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PubMedDate not supplied

[Hormonal contraception in 46 public family clinics in Rome].

This study investigates the role of 46 public Consultori of Rome, as far as the hormonal contraception with "pill', the most common contraceptive method used by roman women, is concerned. With a series of phone calls, a hypothetic potential customer asked for an appointment directly with the gynaecologist for getting adviced to use "pill" for the first time. The results show that, although the wait for the first appointment directly the gynaecologist is not long (11,3 days as an average), it is very difficult to get it and this was possible only in 12 cases out of 46. We have noted that the first appointment for "pill" was offered with no-medical personnel, like social assistants, sanitary assistants or midwives, in most 16 of cases, and that in a significant number of Consultori was not possible to obtain an appointment whatever. In public Consultory of Rome we have found a different attitude in giving appointment to women for contraception with pill, even inside the same USL (Local Sanitary Unit, the basic structure of public health in Italy, in which Consultori have the role of prevention and promotion of maternity and tutelage of infancy). From this study the need emerges of uniformity in the attitude of Consultori staff in managing the customers, in order to avoid that women, finding so many difficulties, give up referring to these public structure for beginning contraception and choose private professionals or decide not to use the "pill".

Appointments and Schedules↗
PubMedDate not supplied

The accessibility of abortion services in the United States.

Abortion services are provided in hospitals, doctors' offices and various types of clinics, but about two-thirds of procedures are performed in specialized abortion clinics. While this system appears to work well for most women, some women seeking abortion face obstacles related to distance, cost, harassment and special medical conditions. Nine percent of nonhospital abortion patients must travel more than 100 miles and 18 percent travel 50 to 100 miles for services. The average woman having a first-trimester nonhospital abortion paid $251 in 1989. Fees were higher in facilities with small abortion caseloads. An abortion at 10 weeks' gestation in a hospital cost an average of $1,757. Charges for abortions at 16 weeks averaged $509 in abortion clinics, compared with $1,539 in hospitals for curettage and $2,246 for instillation procedures. Some women face other barriers: Only 43 percent of all abortion facilities offer services past 12 weeks, and 27-37 percent of nonhospital facilities say they do not treat patients who test positive for the human immunodeficiency virus (HIV), the virus that causes AIDS. Women who need special services such as an administration of Rh immunoglobulin, general anesthesia or HIV testing usually pay extra for these services. In addition, 85 percent of nonhospital facilities that serve 400 or more abortion patients a year reported some form of antiabortion harassment in 1988, most commonly picketing; there was virtually no change in this proportion between 1985 and 1988.

Abortion, Legal↗
PubMed1987

Family planning for inner-city adolescent males: pilot study.

The results of a pilot family planning program (FPP) in a pediatric practice are reported for 66 inner-city male adolescents. The FPP was designed to eliminate registration barriers to the procurement of contraceptives by adolescent males, and to prompt the community neighborhood health center (CNHC) providers to initiate discussion of birth control with their male adolescent patients. Utilization data show that males were more likely to receive contraceptives if the provider first raised the topic of birth control to them. Unstructured follow-up interviews with 27 adolescent male FPP users identified a desire for anonymity/confidentiality and embarrassment or discomfort as the key reasons for not seeking contraceptives from the CNHC. If health care providers are sensitive to male adolescents' feelings about birth control, community health centers potentially could serve as a cost-effective source of contraceptives for sexually active male adolescents.

Adolescent↗
PubMed1991

Expanded services for intrauterine contraception in Sudan.

Twenty nurse-midwives in government service in the Sudan (health visitors) were trained to provide intrauterine contraceptives in a research project designed to evaluate the safety of insertion of IUDs by medical personnel who are not physicians. After training, they inserted 763 IUDs. Independent evaluation of 520 clients was conducted by obstetrician-gynecologists who found that only six (1.2%) had been incorrectly inserted. Outcomes for clients of the health visitors with respect to perforations, infections, expulsions, and pregnancies compared well with those of eight physicians who participated in the study. The research strongly supports the concept of nurse-midwife training for IUD insertions which would greatly expand the availability of family planning services and would conserve physician time and skills for problem cases.

Community Health Nursing↗
PubMedDate not supplied

Organized family planning services in the United States, 1976-1977.

