higher continuation rates
for Norplant may indicate that some women are
• effectiveness • effectiveness • effectiveness
not easily able to have the method removed, as
• regulates • secret use possible • long duration suggested by a study on acceptability of Norplant
menstruation by Zimmerman et al:
• suitable for
lactating women
‘In all four countries there were reports that
• freedom from fear
removal on demand did not occur to the
of forgetting the pill
satisfaction of the user. Women participating in
the clinical study, who asked for removal because
of irregular bleeding, experienced the greatest
Why women discontinue methods difficulty, as clinicians often suggested waiting to
In light of data showing that women highly value see whether the menstrual flow would norma-
hormonal methods for effectiveness and lise . . . . In Thailand, because of the cost of the
convenience, it is surprising that around half of method, women are routinely informed when
the women who start using hormonal pills and choosing Norplant that the implants are appro-
injectables stop using them within 12 months.4 priate for long-term spacing and will not be
Discontinuation rates are much higher for removed for minor side effects.’ 15
injectables and the pill than for the implant
Norplant,10,11 for which the reported one-year
discontinuation rates are from 5 to 18 per cent.12 Health concerns
Why? A substantial number of women taking the
In one university family planning clinic in contraceptive pill in many different socio-
Nigeria, there was a big difference in contin- cultural settings fear its effects on their health.
uation rates between the contraceptive pill and Apart from wanting to try for a pregnancy, side
Norplant; after 12 months of use, the continu- effects are the most important reason for
ation rate for oral contraceptive users was only discontinuation of hormonal contraceptives and
27.7 per cent, while for Norplant it was 93.7 per are therefore an important focus in user studies
cent.13 A field survey in Bangkok found that after of these methods, especially the pill.
12 months only 47 per cent of those who chose The most commonly reported side effects are
the pill and 39 per cent of those who chose the headaches, dizziness, and weight changes. Other
injectable were still using the same method, health concerns appear to be more context
mainly due to disagreeable health effects.14 dependent, such as heart palpitations, weakness
Reports on these differentials tend to or decreased libido. It is not possible to draw
conclude that because of high continuation rates conclusions based on existing studies of the
Norplant is a relatively acceptable method of range and variability of reported side effects of
contraception. However, the data on Norplant hormonal methods, because the methods used
have been gathered in introductory trials; under differ. A multi-country study, using uniform
normal programme conditions, continuation methods and with the explicit objective of
rates are likely to be lower. Further, the women assessing women’s experiences with hormonal
choosing implants may differ from those using methods, would need to be done for more insight
injectables and pills. The latter may be using into these issues.
these methods for spacing purposes, while the In the Netherlands, for example, 58 per cent of
former may be using the method as an a random sample of 1200 women aged 20-40 felt
alternative to sterilisation, or for longer-term that taking a pill everyday was not healthy.16
contraceptive purposes. Indeed in the Nigeria Two-thirds of the women who were actually
study, Norplant users were found to have more using the pill during the study reported that they

