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PubMed1977

Very young adolescent women in Georgia: has abortion or contraception lowered their fertility?

Despite a state law enacted in 1972 which allowed minors to obtain contraceptive services without parental consent, births to very young women in Georgia (age 14 and less) have risen in recent years. Beginning in 1974, however, this trend has reversed. Increased access to induced abortion following the 1973 U.S. Supreme Court decision appears to have been responsible for the decline. Supporting this assertion are: 1) the temporal relationship between increased access to abortion and the decline in births, 2) the geographic evidence that the decline in births occurred first in Atlanta where abortion utilization is the highest and then followed in areas with somewhat more limited utilization, and 3) a similar observation that the decline occurred earlier and more markedly among young white teenagers whose abortion utilization is higher. Although abortion appears to have had the most visible impact on births, most people would probably agree that efforts toward providing contraception to these young women remain worth the challenge. The ratio of young teenegers accepting contraceptives to young teenegers getting pregnant is suggested as a useful intermediator of the success of family planning programs.

Abortion, Legal↗
PubMed1997

Men's unmet need for family planning: implications for African fertility transitions.

This article introduces the concept of men's unmet need for family planning and explains its programmatic relevance. Using data from Demographic and Health Surveys (DHS) of Ghana (1988, 1993) and Kenya (1989, 1993), married men are found to have high levels of unmet need for family planning that are comparable to, although slightly lower than, those for women. The importance of men's unmet need is demonstrated when the analysis is restricted to marital pairs in the DHS samples; trends in the joint unmet need of husbands and wives are shown to be closely associated with the nature of the fertility transitions occurring in Ghana and Kenya. Because of wide discrepancies found between husbands' and wives' unmet need statuses, family planning programs that foster spousal communication are likely to facilitate the transition to lower fertility.

Adolescent↗
PubMedDate not supplied

Family planning clinics--a story of growth and conflict.

During the 1960s, as demand for effective contraceptives increased and women expressed a desire for smaller families, an "odd lot" of groups came together to press for federally supported family planning services for low-income women. The drive culminated in 1970 with the passage of Title X of the Public Health Service Act, which authorized the funds that fed a network of family planning clinics. At the height of the national family planning program, approximately 2,500 agencies were operating clinics at more than 5,000 sites, providing services annually to almost five million patients. As part of the screening for medical methods of birth control, family planning clinics have provided basic physical examinations and related tests to millions of low-income women and teenagers who might not otherwise have had access to those services. Clinics have also been heavily utilized for pregnancy tests, screening for sexually transmitted diseases (STDs), infertility screening and referral for abortion, adoption and sterilization services. Other desired achievements have been more elusive and difficult to document--reductions in the number of high-risk and unintended pregnancies and in poverty rates, for example. The program's role in providing contraceptive services to teenagers and its involvement in the abortion controversy have led to a number of political, legislative and judicial skirmishes with conservatives, Congress and the Reagan administration. Funding for Title X declined during the 1980s and is now surpassed by Medicaid as the largest source of family planning dollars. Diminishing funds at a time when some expenses--for supplies, malpractice insurance and treatment of STDs, for example--are increasing have resulted in fewer clinic sites and other service cutbacks. The suggestion has been made that it is time to eliminate categorical funds for family planning and integrate all services into the general medical care system. Family planning providers say an integrated arrangement would not meet the needs of much of their patient population and would not provide the special attention they feel is needed for successful contraceptive practice among low-income, high-risk women. Instead, they suggest expanding the scope of services in family planning clinics, out of an awareness that the continuing high prevalence of unintended childbearing, among the young and disadvantaged in particular, is part of a larger problem of living in a desolate social environment.

Black or African American↗
PubMed1994

Genetics and public health.

Worldwide, genetic diseases affect no less than 5% of all newborns. Most are caused by altered genes transmitted at conception, while a lesser share are due to chromosomal abnormalities--quantitative imbalances in the genetic material leading to various disorders including Down syndrome. The impact of these pathologies is especially severe because they are typically chronic, often affect more than one child in a family, and commonly demand expensive or inaccessible therapeutic methods. Current trends indicate that the demand for health services dealing with these and other congenital defects in Latin America will continue to grow, making it imperative that health plans include strategies for providing appropriate services. The steps called for in seeking to provide such services are as follows: (1) clearly define the aims of the genetic health program; (2) assess, organize, and distribute the available human and material resources; (3) plan and implement primary care activities designed to detect genetic risk factors, and see that these are integrated into all relevant programs (family planning, prenatal care, etc.); (4) organize a referral network for complex diagnostic studies, genetic counseling, treatment, and rehabilitation; (5) encourage close collaboration between health planners and medical geneticists on education and health activities; (6) provide genetic health training programs for primary health care personnel; (7) develop genetic health education programs for the general public; and (8) adopt standardized procedures for supervising and evaluating these various activities and their results. By means of such strategies it has already been possible to considerably reduce morbidity and mortality caused by genetic problems in various parts of the world, including a number of developing countries.

Congenital Abnormalities↗
PubMed2002

Transforming family planning services in the Latin American and Caribbean region.

