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PubMed1994

Characteristics of women receiving family planning services at Title X clinics--United States, 1991.

In 1970, enactment of federal legislation created a national family planning program funded under Title X of the Public Health Services Act. Since the enactment of this legislation, clinics funded entirely or partially by Title X have been the primary source of subsidized family planning services in the United States. Although information characterizing women who receive family planning services at Title X clinics can assist in program planning and operations, such information has not been compiled at the national level since 1981. In 1992, state family planning administrators and CDC, with cooperation from Title X grantees, initiated the Family Planning Services Surveillance (FPSS) project to characterize women receiving family planning services from Title X clinics in 1991. This report presents the findings of FPSS.

Adolescent↗
PubMedDate not supplied

The effect of operations research on program changes in Bangladesh.

This article is based on the ten-year experience of an operations research project in Bangladesh. It assesses how, and under what circumstances, research-based advice and results of pilot projects contribute to change in large-scale public programs. It discusses project research on issues facing the national family planning program: recruitment and training of field-workers; delivery of injectable contraceptives; management information; field-workers' use of service registers; field supervision; satellite clinics; and contraceptive user fees. These issues are used to illustrate the advantages and disadvantages of a long-term institutionalized project, and to describe the diversity of means for communication with policymakers. The analysis shows that research, policy decision, and implementation can occur in any sequence. Policy advice that disrupts long-standing power relationships and organizational culture takes a great deal of effort to implement. Operations research can produce useful changes in organizational behavior, even when large-scale problems remain.

Bangladesh↗
PubMedDate not supplied

Partner-specific sexual behaviors among persons with both main and other partners.

CONTEXT: If men and women engage in different sexual behavior with main partners than with other types of partners, then programs aimed at preventing the spread of sexually transmitted diseases (STDs) may need to address individuals' differential risk with each partner type. METHODS: Relationship characteristics, partner risk behaviors and sexual behaviors are examined among 123 male and 106 female STD clinic patients who had both main and other partners. Individual-level comparisons are made for two types of partner pairs: main vs. other frequent (side) partners and main vs. casual partners. RESULTS: Among men and women with both main and side partners, the proportion who had known only their main partner for at least a year (48% of men and 41% of women) was significantly higher than the proportion who had known only their side partner for that long (2% and 9%, respectively); no other variable differed significantly by partner type. Among those with main and casual partners, both men and women were more likely to use alcohol or drugs before or during sex with main partners only (15%) than with casual partners only (1-3%). Women with main and casual partners were more likely to have oral sex only with main partners than only with casual partners (37% vs. 3%), and were more likely to use condoms only with casual partners than only with main partners (33% vs. 4%). CONCLUSIONS: Providers need to ask individuals about their sexual behaviors with different partner types, and should tailor prevention messages to an individual's risks and reproductive intentions with each partner.

Chi-Square Distribution↗
PubMed1992

Oral contraceptive marketing in Ibadan, Nigeria.

The demographic transition in Nigeria is gradually moving towards the second stage. There is clear evidence of a declining mortality but the fertility rate remains exceptionally high. A realistic approach towards reducing fertility rate is the use of oral contraceptive. This study assesses the distribution system of oral contraceptive in Ibadan, the second largest city in Nigeria. The findings revealed that the people are aware of modern oral contraceptives as they purchase them freely at chemist shops. But effective distribution is hampered by existing channels and high costs. A local source recommended is the proprietary medicine stores, often at convenient locations to the potential users of contraceptives. The current cost which is between $1.3 and $19.5 per couple-years of protection is exorbitant, consuming 0.5-7.8% of the gross annual income of the average individual. Therefore, the government should subsidize the prices of oral contraceptives, to facilitate freedom from the tyranny of excessive fertility.

Contraception↗
PubMed1995

Effects of low-dose estrogen oral contraceptives on weight, body composition, and fat distribution in young women.