70
 Beyond Acceptability

had had adverse effects. Those mentioned were measured non-compliance with oral contra-
headaches, weight gain, bleeding irregularities, ceptives in rural Bangladesh by observing at the
decreased libido, depression and fatigue. Ex-pill household level the number of pills remaining in
users emphasised that by discontinuing the pill, packets. Unexpectedly high levels of non-
the complaints stopped. In Matlab in Bangla- compliance were found: in one study area, 56 per
desh, reported side effects such as dizziness, cent of women took too many pills and 34 per
nausea, headache and general weakness were cent too few; in another study area, these figures
major reasons for discontinuing the pill.17 When were 35 and 30 per cent respectively. Though the
a lower-dose pill was introduced, it was study was not designed to investigate the causes
discontinued less.18 In the Sri Lanka study,10 of non-compliance, a few in-depth case histories
women mentioned nausea, vomiting, headaches are given, which indicate that under-use of pills
and dizziness as caused by the pill. In Thailand, was partly related to taking a pill only when the
respondents mentioned reduced menstrual flow, husband was around. Other reasons for under-
heart palpitations, headache, dizziness, and use were lost or damaged packets, visits to
weight loss as side effects.19 Perceptions of the relatives who disapproved of contraception, and
pill among urban women in Rabat20 and Cairo21 illness. One or two women were found to be
were that it affected blood pressure and caused taking too many pills, ie. two per day to alleviate
heart palpitations, weakening of the entire body menstrual problems, apparently following advice
and dizzy spells. In three cities in Brazil from health workers that it would control
(Fortaleza, Recife and Salvador) around 80 per breakthrough bleeding.
cent of pill users and non-users found the pill A more recent study in Bangladesh17 found
annoying and difficult to take every day and that although most women knew they should
considered it harmful. Many respondents take one pill per day, and two pills if they missed
reported side effects such as headaches, weight one, 16 per cent of urban women and 2 per cent
gain and dizziness (60-70 per cent).22 of rural women did not think it was necessary to
Side effects of headaches, dizziness and take a pill when their spouses were absent for
weight changes have also been reported for less than 30 days. Problems related to the
the longer-acting progestogen-only injectables transition from one packet to the next were also
and implants, but changes in bleeding patterns reported: 53 per cent of respondents thought
are the main problem with these methods and they had to wait for bleeding in order to start a
an important reason for discontinuation, new packet.
occurring in around two thirds of users.23,24,25 In Colombia28 of 341 women, only 42 per cent
The type of menstrual changes vary: either no reported having taken the pill correctly and
bleeding, irregular bleeding or spotting, or consistently during the previous two weeks.
heavy/prolonged bleeding. Reasons varied: 10 per cent said they had run out
of pills. About 43 per cent had missed a pill at
least once during the cycle and not made it up;
Inconsistent use these women gave such reasons as the absence
Health concerns about hormonal methods may of their partner, irregular sexual activity,
often lead to discontinuation of use. When attempting to reduce side effects, or trying to
methods are administered by the user, such make their supplies last longer by taking a pill
concerns can lead instead to inconsistent use, only every other day. While 88 per cent of users
such as forgetting to take the pill. (Inconsistent did know that they should take a pill daily, many
use is not reported for injectables and implants.) did not know what to do if they had missed a pill.
The contraceptive pill must be used according Further, 47 per cent of women using the method
to a fixed regimen of one tablet per day. Some incorrectly also made errors in moving from one
are taken for 21 days with 7 pill-free days pill packet to the next, partly due to confusion
before the next packet is started; others are used caused by the availability of more than a dozen
with no pill-free days between packets. There different types of pill, including 21-day and 28-
is a lot of evidence that women are using the day packets.
pill inconsistently.26 Maynard Tucker reported in 198629 that rural
One systematic study of this problem27 Quechua-speaking Indian women in Peru often

