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Provider attitudes toward IUD provision in Zimbabwe: perception of HIV risk and training implications.

This study was conducted to assess providers' attitudes toward the provision of long-term methods of contraception, in particular the IUD, and provider concerns about human immunodeficiency virus (HIV) in the context of family planning (FP) services. The data were collected using self-administered structured questionnaires. Between 65% and 80% of the public and private providers thought that the IUD is a good contraceptive method for Zimbabwean women. In addition, the majority of these two provider groups felt that neither the IUD nor tubal sterilization (TL) posed much risk of HIV infection to the client. A significant number of providers (especially the public nurses), however, thought that the provision of TL put the provider at high risk of HIV infection and a significant proportion of public nurses were also concerned about provider risk associated with providing IUD and injectables. To address such concerns, future training interventions should emphasize appropriate infection prevention practices associated with surgical FP method provision. Nurses, in particular, should be informed about the magnitude of risk associated with FP service provision and ways to protect themselves. Logistic activities also need to be strengthened so that legitimate concerns among providers regarding lack of adequate infection prevention supplies (e.g. gloves) in the field can be addressed.

Attitude of Health Personnel↗

Emergency contraception use by Irish teenagers.

OBJECTIVE: To audit teenagers attending a family planning clinic requesting emergency contraception. METHODS: A non-judgemental, relaxed, confidential interview was carried out. RESULTS: Many young Irish women become sexually active at a young age. Many teenagers appear to have problems using condoms correctly while others are taking chances by not using any method of contraception. CONCLUSIONS: These findings have important implications for those drawing up a sexual health strategy for young people.

Adolescent↗

The intrauterine device in modern contraception: Still an actuality?

The intrauterine devices (IUD) is a contraceptive method largely used as an effective, safe and economic method of contraception; IUD efficacy is demonstrated to be about 97%, and copper IUD contraceptive failure frequency is about 0.8% for the first year of use, and this is about 0.1-0.2% for the progestin IUD. IUD benefits are different; it produces a well-defined contraceptive efficacy for long time, is useful for sexual activity and is rather free from common problems. However, IUD utilization is associated with an increasing risk of pelvic infection (0.5%) in the 8 years from initial use, and the common risk of pelvic inflammatory infection (PID) is about one to two cases per year; this risk, for copper IUD users, is 0.2-0.5% per year. The possible side effects of IUD use are: pelvic pain, irregular meshes, infections, bleeding and uterine perforation; we report a uterine perforation due to IUD migration in the Retzius space, diagnosed on transvaginal ultrasonography, confirmed on CT and removed by laparoscopy. In any case, the IUD remains the mainstay of family planning measures in developing countries but, unfortunately, its association with possible serious complications, change the cost-benefit link and restrict its utilization by a large part of the general population.

Adult↗

Birth planning and sterilization in China.

Sterilization is the most prevalent method of contraception in China. Approximately half of all women of reproductive age report that they or their husbands are sterilized. Using data from the China Health and Nutrition Survey we describe patterns of sterilization in eight Chinese provinces. With a discrete-time event history model we investigate the link between characteristics of local birth planning policy and the risk of sterilization. After controlling for parity, the risk of sterilization is highest in communities where birth planning policy is least strong as measured by exceptions to the one-child policy. These results suggest that couples with more flexibility in family building may have less control over contraceptive method use. Other factors affecting the risk of sterilization are a woman's age, parity, and whether or not she has a son. Our results emphasize the importance of taking into account multiple dimensions of reproductive behaviour when assessing one-child policy changes.

China↗

Effect of combined oral contraceptives on glycosylated haemoglobin.

Glycosylated haemoglobin (HbA), was measured in 164 Caucasian women aged 20-40 years who were using: (1) barrier contraceptive methods; (2) contraceptive pills with 30 micrograms ethinyloestradiol and 150 micrograms laevo-norgestrel; (3) contraceptive pills with 30-35 micrograms ethinyloestradiol and 0.5-1 mg norethisterone. Mean +/- 1 s.d. values for the three groups were 7.64 +/- 0.69, 7.56 +/- 0.56 and 7.27 +/- 0.74 respectively. Groups (1) and (2) did not differ significantly from one another but the mean value for group (3) was significantly lower than for the other groups (P less than 0.01). Age, percentage ideal body weight and smoking did not influence HbA, but the value was higher for parous than for nulliparous women (P = 0.02). These findings can be explained in terms of the known effects of oestrogens and progestogens on fasting blood glucose.

Adult↗

Five-year experience with depot medroxy progesterone acetate injectable contraception.

