State actions on reproductive health issues in 1994.
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Abortion, Induced↗
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Functioning and utilization of rural water supplies in Sarawak, Malaysia.
A cross-sectional survey of 976 households in 41 villages covered by the Rural Health Improvement Scheme in Sarawak was carried out to determine the state of functioning and utilization of rural water supplies. The survey was carried out by inspection and interview. About one-third of the systems were functioning well, one-third imperfectly, and the remainder were no longer functioning. The coverage of households by water supply varied with the type of water supply, the overall coverage being 81.3%. Usage varied with the type of water supply and access, the overall figure being 87.1%, and the overall utilization was 70.8%. The study showed that it is important to account for water supply usage in impact evaluation because not all households have access and not all those with access use the water supply. It is also important to define water use, depending on whether the health outcome is a reduction in diseases that are water-borne or related to washing with water, because the percentage of households using the water for drinking is different from those using it for bathing.
Cross-Sectional Studies↗
Abortion services in the United States, 1987 and 1988.
A 1989 survey by The Alan Guttmacher Institute shows that 1.6 million abortions were performed in the United States in 1988, a number that has remained relatively unchanged since 1980. More than 98 percent of abortions in 1987-1988 were performed in metropolitan areas. Although 51 percent of metropolitan counties have no provider of abortion services, 93 percent of nonmetropolitan counties are without a provider. The lack of abortion services in nonmetropolitan areas has been intensified by a 13 percent reduction since 1985 in the number of hospitals that offer abortion services. The number of nonhospital facilities providing abortion services increased by four percent, however, and specialized clinics provided 64 percent of all abortions performed in 1988.
Abortion, Legal↗
Black/white comparisons of deaths preventable by medical intervention: United States and the District of Columbia 1980-1986.
Blacks in the US experience increased mortality (1113 versus 745 per 100,000 males; 631 versus 411 per 100,000 females) and decreased life expectancy (63.7 years versus 70.7 years for males; 72.3 years versus 78.1 years for females); compared to Whites. In an effort to determine if the excess mortality among Black Americans might be explained by differences in access or quality of health care services, we performed a race-specific analysis of conditions for which mortality is largely avoidable given timely and appropriate medical care. Using methodology proposed by Rutstein and Charlton, mortality due to 12 causes was evaluated including tuberculosis, cervical cancer, Hodgkin's disease, rheumatic heart disease, hypertensive heart disease, acute respiratory disease, pneumonia and bronchitis, influenza, asthma, appendicitis, hernias and cholecystitis. In the US, during 1980 to 1986, an average of 17,366 deaths and 286,813 years of potential life (YPLL) before age 65 were lost each year due to all 12 sentinel causes combined. Of these causes, hypertensive heart disease, pneumonia and bronchitis, cervical cancer and asthma accounted for the greatest number of deaths. The mortality rate for all 12 causes combined among Blacks was 4.5 times that of Whites. The highest relative rates among Blacks compared to Whites were observed for tuberculosis, hypertensive heart disease and asthma. The overall mortality rate in the District of Columbia for the selected causes was 3.7 times the national rate. Compared to national rates, statistically significant elevated rates in the District were observed for tuberculosis, hypertensive heart disease and pneumonia and bronchitis.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Assessment of health needs and willingness to utilize health care resources of adolescents in a suburban population.
We investigated whether adolescents living in a middle-class suburb believed that their health needs were being met, and the extent to which they were willing to utilize local health care resources for a range of problems. Self-administered, anonymous questionnaires were completed by 649 students in grades 9 through 12. The mean age of respondents was 15.4 years; 52% were female, and 95% white. They had ready access to medical care: 90% used a specific private physician. From a list of 15 health problems, 60% indicated that they had seen a health provider for at least one of them, most often for stomach pains (22%), headaches (18%), and coughing (16%). From an identical list, 48% indicated that there was at least one problem for which they had never seen a health provider but would like to, most often for a weight problem (14%), birth control (10%), and emotional upset (9%). Although 20% regularly used illegal drugs, 24% were sexually active, and 38% thought they had a weight problem, only 1%, 4%, and 10%, respectively, had sought care for these matters. A majority of students would not choose to go to a private physician for care related to sexuality, substance abuse, or emotional upset, and would not be willing to seek care for these problems with their parents' knowledge. Ready access to private primary care did not assure attention to important health needs among these suburban adolescents.
