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PubMed2005

The effects of Islam and traditional practices on women's health and reproduction.

The aim of this study was to investigate the effects of Islam as a religion and culture on Turkish women's health. The study included 138 household members residing in the territory of three primary health care centers in Turkey: Güzelbahçe, Fahrettin Altay and Esentepe. Data were collected by means of a questionnaire prepared by a multidisciplinary team that included specialists from the departments of public health, psychiatric nursing and sociology. We found that the women's health behavior changed from traditional to rational as education levels increased, and that religious and traditional attitudes and behaviors were predominant in the countryside, especially practices related to pregnancy, delivery, the postpartum period, induced abortion and family planning. One of the most important prerequisites for the improvement of women's health is that nurses should know the religious practices and culture of the society for which they provide care, so that their efforts to protect and improve women's health will be effective.

Abortion, Induced↗
PubMed2003

The psychosocial context of young adult sexual behavior in Nicaragua: looking through the gender lens.

CONTEXT: Understanding the nature and magnitude of gender differences in sexual norms among young adults in Nicaragua, and how these differences affect sexual behavior, is important for the design of reproductive health programs. METHODS: A representative cross-sectional survey was conducted in six departments in the Pacific region of Nicaragua in 1998. A total of 552 never-married women and 289 never-married men aged 15-24 were interviewed about their perceptions of social pressure to engage in premarital sex; perceived social approval of and attitudes toward premarital sex and premarital pregnancy; perceived sexual activity among peers and siblings; communication with parents on sexuality issues; the psychosocial context of sexual debut; and preferred sources of information on sexuality issues. RESULTS: Most young men (83%) reported that they had received direct encouragement from at least one person in the last year to engage in premarital sex, and at least half perceived that their father, siblings, other relatives and friends approved of premarital intercourse. A significantly greater proportion of men than of women reported that curiosity or gaining experience motivated their sexual debut (61% vs. 21%). Men perceived themselves to have a higher risk of unplanned and unprotected sex than did women. In contrast, women held more negative attitudes toward premarital sex and were more often discouraged by parents or siblings from engaging in sex. CONCLUSIONS: Reproductive health programs for young Nicaraguans need to address gender-based double standards, which raise the risk of unplanned, unprotected sex and unintended pregnancy.

Adolescent↗
PubMedDate not supplied

[Pregnancy, labor, and puerperium: concepts and practices of midwives in the state of Morelos].

In Mexico a combined type of care for the health-sickness phenomenon exists, where three systems interact: domestic, academic and traditional medicine. In relation to reproductive health, in the state of Morelos approximately 50 per cent of women in rural areas receive attention from traditional birth attendants, who make up one of the principal resources of traditional medicine. The goal of this study was to gather knowledge about and describe the concepts, resources and practices used by traditional birth attendants in their care during pregnancy, birth and puerperium; and likewise to determine their socio-demographic characteristics, their geographic distribution, their number and the level of training which they possess. A census based on three sources was carried out in which information about seven basic variables was sought. This information was completed with structured interviews with key informants which allowed the definition of a profile of the different types of traditional birth attendants according to the population they care for and the resources they use. The most relevant results indicate that 630 traditional birth attendants are distributed throughout the 32 municipalities of the state, with an average age of 52 years and 50 per cent having attended training courses. 17.5 per cent fall within the category of traditional birth attendant, 50 per cent are trained empiricists and 11.6 per cent are non-trained empiricists. The 20 per cent did not fit this typology. The strong social and cultural identification that exists between traditional birth attendants and their patients indicates the need to incorporate this valuable resource in rural reproductive health programs.

Adult↗
PubMed2003

Infertility drugs and the risk of breast cancer: findings from the National Institute of Child Health and Human Development Women's Contraceptive and Reproductive Experiences Study.