In 1977, an estimated 4.2 million women received contraceptive services from organized family planning programs in the United States. The number of patients has grown each year since the late 1960s, but since 1973, growth has slowed concurrently with a diminished increase in the level of federal funding for family planning services. The proportion of clinic patients who are teenagers increased from 20 percent in 1969 to 31 percent in 1977. An estimated 1.3 million adolescents received services in 1977, compared with just 214,000 in 1969. Contraceptive services were provided during 1977 by 2,574 agencies at some 5,300 clinic sites. Health departments served 42 percent of all family planning patients; Planned Parenthood affiliates served 27 percent; hospitals served 13 percent; and community action groups, free clinics, neighborhood health centers and women's health programs together served 18 percent. Federal expenditures for medical family planning services provided by organized clinics and private physicians rose from an estimated $13.5 million in 1968 to $239.1 million in 1977. Estimated federal expenditures for clinic services were $192.5 million--three-quarters of the total $252.6 million in public and private expenditures for such programs. Federal project grant funds under Title X of the Public Health Services Act accounted for 42 percent of all medical family planning expenditures in clinics, and for 55 percent of all federal funds expended for this purpose. These findings are based on data from the most recent study of the organized family planning service network conducted by The Alan Guttmacher Institute (AGI) for 1977.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

A decade of Nepal's family planning program: achievements and prospects.

Knowledge and practice of family planning in Nepal increased considerably from mid-1976 through mid-1986, with significant improvements in the availability of and accessibility to contraceptives. However, a proportionately larger share of the achievements were made during 1976-81 than in 1981-86. The impact on fertility of contraceptive use during the decade was minimal. Knowledge and use of reversible contraceptive methods remained very low, primarily because of the continued strong emphasis on sterilization in Nepal's family planning program. Consequently, the welfare of many couples who may be in need of contraception for spacing births, but not necessarily for terminating childbearing, does not appear to be adequately addressed by the program. A more balanced emphasis on reversible methods of contraception does not necessarily imply that a substantially higher level of contraceptive prevalence would be required to reach the fertility target. Several steps to improve program performance and contraceptive method mix are suggested.

Adolescent↗
PubMedDate not supplied

The effect of family planning participation on prenatal care use and low birth weight.

Data on approximately 45,000 North Carolina women who gave birth in 1989 and 1990 and received prenatal care in public health facilities were studied to assess the effects in a low-income population of prior family planning services on low birth weight and adequacy of prenatal care. Women who had used family planning services in the two years before conception were significantly more likely than those who had not used such services to have a birth-to-conception interval of greater than six months. They were also more likely to receive early and adequate prenatal care and to be involved in a food supplement program and maternity care coordination. In addition, the family planning participants were less likely than the nonparticipants to be younger than 18 and were somewhat less likely to deliver a low-birth-weight infant. Though the results of this retrospective study must be interpreted with caution because of such factors as self-selection into family planning programs, they suggest that family planning services may improve birth weight and use of prenatal health services among low-income women.

Adolescent↗
PubMed1980

Teaching family planning management and evaluation skills.

In the last several years the need for training schemes in family planning programme administration has become increasingly apparent with the rapid growth of family planning services throughout the world. This paper reports on the development and use of a series of 16 practical classroom training exercises designed for teaching planning, management and evaluation skills. Each exercise can be introduced, worked and discussed in a morning or an afternoon. It is available in an individual booklet, which contains worksheets, blank tables and step-by-step instructions for working the exercise, along with a discussion of the skills being taught. Topics covered include demographic rates and concepts, the Dryfoos-Polgar-Varkey formula, risk factor analysis, target-setting, case load forecasting, service statistics, contraceptive supplies, manpower planning, couple-year of protection, cost-effectiveness, contraceptive use-effectiveness, life table techniques, numerator analysis, fertility pattern method, sampling methods and questionnaire design. These curriculum materials concentrate on imparting through the medium of actual experience a series of specific management techniques of a quantitative nature that will enhance the ability of the trainees to plan, administer and evaluate any family planning programme anywhere in the world. The exercises in this series have been tested in the family planning training programmes at Columbia University and at Downstate Medical Center in New York. They have also been used in WHO workshops in Thailand and Tanzania and in training programmes in France, Kenya and Nicaragua.

Family Planning Services↗
PubMed1984

Who attends family planning clinics?

