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PubMedDate not supplied

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↗
PubMed1996

Factors related to the initiation of prenatal care in the adolescent nullipara.

The purpose of this cross-sectional descriptive study was to explore factors that influence the timing of the first prenatal care visit of pregnant adolescents. Although researchers agree that barriers to prenatal care need to be identified and interventions formulated, barriers have not been well defined for any specific population. Increased availability and adequacy of health care resources, more family system support, and higher self-care agency scores are hypothesized to predict earlier prenatal care. A convenience sample of 51 pregnant adolescents from a university clinic was surveyed. The study found that the availability/adequacy of health care resources was the most significant predictor of the initiation of prenatal care (p = .03). Of the various health care resources assessed, only the ease in attaining a medical card was positively related to the onset of prenatal care. Practitioners can be instrumental in disseminating information about the availability of health care resources and in easing access to those resources through local and national political involvement.

Adolescent↗
PubMed1990

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↗
PubMed1983

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↗
PubMedDate not supplied

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↗
PubMedDate not supplied

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↗
PubMed1991

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↗
PubMed1989

Fostering primary and secondary prevention in public policy for pregnant adolescents.

The diverse factors associated with sexuality among adolescents and the specific issues related to contraception in this developmentally diverse group result in complexity in policy formation. The future of an adolescent may be determined solely on the basis of access to supportive physical and emotional services funded by public and private sector monies. The purpose of this paper is to briefly present contemporary and social policies regarding pregnant adolescent health care. Suggestions as to how these policies can be translated into public adolescent health models are provided. The strategies will be related to primary and secondary public policy interventions.

Adolescent↗
PubMedDate not supplied

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↗
PubMed1995

Trends in utilization of obstetric care at Wesley Guild Hospital, Ilesa, Nigeria. Effects of a depressed economy.

Perinatal mortality rate (PNMR) at Wesley Guild Hospital (WGH), Ilesa, Nigeria, over a ten-year period was retrospectively analysed. The main objective was to determine the trends in the utilization of obstetric care and PNMR in the face of current economic difficulties in Nigeria and to make suggestions for improvement. The average PNMR over the period was 57.8/1000 births. There was a sharp rise in PNMR in 1985 to a peak of 110/1000 in 1987 (p < 0.0001). This was associated with a decline in utilization of maternity services, probably as a result of the introduction of fees for maternity services late in 1984 and increase in economic hardship in Nigeria. Actions are needed to improve enhanced access to obstetric care for the poor. These actions include: improvement in the economic conditions of the people, emphasis on primary health care (PHC) and early referral of high-risk pregnant women to tertiary units.

Developing Countries↗
PubMed1993

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↗
PubMed1996

Population and women's reproductive health: an international perspective.

This paper gives a brief overview of current world population or demographic issues, followed by a discussion of the ICPD proceedings and various notable aspects of the ICPD Programme of Action. It then focuses on six of the most pressing reproductive health concerns facing women today: gender inequalities, access to contraceptive services, sexually transmitted diseases (including HIV), maternal mortality, unsafe abortion, and adolescent pregnancy. Because the ICPD Programme of Action is intended to have far-reaching consequences for each of these issues, it is taken as a focal point of analysis.

Abortion, Legal↗
PubMed1993

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↗
PubMed1992

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↗
PubMed1993

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↗
PubMed1998

Births, deaths and medical emergencies in the district: a rapid participatory appraisal in Nepal.

Two qualitative rapid appraisal techniques were used in a community-based study to investigate health beliefs, attitudes and practices in a rural district in Nepal. Pregnancy and childbirth remain non-medical activities managed at home. Deaths may be avoided by better access to hospital emergency services. Health awareness of some problems, e.g. oral rehydration and diarrhoeal disease, is high; but of others, e.g. association of haemoptysis with tuberculosis, is poor. These methods require few resources, are efficient in time and manpower required, and generate useful relevant information on a target population. They are recommended for district health development programmes elsewhere.

Adolescent↗
PubMed2000

Health sector reform and reproductive health in Latin America and the Caribbean: strengthening the links.

Many countries in Latin America and the Caribbean (LAC) are currently reforming their national health sectors and also implementing a comprehensive approach to reproductive health care. Three regional workshops to explore how health sector reform could improve reproductive health services have revealed the inherently complex, competing, and political nature of health sector reform and reproductive health. The objectives of reproductive health care can run parallel to those of health sector reform in that both are concerned with promoting equitable access to high quality care by means of integrated approaches to primary health care, and by the involvement of the public in setting health sector priorities. However, there is a serious risk that health reforms will be driven mainly by financial and/or political considerations and not by the need to improve the quality of health services as a basic human right. With only limited changes to the health systems in many Latin American and Caribbean countries and a handful of examples of positive progress resulting from reforms, the gap between rhetoric and practice remains wide.

Caribbean Region↗
PubMed1994

An operational evaluation of the Community Oral Rehydration Units in Peru.

Since 1984, in Latin America donor agencies and national governments have extensively supported the implementation of the Community Oral Rehydration Units (CORUs) in an attempt to increase the access to oral rehydration therapy and improve the case management of diarrhoea at the community level. This study surveyed 40 CORUs in two regions of Peru to assess their operation, the number of patients with diarrhoea attended, and the knowledge of volunteers in charge. The results show that CORUs were mainly implemented close to existing health centres; the median of case load was 2.0 patients in the preceding month; and the volunteers' knowledge of case management was principally deficient in the diagnosis of hydration status, dietary management and in preventive measures. This lack of knowledge was replicated by professionals at the supervising health centres. Despite the fact that CORUs have been functioning for around four years, they exhibit numerous deficiencies which prevent them from fulfilling their objectives. A global review of the whole CORU strategy is called for.

Community Health Services↗