The 1994 International Conference on Population and Development held in Cairo has generated widespread commitment to changing family planning programs from categorical and medically focused service organizations to reproductive health initiatives that embrace a wide range of social and human services. This article uses qualitative data analysis to review the experience of nine family planning association projects in the Latin American and Caribbean region that have made a successful organizational transition from services focused on family planning to a gender-based and sexual health approach. A conceptual framework is proposed, including factors external to the organization. Factors that can promote a pilot intervention's becoming fully institutionalized include: the need for commitment from high-level staff and members of the board of directors, the creation of partnerships with other agencies, and an emphasis on monitoring and evaluation. Lessons from this experience and their potential relevance to other settings are reviewed and discussed.

Caribbean Region↗
PubMed1998

Dispensation of emergency contraceptive pills in Michigan Title X clinics.

OBJECTIVES: Emergency contraceptive pill dispensation was estimated in Michigan Title X family planning programs. METHODS: Logistic regression and tobit estimation models were used to predict whether and to what extent emergency contraceptive pills are dispensed. RESULTS: Of the 53 programs studies, 32 dispensed emergency contraceptive pills, averaging fewer than one client per month. Total dispensation was skewed toward a few programs, and the contribution of health departments to this total was small. Emergency contraceptive pill services appeared to be randomly distributed across programs, although most dispenser reported having provided the pills for less than 12 months. CONCLUSIONS: Recent policy advances should lead to more consistent emergency contraceptive pill dispensation in Title X programs.

Contraceptives, Postcoital↗
PubMed1981

Adolescent induced abortion in Benin City, Nigeria.

Induced adolescent abortion is a major cause of maternal and gynecologic death in the University of Benin Teaching Hospital, where 244 out of 349 such cases seen from January 1, 1974 to December 31, 1979 were reviewed. Ignorance and lack of contraceptive facilities were contributory factors. To deal with this problem that has been pervasive throughout Nigeria for the past decade, the authors advocate sex education, systematic dissemination of information for planned and conscientious parenthood as well as free availability of alternative methods of contraception. Interruption of early pregnancy should be an essential component of a national family planning program.

Abortion, Induced↗
PubMed1998

Cyclofem/Cyclo-Provera: emerging countries' perspective.

Cyclo-Provera, the original name of the combination of 25 mg medroxyprogesterone acetate and 5 mg estradiol cypionate, later known as Cyclofem and hereafter referred to MPA/E2C, has proven its use-effectiveness (pregnancy rate less than 1%) in routine service delivery conditions. Overall, the life-table discontinuation rates at 1 year ranged from 33.5% to 71.8%. Only a third of total discontinuations were attributable to the injectable contraceptive method, thus raising the importance of service delivery issues related to its continued use. The results of introductory trials in Mexico, Indonesia, Thailand, Tunisia, Jamaica and, more recently, Brazil, Colombia, Chile and Peru have demonstrated that MPA/E2C is a highly effective contraceptive that could be offered as an alternative to current fertility regulation methods for many women around the world. In addition, the results of studies were the basis for the approval of MPA/E2C by local health authorities and its inclusion in the Ministries of Health Family Planning Programs.

Contraceptive Agents, Female↗
PubMed2002

Optimal resource allocation for curing Chlamydia trachomatis infection among asymptomatic women at clinics operating on a fixed budget.

GOAL: The goal was to determine the optimal strategy for screening coverage, test selection, and treatment for infection in asymptomatic women for a given family-planning-program budget. STUDY DESIGN: We developed a resource allocation model to determine the optimal strategy using data from 5078 visits by women universally screened for infection in a publicly funded family planning clinic system in Philadelphia. We maximized the number of infected women cured from the clinic perspective and maximized the cost-savings from the healthcare system perspective. The model incorporated the following age distributions: <20 years (27%), 20 to 24 years (30%), and >24 years (43%), with prevalences of 10.6%, 6.9%, and 2.3%, respectively. We modeled two screening test assays (DNA probe and ligase chain reaction [LCR] for cervical specimens) and two treatments (doxycycline and azithromycin). The model allowed for different test and treatment choices by age group. RESULTS: At the baseline annual budget of $6 per visit, the strategy that maximized both the number of infected women cured and cost savings would be to screen all women with DNA probe and to treat all women with positive tests with azithromycin. This strategy would result in 183 women cured at a cost-savings of $140,176. Sensitivity analysis showed that the total budget had a great impact on the optimal strategy, incorporating screening coverage, test selection, and treatment. CONCLUSIONS: Using resource allocation models enables clinic managers operating with a fixed budget to identify a strategy that maximizes the number of asymptomatic women cured and cost savings when the clinic age distribution and age-specific prevalences are known.

Ambulatory Care Facilities↗
PubMed2002

Links between Cairo and Kyoto: addressing global warming through voluntary family planning.