71
Hardon

started taking the pill on the wrong date, forgot truation is an important event in any woman’s
to take them for a few days or quit in the middle life. The meaning attributed to menstruation and
of a cycle because they ‘did not feel good’. They its absence can affect, among other things,
also tended to forget to go to the health post cooking procedures, sexual interaction and
every month for a new supply. Taking too few or religious practice.30,32,33
too many pills can cause or aggravate bleeding Women in many different societies have
disturbances and also lead to other physiological perceived delay or absence of menstruation as
reactions, such as headaches or nausea. These unhealthy.34 In Colombia, loss of bleeding has
consequences of incorrect use are hardly been seen as a sign of illness,35 and among
mentioned in the studies reviewed here, the Chinese Malays36 irregular menstruation is
emphasis being on the impact that incorrect use believed to be unclean and bad for women’s
has on effectiveness. health, and as in other parts of Malaysia requires
remedies to ensure onset of bleeding.37
Amenorrhoea also means that women do not
Anthropological studies: understanding know if they are pregnant or not. If they are not
women’s perceptions and experiences adequately warned about this effect of hormonal
Published studies also tend to focus on issues methods, the absence of menstruation can lead
that are of importance to programme admini- to much anxiety that they are pregnant.
strators and policymakers, rather than to Anthropological studies have also shed new
contraceptive users themselves. There is little light on other reported side effects. In most
understanding of the range and variation in quantitative studies, it has been assumed that the
views, experiences and use of the methods, and it methods have a universal physiological effect
is impossible to draw conclusions about the that is the basis for what women report and,
relative advantages and disadvantages of the pill, indeed, there are obvious similarities in these
injectables and implants as perceived by women reported effects. Dizziness, weight changes and
in different socio-cultural contexts. Clearly, for headaches are very common for the pill as are
example, inconsistent use of the pill is related to bleeding disturbances for the implant and
the extent and quality of counselling provided by injectables. However, there are also cultural
family planning providers; this is not elucidated. differences in reported adverse effects,
A few anthropological studies do provide a suggesting that these effects not only reflect
deeper understanding of users’ views and experi- some underlying physiological disturbance, but
ences of hormonal contraceptives. These may also that the technology can act as a screen on
affect contraceptive practices women engage in, which people project feelings, anxieties and the
based on fears that may be widely shared, such as like.30,31 For example, one woman complained of
fear of infertility. In 1980, few women in Iran were becoming thin due to the pill:
willing to use the pill to space their children until
they had enough children, as they feared the pill ‘What became apparent over time was that the
would cause infertility, which they related to the woman was using a somatic idiom of distress
diminished flow of menstrual blood.30 A perva- to . . . communicate to us problems she was having
sive notion in a Sri Lanka study was that the pill with her husband . . . . The woman’s anxiety was
caused side effects because of its ‘heating’ effect, articulated vis à vis the weakness-thinness idiom
and burned up vitality and strength so that a . . . which allowed her to . . . communicate that she
pregnancy could not be started; they thought was feeling powerless in her situation as well as in
it might cause permanent infertility because of her body.’ 31
this as well.31 In the more recent Bangladesh
study, 33 per cent of respondents also thought Disorders such as heart palpitations, weak
that the pill would prevent them from ever having nerves and short tempers are sometimes
any more children.17 attributed to the pill by respondents, and also to
Anthropological studies of fertility regulation other stresses experienced by women, such as
indicate that women value regular menstruation, sexual intercourse, pregnancy, childbirth, child-
and have shown that the consequences of rearing, poverty, worry and grief. These symp-
menstrual disturbances are far-reaching. Mens- toms can be a physiological expression of

