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Legislation on contraception and abortion for adolescents.

The serious health and social consequences of adolescent pregnancy call for the examination of the laws that affect adolescents' access to contraception and abortion. The general law of any country relating to the availability, sale, or distribution and financing of contraceptives affects adolescents. Similarly, a country's general law on abortion applies to adolescents faced with unwanted pregnancy and affects them accordingly. In addition, special legislation relating to adolescents, particularly legislation or court decisions concerning parental consent for contraception or abortion for a minor, has an important influence on the access that sexually active young people have to services.

Abortion, Legal↗

Modification of corporal weight, body fat distribution, blood lipids and glucose levels in oral contraceptive users.

The association between oral contraceptives and the modification of corporal weight and body fat distribution is controversial. The characteristics of the menstrual cycle, lipids and glucose levels were also analyzed. Thirty women who received ethinylestradiol 0.035 mg and norethindrone 0.400 mg for one year were studied. The following variables were analyzed every 3 months: weight, body mass index (BMI), hip perimeter, waist perimeter, waist-hip ratio (WHR), duration of menstrual cycle, quantity of uterine bleeding, as well as blood levels of cholesterol, triglycerides and glucose. Waist and hip perimeters increased during the third evaluation; as well as the BMI starting from the second evaluation. The triglycerides levels rose from the first evaluation. No modifications were found in the WHR, glucose and cholesterol levels and the duration of the menstrual cycle, but the quantity of uterine bleeding decreased from the third month. The oral contraceptive significantly increased BMI and triglycerides level, but no changes were detected in body fat distribution, cholesterol and glucose levels. Uterine bleeding decreased from the first evaluation.

Adipose Tissue↗

Steroidal contraceptive use update, United States, 1989-1994.

OBJECTIVE: To update United States steroidal contraceptive use data for the period 1989 to 1994. STUDY DESIGN: Pharmaceutical marketing data were used to examine trends in the utilization and distribution of oral contraceptives, Norplant, and Depo-Provera. RESULTS: There were 56.8 million prescriptions for oral contraceptives dispensed through retail pharmacies in 1994. Estrogen and progestin doses remained fairly stable over time. The average ethinyl estradiol dose of formulations was approximately 34 microg per pill. Mentions for oral contraceptives among 35- to 44-year-old women increased. Approximately 169,000 Norplant systems were distributed from 1991 through 1994. More than 1.5 million milliliters of Depo-Provera were distributed from 1993 to 1994. CONCLUSIONS: Oral contraceptives remain a popular form of contraception. Parenteral formulations have been rapidly accepted.

Journal Article↗

Higher prices in Jamaica.

Price increases in the Jamaica CSM program went into effect on August 31, 1981. The program began in 1975. While the need for higher prices has been under discussion for the past 3 years, this is the 1st time the requisite approval from the Jamaica Price Commission has been obtained. The Jamaica National Family Planning Board (JNFPB) reports that the Panther 3-pack (condom) is up US$0.15 to US$0.30. Each Perle package (oral contraceptive) was increased by US$0.20. Single cycle Perle now sells for US$0.50, and 3-pack Perle sells for US$1.10. The 6-year price stagnation experienced by the CSM program resulted in a decreasing operational budget as program costs continued to rise. Marketing costs alone during this period escalated by 100-300%. For example, Panther pop-up display cartons cost the project US 16U each in 1975. By 1979 the same product cost US 49U. Newspaper advertisements have increased from the 1975 cost of US$68.00 to nearly $200.00 per placement. The overall inflation rate in Jamaica during the last 5 years has averaged more than 20% annually. In the face of these rising costs, outlet expansion for Perle has been prevented, wholesaler margins have been unavailable, and new retailer training has been discontinued. It is projected that the new prices will result in an annual increased revenues of US$80,000 which will be used to reinstate these essential marketing activities. The JNFPB is also planning to introduce a Panther 12-pack and Panther strips to the CSM product line. According to Marketing Manager Aston Evans, "We believe the public is now ready for this type of packaging" which is scheduled to be available soon. Panther is presently only available in a 3-pack, but annual sales have been steady. The new 12-pack will be stocked on supermarket shelves to provide higher product visibility and wider distribution. The selling price has been set as US$1.20 and is expected to yield a 25% increase in sales during the 1st year. A complete sales promotion and advertising campaign will accompany the 12-pack introduction. The marketing plan for Panther strips emphasizes placement in government and private sector offices and factories throughout the country. In the deep rural areas the strips will be available for sale in shops, bars, nightclubs, and other distribution points.

