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PubMed1989

The effectiveness of family-planning programmes.

By the mid-1960s, countries that accounted for 66% of the population of developing countries had adopted policies designed to reduce their rates of population growth; by 1986, the corresponding figure had reached 78%. In the developing regions as a whole, fertility has fallen by more than 30% since 1950. Contraceptive use has risen sharply, and there has been more than 10-fold increase in the number of couples in developing countries who use contraceptives. There is a very strong association between use of contraception and fertility in developing countries. Social and economic modernization is also taking place, although quite unevenly in the developing regions, so that the relationship of modernization is fertility is not very easy to demonstrate. In general, the experience of the developing countries suggest that a strong family- planning program effort can, and does, lead to a more rapid fertility decline than would be likely based only on socioeconomic variables. The effectiveness of family-planning programs can be enhanced by increasing the range of choice of contraceptive methods offered. However, it is difficult to disentangle the various factors that contribute to the effectiveness of family-planning programs. The public sector is the main supplier of family-planning services in most developing countries, and there is no clear trend towards the reliance on the private sector.

Contraception↗
PubMed1995

From birth control to reproductive health.

During the 1960s birth control was seen as the only means of curbing the very rapid population growth that resulted from decreased mortality without a parallel decrease in fertility. Birth control was considered such a priority that the means used to achieve it were not always respectful of human rights, and, for the same reason, it did not work as expected. During the 1970s and 1980s, birth control policy was re-evaluated. Concepts such as the need to balance birth control with socioeconomic development, to avoid target-oriented programs that imposed particular contraceptive methods on people, to integrate contraceptive services within a comprehensive women's health care program, and to emphasize the importance of quality of care became accepted. This led to the understanding that a reproductive health care approach was a more efficient way to achieve people's wellbeing and, at the same time, to reduce fertility. The need for greater dialog between women/clients and men/providers is emphasized.

Brazil↗
PubMed2002

Prevalence and determinants of contraceptive practice in a defined Nigerian population.

This study investigates the prevalence and determinants of contraceptive practice in Ile-Ife, Nigeria. A prospective study of 500 rural women in the reproductive age group was conducted between April to June 1999 in the Igboya health district of Ife central local government area of Osun State. A comprehensive contraceptive promotion and distribution had been carried out in this area by the University Teaching Hospital, the State Ministry of Health and many non-governmental organisations in the past 10 years. It is therefore expected that the contraceptive awareness and use in this environment would be high. Unfortunately, although all the respondents (100%) were aware of contraception and 78% were sexually active, only 18.8% used contraception. A majority of the non-users gave no reasons for failure to use contraception. Among reasons given by others include fear of side effects, no need for contraception, not married, religion, need for more children and student status. The most common contraceptive method among users was intrauterine contraceptive device followed by pills, condoms and injectable contraceptives. Factors which were significantly associated with utilisation of contraception were availability of family planning services, parity, knowledge of contraception and child spacing (P < 0.05). Religion, literacy level, attitudes of family planning providers and distance to family planning services were not found to be significant (P > 0.05). Recommendations that will improve wide contraceptive usage are preferred.

Adolescent↗
PubMed1997

In vitro inhibition of the biological activity of follicle-stimulating hormone by anti-peptide antisera representing the human follicle-stimulating hormone beta subunit sequence 33-53.

There are few male contraceptive methods, and research is required to broaden the scope of available male antifertility methods. Two approaches toward hormonal contraception are currently being investigated. The first relies on elimination of testosterone while the second is based upon immunizations against FSH. However, most anti-whole FSH antisera cross-react with LH, thereby possibly inhibiting testosterone and leading to potential loss of libido. Therefore, a more effective alternative would be to define an FSH peptide that differs significantly from LH in order to prevent cross-reactivity between anti-FSH antisera and LH. Two peptides were selected from the beta subunit of FSH that were considered to be inducers of anti-FSH activity but not anti-LH activity. The first peptide (sequence beta33-53) is a linear antigenic site of human FSH found only in anti-FSH antisera that do not cross-react with LH. The second peptide (sequence beta81-95) is a part of FSH that confers receptor specificity. These peptides, in monomer and tandem form, were used to immunize rabbits. The antisera were tested for inhibition of FSH activity in a bioassay; they were also tested in a Leydig cell assay to detect anti-LH activity. It was found that antisera raised against the beta33-53 tandem could inhibit the FSH bioactivity but not that of LH. Antisera against the beta33-53 monomer or the beta81-95 monomer or tandem did not inhibit FSH. Thus, the tandem peptide beta33-53 is an attractive candidate for use as antigen in a male contraceptive vaccine. The better results obtained with tandem vaccinations might be related to the ability of the tandem peptide to direct the antibody response toward the N-terminal end of the peptide and to raise antisera with the ability to react with shorter chains of amino acids.