72
 Beyond Acceptability

feelings of anxiety and ambivalence associated ‘flesh’ comes from listening to people with direct
with contraception and sexual intercourse, experience.’ 9
fertility and infertility, and the stresses of
women’s lives.30 To illustrate the problem of continuous bleeding
with a hormonal method, for example, Widyan-
toro quotes a woman who explained why her
Non-prescribed use of contraceptives: safe husband was furious when she suffered from
and unsafe continuous bleeding with Norplant. Not only was
Anthropological studies can also draw attention he worried about his wife’s condition, but also
to indigenous practices involving non- she was reluctant to have sex with him. He could
prescribed uses of contraceptives, which are in understand that, but the bleeding disturbed their
congruence with culture-specific notions of relationship and made both of them worried and
efficacy and safety of the methods.38 In Iran, depressed.9
women who were aware of the fact that the pill Another example is a study in the Philippines,
causes amenorrhoea when used continuously, which aims to document the dynamics of fertility
have taken it to prevent ritual impurity from regulation through reproductive life histories.
menstruation during Ramadan or on a pilgri- Preliminary findings of these studies are showing
mage to Mecca.30 how women use different methods at different
In Colombia and Jamaica, some women take points in their reproductive lives. They go through
up to a month’s worth of pills at one time, to phases of wanting to be pregnant, conceiving, not
induce a miscarriage when they are pregnant, as wanting to be pregnant but wanting to have more
they know it can cause bleeding.35,39 They buy the children later, using fertility regulation methods,
pills over the counter in pharmacies, without not using fertility regulation methods because of
medical advice or guidance, learning how to use side effects, becoming pregnant, having an
them from friends. Similarly, in the Philippines, abortion, and so on.42
high-dose oestrogen-progestogen drugs on the
market for treating bleeding disturbances, were
being bought over the counter and used Challenges
routinely by women to induce abortions when Many positive attributes were associated with
their periods were less than a month or two hormonal contraceptives according to this
overdue.40 Women believed that the bleeding literature review. Yet high discontinuation rates
could cause an abortion, yet there is no scientific with the pill and three-month injectables are
evidence that such drugs work as abortifacients. indicative of a range of problems associated with
In fact, they only induce bleeding if the woman is these methods, including side effects and other
not pregnant. If she is pregnant, these drugs health concerns. Viewing these positives and
could lead to birth defects.41 negatives together, it can be argued that there is
a strong case for further development of
methods that need not be taken daily and that
Women’s needs as a point of departure cause fewer, and if possible, minimal menstrual
In the 1990s more and more studies are taking disturbances. These might include once-a-month
women’s health needs and autonomy as a point injectables and once-a-month pills. New
of departure, often conducted by researchers methods such as these would help to broaden
connected to women’s health organisations. women’s choices.
Such studies emphasise gender dynamics, and Once-a-month injectables came on the market
the quality of care provided by family planning in some Latin American countries as early as the
services as factors in women’s use of contra- 1980s, produced by local companies. A 1984
ception and their views on it. These studies are qualitative study of these methods in Mexico
usually qualitative in nature, and quote women’s showed that women preferred them over three-
views and experiences extensively. As Widyan- month injectables.8 Two newer once-a-month
toro comments: injectables (brand names Cyclofem and Mesi-
gyna) each contain a combined oestrogen and
‘Survey results are the bones of any topic; the progestogen, which reduces the extent of

73
Hardon

bleeding disturbance.43 One as-yet unanswered their reproductive lives;

question is whether the need to return to a clinic • show how power relations between husbands
monthly for an injection will be perceived as a and wives, and others in sexual relationships,
disadvantage over a longer period of time. affect fertility regulation practices;
A once-a-month oral pill is currently • determine in what way women’s and men’s
produced in China and is reportedly popular in views on, use of and experiences with fertility
Laos, where it is available on the private market. regulating methods are related to the quality
This pill is a combined, long-acting oestrogen of services that provide the methods. Special
and a progestogen, developed in 1967 and attention is needed to the content of the
introduced into the Chinese family planning information provided on the range of
programme in 1978.44 One clear advantage of a contraceptive methods, the quality of the
once-a-month pill is that users do not need to interpersonal communication between the
depend on health workers for its administration. providers and users and the extent to which
Apparent from anthropological studies of people trust the services;
indigenous practices in fertility regulation is the • consider ways in which women’s and men’s
non-prescribed use of hormones (and other cultural notions of fertility and health affect
drugs45 ) as abortifacients when contraceptives their use of fertility regulation methods in
were not used or may have failed to work. different socio-cultural settings;
Reports suggest that women in diverse socio- • deepen understanding of women’s and men’s
cultural settings use and value methods for health concerns about existing hormonal
inducing delayed menstruation. Post-coital hor- contraceptives. Are the health concerns that
mones that can be used when menstruation is women express narratives of distress, some of
delayed or after unprotected sex may be which may be culture-specific? Are women –
preferred over hormonal methods that have to between the lines – talking about fear of loss of
be taken continuously – whether daily, monthly fertility due to contraceptive methods, or
or every three months. Further development of about guilt for not complying with religious
safe and effective post-coital methods thus also rules, or using contraceptives without the
seems to be called for. knowledge of their husbands? Or are they
Studies by women’s health advocates draw simply reporting bodily reactions to the
our attention to the ways in which information hormones?
and advice given to women by family planning • reveal what trade-offs women and men make
providers affect women’s preferences and when selecting a fertility regulation method,
experiences.46 Such studies point to related thus eliciting the attributes of methods
issues that affect method acceptability, such as (including the protection provided against
their ability to protect women against sexually STDs) that they perceive as important, and
transmitted diseases, and the role of men in revealing cultural criteria that they use to
fertility regulation. More such in-depth, quali- evaluate the safety and efficacy of methods.
tative studies are needed to understand better • document non-prescribed uses of existing
women’s and men’s fertility regulation practices contraceptive methods, and traditional
and their views of and experiences with fertility fertility regulation practices and how these
regulation methods. Such studies should focus may be linked with the practice of modern
not only on hormonal methods, but on all forms contraceptive use or non-use.
of fertility regulation, both contraceptive and
post-coital. In sum, this review suggests that Given the difficulties of drawing conclusions on
studies are needed that: the range and variations of user views, experi-
ences and practices, because existing studies
• do not focus on methods and do not take the differ in focus, objectives, and methodology, it is
concerns of family planning administrators clear that more standardised, quantitative
and planners as a starting point, but focus on studies are needed to facilitate comparative
women and men and their changing needs for analysis. Such studies should not only describe
fertility regulation, shedding light on their women’s and men’s views and use of methods,
preferences, experiences and practices during but also aim to understand their perceptions and

