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PubMed1982

Adolescent sexual counseling.

The physician provides a much-needed service to teenagers by counseling them regarding sexuality. A series of conferences during adolescence and use of questionnaires can facilitate discussion and point up potential problems. When the patient is confronted with a problem such as a need for contraception or an unwanted pregnancy, the physician should present all the options available and leave the final choice up to the patient. The physician is not obligated to participate in a solution that is counter to his or her moral values.

Abortion, Induced↗
PubMed2000

Acceptability of Norplant at a well-woman clinic in Turkey.

OBJECTIVE: To make an assessment of the acceptability and cost of subdermal implants, a new method in Turkey, in a free-choice environment. METHODS: The records of women attending a university well-woman clinic in Istanbul, Turkey, were analyzed retrospectively. Among other contraceptives registered in the country, the women were offered subdermal contraceptive implants (Norplant) during counselling sessions. The women who chose implants were invited to attend for follow-up three times during the first 12 months and were advised to return annually thereafter. An estimation of cost was performed for Norplant, using the government price of the implant and the wage rates of public-sector staff. An estimation of cost was also performed for oral contraceptives. RESULTS: Among the 5650 women who applied to the Clinic for contraception between 1 January 1995 and 31 December 1998, 274 women decided to use implants, giving an initial acceptance rate of 5.1%. Continuation rates were 91.8%, 71.6% and 42.5% at 12 months, 24 months and 36 months, respectively. There were no pregnancies within the study period. The only demographic characteristic that was positively related to the acceptability of Norplant was younger age. The cost of contraception with Norplant was found to be lower than that for oral contraceptives. CONCLUSION: The high initial acceptance and continuation rates, combined with its high efficacy, make Norplant a valuable tool for Turkey's National Family Planning Program. Contraception with Norplant is also a cost-effective method, at least for the public sector.

Adult↗
PubMed2005

The unmet need for contraception among Nigerian women in the first year post-partum.

OBJECTIVE: To determine the level of Unmet need for Contraception among women in the first year post-delivery in Ile-Ife, Nigeria. METHODS: A prospective study of 256 women attending antenatal clinic of the OAUTHC, Ile-Ife, Nigeria was carried out 9-10 months post-delivery. Using a semi-structured questionnaire, the respondents were interviewed for socio-demographic characteristics; obstetric, sexual, and contraception history were also taken. The data were analyzed using descriptive and inferential statistical methods. RESULTS: There was a high level of unmet need (59.4%) in the sample of Nigerian women despite a high level of awareness of common methods of contraception. Education and parity had no significant effect on usage of contraception (p > 0.05). No reason was given for non-usage in the largest proportion (30.3%) of the non-users. Only one-third of the respondents could correctly report the 'at-risk' period for getting pregnant in the post-partum period. CONCLUSION: There is a need to study in more detail the social and cultural factors that determine contraceptive utilization before success can be achieved in closing the gap of unmet need, as it has become evident that increasing the awareness and knowledge of contraception is not enough to achieve the objectives of family-planning programs.

Adolescent↗
PubMedDate not supplied

Analysis of motivation to contraceptive use applying the weighting procedure.

This paper presents a technique for scaling contraceptive use motivation for the sample population of the Family Planning Health Services Project in Matlab. The project, which began in 1977, is conducted by the International Centre for Diarrhoeal Disease Research, Bangladesh. The hypothesis of the research is that through the use of a scaling algorithm the power of demographic characteristics, attitudes, and intentions for predicting contraceptive use can be enhanced. The analysis shows that two factors explain use motivation. Scale 1 is weighted for demographic variables and desire for additional children, while Scale 2 is comprised of education and intentions of contraceptive use. Both scales have a pronounced independent predictive power. We conclude that scaling has improved upon the predictive power of indicators of reproductive motivations.

Bangladesh↗
PubMed1999

Pelvic relaxation and associated risk factors: the results of logistic regression analysis.

BACKGROUND: To determine the possible risk factors in our population. METHODS: From 250 patients attending our clinic 28 patients with pelvic relaxation were the study group and the rest, 222 in all, were the control group. RESULTS: Age, marriage period, parity and number of abortus in pelvic relaxation group are found to be significantly higher with univariate analysis. With logistic regression analysis menopause, grandmultiparity, abortus (two or more), home deliveries, history of macrosomic infant (4500 gr. or more), deliveries without episiotomy and laceration of uterine cervix are found to be risk factors for pelvic relaxation. CONCLUSIONS: Good family planning programs to reduce grandmultiparity and unnecessary curettage for undesired pregnancies, preventing harmful home deliveries by inexperienced people, and fearless usage of episiotomy in difficult deliveries are necessary to prevent pelvic relaxation.

Abortion, Induced↗
PubMed1999

Combining qualitative with quantitative approaches to study contraceptive pill use.