Data were obtained from 1,810 consecutive women who attended a central metropolitan (Brisbane) Family Planning Clinic during a 5 week period in 1982. Young women in particular formed the major client group with 32% being under 20 years of age. The client population was skewed towards women of upper socioeconomic status (SES). There was no SES disproportion in the use of oral contraceptives or IUD's. However, diaphragm use occurred disproportionately in women of upper SES groups; postcoital contraception was sought by and limited to, women of SES classes A and B only. The clinic satisfied a need for women with a history of failed or absent contraception and 15% had already had a termination of pregnancy by the time they first presented at the clinic.

Abortion, Induced↗
PubMed1998

A profile of family planning audit in England 1994-1997.

Audit has been entered into enthusiastically by most of the multidisciplinary teams giving family planning services but the nature of the subject makes audit particularly difficult in this field. In many cases it has been used as a tool for determining standards rather than a tool for determining compliance to them. If family planning audit and evaluation is to substantially improve in quality, a great deal of work needs to be done, particularly in the formation of appropriate guidelines and in the increased utilisation of audit/research specialists to advise on methodology. It is hoped that the new clinical effectiveness committee of the faculty will take a lead in this; if so it will undoubtedly gain support from faculty members.

England↗
PubMed1983

Family planning field research projects: balancing internal against external validity.

This report discusses the experience of a two-year family planning and maternal/child health project in Nepal. Although the project was planned as an experimental field research endeavor, a series of unanticipated events repeatedly compromised the internal validity of the project and forced design changes. While unexpected events are common in the history of most field projects, they present the research evaluator with the fundamental dilemma of trying to maintain a high degree of internal validity without sacrificing external validity. Rigid research designs with tight control over the introduction and measurement of experimental variables may serve to increase internal validity but they may also create an atypical and artificial situation that fails to mirror real field conditions and thus threatens external validity.

Community Health Services↗
PubMed1995

Oral contraceptive use among African American adolescents: individual and community influences.

Side effects of oral contraceptives are a noteworthy problem, particularly among low-income young women who reside in inner-city communities. The problem may be compounded by inadequate family planning services, particularly when such services are provided by general medical practices with high volumes of clients. This study examined the prevalence and correlates of pill-related side effects, with particular attention to the role of clinic characteristics. Participants were 177 pregnant and parenting African American adolescents and young women (average age = 18.34). The experience of a pill-related side effect was the most frequently cited barrier to birth control use, and it was significantly related to contraceptive behavior. Finally, although participants attending comprehensive clinics experienced more barriers to medical service use than those attending neighborhood clinics, they reported fewer problems with pill-related side effects and better psychological functioning. Implications for future research and policy are discussed.

Adolescent↗
PubMed1989

The effect of sexual behavior and a pregnancy on contraceptive method switching among black female teens.

Little is known about determinants of contraceptive method switching and few reports use data that can link events that occur close in time. Using retrospective information from the sexual calendars of black female teens who attended a reproductive health clinic, determinants of method switching in four areas were investigated. Method switchers, those who switched from an unprepared to a prepared method (n = 62) and those who switched from a prepared to an unprepared method (n = 18), were matched with nonswitchers who used the same initial method. Associations between switching and changes in the frequency of intercourse, sexual abstinence, and pregnancy were found. It is suggested that abstinence may have a different role in switching from each type of method. Counselors need to emphasize the importance of method continuation, even when sex has not occurred for a short period of time.

Adolescent↗
PubMedDate not supplied

Teaching inner-city mothers about family planning and prenatal and pediatric services.

One hundred thirty-five young, black, inner-city, pregnant women assessed the usefulness of a videotape designed by community health nurses to increase the self-care practices of low-income minority women with regard to their prenatal, pediatric, and family planning health needs. Seventy percent of the women rated as very useful information on the availability of health care and the protocols of public health clinics. The women also stated that they would tell others about public health care services and intended to make use of these services themselves as a result of viewing the videotape. The viewers' responses help clarify the preferred modality, content, and length of patient education for medically and socioeconomically high-risk pregnant women who tend to underuse preventive and primary health care.

Child Health Services↗
PubMed1991

Natural family planning use-effectiveness and continuation.

Numerous studies have been conducted to assess the use-effectiveness of natural family planning. However, because of imprecise definitions of terms, these studies show noncomparable results. Special effort is required to study natural family planning use-effectiveness by the same criteria as other family planning methods.

Family Planning Services↗