74
 Beyond Acceptability

practices. An appropriate conceptual framework Acknowledgements

for such studies could build on the results of in- The literature review presented here was
depth qualitative studies, in accordance with the supported by the Gender, Reproductive Health
suggestions above. and Population Policies Project, funded by the
In-depth, qualitative studies can elaborate on Netherlands Ministry of Foreign Affairs. I wish to
attributes of methods that women and men thank Michael Lim Tan for showing me
consider important, while quantitative studies preliminary data from the project’s ongoing study
can highlight the relative importance of such in the Philippines, and Pieter Streefland for
attributes in different socio-cultural settings. The valuable comments and suggestions for revision
attributes that people value or are concerned of this paper. This is a revised version of a paper
about do not occur in a vacuum. They are related presented at the meeting on ‘Women’s and Men’s
to the health care context and the culture in Perspectives on Fertility Regulation Methods and
which people live. A greater understanding of Services,’ Geneva, November 1995.
the way in which quality of care affects people’s
fertility regulation practices, and more profound Correspondence
insight into people’s health concerns can not Anita Hardon, Medical Anthropology Unit,
only help us to understand the attributes of Oudezijds Achterburgwal 185, 1012 DK Amster-
methods that people consider important, they dam, Netherlands. Fax: 31 20 525 3010. E-mail:
can also contribute to improved counselling in hardon@pscw.uva.nl
family planning services, and consequently more
informed choice and more appropriate use of
fertility regulation methods.

