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PubMed1997

Family planning in the 21st century: perspective of the International Planned Parenthood Federation.

Many women still die as a result of pregnancy or childbirth and yet there are an increasing number of women who wish to regulate their fertility and space or limit their child-bearing. This paper, outlining some success stories, elucidates the family planning challenges and identifies key messages to indicate the role that IPPF can play in the 21st century. Issues such as advocacy for sexual and reproductive health and rights, increased male participation, serving the interests of marginalized groups, appropriate technology, quality of care and cooperation between various partners, all need to be addressed to improve sexual and reproductive health including family planning in the 21st century.

Developing Countries↗
PubMedDate not supplied

[Perception of common symptomatology during pregnancy, puerperium and lactation].

The objective of this investigation was to identify women's perception on normal and abnormal symptoms of pregnancy, puerperium and breastfeeding; its purpose was to assess the varying educational needs in the geographical area where a reproductive health education program will be implemented. 405 fertile females living in non-residential areas were interviewed in their homes. A predominantly pre-coded questionnaire was used; items related to reproductive health, preventable and susceptible to education were included. Symptomatology perceived incorrectly as normal: a) In pregnancy: Dysuria: 24 percent, genital hemorrhage: 15 per cent, absence of fetal movement: 23 per cent, did not know how to recognize preterm birth symptoms: 70 per cent. b) In puerperium: Increased quantity in lochia rubra: 17 per cent, fever: 22 per cent, fetid lochia: 28 per cent, and c) In breastfeeding: Breasts red and warm: 48 per cent, fever: 30 per cent, nipple fissures: 70 per cent. Symptomatology perceived incorrectly as abnormal: a) In pregnancy: Frequent urination: 17 per cent, morning nausea in the 1st trimester: 9 per cent, emotional instability: 21 per cent, Braxton Hicks contractions: 41 per cent, and b) Postpartum period: Decreased quantity in lochia rubra: 9 per cent, non-fetid lochia alba: 43 per cent, calostrum: 20 per cent. The assessment educational needs showed an inaccurate identification of abnormal and normal obstetric events; its frequency varied. It is essential that a pregnant woman be well informed and educated in order to preserve her own health as well as that of her unborn child. She must be able to recognize warning signs, take action and demand appropriate medical care. Health care personnel and health educators must be responsible for the promoting of maternal and child health during pregnancy.

Adolescent↗
PubMed2000

Bahraini women's health: a background paper.

This study assessed the trends in the health status of Bahraini women from the early 1980s to the mid 1990s through review of census data and health data. Sociodemographic characteristics, reproductive health, mortality, morbidity and lifestyle patterns were studied. The implications of the data and measures needed to be taken to further improve the health and health care services of women are discussed.

Adolescent↗
PubMed2004

A multimedia psychosocial support program for couples receiving infertility treatment: a feasibility study.

OBJECTIVE: To develop and test the feasibility of a theory-driven, psychosocial support CD-ROM prototype for couples in infertility treatment. DESIGN: Focus group meetings with reproductive health experts, semistructured interviews with infertility patients, and content analysis of an infertility message board to determine content domains of the CD-ROM. Usability and acceptance testing of prototype CD-ROM based on predetermined feasibility criteria. SETTING: Private offices and fertility centers. PATIENT(S): Expert panel of 5 reproductive health specialists; interviews with 62 individuals with infertility (35 women, 27 men); feasibility study with 12 patients and 12 experts in reproductive medicine and infertility support. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Product usability/acceptance test. RESULT(S): Participant feedback and content analysis informed the development of a prototype patient education CD-ROM that uses audio, video, interactive tasks, and personalized feedback. Over 80% of participants successfully completed usability tasks, and over 90% rated prototype satisfaction as "good" to "excellent." Some areas were noted for improvement in navigation and refinement in delivery of instructions. Results strongly indicate an interest in an infertility multimedia support tool. CONCLUSION(S): Multimedia methods may serve as an effective, innovative psychosocial intervention for infertility patients and overcome barriers of limited local access to educational and support services.

CD-ROM↗
PubMed2001

Testicular dysgenesis syndrome: an increasingly common developmental disorder with environmental aspects.

Numerous reports have recently focused on various 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 testis and hypospadias; and an apparently growing demand for assisted reproduction. Due to specialization in medicine and different ages at presentation of symptoms, reproductive problems used to be analysed separately by various professional groups, e.g. paediatric endocrinologists, urologists, andrologists and oncologists. This article summarizes existing evidence supporting a new concept that poor semen quality, testis cancer, undescended testis and hypospadias are symptoms of one underlying entity, the testicular dysgenesis syndrome (TDS), which may be increasingly common due to adverse environmental influences. Experimental and epidemiological studies suggest that TDS is a result of disruption of embryonal programming and gonadal development during fetal life. Therefore, we recommend that future epidemiological studies on trends in male reproductive health should not focus on one symptom only, but be more comprehensive and take all aspects of TDS into account. Otherwise, important biological information may be lost.