Americas↗

Act No. 167, 8 June 1987.

This Act provides that "No contraceptive device or contraceptive medication may be distributed in or on the school grounds of any public elementary or secondary school. No school district may contract with any contraceptive provider for their distribution in or on the school grounds."

Americas↗

[Epidemiology of induced abortion and contraception].

This article describes prevalence and distribution patterns of induced abortion and contraception in various regions of the USSR. Selective studies have elucidated a spectrum of factors of abortion and contraception prevalence, their roles in birth control and priorities in implementation of updated methods of induced abortion prevention.

Abortion, Induced↗

Access to emergency contraception.

The merits of non-prescription distribution of levonorgestrel as emergency contraception (EC), which is effective within 72 hours of unprotected intercourse, are contentious. The advantage of promptness and convenience of access may be offset by the absence of medical counselling. Opposition to EC based on the possibility of the drug acting after fertilization but before implantation departs from standard medical criteria of pregnancy. Physicians who propose to apply non-medical criteria, and use religious objections to abortion to deny prescription of EC, must publicize their opposition in advance, so that women may seek assistance elsewhere. When objecting practitioners, or facilities, become responsible for women for whom EC is indicated, such as rape victims, they are bound ethically and legally to refer them to reasonably accessible non-objecting sources of care.

Adult↗

[Association between low-dose oral contraceptive use and stroke in Chinese women].

OBJECTIVE: To investigate the association between low-dose combined oral contraceptive (COC) widely distributed in China and the risk of hemorrhagic stroke so as to decrease the adverse reaction of COC. METHODS: A prospective cohort study was made among 44 408 women who took hormonal contraceptives (HCs) and 75 230 women who used in trauterine device (IUD) in 25 townships and toens in Rudong County and Taicang City, Jiangsu Province, to compare the incidence of stroke among them from 1 July 1997 to 30 June 2000. RESULTS: (1) The incidence of hemorrhagic stroke (age-and-county standardized rates) was 34.74 per 100 000 py in the HC cohort, 2.72 times higher than that in the IUD cohort (P < 0.01). The incidence of hemorrhagic stroke among women less than 45 years of age was remarkably higher in HC cohort than in the IUD cohort. The relative risk of incidence of hemorrhagic stroke was 2.17 (1.16, 4.06) among the HC users who had stopped HC use for more than 10 years, still significantly higher than among the IUD users. (2) The relative risk of incidence of hemorrhagic stroke among the women who used low-dose COCs during the survey was 3.60 (1.73, 7.53) times higher than that among the IUD users. The relative risk of incidence of hemorrhagic stroke was 3.09 (1.26, 7.57) among the women who had stopped low-dose COC use for less than five years, however, the risk of hemorrhagic stroke remarkably decreased after they stopped taking COC for more than 5 years. (3) No obvious increase in incidence of infarctional stroke was found among the women who took low-dose COC during the survey. (4) Hypertension might be the most important risk factor of hemorrhagic stroke among the low-dose COC users. CONCLUSION: There is an obvious increase in risk of hemorrhagic stroke among the Chines women who take low-dose of China-made COCs for a long time. The efffect of China-made COCs on pathogenesis of hemorrhagic stroke lasts sometime after the discontinuation of COC use.