Amino Acid Sequence↗
PubMed1985

The influence of client-provider relationships on teenage women's subsequent use of contraception.

This paper describes the relationships of selected dimensions of nurse-client interaction in county health department family planning clinics to the subsequent contraceptive use of the clinic's unmarried teenage clients. The subjects for the study are the clients and professional staff of 78 clinics: 2,900 eligible clients making their first contraceptive visit and 338 clinic staff nurses. Results of interviews demonstrate that client and staff expectations and interactions are significant predictors of adherence to a contraceptive regimen; under circumstances where clients anticipate, and staff employ, authoritative guidance in helping the clients to select a contraceptive method, clinic mean levels of contraceptive use are substantially increased. Overall, 40 per cent of clinic variation in contraceptive compliance is explained by the interaction dimensions and other aspects of clinic organization addressed in this paper. Implications of these results for the structuring of family planning clinic programs directed toward teenage women are briefly considered.

Adolescent↗
PubMed1987

[Postcoital contraception with dienogest].

Fifty eight fertile female volunteers between 20 to 45 years were enrolled in a clinical trial to evaluate the efficacy and tolerance of the progestin dienogest (17 alpha-cyanomethyl-17 beta-hydroxyestra-4,9-dien-3-one, VEB Jenapharm Jena GDR) as a postcoital contraceptive. An oral dose of 2 mg dienogest was administered immediately after each coitus. The 58 women reported 872 intercourses during 302 cycles. Frequency of ingestion was on average 3 times per cycle. Pregnancy occurred in 14 women corresponding to a Pearl-index of 55.6. The observed pregnancy rate referring to all intercourses was 1.6 per cent. The incidence of expected pregnancies in relation to the coital exposures was 4.04 per cent. As a result the risk of pregnancy was reduced 2.5 times by dienogest. Menstrual disorders occurred in 18.9 per cent in regard of the total numbers of cycles. The results and an overview of literature suggest that neither dienogest nor other progestins are suitable as a sole contraceptive method when used as a postcoital agent. They are only indicated as a risk-reducing method after so-called "contraceptive emergencies".

Adult↗
PubMedDate not supplied

The influence of health care on contraceptive acceptance in rural Mexico.

This paper offers two types of evidence in support of the idea that family planning services are most expediently provided as an integral part of the health and medical organization for maternity care. First, prenatal care and medical attention at delivery are found to be closely associated with postpartum contraceptive acceptance in a 1981 survey of family planning in rural Mexico. Second, interviews of a sample of doctors, nurses, and auxiliaries who provide maternal health services to the rural population reveal that these practitioners favor long birth intervals and small completed families, that they recommend the use of modern contraceptive methods including female sterilization, and that those in the employ of public institutions are motivated to recruit acceptors of these methods. The main impediment to contraceptive acceptance in this context is believed to be fear of side effects and permanent health consequences rather than the desire for additional children.

Attitude of Health Personnel↗
PubMed1983

Public policy and female sterilization in Costa Rica.

For 20 years, female sterilization has been increasing in popularity as a contraceptive method in Costa Rica. However, contraceptive sterilization has never been allowed explicitly under Costa Rican law. In 1976 the Costa Rican National Assembly instituted more stringent guidelines regarding medical sterilizations in order to eliminate contraceptive sterilizations, which had been occurring under relatively loose interpretations of national policy. Data from the 1976 National Fertility Survey and the 1981 Contraceptive Prevalence Survey indicate that the change in policy had only a short-term effect. Period sterilization rates fell substantially after 1976 but rebounded considerably by 1980, and the estimate of the proportion of married women who will ultimately be sterilized was approximately .5 for the periods both before and after 1976.

Adolescent↗
PubMedDate not supplied

Contraceptive prevalence in Paraguay.