References and Notes

1. Key words were ‘use’, Research Training in Human Planning. 15(6):285-90.
‘acceptability’, ‘compliance’ and Reproduction, Geneva, 11. Trussell J, Hatcher RA, Cates W
‘user-perspective’ vis à vis the February. (Unpublished) et al, 1990. Contraceptive failure
methods mentioned. The studies 5. The DHS data do not provide in the United States: an update.
reviewed were on the use and comparative data on the Studies in Family Planning.
acceptability of hormonal preference for implants, as these 21(1):51-54.
implants (since 1985), injectables hormonal methods are not 12. Sivin I. 1988. International
(since 1970) and oral widely available. experience with Norplant and
contraceptives (since 1970). 6. Russel-Brown P, 1983. Norplant II contraceptive.
While all the reviewed studies Qualitative focus group sessions Studies in Family Planning.
present empirical data on – St. Vincent: summary report. 19(2):81-94. See also these
contraceptive use, not all of them Unpublished report (in Popline). papers on Norplant:
cover users’ views and 7. Singh K, Viegas OA, Ratnam SS, – Shaaban SMM et al, 1983. A
experiences. 1990. Attitudes towards prospective study of Norplant
2. Ringheim K, 1996. Whither contraceptive implants and implants and the TCu 380Ag IUD
methods for men? Emerging injectables among present and in Assiut, Egypt; Lubis F et al.
gender issues in contraception. former users in Singapore. One-year experience with
Reproductive Health Matters. Journal of Biosocial Science. Norplant implants in Indonesia;
7(May):79-89. 22(1):1-11. Marangoni P et al, Norplant
3. Most user-studies did not do this 8. Network. 1984. implants and the TCu 200 IUD: A
in the past, but aimed to modify 9. Widyantoro N, 1994. The story comparative study in Ecuador;
people to fit existing methods. of Norplant implants in and Satayapan S et al,
4. Shah I, 1995. Perspectives on Indonesia. Reproductive Health Perceptions and acceptability of
methods of fertility regulation: Matters. 3(May):20-30. Norplant implants in Thailand –
setting a research agenda. A 10. Basnayake S, Higgins JE, Miller all in Studies in Family Planning.
background paper. P et al, 1984. Early symptoms 1983; 14(6/7).
UNDP/UNFPA/WHO/World and discontinuation among – Darney PD, Atkinson E, Tanner
Bank Special Programme of users of oral contraceptives in S et al, 1988. Acceptance and
Research, Development and Sri Lanka. Studies in Family perceptions of Norplant among

75
Hardon

users in San Francisco, USA. rumores. Fortaleza, Recife, Studies in Family Planning.
Studies in Family Planning. Salvador. Rio de Janeiro, 17(6):308-16.
21(3):153-60. CEPPD. 30. Good MJD, 1980. Of blood and
13. Fakeye O, 1991. Contraception 23. Liskin ScM, Blackburn R, 1987. babies: the relationship of
with subdermal levonorgestrel Hormonal contraception: long- popular Islamic physiology to
implants as an alternative to acting methods. Population fertility. Social Science and
surgical contraception at Ilorin, Reports. Series K, No 3. Medicine. 14(B):147-56.
Nigeria. International Journal of Baltimore, Johns Hopkins 31. Nichter M, Nichter M, 1989.
Gynecology and Obstetrics. University, Population Modern methods of fertility
35(4):331-36. Information Program. regulation: when and for whom
14. Chumnijarskij T, Sunyavivat S, 24. McCauley AP, Geller JS, 1992. are they appropriate. Studies in
Onthuam Y et al, 1984. Study on Decisions for Norplant International Health in South
factors associated with programmes. Population Asia. M Nichter (ed). Kluwer,
contraceptive discontinuations Reports. Series K, No 4. Dordrecht.
in Bangkok. Contraception. Baltimore, Johns Hopkins 32. Buckley T, Gottlieb A (eds), 1988.
29(3):241-49. University, Population Blood Magic: The Anthropology
15. Zimmerman M, Haffey J, Crane Information Program. of Menstruation. University of
E et al, 1990. Assessing the 25. Most studies focus on the California Press, Berkeley.
acceptability of NORPLANT acceptability of Norplant to 33. World Health Organization Task
implants in four countries: users and to women who Force on Psychosocial Research
findings from focus group discontinued use. One four- in Family Planning, 1981. A
research. Studies in Family country study has also assessed cross-cultural study of
Planning. 21(2)92-103. acceptability to potential users, menstruation: Implications for
16. Vennix P, 1990. De pil en haar ie. people coming to a family contraceptive development and
alternatieven. NISSO Studies planning service in search of a use. Studies in Family Planning.
Nieuwe Reeks 6, Eburon, suitable fertility regulating 12(1):3-16.
Utrecht. method. See: Kane TT, Farr G, 34. Newman LF (ed), 1985. Women’s
17. Larson A, Mitra SN, 1992. Janowitz B, 1990. Initial Medicine: A Cross-Cultural
Family planning in Bangladesh: acceptability of contraceptive Study of Indigenous Fertility
an unlikely success story. implants in four developing Regulation. Rutgers University
International Family Planning countries. International Family Press, New Brunswick.
Perspectives. 18(4):123-29. Planning Perspectives. 16(2):49- 35. Browner CH, 1985. Traditional
18. Salway S, Fauveau V, 54. Another comparative study techniques for diagnosis,
Chakrabarty J, 1994. looked into acceptability to treatment and control of
Introducing the low-dose pill to husbands and to family planning pregnancy in Cali, Colombia.
Bangladesh: issues of programme personnel [15 Women’s Medicine: A Cross-
continuation and failure. above]. Cultural Study of Indigenous
Contraception. 49:171-83. 26. Hubacher C, Potter L, 1993. Fertility Regulation. LF Newman
19. Iddhichiracharas N, Chiowanich Adherence to oral contracaptive (ed). Rutgers University Press,
P, Zankel S et al, 1983. The user regimes in four countries. New Brunswick.
perspective in Northern International Family Planning 36. Ngin C, 1985. Indigenous fertility
Thailand: a series of case- Perspectives. 19(49):53. regulating methods among two
studies. Studies in Family 27. Seaton B, 1985. Non-compliance Chinese communities in
Planning. 14(2):48-56. among oral contraceptive Malaysia. Women’s Medicine: A
20. Mernissi F, 1975. Obstacles to acceptors in rural Bangladesh. Cross-Cultural Study of
family planning practice in Studies in Family Planning. Indigenous Fertility Regulation.
urban Morocco. Studies in 16:55-60. LF Newman (ed). Rutgers
Family Planning. 6(12):418-25. 28. Potter L, Wright S, Berrio D et University Press, New
21. Krieger L, 1984. Body notions, al, 1988. Oral contraceptive Brunswick.
gender roles and fertility compliance in rural Colombia: 37. Laderman C, 1983. Childbirth
regulating methods used in knowledge of users and and Nutrition in Rural Malaysia.
Imbaba, Cairo. PhD dissertation. providers. International Family University of California Press,
Department of Anthropology, Planning Perspectives. Berkeley.
University of North Carolina, 14(1):27-31. 38. Haak H, Hardon AP, l988.
Chapel Hill. 29. Maynard Tucker G, 1986. Indigenized pharmaceuticals in
22. Costa MA, Chaloub R, 1992. Barriers to modern developing countries: widely
Anticoncepç´ão oral. Uso e contraceptive use in rural Peru. used, widely neglected. Lancet.

