[Doctors and injectable contraception. Analysis of the logistics of prescribing in accordance with the views expressed by doctors].
Injectable contraception (IC) using medroxyprogesterone acetate (Depoprovera) and norethisterone enanthate (Noristerat) has been discussed in numbers of publications since the Food and Drug Administration (FDA) of the USA have refused to authorize the use of Depoprovera as a contraceptive in America. This has provoked a large number of publications in the international literature. The refusal was based on the potential oncogenic risk of the molecule. The distribution of this product as a contraceptive in developing countries and its restricted authorisation in many industrialised countries including France has brought about contradictory debates about the assessment of this method (secondary effects, risks of developing cancer and teratogenesis). In 1986 we started a research using close collaboration between the health teams of Seine-Saint-Denis (which control clinics, family planning clinics and hospitals) in order to try to find some solution to this problem "for or against IC". The object of this research was to find out how acceptable this method was as compared with other contraceptive methods. The fact that many disciplines were involved (gynaecologists, sociologists, epidemiologists and pharmacologists) in this work made it possible first to find out the conditions under which IC was prescribed (by sociological analysis and discussions with doctors). And the socio-cultural features in which the doctors who prescribed this method of contraception were situated also came into play. The criteria under which ICs are prescribed are not mainly medical but are narrowly linked to socio-cultural factors and the socio-economic factors of the women for whom it is prescribed: and this is in comparison with other methods of contraception. Prescribing this substance has a degree of urgency about it.
Herschkorn
P
P
Unité de recherches 292 INSERM, Hôpital de Bicêtre, Le Kremlin.
Thebaud-Mony
A
A
Lasselain
J
J
Bretin
H
H
D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003271:Contraceptive Agents, Female / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D003280:Contraceptives, Oral, Synthetic / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D003466:Cultural Characteristics; D005193:Family Planning Services; D005260:Female; D005602:France; D006801:Humans; D007273:Injections, Intramuscular; D008525:Medroxyprogesterone / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D017258:Medroxyprogesterone Acetate; D009640:Norethindrone / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010348:Patient Care Team; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D012959:Socioeconomic Factors
D003271:Contraceptive Agents, Female; D003280:Contraceptives, Oral, Synthetic; D017258:Medroxyprogesterone Acetate; D008525:Medroxyprogesterone; C024319:norethindrone enanthate; D009640:Norethindrone
Médecins et contraception injectable. Analyse des logiques de prescription à partir des discours de médecins.