Contraceptive use, source of contraception, history of abortion, current pregnancy intention, and fertility rates are evaluated for a national sample of women using data from the Paraguay Contraceptive Prevalence Survey, conducted in 1977. The survey found that 15.5 percent of all women aged 15--44 and 23.6 percent of ever-married women were using effective contraceptive methods. The urban/rural difference in contraceptive use paralleled fertility differentials: over 40 percent of ever-married women were using contraception in Greater Asuncion and other urban areas compared with 15 percent in rural areas. Overall, the data indicate that high-parity rural women have the greatest need for family planning services in Paraguay.

Abortion, Induced↗
PubMed1995

[The medicosocial aspects of contraception for teenagers].

The authors study and examine the influence of some medical and social factors on the teenagers use of contraceptives. The study is based on the questionnaires fulfill by 568 teenagers (aged 13-19). In the enquêtes are shown the role of the family status of the parents the involvement of the family and the school in the sex education, and also are indicated the favorite teenager's contraceptive methods. The positive attitude on contraception and on this kind of researches is very characteristic for 94% of the analyzed teenagers. The authors made a conclusion on optimizing the use of modern contraceptives for teenagers.

Adolescent↗
PubMed1983

Frequency of non-hormonal contraception around conception and association with congenital malformations in offspring.

A case-control study using data on deliveries in the mid-1970s at five Connecticut hospitals (cases, n = 1427; controls, n = 3001) found little relationship between delivery of a malformed infant and use by the mother of nonhormonal contraceptive methods at conception. Of particular interest was the lack of an association with use of the rhythm method (odds ratio (OR) = 1.02, 95% confidence limits (CL) = 0.73, 1.42), spermicides (OR = 1.26, 95% CL = 0.85, 1.85) at conception and a modest association for the intrauterine device (IUD) one week before conception (OR = 1.99, 95% CL = 0.98, 4.04). Continued use of the IUD after conception may further increase the risk for malformations but this observation was statistically unreliable in the present study. Mothers of newborns with cleft lip and palate (OR = 2.91) and congenital hydrocele (OR = 4.64) were more frequent rhythm users at conception, and mothers of newborns with multiple anomalies had more recent IUD exposure (OR = 9.87), but these and all other specific congenital malformation groups were not significantly related to any non-hormonal contraceptive after adjustment for multiple observations. Potentially confounding maternal risk factors were controlled.

Adult↗
PubMed1982

Oral contraceptives and pelvic inflammatory disease.

To study the association of the use of oral contraceptives and pelvic inflammatory disease (PID), we analyzed data from a large multicenter case-control study of contraceptive use and serious gynecologic disorders. The analysis included data from interviews of 648 women hospitalized with an initial episode of PID and 2,516 hospitalized control subjects. The risk of PID for women using oral contraceptives in the 3 months prior to interview was 0.5 (95% confidence limits, 0.4 to 0.6) relative to women using no contraceptive method during this period. This association was not explained by differences between case subjects and control subjects in demographic variables, level of sexual activity, or medical history. The protective effect of current oral contraceptive use against PID was restricted to women using oral contraceptives for more than 12 months; past use of oral contraceptives did not exert a protective effect against PID. Annually, an estimated 50,000 initial cases of PID are prevented by oral contraceptive use; 12,500 hospitalizations are also averted by oral contraceptive use. Consequently, protection against PID is one of the most important noncontraceptive benefits of oral contraception.

Adolescent↗
PubMed1997

Implantable hormonal and emergency contraception.

Recent publications about emergency and implantable contraception focused on increasing the awareness about emergency contraceptive methods and on updating readers about the controversies surrounding Norplant. Both emergency and implantable contraception have excellent safety and efficacy profiles, yet neither has realized its potential for widespread use. This review addresses these concerns and attempts to place these issues in perspective.

Contraception↗
PubMed1998

AIDS and reproductive health.