Androgen Antagonists↗
PubMed2000

Postpartum care of the woman with diabetes.

The postpartum period in women with diabetes or GDM allows both the physician and mother to relax from the intensive medical and obstetric management that has permitted, in most cases, a successful and joyous outcome. The role of the physician, however, must switch to a proactive and preventive mode to formulate a reproductive health plan for women with diabetes and GDM. The plan should be individualized to address glycemic management and surveillance, nutritional management, contraception prescription, future pregnancy planning, and lifestyle changes. Essential to the development of a reproductive health plan is the active participation of the patient, who through education gains an understanding of the far-reaching effects her active participation will have on her subsequent health and possibly on that of her future children.

Blood Glucose Self-Monitoring↗
PubMed2004

Women are silver, women are diamonds: conflicting images of women in the Cambodian print media.

This paper examines 116 articles related to sexual and reproductive health translated into English from the Khmer press from April 1997 to February 2004. These excerpts were found in The Mirror, a publication of the non-governmental organisation Open Forum of Cambodia, which collates and reviews all issues of the Khmer press on a weekly basis. Five major themes were identified: the politics of women's health, government regulation and control, the sex industry in Cambodia, rape, and the HIV epidemic. Discourse analysis of these articles in the context of other sources and experience allows a gendered exploration of the reporting of sexual and reproductive health and rights issues in Cambodia by the Khmer print media. The reports explore the contested political empowerment of women in this strongly hierarchical society, and the mechanisms used to regulate and control sexual activity The expanding sex industry and associated sexual trafficking are reported, together with the corruption of legal structures designed to regulate health systems and protect women and children from sexual exploitation and rape. The growing problem of AIDS and successes in reducing HIV transmission through the collaboration of sex workers in the 100% condom use policy is documented, and the tensions implicit in a cultural representation of women that both protects and constrains women are explored.

Cambodia↗
PubMed1996

Semen quality of men employed at a lead smelter.

OBJECTIVE: To evaluate the effects of recent and long term occupational lead exposure on indicators of male reproductive health. METHODS: In a cross sectional study of male employees of a lead smelter (n = 2469), blood samples were obtained from 152 workers including 119 who also provided semen samples. Semen analysis and serum concentrations of testosterone, follicle stimulating hormone, and luteinising hormone were used as indicators of reproductive health. Semen and hormone variables were examined in relation to measures of current and long term body lead burden estimated from current blood lead concentrations and historical blood lead monitoring data. RESULTS: For current blood lead concentration groups of < 15, 15-24, 25-39, > 40 micrograms/dl, the geometric mean sperm concentrations were, respectively, 79.1, 56.5, 62.7, and 44.4 million cells/ml and geometric mean total sperm counts were 186, 153, 137, and 89 million cells (P for trend 0.04). Compared with workers with blood lead concentrations less than 15 micrograms/dl, workers with current blood lead concentrations of 40 micrograms/dl or more had an increased risk of below normal sperm concentration (odds ratio (OR) 8.2, 95% confidence interval (95% CI) 1.2-57.9) and total sperm count (OR 2.6, 95% CI 0.4-15.7), based on World Health Organisation standards. Independent of current lead exposure, sperm concentration, total sperm count, and total motile sperm count were inversely related to measures of long term lead exposure. No association was found between lead exposure and measures of sperm motility, sperm morphology, or serum concentrations of reproductive hormones. CONCLUSIONS: Blood lead concentrations below the currently accepted worker protection criteria seem to adversely affect spermatogenesis.

Adult↗
PubMed1994

Multi-farm use of bovine somatotropin for two consecutive lactations and its effects on lactational performance, health, and reproduction.

In a two-lactation study, 352 Holstein cows (124 primiparous) from six commercial dairy herds were assigned to daily injections of bST. Dosages were 0 (control), 5.15, 10.3, or 16.5 mg/d of bST; injections began 28 to 35 d postpartum. During yr 1, FCM production increased linearly as bST dose increased for primiparous and multiparous cows. However, FCM production for primiparous cows that were retained for yr 2 was not increased by bST, and the increase in FCM for multiparous cows was only 67% of that observed during yr 1 for doses of 10.3 and 16.5 mg/d. Milk SCC were not increased with the use of bST during either lactation. Days to conception of multiparous cows during yr 1 tended to increase linearly with increasing dose. Multiparous cows administered bST during yr 2 tended to have a lower conception rate than control cows (71 vs. 87%, respectively). Body condition was decreased linearly by bST dose at the end of yr 1 and 2. Prior to receiving bST during yr 2, bST-treated cows regained less body condition than control cows. Number of health disorders at parturition and assisted births of cows that received bST during yr 1 were unaffected by previous treatment. General health, ratio of single to multiple births, and BW gain of calves was similar among treatments.