Adolescent↗
Barriers to prenatal care among low-income women in New York City.
Postpartum in-hospital interviews with 496 low-income women in New York City revealed that attitudinal and motivational barriers as well as financial obstacles are significant impediments to timely initiation of prenatal care. The two most common reasons cited by these women in explaining why they had obtained prenatal care late or not at all were motivational items: "feeling depressed and not up to going for care" and "needing time and energy to deal with other problems." In logistic regression analyses, receipt of late or no prenatal care was significantly associated with the latter motivational barrier, along with the cost of care, having no health insurance, being Hispanic, being a substance abuser and holding negative attitudes toward the use of prenatal care.
Adolescent↗
The availability of reproductive health services from U.S. private physicians.
Data on the provision of seven types of reproductive health care were collected from private physicians in four specialties: general/family practitioners (GP/FPs), general surgeons, obstetrician-gynecologists and urologists. All ob-gyns, and eight in 10 GP/FPs, provide the pill, IUD or diaphragm. Over nine in 10 ob-gyns provide infertility and obstetric care and prenatal genetic screening; but only one-third or fewer of GP/FPs do so. Ob-gyns and urologists are far more likely to perform sterilizations than are GP/FPs and surgeons (nine in 10, compared with one-fifth to one-half). Although ob-gyns are the most likely to perform abortions, only four in 10 do so. Among ob-gyns who do not perform tubal sterilizations or abortions, and among urologists who do not perform vasectomies, the primary reason is moral or religious objections (reported by 59-71 percent). For GP/FPs and surgeons who do not perform the three procedures, the leading reason is that they do not perform surgery or that type of surgery; however, 34 percent of nonproviders in these specialties report moral or religious opposition to abortion. Eight in 10 ob-gyns will provide contraceptives to minors without parental consent, but only six in 10 GP/FPs will do so. One-half of doctors who perform female sterilizations, and eight in 10 of those who do vasectomies, require spousal consent. Among those who perform abortions, half require parental consent for minors. Access to private reproductive health care is quite limited for the poor, because many physicians will not accept Medicaid reimbursements or reduce their fees for low-income patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Abortion, Legal↗
Determinants of the evolution of the health situation of the population.
The objective of the present project is to evaluate the relative importance of different governmental social programmes for health development during the 1970's. National statistics available for the whole period and disaggregated to district level were analyzed with particular regard to three indicators of infant health status when the infant mortality rate was used, increased access to secondary care and improved socio-economic status were related to improvement in infant health status. When the percentage of neonatal deaths or the percentage of deceased live births per woman was used, neither the socio-economic improvement nor the assess to secondary did explain the improvement. Moreover, the primary health programme did not seem to be of importance in explaining the changes in the three indicators of infant health status. A second phase of the project, currently ongoing, is aimed at the evaluation of other factors such as the degree of efficiency of some of the health programmes. This study is based on directly collected information, quantitative as well as qualitative. Structured interviews have been used together with anthropological information from in-depth interviews with individuals and groups. The preliminary results of this second phase indicate that the contradictions observed in the first phase might be due to shortcomings in the national registers. In one of the study areas the coverage of PHC developed earlier than indicated by the official information. In other areas it was found that different obstacles as access problems, lack of health centers, socio-economical problems and lack of cultural knowledge reduced the effectiveness and impact of the primary health programmes.
Costa Rica↗
Abortion in Europe, 1920-91: a public health perspective.
This article grew out of a keynote address prepared for the conference, "From Abortion to Contraception: Public Health Approaches to Reducing Unwanted Pregnancy and Abortion Through Improved Family Planning Services," held in Tbilisi, Georgia, USSR in October 1990. The article reviews the legal, religious, and medical situation of induced abortion in Europe in historical perspective, and considers access to abortion services, attitudes of health professionals, abortion incidence, morbidity and mortality, the new antiprogestins, the characteristics of abortion seekers, late abortions, postabortion psychological reactions, effects of denied abortion, and repeat abortion. Special attention is focused on the changes occurring in Romania, Albania, and the former Soviet Union, plus the effects of the new conservatism elsewhere in the formerly socialist countries of central and eastern Europe, particularly Poland. Abortion is a social reality that can no more be legislated out of existence than the controversy surrounding it can be stilled. No matter how effective family planning services and practices become, there will always be a need for access to safe abortion services.