OBJECTIVE: To determine the association between infertility drug use and invasive breast cancer in a population-based case-control study. DESIGN: Multicenter case-control study. SETTING: Women aged 35 to 64 years in metropolitan Atlanta, Detroit, Los Angeles, Philadelphia, and Seattle. PATIENT(S): The 4,575 case patients had histologically confirmed primary invasive breast cancer. The 4,682 control subjects were women without breast cancer identified in the same geographic locations using randomized-digit dialing. INTERVENTION(S): A standardized questionnaire focusing on reproductive health and family history as well as use of oral contraceptives and other hormones and infertility drugs was administered to all subjects. Data on the type of breast cancer were also obtained. MAIN OUTCOME MEASURE(S): Odds ratios examining the association between use of various infertility drugs and invasive breast cancer. RESULT(S): Overall, a history of infertility drug use was not associated with the risk of developing breast cancer. Compared with women who never used any fertility medication, however, women using human menopausal gonadotropin (hMG) for > or = 6 months or for at least six cycles had a relative risk of breast cancer ranging between 2.7 to 3.8. CONCLUSION(S): Long-term use of certain infertility drugs could adversely affect risk of breast cancer. Additional confirmatory studies are needed.

Adult↗
PubMed2006

[Educators, advisors, therapists? Youth, sexuality, and social intervention].

Sexual and reproductive health programs directed at youth have a recent history, related to international politics, especially the International Conference on Population and Development in Cairo, which in 1994 recommended specific services for adolescents and proposed to reduce substantially the pregnancies in this social group. This effort is an opportunity to consider young people as citizens with rights, or also as new clients and health consumers. In this article, we analyze how this conflict is addressed in the Sexual and reproductive health programs, and the limits and range of the mediating role played by civil employees who carry out health interventions, specially when they enter into relationships with other agents of socialization of adolescents (fathers, mothers, educators, etc.), but also with the public health system. In this field we identified the predominant perspectives of social intervention that seeks to direct and structure the possible field of action of youth in sexual matters. These perspectives emphasize individual responsibility in relation to self care and articulate very well with the effective model of health, based on market rationality.

Adolescent↗
PubMed2005

Gynecologic care and family planning for HIV-infected women.

Owing to advances in the understanding and treatment of HIV infection, most persons infected with HIV are now living longer, healthier lives. With the dramatic reduction in mother-to-child transmission in the past decade, the outlook on life has changed for women with HIV infection. It is critical that a new strategic plan for prevention of HIV transmission and a proactive approach to reproductive health care be implemented by health care providers who care for these women. Promotion of risk reduction counseling, screening for sexually transmitted diseases and lower genital tract disease, assessment of options for birth control, and pre-conception counseling should be integral components of gynecologic health care for HIV-infected women. This article reviews the current status of gynecologic and reproductive health care for HIV-infected women.

Adult↗
PubMed1996

Integrating MCH/FP and STD/HIV services: current debates and future directions.

The issue of integrating MCH/FP and STD/HIV services has gained an increasingly high priority on public health agendas in recent years. In the prevailing climate of health sector reform, policy-makers are likely to be increasingly pressed to address the broader concept of "reproductive health' in the terms consolidated at the Cairo International Conference on Population and Development, and the UN Conference on Women in Beijing. Integrated MCH/FP and STD/HIV services could be regarded as a significant step towards providing integrated reproductive health services, but clarity of issues and concerns is essential. A number of rationales have emerged which argue for the integration of these services, and many concerns have been voiced. There is little consensus, however, on the definition of "integrated services' and there are few documented case studies which might clarify the issues. This paper reviews the context in which rationales for "integrated services' emerged, the issues of concern and the case studies available. It concludes by suggesting future directions for research, noting in particular the need for country-specific and multi-dimensional frameworks and the appropriateness of a policy analysis approach.

Child↗
PubMed2005

Diversity in sexual health: problems and dilemmas.

The increase in migrant populations in western Europe has led to specific problems and dilemmas in the area of sexual and reproductive health and service provision. In general, these problems and dilemmas can be divided into four categories: (1) epidemiology of diseases and risk factors; (2) psychosocial and cultural aspects; (3) communication; and (4) moral and ethical dilemmas. Regarding epidemiology, there is an increased prevalence in migrant groups of unwanted pregnancy and abortion, HIV/STDs, and sexual violence. Effective contraceptive use is hampered by knowledge deficits, uncertain living conditions, ambivalence regarding the use of contraceptives, and problems accessing (information on) contraception. Psychosocial and cultural aspects relate to the norms and attitudes individuals and groups have regarding the family, social relationships, sexuality, and gender. These norms and attitudes have an impact on the sexual and reproductive choices people make and the possibilities and restrictions they feel in this respect. Problems in communication concern not only language but also communication styles, the way patients present their problems, and the expectations they have from the service provider. Communication problems inevitably lead to a lower quality of care. Moral and ethical dilemmas arise where cultures collide, for example regarding sexuality education and virginity problems. Two examples of practical situations in which migrant patients ask for help with sexual or reproductive health problems will be described.