According to large-scale studies, oral contraceptive users become pregnant at rates that exceed ideal use failure rates. It is thought that a major cause is missed pills, but current research on consistent contraceptive pill taking is characterized by inadequate measures and a failure to investigate women's thinking about their own patterns of use. The purpose of this study was to gain some understanding about women's interpretations of consistency in their own pill taking through combining qualitative with quantitative data. The study was conducted in China, where contraception is free and widely available. Five urban and five rural oral contraceptive users were followed for up to three pill-taking cycles during 1996 for a total of 759 person-days. Consistency of pill taking was measured with electronic data obtained from a new blister package made by Anderson Clinical Technologies (Elmhurst, IL). Data from these devices were reviewed and interpreted by the study participants during in-depth private interviews. The users' reasons for missing pills included disruptions in their daily routines, their husband's absence, spotting, and trouble implementing the family planning program's instructions to take one pill per day for 22 days and start the next cycle on the fifth day of menses. One user gave these reasons for two cycles but denied missing numerous pills in her third cycle. Data from a series of four questionnaires showed that most demographic, psychosocial, and service system characteristics were not related to missed pills. However, results suggested that the daily routines of rural living may make consistent use more likely and that instructions for taking the pill may be associated with prolonged pill-free intervals and skipping pills during episodes of spotting. Three of the 10 women were at increased risk of pregnancy during the study period because of their pill-taking pattern. We concluded that the combination of qualitative with quantitative data enhances understanding of contraceptive use. Women themselves offer plausible reasons for their use behaviors. Listening to women could be useful in improving programs.

Adolescent↗
PubMed2006

The value of contraception to prevent perinatal HIV transmission.

OBJECTIVE: The objective of this study was to highlight the value of preventing unintended pregnancies among HIV-infected women as a strategy to prevent perinatal HIV transmission. GOAL: The goal of this study was to assess the cost-effectiveness of family planning programs to avert HIV-positive births with the current programmatic emphasis: prenatal care services that provide and promote nevirapine for prevention of mother-to-child transmission of HIV. STUDY DESIGN: Cost-effectiveness analyses were conducted from the health system perspective during 1 year with a hypothetical sub-Saharan African population. Expected program costs were combined with number of HIV-positive births averted for each strategy. RESULTS: At the same level of expenditure, the contraceptive strategy averts 28.6% more HIV-positive births than nevirapine for prevention of mother-to-child transmission of HIV. CONCLUSIONS: Increasing contraceptive use among nonusers of contraception who do not want to get pregnant is cost-effective and is an equally important strategy to prevent perinatal transmission as prenatal care programs that provide and promote nevirapine to HIV-infected mothers.

Adolescent↗
PubMed1997

Unintended childbearing, maternal beliefs, and delay of prenatal care.

BACKGROUND: Delay of prenatal care is an important risk for poor birth outcome, yet its association with maternal knowledge and beliefs remains insufficiently studied. This research examined the relationship of unintended childbearing and beliefs about the importance of prenatal care with initiation after the first trimester, adjusting for key sociodemographic determinants. METHODS: One hundred fifty-four Texas hospitals accounting for 80 percent of state births were asked to collect surveys from all women delivering infants during a one-week interval in 1986. Seventy-four percent of hospitals and 70 percent of women participated (n = 2032). No differences occurred between the sample and the population on rates of delayed care and low birthweight or maternal demographics. RESULTS: Since delayed prenatal care is more frequent among low-income women, analyses were limited to those below the 200 percent poverty level. After adjustment for maternal age, marital status, education, parity, race, and health insurance status employing logistic regression, unintended births were 1.6 times more likely to involve delayed care. Mothers who believed prenatal care was unimportant were 2.1 times more likely to delay care. These coefficients exceeded or about equaled those for the covariates. CONCLUSIONS: Preconception education about the value of prenatal care and family planning programs to prevent unintended pregnancies should be conducted together with efforts to overcome financial and structural barriers if progress toward national prenatal care objectives is to be achieved.

Adult↗
PubMed2003

The proximate determinants of the decline to below-replacement fertility in Addis Ababa, Ethiopia.

Between 1990 and 2000, the total fertility rate (TFR) in Ethiopia declined moderately from 6.4 to 5.9 children per woman of reproductive age. During the same period, the TFR in the capital city of Addis Ababa declined from 3.1 to 1.9 children per woman. Even more striking than the magnitude of this decline is that it occurred in the absence of a strong and effective national family planning program. In this study, the components of this fertility decline are identified using the Bongaarts framework of the proximate determinants of fertility. The results of a decomposition analysis indicate that a decrease in the age-specific proportions of women who are married, followed by an increase in contraceptive use are the most important mechanisms by which fertility has declined in Addis Ababa. Poor employment prospects and relatively high housing costs are likely factors that encourage couples to delay marriage and reduce marital fertility.

Abortion, Induced↗
PubMed2003

Contraceptive use before and after marriage in Shanghai.