OBJECTIVE: To determine prospectively whether the use of low-dose estrogen oral contraceptives (OC) is associated with changes in weight, body composition, or fat distribution. DESIGN: Anthropometric measurements were performed in 49 healthy young (16 to 21 years old) women before commencement of OC use (30 micrograms ethinyl estradiol [EF2] plus 75 micrograms gestodene) and after three and six treatment cycles. Thirty one age- and weight-matched women who were not using OC served as controls. SETTING: Outpatient gynecological clinic of Hadassah Medical Center, a tertiary level hospital, and the "Shilo" voluntary service for the prevention of unwanted pregnancy. MAIN OUTCOME MEASURES: Anthropometric measurements included body mass index (BMI), waist-to-hip girth ratio, and body composition (the percentage of body fat and water), estimated by mean of infrared interactance. RESULTS: In the group of OC users, baseline BMI, percent fat, percent water, and waist-to-hip girth ratio were 21.1 +/- 0.32 (kg/m2), 23.8% +/- 0.63%, 57.4% +/- 0.39%, and 0.73 +/- 0.01, respectively, and did not change significantly after six cycles (20.6 +/- 0.41 [kg/m2], 23.9% +/- 0.57%, 58.1% +/- 0.49%, and 0.72 +/- 0.03, respectively). These measurements were not significantly different when compared with the nonusers. Fifteen OC users (30.6%) gained weight (> 0.5 kg). Weight gain was due to a significant accumulation of fat (from 22.5% +/- 1.1% to 25.6% +/- 0.74%), whereas the percentage of body water remained stable. The waist-to-hip girth ratio also was not changed significantly. Similarly, 11 nonusers (35.4%) gained weight because of similar nonabdominal fat accumulation. Ten OC users (20.4%) lost weight (57 kg +/- 1.51 to 55.4 +/- 1.47 [mean +/- SEM]) and 6 nonusers (19.3%) also lost weight (59 kg +/- 1.42 to 57.3 +/- 1.92). In both groups the loss of weight was not associated with significant change in body composition. CONCLUSIONS: The use of low-dose OC (EE2 plus gestodene) was not associated with overall impact on weight, body composition, or fat distribution. However, when weight gain did occur during OC use, it was due to increase in body fat and not in volume of body water, and it was not associated with changes in fat distribution.

Adipose Tissue↗
PubMed1994

Awareness of HIV results in increased condom sales.

India's government reports a campaign against HIV increased condom sales by 4% in 1994. New Delhi reported a sale of more than 1 billion condoms in 1993-94 after a sharp decline of 8% in 1993, the Times of India said. Increasing awareness of HIV accounted for the growth in the condom market, said an official of Hindustan Latex Ltd. "Men in India do not use condoms for contraception," the company's executive director Daolly Frances said. "They leave that burden to women." The total market sale of condoms for 1994 was 1.1 billion items, almost the same number distributed free of charge under the government's family welfare program. "It is encouraging but still far below the market potential," the chairman of the condom-making company said. The WHO (World Health Organization) has identified India as one of the countries that will witness the greatest explosion of HIV cases in the coming years. According to WHO figures, incidence of HIV in Asia has increased 5 times in the last 3 years from 0.5 million in 1991 to more than 2.5 million cases at present. "The figure is expected to quadruple by the year 2000 to over ten million infections," regional director of WHO for Southeast Asia Uton Muchtar Rafei said on the World AIDS Day December 1, 1994. Official records say there are 885 full-blown AIDS cases in India, with 1.6 million people testing positive for HIV. But non-government organizations place the figure much higher. India's Health Organization said India will have up to 30 million HIV cases by the year 2000. "The epidemic has now moved from sex workers and their clients to housewives and newborn babies," said I.S. Gilhada, secretary-general of Indian Health Organization. A government survey among Bombay's sex workers has shown 52% tested positive for HIV. Despite a $100 million World Bank-WHO funded AIDS control program, reports suggest a gross misuse of government's free condoms distribution scheme.

Asia↗
PubMedDate not supplied

Contraceptive social marketing and community-based distribution systems in Colombia.

Three operations research experiments were carried out in three provinces of Colombia to improve the cost-effectiveness of Profamilia's nonclinic-based programs. The experiments tested: (a) whether a contraceptive social marketing (CSM) strategy can replace a community-based distribution (CBD) program in a high contraceptive use area; (b) if wage incentives for salaried CBD instructors will increase contraceptive sales; and (c) whether a specially equipped information, education, and communication (IEC) team can replace a cadre of rural promoters to expand family planning coverage. All three strategies proved to be effective, but only the CSM system yielded a profit. Despite this, Profamilia discontinued its CSM program soon after the experiment was completed. Unexpected government controls regulating the price and sale of contraceptives in Colombia made the program unprofitable. As a result, family planning agencies are cautioned against replacing CBD programs with CSM. Instead, CBD programs might adopt a more commercial approach to become more efficient.

Colombia↗
PubMed1995

POPs less widely used.

Progestin-only pills (POPs) are less widely used and available than combined pills. For example, the U.S. Agency for International Development (USAID) shipped only 3 million packets of POPs worldwide in 1994, compared with 62 million packets of combined pills, according to Mark Rilling, program analyst with USAID's Office of Population. While USAID considers POPs to be an acceptable contraceptive option for some women and intends to continue providing them, the worldwide market for them is small, Rilling says. The London-based International Planned Parenthood Federation (IPPF) reports a similar trend. IPPF shipped 16 times more combined pills than POPs during 1994, says Dr. Carlos Huezo, the organization's medical director. New efforts to clarify the role of progestin-only pills may make them more acceptable. For example, new studies have provided additional evidence that POPs do not harm breastfed infants whose mothers use them. A new label that reflects these findings, and clarifies other distinctions from combined pills, is being developed for POPs by the U.S. Food and Drug Administration, based on a draft developed by FHI. The pills also are being more actively promoted among some family planning organizations, and may prove useful for community-based distribution.