Abortion, Induced↗
Childspacing intervals and abortion among blacks and whites: a brief report.
Although physical, psychological, and social problems for children born to women denied abortion have been identified, little attention has been paid to the role that close childspacing might play in contributing to those problems. Small childspacing intervals (less than two years) have been linked to numerous physical, psychological, and social problems for mother and child. Using secondary analysis, this study examines the characteristics of 596 mothers who sought abortions in 1987 by race and age. Nearly 25% of these mothers had at least one child under two years of age. Abortion patients with such young children were more likely to be Black and have low incomes than abortion patients with older children. More than half of the mothers studied had more than two children. The findings suggest that a substantial number of children born to women denied access to abortion would be closely spaced, with the resulting adverse health consequences falling more heavily on subpopulations of abortion patients already at higher risk for negative perinatal and neonatal outcomes.
Abortion, Legal↗
Preventing unintended teenage pregnancies.
A review of the literature on unplanned and teenage pregnancies was undertaken for four District Health Authorities. This work was carried out within a national context of increasing conception rates for teenage women aged 16 and under and in the knowledge that pregnant teenagers and their children tend to have poor life chances. The Health of the Nation White Paper has now focused attention on this by the inclusion of a target to reduce pregnancies to under 16-year-old women by half. To achieve this, health authorities need some understanding of the types of services which might be effective. Whilst there is limited evaluative work on the effectiveness of services for young people in this country, international comparisons suggest that some methods for reducing unintended teenage pregnancies may be more effective than others. The specific service issues identified are the need for advice and support pre-conceptually, during pregnancy and after abortion/birth; the need for easier access to contraception; the need for improved information on risky behaviour--particularly relating to pregnancy, sexually transmitted diseases, HIV/AIDS and substance abuse, and the need for improved medical and social care for pregnant teenage women. The most effective approaches for preventing unintended teenage pregnancy would appear to be the development of comprehensive advisory and family planning services, including sex education and the commitment by central and local government to tackle the adverse socio-economic factors which are associated with teenage pregnancy.
Adolescent↗
The untold story: how the health care systems in developing countries contribute to maternal mortality.
This article attempts to put together evidence from maternal mortality studies in developing countries of how an inadequate health care system characterized by misplaced priorities contributes to high maternal mortality rates. Inaccessibility of essential health information to the women most affected, and the physical as well as economic and sociocultural distance separating health services from the vast majority of women, are only part of the problem. Even when the woman reaches a health facility, there are a number of obstacles to her receiving adequate and appropriate care. These are a result of failures in the health services delivery system: the lack of minimal life-saving equipment at the first referral level; the lack of equipment, personnel, and know-how even in referral hospitals; and worst of all, faulty patient management. Prevention of maternal deaths requires fundamental changes not only in resource allocation, but in the very structures of health services delivery. These will have to be fought for as part of a wider struggle for equity and social justice.
Abortion, Legal↗
Experiences of legal sterilization in Scandinavia.
The three Scandinavian countries--Denmark, Norway and Sweden--all legalized voluntary sterilization in the 1970s. Previous legislation had been very restrictive, limiting access to certain defined minority groups. During the two decades with this new possibility, sterilization has been accepted as a good contraceptive alternative, equally accessible for men and women above age 25 years. The sterilization frequency varies considerably between the three countries, being most popular in Norway and Denmark. The proportion of sterilization in males versus females is 40% in Denmark, 25% in Norway and 20% in Sweden. Published follow-up studies point out risk groups for regret of the intervention, and underline the need for good preoperative counseling. The overall results are very positive.
Counseling↗
Maternal mortality in the Thyolo District of southern Malawi.