Over 24 million adults worldwide have been infected with HIV. Primarily a sexually transmitted disease, AIDS is inexorably linked to reproductive health and care. Because HIV tends to infect those who are in their reproductive years, the impact of this disease on population growth and life expectancy is projected to be immense in some parts of the world, especially in sub-Saharan Africa. Not least is the challenge to individual families and infant care programs to care for AIDS babies. Estimates of the rate of vertical transmission of HIV range from < 10 to 46%. Transmission through sexual contact accounts for 75-85% of HIV infection worldwide, and today, nearly 20 years into the epidemic, the main tool to stall the spread is advocating change in sexual conduct. Numerous studies leave no doubt that the attributable risk of co-infection with other STDs--both ulcerative and non-ulcerative--in heterosexual transmission is substantial. The only known contraceptive method proven to reduce both infectiousness and susceptibility to HIV is barrier contraception. Spermicidal agents currently available have not been shown to reduce HIV concentrations in genital secretions, or to reduce transmission of the virus. The challenges that lie ahead are tremendous: we must continue to focus on development of affordable preventive measures; urge policy-makers to back further research in prevention to complement condom use; and advocate for continued support of basic research to learn more about fundamental mechanisms of HIV transmission.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Family planning in Rwanda: status and prospects.

This article analyzes the status and future prospects of family planning in Rwanda. The use of traditional contraceptive methods is examined and major constraints to modern contraceptive use are discussed, both for potential users (low demand) and family planning delivery systems (poor supply). Current contraceptive prevalence, as well as evidence of potentially higher demand, are analyzed. Contraceptive prevalence for modern methods is estimated at 3-4 percent, for 1988, of women of reproductive age who are at risk of exposure to conception. An attempt is also made to target future contraceptive prevalence rates needed to attain specific levels of fertility. Finally, the prospects for family planning as well as recommendations to increase contraceptive use are reviewed.

Adolescent↗
PubMed1999

Women's attitudes to condoms and female-controlled means of protection against HIV and STDs in south-western Uganda.

The consistent and correct use of the male condom makes it highly effective in both disease prevention and as a contraceptive method. However, it is also well recognized that its use is under men's control. Because of this vital limitation, there have been frequent calls for female-controlled methods of HIV prevention, particularly from women from sub-Saharan Africa. Here we report on data collected in focus-group discussions (FGDs) with women aged 17-54 in South-Western Uganda. A total of 138 women, from rural villages, urban family planning clinics and a truck-stop town, were recruited to participate in 18 FGDs on the male condom, the female condom and existing formulations of vaginal microbicidal products. Three themes emerged: (i) problems with men's control over the male condom, (ii) the importance of control over and secrecy about protective measures and (iii) sexual pleasure associated with different methods. We found that the female condom, while being perceived as an improvement over the male condom, was recognized as having limited value because of the need to agree its use prior to sex taking place. Other products were considered to be significantly better than the female condom; the sponge, in particular, was perceived as having advantages over every other product. Women like the fact that it could be inserted some time before, and left in place some time after, sexual intercourse, that it was effective for multiple instances of intercourse, and that men would be unaware that it was being employed. Female-controlled methods to prevent sexually transmitted infections, including HIV, and to increase reproductive choice, hold the promise of ceding some control over sexual and reproductive health to women.

Adolescent↗
PubMed1996

Acceptability and discontinuation of Depo-Provera, IUCD and combined pill in Kenya.

This paper reports on a prospective study conducted between June 1990 and June 1992 to determine method acceptability, user satisfaction and continuation rates for three highly effective and reversible contraceptive methods currently available in Kenya: the CuT 380A (IUCD), the injectable, Depo-Provera and the low-dose oral contraceptive pill, Microgynon. A non-randomised sample of volunteer participants was used. One thousand and seventy-six users were followed up for a period of one year or up to the time of discontinuation of the method, whichever came earlier. Analysis revealed method specific differences in users' characteristics. The OC users were younger and had fewer children than the IUCD or Depo-Provera users. The Depo-Provera users were older, and had the largest family sizes. Many OC users (almost 40%) were single, while almost three-quarters of IUCD and Depo-Provera users were married. IUCD users were also more educated compared to OC and Depo-Provera users. Survival analysis was used to calculate cumulative life table discontinuation rates by method for the 12 month period. Discontinuation rates were highest for OC users (80%) and lowest for IUCD users (20%) and intermediate for Depo-Provera users (39%). Ninety percent of OC and Depo-Provera users and 86% of IUCD users said they were satisfied with their respective methods. While OCs are among the most popular family planning methods in Kenya, they are also one of the most problematic, while IUCD has the fewest compliance problems. Service providers need to address the issue of high discontinuation rates among the young OC users.

Adolescent↗