BACKGROUND: The objective of this article is to describe the characteristics and experiences of clients who used depot medroxy progesterone acetate for contraception. METHODS: A retrospective review of family planning records of clients who used depo-provera between 1992 and 1996 at the family planning clinic of University of Nigerian Teaching Hospital, Enugu. RESULTS: The mean age of clients was 32.7 +/- 5.2 years. Over 71% of clients had five or more children. Clients with no education (78.7%) or primary education (75.1%) were more likely to be grand-multiparous compared to women with at least secondary education (49.6%). Among clients with 1-4 living children, 81.3% used depo-provera for child spacing. Among those with 5-8 living children, 48.8% used it for child spacing. Menstrual abnormalities were the main complications but the commonest reason given for discontinuation was "husband's wish". The continuation rate at 36 months was 82.7%. CONCLUSION: Depot medroxy progesterone acetate is an acceptable and effective method of contraception. The involvement of men in family planning programmes cannot be over-emphasised as they significantly influence the decision of women regarding contraceptive use.

Adult↗

Establishing an educational programme for nurses to supply emergency hormonal contraception (combined method) to protocol.

This paper gives an account of an innovative educational programme developed by the Department of Midwifery Studies at the University of Central Lancashire (UCLAN) in 1995. The North West Regional Health Authority (NWRHA) approached the Department of Midwifery Studies to develop an educational programme for family planning nurses to supply the combined method of emergency hormonal contraception (EHC) under protocol when a doctor was not present. The purpose was to increase the availability and accessibility of EHC for young people in the North West region. The 3-day programme was designed to complement previous ENB 901/900 training, and also to provide the nurses with the specific skills and knowledge required to undertake this new role. One hundred and thirty-nine nurses from the North West area attended the programme between 1995-1998. Students were assessed both theoretically and clinically. Extending the role of family planning nurses to supply EHC gives purchasers and providers of sexual health care the potential to offer a wider range of accessible services. The recently published interim Crown Report1 on the supply and administration of medicines under group protocols states that protocols should specify clear arrangements for professional responsibility and accountability. Appropriate training is essential to ensure that the extended role of the nurse in family planning is fully understood.

Adolescent↗

Act (Chapter 13), 9 June 1988.

This Rhode Island Act authorizes and directs the Director of Health to establish a payer of last resort program to cover the cost of outpatient family planning counseling and comprehensive reproductive health services for those ineligible for Medicaid and who lack coverage for these services and whose family income is between 100 and 185% of the federal poverty level. The following services are to be included in the program: 1) patient education and counseling on options for timing and spacing pregnancy; 2) comprehensive medical services to prevent and control the spread of sexually transmitted diseases; and 3) access to safe and effective methods of contraception. Excluded services include, among other things, abortion and infertility related services. No funds are to be expended to support school-based clinics dispensing "contraceptive methods."

Americas↗

[Intergamete complementarity: short review].

OBJECTIVE: The aim of this review is to recognize the role of molecules involved in intergamete interactions during the process of fertilization and further understanding of the molecular basis of fertilization in humans for the development of new methods for contraception. METHODS: We carried out a bibliographic review on intergamete interactions. RESULTS: Fertilization is the product of a series of ordered steps that must take place both in the sperm and the oocyte for a correct interaction leading to the development of the new individual; this interaction requires that both cells are in perfect state for recognition to occur; this recognition is dependant on terminal oligosaccharide residues present in zona pellucida and their complementary receptors on sperm plasmatic (primary receptors) and inner acrosomal (secondary receptors) membranes. CONCLUSIONS: Knowledge of these processes will provide a better understanding of the molecular mechanisms in intergamete interaction and could lead to the development of tools for controlling reproduction as well as for helping couples presenting alterations of their

Female↗

A survey of genital infections in patients attending a clinic for sexually transmitted diseases.

747 consecutive patients, 531 men and 216 women, attending the Division of Dermatovenerology, City Health Dept., Oslo, were screened for N. gonorrhoeae (14.5% and 18.5%), C. trachomatis (19.6% and 20.8%), G. vaginalis (0.2% and 6.5%), and C. albicans (1.1% and 21.3%). The prevalence is given in brackets for men and women, respectively. This study was undertaken in order to determine the relative prevalence of these microorganisms with particular reference to G. vaginalis, to determine the importance of concomitant infections, and the possible effect of contraceptive methods (oral contraceptives and IUD) on the prevalence of these microorganisms.

Adolescent↗

[Barrier family planning methods as risk factor which predisposes to preeclampsia].