Cerebral Hemorrhage↗

[The importance of subsequent contraception in reducing unwanted pregnancies].

The most established hormonal method of subsequent contraception is the so-called Yuzpe-method; another important method is placement of a copper coil. Hormonal subsequent contraception has no health-hazardous side effects, so there is nothing to prevent its use but a known pregnancy. More information about subsequent contraception and easier distribution are seen as important means of decreasing unwanted pregnancies as well as abortions.

Abortion, Induced↗

Emergency contraception: the nurse's role in providing postcoital options.

Emergency contraception refers to pregnancy prevention methods initiated after unprotected sexual intercourse. Research has shown that 75% of the 3.5 million unintended pregnancies that occur in the United States every year could be prevented through use of emergency contraception. Hormonal methods and postcoital insertion of intrauterine devices have been shown to be safe and effective. Nurses play an essential role in the distribution of emergency contraception as patient educators, advocates, and support persons.

Contraception↗

Vanguard family planning acceptors in Senegal.

This study examines contraceptive use among clients at the three clinics providing family planning services in Dakar, Senegal in early 1983. Most clients first became interested in family planning following the birth of a child, and most are interested in spacing future pregnancies, although one-third state that they want no more children. The clinic itself was found to be an important determinant of the type of contraceptive used, with only the government-operated clinic providing a balance between IUDs, oral contraceptives, and barrier methods. Nearly half of the clients interviewed said that a lack of knowledge about contraception is the reason for the low contraceptive prevalence rates among Senegalese women; another frequently cited reason was the opposition of the husband. Most clients reported the broadcast media to be the best means of providing family planning information to potential acceptors.

Contraceptive Devices, Male↗

Distribution along a stages-of-behavioral-change continuum for condom and contraceptive use among women accessed in different settings. Prevention of HIV in Women and Infants Demonstration Projects.

The numbers of women of childbearing age in the US with HIV and AIDS from heterosexual transmission continues to rise. Behavioral interventions remain the best means of preventing transmission of HIV. Program planners often implement interventions to promote behavioral change in a wide range of settings such as family planning or sexually transmitted disease clinics, drug treatment facilities, or medical facilities that serve high risk and HIV positive women. Women recruited in different types of settings, however, may differ with respect to their experience with, attitudes toward, and willingness to use condoms and contraception. Such differences should be considered when tailoring interventions to the populations being served. We examined the readiness to use condoms and contraception among 3784 women in four cities recruited in three different types of settings: community, facilities not targeted to HIV positive women and medical facilities for HIV positive populations. Readiness to use condoms or contraception was measured using The Transtheoretical Model of Change. Women reported being in different stages along the continuum of condom and contraceptive use in the three settings. A greater proportion of women in the HIV-facility, 45%, had used condoms consistently for the previous 6 months compared to women in the other two settings (12% and 11%). Similarly, variation across settings was seen for contemplation of consistent contraceptive use to prevent unintended pregnancies. The variability in the distribution of condom and contraceptive use across settings underscores the importance of assessing the readiness for the behavior change and designing interventions that meet the specific needs of the populations being served.

Adolescent↗

Oral contraceptives and blood pressure.

Both cross-sectional and longitudinal analysis of data from 13,358 women showed that oral contraceptive use is associated with a slight but statistically significant (P lesser than .05) rise in mean blood pressure, which is reversible. The age-adjusted proportion of oral contraceptive users with a blood pressure over 140/90 mm Hg was about three times that on nonusers. These findings are caused by a uniform upward shift in the blood pressure distribution of oral contraceptive users compared to nonusers. Women continuing oral contraceptive use had no appreciably greater change in blood pressure between two visits than persistent nonusers. The clinical implications of a mild contraceptive-induced blood pressure elevation (systolic, 5 to 6 mm Hg; diastolic, 1 to 2 mm Hg) remain unsettled but disturbing.

Adolescent↗