Adolescent↗
PubMedDate not supplied

Reproduction and the workplace: an industry perspective.

The main issue confronting industry in addressing reproductive health and the workplace is how to obtain needed data. The advantages and limitations of four methods of data collection--literature reviews, toxicology, epidemiology, and medical surveillance--are described, and recommendations made for improving reproductive health monitoring by industry.

Animals↗
PubMed2003

Testicular dysgenesis syndrome.

In the Western world fertility rates are low and infertility is a major health problem. Unofficial statistics from Denmark reveal that about 6% of all Danish children are now born after assisted reproduction techniques, including in vitro fertilization, intracytoplasmic sperm injection, donor insemination or homologous insemination. However, there are no retrospective data on trends in fecundity (ability to conceive). We, and others, have focused on some aspects of adverse trends in male reproductive health such as the rising incidence of testicular cancer, low and probably declining semen quality, high and possibly increasing frequencies of undescended testes and hypospadias. Due to medical specialization and the different ages at presentation of symptoms, reproductive problems used to be analysed separately by various professional groups, for instance paediatric endocrinologists, urologists, andrologists or oncologists. There is evidence that poor semen quality, testicular cancer, undescended testes and hypospadias are symptoms of one underlying entity, testicular dysgenesis syndrome (TDS), which may be increasingly common due to adverse environmental influences. Experimental and epidemiological studies suggest that TDS is the result of disruption of embryonal programming and gonadal development during fetal life. An endocrine disrupter hypothesis to explain the adverse trends has been proposed. It is recommended that future epidemiological studies on trends in male reproductive health should not focus on one symptom alone, but be more comprehensive and take all aspects of TDS into account.

Cryptorchidism↗
PubMed1998

The transition to managed care: experiences of planned parenthood patients.

A review of the findings from a 1996 survey of women visiting a Planned Parenthood clinic reveals that some members of managed care organizations (MCOs) may not be receiving appropriate preventive services and information from their primary care providers. This article details the results of a survey of 115 women who attended a Planned Parenthood of New York City clinic for reproductive health services. Based on these survey findings, the authors provide recommendations for MCOs and traditional providers of reproductive health to improve service delivery.

Family Planning Services↗
PubMed2001

Estimates of maternal mortality for 1995.

OBJECTIVE: To present estimates of maternal mortality in 188 countries, areas, and territories for 1995 using methodologies that attempt to improve comparability. METHODS: For countries having data directly relevant to the measurement of maternal mortality, a variety of adjustment procedures can be applied depending on the nature of the data used. Estimates for countries lacking relevant data may be made using a statistical model fitted to the information from countries that have data judged to be of good quality. Rather than estimate the Maternal Mortality Ratio (MMRatio) directly, this model estimates the proportion of deaths of women of reproductive age that are due to maternal causes. Estimates of the number of maternal deaths are then obtained by applying this proportion to the best available figure of the total number of deaths among women of reproductive age. FINDINGS: On the basis of this exercise, we have obtained a global estimate of 515,000 maternal deaths in 1995, with a worldwide MMRatio of 397 per 100,000 live births. The differences, by region, were very great, with over half (273,000 maternal deaths) occurring in Africa (MMRatio: > 1000 per 100,000), compared with a total of only 2000 maternal deaths in Europe (MMRatio: 28 per 100,000). Lower and upper uncertainty bounds were also estimated, on the basis of which the global MMRatio was unlikely to be less than 234 or more than 635 per 100,000 live births. These uncertainty bounds and those of national estimates are so wide that comparisons between countries must be made with caution, and no valid conclusions can be drawn about trends over a period of time. CONCLUSION: The MMRatio is thus an imperfect indicator of reproductive health because it is hard to measure precisely. It is preferable to use process indicators for comparing reproductive health between countries or across time periods, and for monitoring and evaluation purposes.