Contraception↗
PubMed2006

Over-the-counter pill provision: evidence from Jamaica.

Although many countries allow over-the-counter distribution of oral contraceptives, doubt remains about whether such provision is safe for the user. The greatest concern is whether women with contraindications for use are given access to the pill. Clearly, women without such contraindications should be given access to it and be offered adequate information about its correct use. In 15 pharmacies in Jamaica, mystery clients approached pharmacists to determine their willingness to sell oral contraceptives and to solicit information from them about correct use of the method. In addition to data from mystery-client observations, interviews were conducted with 78 pharmacists and with 524 pharmacy customers who bought oral contraceptives, providing complementary information about knowledge of, attitudes toward, and experiences with the method. Analysis of the combined findings suggests that over-the-counter provision of oral contraceptives is a safe, practical, and effective method of distribution in Jamaica.

Adolescent↗
PubMed1980

Contraceptive habits in women between thirty and fifty years of age. A comparison of two periods, 1967--69 and 1972--74.

The use of contraception by women 30--50 years of age is presented. The material was composed of participants in the prophylactic investigations for cancer colli uteri in the southern part of Storstøms County, which was first performed in the period 1967--69 and secondly in 1972--74. A total of 17 028 women were examined, of whom 8 234 participated in both surveys. A comparision of the two periods of investigation revealed a significant increase (p<0.01) in the utilization of contraception and in shifting to more effective methods. This improvement was attributed to the increased amount of information about contraceptive methods which was made available in the country. It was observed that a remarkably large percentage of the women did not use contraception, 24.9 per cent among those 30--34 years of age, 26.9 per cent among those 35--39 years of age, 40.7 per cent among those 40--44 years of age and 57.2 per cent among those 45--49 years of age. Analysis of the influence of socioeconomic conditions showed that women of the lowest social stratum, with slight education and low income, made up a large proportion of those who abstained from contraception. The number of pregnancies was found to play a role in the use of contraception. An expansion of the distribution of information about contraception to the public is recommended, as well as a possible economic subsidy to the socially disadvantaged for procurement of contraceptives.

Adult↗
PubMed1981

Contraceptives and the conceptus. II. Sex of the fetus and neonate after oral contraceptive use.

The sex distribution of 1421 induced abortuses and 2986 newborn infants was correlated with maternal contraceptive histories. Sex of abortuses was determined by chromosome and sex chromatin analyses. No statistically significant differences (P Greater Than 10) were found between the sex ratios either of the fetuses or of the infants of women who used hormonal (oral) contraceptives as compared to those of noncontraceptive controls nor between the induced and newborn series. Also, no correlation was found between sex of the conceptus and total duration of oral contraceptive use, or interval between termination of contraceptive use and conception. Therefore, if the use of low dose oral hormonal contraceptives has an effect on the sex of subsequent offspring, it is likely to be small since the 95% confidence interval for the sex ratios for the oral contraceptive groups divided by the sex ratios of the noncontraceptive group (odds ratio) are 0.80 to 1.22 for induced abortions, and 0.82 to 1.10 for newborns. These conclusions are not in agreement with some earlier reports, generally of small samples, but they are consistent with the results of Rothman and Liess (1976) from a sample of 6109 infants born to oral contraceptive users.

Abortion, Induced↗
PubMed1978

Distribution - on or off prescription (of oral contraceptives)?

Restrictions on sale of oral contraceptives (OCs) in Australia are based on their classification as Schedule 4 poisons; as such they are "restricted substances" and obtainable only on a prescription. In general only a medical practitioner can prescribe OCs and only a chemist or a licensed person can dispense them. Doctors at Family Planning Clinics and Hospital Outpatient Departments may also supply OCs. There are arguments for and against a relaxation of restrictions controlling the distribution of OCs, many of these views were stated in submissions to the Royal Commission on Human Relationships. At present in Australia, a nurse must work under the supervision of a medical practitioner when providing family planning services. A doctor may delegate certain functions to nursing staff but remains ultimately responsible. The Royal Commission "suggests that steps should be taken to enable nurse practitioners to take a wider role in prescribing oral contraceptives." They also think "that the pill should be available only through a person trained to give information and advice on its proper use. (They) would not necessarily restrict the categories of such persons; they might include nurses, or other specially trained personnel, at family planning clinics, specially trained social workers, pharmacists, and possibly others. It would be important to establish proper standards for training these personnel and for their competence to be recognized by the Commonwealth and States under appropriate legislation. This would require cooperation. The Family Planning Associations or other recognized training bodies could be authorized to issue certificates of competence to persons who have received the appropriate training; this would in turn authorize those persons to prescribe OCs. When more is known about the OC it is hoped that it will be possible to make it available without restriction.

Australia↗