Preeclampsia is a pregnancy-specific syndrome, it occurs in approximately 5-10% of all pregnancies and the etiology remains unknown, but the primigravida adolescent as such as multigravid older women whom have conceived with a new sexual partner have a greater risk, this has been associated also with the use of barrier contraceptive methods that prevent exposure to sperm with the endometrial cavity. An immunological factor has been suspected because fetal antigen's could cause antigenic reaction with the maternal immunological apparatus, for first exposure at these antigens, since the fetus is considered like an allotransplantation. This is supported in some studies that report that the use of condoms, spermicides and withdrawal are associated with developing of preeclampsia in subsequent pregnancy, and another hand indicate at cohabitation preceded for long period, practiced oral sex and use of contraceptive methods that permit exposure to sperm viable with uterus decreased the prevalence of preeclampsia. To test this hypothesis, we initially used data from two groups of pregnant women, comparing the contraceptive and reproductive history of 73 pregnant women with preeclampsia and 70 pregnant women without preeclampsia. The odds ratio for preeclampsia indicated a 2.52-fold (with 95% confidence interval, 1.17 to 5.44, p < 0.05), increased risk of preeclampsia for users of barrier contraceptives compared with women using nonbarrier contraceptives methods. Other variables like socio-demographic and obstetrics analysis were not different between both groups. This study suggest that nonbarrier contraceptive methods or the exposure of paternal spermatic antigens is protective against development of preeclampsia. Further immunological studies are necessary to determine the role of contraception methods and preeclampsia.

Adult↗

Selecting the optimum method of contraception for each patient.

The factors relating to the choice of the optimal method of contraception are discussed, indicating the wide range of variables which must be evaluated. Religious, cultural, educational and social factors are considered, as well as age and family size. Facts elicited through discussion of general medical, family, obstetric and menstrual histories help to indicate the advantages and disadvantages of available methods. The influences of the doctor, relatives, friends, and publicity are shown to affect the patient's choice and indicate that the theoretical effectiveness of a particular method forms only one part of a complex situation.

Contraception↗

Fertility awareness-based methods for contraception: systematic review of randomized controlled trials.

CONTEXT: Fertility awareness-based (FAB) methods of family planning estimate the fertile days of the menstrual cycle whether by observing fertility signs such as cervical secretions and basal body temperature or by monitoring cycle days. The efficacy and acceptability of these methods are unclear. METHODS: We retrieved and analyzed all randomized controlled trials that examined any FAB method used for contraception. RESULTS: Because of poor methods and reporting, pregnancy rates could not be determined. A trial in Colombia found similar numbers of pregnancies among women randomized to the ovulation and symptothermal methods, but a trial in Los Angeles observed more pregnancies in the group assigned to the ovulation method. In the two American trials, recruitment of participants was unexpectedly difficult. Continuation rates were poor. CONCLUSION: Despite intensive training and ongoing support, most participants in these trials discontinued prematurely. The comparative efficacy of these methods remains unknown. However, with the ovulation and symptothermal methods, pregnancies appear to be common; method continuation rates are low.

Awareness↗

The effectiveness of barrier methods of contraception in preventing the spread of HIV.

Because barrier methods provide protection against bacterial sexually transmitted diseases, these methods are valuable public health adjuncts irrespective of their effect on HIV. Male latex condoms offer substantial protection against HIV infection. Women at risk of sexual acquisition of HIV infection need one or more prophylactic methods that they can control. While the available spermicide products may serve this purpose, current data do not allow firm casual inferences. Large and well designed epidemiologic studies are required to examine the association between female use of barrier methods and HIV infection. These are difficult and costly to perform, however, and to date have yielded conflicting results. Finally, prospective studies in high-incidence cohorts are necessary, and the relationships between spermicide use, local irritation, the vaginal flora and HIV incidence rates must be clarified.

Condoms↗

Knowledge on lactational amenorrhoea and contraception in Kocaeli, Turkey.

OBJECTIVE: To determine the knowledge of women about lactational amenorrhoea and contraceptive properties of breastfeeding. DESIGN: A prospective, randomised descriptive study. SETTING: Kocaeli University School of Medicine, Department of Obstetrics and Gynecology. SUBJECTS OR PARTICIPANTS: Nine hundred and twenty-two women in their reproductive ages. INTERVENTION: A questionnaire was filled by doctors or nurses during face to face interview. MAIN OUTCOME MEASURES: There was significantly less knowledge for the importance of frequency and duration of suckling (p < 0.0001). The education increases the knowledge of lactational amenorrhoea as a interruptus contraceptive method. RESULTS: More than fifty-three per cent of women were using one of the modern contraceptive methods, 23.86% were using natural methods and 22.78% not using any family planning method. Intrauterine devices (30.15%), coitus interuptus (21.69%) and condom (16.48%) were the most common contraceptive methods. Nearly fifty-two per cent of women were not aware of the contraceptive property of breastfeeding, 25.68% of women knew lactation had a protective effect from pregnancy, 48.16%, did not know the importance of frequency and duration of suckling on fertility reducing effect of lactation. CONCLUSION: The level of knowledge on lactational amenorrhoea and frequency of suckling was significantly low in our study, especially in the illiterate group. Since efficacy of natural family planning depends on the compliance of women, education of women about lactation is very important. Family planning programmes should be focussed on breastfeeding and type of breastfeeding practices used, especially where there are no contraceptive alternatives.

Adolescent↗