Cross-Cultural Comparison↗
PubMed2002

Women's little secrets: defining the boundaries of reproductive knowledge in sixteenth-century France. Society for the social history of medicine student essay competition winner, 1999.

Although there has been much recent work on the contribution of midwives to early modern medical practice, there has been less investigation of the participation of other women outside of the corporative or professional medical arena. This article seeks to examine how élite women were involved in medical discussion of reproduction, using the sixteenth-century correspondence surrounding the reproductive health of Elisabeth de Valois, Queen of Spain. Letters passed between the courts of France and Spain demonstrate that control of Elisabeth's reproductive health became a source of conflict between the Spanish and French. National rivalries created possibilities for women to be authoritative contributors in medical discussion with the support of university-trained physicians.

Awards and Prizes↗
PubMed2003

Breast cancer in younger women: reproductive and late health effects of treatment.

PURPOSE: In 1997, we initiated a cohort study to evaluate quality of life (QOL) and reproductive health outcomes in younger female breast cancer survivors. MATERIALS AND METHODS: Using listings from two tumor registries, we recruited women with stage 0, I, or II breast cancer who were 50 years or younger at diagnosis and were also disease-free survivors for 2 to 10 years. A mailed survey questionnaire assessed medical and demographic factors, health-related QOL, mood, outlook on life, and reproductive health outcomes. RESULTS: We recruited 577 women, who ranged in age from 30 to 61.6 years (mean, 49.5 years) and were surveyed approximately 6 years after diagnosis. Almost three fourths had received some form of adjuvant therapy. Amenorrhea occurred frequently as a result of treatment in women > or = 40 years at diagnosis, and treatment-associated menopause was associated with poorer health perceptions. Across the cohort, physical functioning was quite good, but the youngest women experienced poorer mental health (P =.0002) and less vitality (energy; P =.03). Multiple regression analyses predicting QOL demonstrated better outcomes in African-American women, married or partnered women, and women with better emotional and physical functioning, whereas women who reported greater vulnerability had poorer QOL. CONCLUSION: Overall QOL in younger women who survive breast cancer is good, but there is evidence of increased emotional disruption, especially among the youngest women. Factors that may contribute to poorer health perceptions and QOL include experiencing a menopausal transition as part of therapy, and feeling more vulnerable after cancer.

Adult↗
PubMed2004

Reproductive and sexual health among young adults in Uzbekistan.

Since 1991, contraceptive use has risen significantly in Uzbekistan while reliance on abortion has declined; yet reproductive health improvements have not translated into better conditions for sexual health. The prevalence of sexually transmitted diseases increased significantly in the 1990s, and UNAIDS currently identifies the Central Asian region as a high HIV-growth zone. Structural, institutional, and attitudinal factors have contributed to the disconnection between reproductive and sexual health in Uzbekistan, even though family planning programs have been well established during the HIV pandemic. Integrating state statistics, Demographic and Health Survey data, and focus-group-discussion results, we highlight the ways in which a heavily centralized program focusing on reproductive health did little to better sexual health, especially among young adults. The example of Uzbekistan reveals pathways by which reproductive health efforts may continue to be compartmentalized, decreasing their potential contributions to sexual health, especially among young adults.

Adolescent↗
PubMed1993

Training in family planning.

In spite of extensive programmes for training in family planning and extensive services in contraception in the UK, the number of unplanned pregnancies has not decreased. On the contrary it is increasing. Medical graduates are now educated in methods of contraception. There is an extensive programme for postgraduates, regulated by the Joint Committee on Contraception (JCC), which is well integrated and co-ordinated. The provision of good training opportunities at a local level will be enhanced by the establishment of consultant posts in Reproductive Health/community Gynaecology and the development of higher training programmes to meet the projected expansion of these posts. They can play a role in education in reproductive health with respect to sexuality and personal relationships, as well as in the provision of family planning services and training to all reproductive health care professionals and teachers.

Education, Medical, Graduate↗