many young women still do not take sufficient precaution, according to Government's maternal health clinic. According to medical officer, Cheryl Peek-Ball, although many do take the necessary measures to keep from getting pregnant, they neglect to take precautions against disease. "In my personal opinion, the best barrier against sexually transmitted diseases (STDs) is a latex condom and spermicide,'' she said. "So, in a situation where infection is possible, most women should consider that unless they know for a fact that their partner is HIV negative and has no other STDs. Unless they know that for a fact, people should assume that the person is infected, and take precautions.'' A lack of prevention against STDs was especially seen with those women who were taking a chemical form to safeguard against pregnancy, she added. "Those methods make people feel carefree about sex. They often forget that they still must be concerned about sexually transmitted infections; especially young women not in a committed relationship. If they are using a shot and nothing with it, a condom and also spermicide is essential if they are not sure of their partner's health and fidelity. And I would say that the rate of condom use is the same in young and older women.

Otherwise intelligent, career women are not any more likely to use condoms than a teenager. And if adults do not take the message of prevention seriously, it's not likely that adolescents will take it seriously either.

"The bulk of the women we see here are younger than perhaps in the average family doctor's office and while they might know in theory the importance of protection against disease, a lot of them haven't come to accept that it applies to them personally. They understand they can get pregnant but they haven't translated that into behavioural changes. The bulk come for protection and it's only the minority that don't avail themselves to it.'' The Maternal Health Clinic sees women for reproduction matters, primarily those within the reproduction period of their lives -- between the ages of 12 and menopause.

According to Dr. Peek-Ball, however, most patients fall in the younger age range, from the mid teens through to their late 30's. And for most of those, the most popular choice of contraception is the pill. "The pill is one of the older of the modern methods,'' she said. "It's about 40 years old in terms of commercial use. It's well-studied and people are very familiar with it and feel comfortable with it. But in the last six years, there has been an increase in the popularity of injections.'' There are three different kinds of injection, she explained. Two are very well-studied and have been in use worldwide for some time -- Depo Provera and Noristerat, and last for three months at a time. However for them to be used as effective measures of contraception, it is critical that the injection be taken on time. "These two injections are both synthetic progesterone injections and are extremely effective, extremely safe and very popular because of their convenience.

However they are not without minor side effects in some cases -- menstrual irregularities and weight gain. "The third, which we stock in small quantity, is Mesigyna. A synthetic progesterone and oestrogen injection, it is essentially the pill in injection form and it's done once per month. It has not been as well studied as the other two and, for those women for whom it is not safe to use the pill it would not be safe for them to use Mesigyna. We have not put anyone on it at the clinic. People are not as enthusiastic about a shot that you have to take once a month as they are about one that has to be taken every three months. According to the manufacturer, there are no menstrual irregularities as there are with the three-month shots and ideally, women have periods every 30 days. But I can't vouch for it because we haven't started anyone on it yet.'' Norplant, a progesterone implant, is also available through the clinic. On the market since the early 1990's, it is FDA-approved in the United States and has been used locally since the end of 1995 or the beginning of 1996. Less than ten women are using it locally Condoms still the best slow release of a progesterone-like hormone on a daily basis for five years,'' she said. "For those women who are heavier than say 154 pounds, there is a higher failure rate. The plants are not enough to prevent ovulation. But it's obviously for someone who wants long-term protection.'' Dr. Peek-Ball said the implants are inserted under the skin in the upper arm. "The success rate is difficult to determine because five years is just now being completed since it was first introduced in the US. But I can say that a lot of people have had it taken out way before the five-year mark. Some patients are bothered, sometimes by the local irritation at the site of the plant. They're aware of it and they don't like it. I had one other complain that it left scar tissue and have had others say that it caused irregular bleeding, especially after the first 18 months.'' There has also been controversy about Norplant, she said, with a small number of women across the United States complaining of things such as rash, muscle aches and rheumatoid symptoms which they feel were caused by the drug. "These were rare complaints which tainted Norplant early in its introduction to US. It doesn't take much to turn the public against a safe and effective birth control. One story, however unsubstantiated, is often enough.

So the verdict is still out on Norplant. It's not that popular in Bermuda, but it is available, and for certain people, an excellent choice.'' The clinic also carries femidom, the female condom. "However, it requires a bit of ability on the part of the woman to use. It must be inserted properly and has to be used carefully. Also, it's not thought to be quite as effective as the male condom. And it should never be used with the condom. The friction inevitably dislodges one or the other and effectively causes less protection than more.'' IUDs, said Dr. Peek-Ball, are best used by women who have already had children. "They are not very popular, and I don't recommend them in women who have not given birth to children. It is quite safe, but where a woman might contract an STD, the risk is greater for a more serious infection with the IUD in place and there is the longterm risk of infertility.'' The diaphragm is another barrier method which is popular. "It doesn't protect from STDs, but it gives a fairly good protection against pregnancy if used properly.'' PHOTO Some of the latest forms of contraception which are available in Bermuda HEALTH HTH