Data from a cohort study of 7,336 newly married fertile couples conducted between 1987 and 1995 were used to analyze contraceptive method choice, switching, and discontinuation in two districts of Shanghai. Twelve percent of couples reported that they had had sexual intercourse before marriage. Only one-third of those exposed to premarital risk of conception were protected by some form of contraception, mostly by withdrawal and periodic abstinence. As a consequence, a majority of these couples conceived, prompting rapid marriage in most cases and induced abortion among one-fourth of them. After marriage, about half of the couples used contraceptives to postpone the birth of their first child, but of these, 40 percent experienced an unintended pregnancy. Method choice was dominated by condoms, withdrawal, and abstinence. After the birth of their first child, almost all couples (98 percent) adopted contraceptives, but one-third of them used ineffective methods. Failure and discontinuation rates were high, giving rise to a high incidence of induced abortion. Increasing numbers of couples switched to the IUD, and this was the preferred method for the majority by the third year following childbirth. These results suggest that wider method choice that includes hormonal contraceptives should be provided to meet couples' needs in Shanghai and that the family planning program's attention should be focused specifically on sexually active unmarried individuals and on the availability of postpartum services.

Adult↗
PubMed1993

Controlled studies of multivitamin supplementation on pregnancy outcomes.

The Hungarian Family Planning Program includes a randomized prospective blind study of periconceptional multivitamin and trace element supplementation to test the efficacy of this treatment in the reduction of the first occurrence of neural tube defect. This program is appropriate for the evaluation of pregnancy outcomes in general. Periconceptional multivitamin supplementation had no beneficial effect on fetal death, that is, chemical and ectopic pregnancies, missed miscarriages, miscarriages, and stillbirths. The proportion of low birth weight (5.8%) was higher in the combined vitamin I-II sample than in the combined trace element I-II sample (4.3%), but it was explained by a higher rate of multiple births in the vitamin sample. The estimated rate of monozygotic twins was higher after periconceptional multivitamin supplementation. The number of informative pregnancies using vitamin and trace elements was 2104 and 2052, respectively. The rate of cases with congenital abnormality was significantly higher in the total trace element sample (22.4 per 1000) than in the total vitamin sample (13.3 per 1000).

Adult↗
PubMed1980

Social and psychological correlates of pregnancy resolution among adolescent women: a review.

A review of the recent literature on pregnancy resolution among unmarried adolescent women suggests that those who seek and go through with an abortion do not comprise a "special" population, but are similar to their age mates in many of their social and psychological characteristics. Previous research does suggest, however, that teenage abortion patients differ from their term counterparts on a number of significant variables.

Abortion, Induced↗
PubMed1994

Repeat abortion and contraceptive use. Report from an Interview Study in Stockholm.

Semistructured interviews were made among a random sample of applicants for abortion in Stockholm, when legal abortion on demand had been available in Sweden for 10 years. One hundred and twenty women were interviewed, 75 of them having their first abortion and 45 having a repeat abortion. The use of contraceptives was similar among first-time aborters and repeat aborters, but 70% in both groups had temporarily been without contraceptives at the time of conception. The interviews show that the family circumstances were more difficult for the women who had already experienced an abortion than for those who had not. The study indicates that the male partner and family circumstances were important for the decision to abort. Thus, family planning programs should reach also men. The main way to prevent repeat abortions seen in this study is to prevent abortions in general, by making contraceptives accepted by and easily obtainable for all groups in society, thus diminishing those times when sexually active men and women temporarily do not use contraceptives.

Abortion, Induced↗
PubMed1999

[Pediatric care and associated factors in São Luís (Maranhão) Brasil].

Pediatric care is fundamental to preventing several diseases during the early years of childhood. Early medical care and having at least nine checkups in the first year of life are the ideal in pediatric care. It is essential to periodically assess whether or not these goals are being met. In 1994, a cross-sectional study was carried out using three-stage cluster sampling to measure coverage of pediatric care and factors associated with that care among children in the city of São Luís, in the state of Maranhão, Brazil. For data collection, a standardized questionnaire was used with the mother of the child or another person responsible for the child. The percentage of those refusing to participate or who were absent was 7%. This work analyzes data concerning 290 children between 1 and 23 months of age. The coverage estimates and 95% confidence intervals took into consideration possible effects of the study design. Cox's regression, modified for cross-sectional studies, was used to estimate adjusted relative risks. Pediatric care coverage for the population studied was 80%. The children had an average of 7.8 checkups in the first year; 44% of the children had six or fewer checkups during the first year of life, well below the recommended number. Eighty-one percent of the children were seen in the Brazilian public health care system (Sistema Unico de Saúde, SUS), and only 15% used health insurance. After adjusting for confounding factors, the factors "greater number of siblings at home" and "father with four or fewer years of schooling" were associated with not having checkups. After adjustment, family income was not associated with the number of checkups. Encouraging educational activities and perhaps also family planning programs are important strategies for increasing the coverage of pediatric care in the city of São Luís.

Brazil↗