Over the past three decades, with a combination of new technology, rising female literacy rates, and strengthened family planning programs, the world has seen dramatic increases in the use of contraception, with corresponding declines in fertility and population growth rates. At the International Conference on Population and Development, Cairo in 1994, parties pledged a tripling of funding for reproductive health programs in developing countries. Many demographers believe that making such programs more widely available to women would extend the decline in birth rates and shift the world towards the low scenario of United Nations population projections over the next century and a half. By examining the costs and impacts of such programs, in view of the links between population and carbon emissions, this paper shows that extension of voluntary family planning could make a large and cost-effective contribution to the greenhouse gas limitation goals of the Kyoto Protocol that was negotiated in 1997.

Birth Rate↗
PubMed1980

[Guizhou planned parenthood circular].

The Guizhou Provincial CCP Committee and the provinical people's government recently issued a circular on launching mass inspection of planned parenthood work throughout the province in late June. The inspection will look at whether or not the masses have been mobilized to pay serious attention to planned parenthood work, whether or not such education has been launched, what kind of concrete measures have been adopted, and what kind of concrete experiences have been learned. It will also include the implementation of birth control measures, the resolute prohibition on having a 3rd child, and the promotion of having only 1 child/couple. The circular urged the departments at all levels to strengthen their leadership over planned parenthood work, deepen investigation and study, continuously study the new situation and solve the new problems.

Asia↗
PubMedDate not supplied

Differences between physicians and nurses in providing family planning services: findings from a Bogota clinic.

Having nurses provide a variety of services generally available only from physicians is one way to overcome shortages of physicians in family planning programs. To aid in determining if the quality of care provided by nurses is comparable to that of physicians, a study at a Profamilia clinic in Bogota, Colombia, evaluated the management of family planning clients by physicians and nurses. The study found significant differences between physicians and nurses in the prescription of contraceptives on the client's first visit, in prescription of methods to be used temporarily, in deferment of IUD insertions, and in changing of methods for the client. Continuation rates among the physicians' and nurses' clients, however, did not differ significantly, and clients of physicians and nurses were equally successful in preventing unwanted pregnancies.

Colombia↗
PubMed1975

Menstrual regulation in family planning services.

Menstrual regulation is a safe, effective, and economical method of fertility control. Its increased safety compared to first trimester abortion establishes menstrual regulation by vacuum aspiration for treatment of up to 14 days missed menstrual period as probably better medical practice than waiting to confirm the presence of a pregnancy. Because it is a postcontraceptive method, menstrual regulation has potential in family planning services both as a recruitment service and for the treatment of contraceptive failures. Its use as an only method of fertility control is being studied. The acceptance of this new family planning service will primarily depend on its availability, dissemination of information about the service, and the ability of women freely to avail themselves of the service without delay. Although long term effects of single and repeated use of menstrual regulation are not known, its immediate complications are few and it can be recommended as a useful addition to present fertility control methods in family planning programs.

Abortion, Induced↗
PubMed1988

Economic analysis of population growth in the Islamic world with special reference to Egypt.

Population growth in predominantly Islamic countries is explored, with a focus on Egypt. The author finds that "if its current rate of increase continues...Egypt's population will increase by an average of one and a half million a year requiring food, housing, education, health services, and other needs." The case is made for the immediate implementation of an effective family planning program.

Africa↗
PubMedDate not supplied

The role of traditional fertility regulation in Sri Lanka.

Among the countries of South Asia, Sri Lanka, with a birth rate of 26 per 1,000, has achieved by far the lowest fertility level. The research reported here shows that at least half of all fertility control there is still practiced by means other than those offered by the national family planning program. This paper reports on an investigation carried out by the Sri Lankan Department of Census and Statistics, employing a micro-approach to demographic research, on the levels of "traditional" methods of family planning and attitudes toward the practice of both modern and traditional contraception. It is shown that knowledge of rhythm was diffused throughout society as the cost of raising children increased during a period when other methods of family planning were not easily accessible. These traditional methods were employed efficiently and their high level of continued use arises from strong cultural resistance to the pill and IUD, based upon local interpretations of how these methods function. Thus, any programmatic effort to reduce dependence on traditional family planning might well result in higher fertility levels. In addition, low fertility among Indian Tamil workers on the Tea Estates, as early as the 1950s, probably resulted from a desire (manifested by lower levels of sexual activity and some abortion) to avoid frequent pregnancies, since pregnancy interrupts work that the female Estate workers cannot afford to miss.

Attitude↗
PubMed1988

A study of costs and behavioral outcomes of menstrual regulation services in Bangladesh.

This paper reports the results of a program evaluation of menstrual regulation (MR) services provided by the Bangladesh Women's Health Coalition, a nongovernmental organization formed in response to a concern about the availability of quality MR services to Bangladeshi women. The program emphasizes individual counseling which stresses informed choice in reproductive health care. The evaluation examines the cost of this process as a function of behavioral outcomes which include the percentage of clients who are post-MR contraceptive acceptors and the percentage which return for follow-up care and consultation 2 weeks after the procedure. The average cost per post MR contracepting client is $3.75; the average cost per returning client is $5.68, figures which appear to be well within the range of costs reported by family planning programs in developing countries.

Bangladesh↗