The Sisterhood Method, a community-based survey technique, was used to estimate the Life Time Risk of a woman dying a maternal death in Southern Malawi. With this figure, the maternal mortality ratio for that area was calculated to be 409 deaths per 100,000 live births. The 4124 adults interviewed reported 150 maternal deaths in sisters. An in-depth questionnaire was then used to determine that 56% of these deaths occurred outside a health facility, largely due to lack of transportation or poor access to fixed health care facilities; 25% died from excessive hemorrhage; 20% from obstructed labour; 18% from abortion; 13% from sepsis; while eclampsia accounted for only 4% of the maternal deaths. This field experience with the Sisterhood Method technique combined with an in-depth questionnaire for determining causes of maternal deaths has provided useful information in a simple and cost-effective manner for use in planning intervention strategies designed to decrease maternal mortality.
Adolescent↗
Sterilization acceptance and regret in Thailand.
The prevalence of sterilization increased steadily in Thailand from 1969/70 to 1984, but remained unchanged over the period 1984-87. This paper uses data from the 1987 Thai DHS to examine sterilization acceptance and regret. The prevalence of sterilization increases with both the number of children and with the age of the woman. Among women with two or more children, there is a positive association between education and wealth, and tubal ligation, but there is no correlation between education and wealth and the percentage of husbands with a vasectomy. Women whose last delivery was in hospital were more likely to have been sterilized than were women with a home delivery, and among women with a hospital delivery, those who had a cesarean section were more likely to have been sterilized than were women with a vaginal delivery. Both accessibility to medical facilities and medical problems apparently play a role in affecting who gets sterilized. The percentage of women who reported that they regretted that either they had gotten sterilized or that their spouses had gotten sterilized was 11% but regret was higher in cases in which the wife had had surgery (12%) than in cases in which the spouse had had a vasectomy (8%). This difference persisted even when other variables were introduced to examine the correlates of regret (number of children at time of sterilization, subsequent death of a child, whether sterilization was done at time of CS, residence of the respondent) using multiple classification analysis. Perhaps when women themselves are sterilized, they attribute subsequent problems in health to the operation, whereas such changes cannot be attributed to the vasectomy of their husband.
Adolescent↗
Vaccination strategies in developing countries.
By 1990 it is hoped that all of the world's infants will have access to immunization services and that these services will then continue indefinitely. The link between people and health services, including immunization, can only be forged and maintained by an effective system of delivery and support to all health workers. A careful choice of strategies for this delivery system and an understanding of local cultural attitudes and behaviour is vital if this link is to be effective. Health workers will have to be trained and then supported in the field by regular contact with their supervisors. They will also need continuous, reliable, predictable and adequate supplies of equipment, drugs, vaccines, fuel and money, including salaries. Immunization is cost effective as a health intervention, but an effective programme of immunization can contribute much more than just vaccines, if it is developed in the context of primary health care (PHC) as originally proposed in 1978 at the conference in Alma Ata.
Child, Preschool↗
Causes and consequences of increase in child survival rates: ethnoepidemiology among the Hmong of Thailand.
The Hmong "hill tribe" minority in Thailand has much higher exposure to factors usually associated with risk of child mortality (high fertility, low status of women, low education, less use of modern medical care for births, exposure to warfare, economic and physical disruption, and poor hygienic conditions) than the rural ethnic Thai population. Nonetheless, infant mortality has declined from over 120 per 1000 to under 50 per 1000 live births among both these populations in the past 30 years. The reason for the rapid increase in child survival among the Hmong appears to be better access to and more use of modern curative and preventive medical care associated with road construction rather than major changes in social or hygienic conditions. Conventional wisdom suggests that high fertility is both a cause and a consequence of high infant and child mortality and that parents will not reduce fertility until they see that mortality has declined. Most Hmong parents recognize the decline in child mortality and attribute it to better access to modern medical care. Most Hmong parents also say that, if they were starting to have children now, they would want to have fewer children. Fear of child death is infrequently mentioned as a motive for having more children, and the perceived decline in child mortality is rarely mentioned as a reason for reduced fertility. Most Hmong parents explain their desired family size in terms of economic conditions rather than perceived risk of child mortality. Results of this study suggest that fertility and child mortality can vary independently of one another and that major reductions in child mortality can be accomplished without waiting for major social changes (e.g., improved education or status of women) or major reductions in fertility.
Child Health Services↗
FDA's cosmetic data information system: the program, design and public access to data.
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Cosmetics↗