76
 Beyond Acceptability

10(Sept):620-21. WEMOS, Amsterdam. Annual Technical Report 1994.

39. Sobo EJ, 1993. Bodies, kin and 42. Part of the multi-country World Health Organization,
flow: family planning in rural Gender, Reproductive Health Geneva 1995.
Jamaica. Medical Anthropology and Population Policies Project, 44. Kotsaythoume and Phimmasone
Quarterly. 7(1):50-73. an action-research and et al, 1994. Social, cultural and
40. Hardon AP, 1991. Confronting networking project. economic determinants of
ill-health: medicines, self-care 43. See, for example, Simmons R, contraceptive use in the Lao
and the poor in Manila. HAIN, Fajans P, Lubis F, 1994. People’s Democratic Republic.
Quezon City. Contraceptive introduction and Asia-Pacific Population Journal.
41. These drugs were taken off the the management of choice: the 9(2):3-24.
market in the Philippines, role of Cyclofem in Indonesia. 45. Arilha M, Barbosa RM, 1993.
following campaigns by Contraception. 49:509-25; other Cytotec in Brazil: ‘At least it
women’s health organisations publications on these injectables doesn’t kill’. Reproductive Health
calling for them to be banned. are listed in: UNDP/UNFPA/ Matters. 2(Nov):41-52.
Wolffers I, Hardon AP, Janssen WHO/World Bank Special 46. Vishwanath S, 1994. May I have
J, 1989. Marketing fertility: Programme of Research, some more milk pills, please?
women, menstruation and the Development and Research Reproductive Health Matters.
pharmaceutical industry. Training in Human Reproduction 3 (May):46-50.

77