Animals↗
PubMed2002

The hide-and-seek game: men's perspectives on abortion and contraceptive use within marriage in a rural community in Zimbabwe.

This paper is based on a study aimed at understanding the perceptions of men to induced abortion and contraceptive use within marriage in rural Zimbabwe. Two qualitative methods were combined. Men were found to view abortion not as a reproductive health problem for women. Instead, they described abortion as a sign of illicit sexual activity and contraceptive use as a strategy married women use to conceal their involvement in extramarital sexual activity. Men felt anxious and vulnerable for lack of control over women. In the absence of verbal communication on sexual matters, women and men resort to what are called here 'hide-and-seek' strategies, where women acquire and use contraceptives secretly while men search for evidence of such use. It is concluded that promoting women's sexual and reproductive health requires both short- and long-term strategies. The short-term strategy would entail providing women with reproductive technology they can use without risking violence. The long-term strategy would entail understanding men's concerns and the way these are manifested. In turn this requires the use of methodologies that encourage dialogue with research participants, in order to capture their deep meanings and experiences.

Abortion, Induced↗
PubMed1995

[Contraceptives, HIV, and other sexually transmitted diseases].

The large majority of women who acquire Human Immuno-Deficiency Virus (HIV) and other sexually transmitted diseases (STDs) are in their childbearing years and are current or potential users of contraceptive methods. Certain STDs augment women's risk for HIV due to damage which these diseases produce in the integrity of the epithelial lining of the vagina and the vulva. There also exists evidence that some contraceptive methods, such as the intrauterine device and certain hormonal products, may increase the risk of HIV and other STDs. Condoms and spermicides offer good levels of protection against these diseases, but are not highly effective contraceptives. The interrelations among these risks are important and create a great problem for women's reproductive health. Moreover, the high vulnerability of the female population for these diseases is also related to a variety of social factors which are referred to as gender relations (power of females in society relative to that of females). Among the gender-related inequalities which affect women are their lack of power to successfully control many aspects of sexual relations. Another problem has to do with the fact that there are no highly reliable female controlled methods for preventing infection by HIV and other STDs. Improvement in the reproductive health care of women depends on the development of new disease prevention products and structural changes in the delivery of care, as well as continued research efforts on the interrelations among contraceptive methods, HIV and other STD.

Contraceptive Agents↗
PubMed2004

Genotype x environment interaction for grazing vs. confinement. II. Health and reproduction traits.

Continual selection for increased milk yield for more than 40 yr, combined with the antagonistic relationship between increasing yield, somatic cell count, and fertility, have resulted in sires that may not be optimal for producing daughters for grazing systems where seasonal calving is very important. The objective of this study was to investigate the possible existence of a genotype x environment interaction (G x E) in grazing vs. confinement herds within the United States for lactation average somatic cell score (LSCS), days open (DO), days to first service (DFS), and number of services per conception (SPC). Grazing herds were defined as those that utilized grazing for at least 6 mo each year and were enrolled in Dairy Herd Improvement (DHI). Control herds were confinement DHI herds of similar size in the same states. For LSCS, the performance of daughters in grazing and control herds was examined using linear regression of LSCS on the November 2000 USDA-DHIA sire predicted transmitting abilities (PTA) for SCS. Genetic parameters for all traits were estimated using REML in a bivariate animal model that treated the same trait in different environments as different traits. Rank correlations were calculated between sires' estimated breeding values for LSCS, calculated separately for sires in both environments. The coefficient of regression of daughter LSCS on sire PTA was less in grazing herds than in control herds. The coefficient of regression for control herds was closer to expectation. Estimates of heritability were approximately 0.12 for LSCS, and less than 0.05 for the reproduction traits. Heritabilities for DO, DFS, and SPC were slightly higher for control herds. Estimates of genetic correlation for each reproductive trait between the 2 environments were high and not significantly different from unity. Generally, these traits appear to be under similar genetic control, but a lower coefficient of regression of LSCS on sire PTA for SCS in grazing herds suggests differences in daughter performance in grazing herds may be overstated based on current PTA for SCS.

Animals↗
PubMed2005

Adolescent girls with negative pregnancy tests.

UNLABELLED: STUDY OBJECTIVES AND DESIGN: This descriptive study assessed background characteristics and attitudes about pregnancy held by adolescent girls presenting for pregnancy tests and receiving negative results. An additional aim was to determine types of health care services that would be of perceived benefit to them to reduce their risk of subsequent pregnancy. SETTING: Two health care sites in an urban community included a hospital-based adolescent clinic and a hospital-based women's health care clinic. PARTICIPANTS: Sixty-five adolescent, low-income, single women with negative pregnancy test results in a consecutive sample were included in the study. Participants had a mean age of 16.9 (+/-1.3) years and described themselves as 64.1% African American, 26.6% Latina and 9.4% white, with 81.5% enrolled or recently graduated from high school. MAIN OUTCOME MEASURES: The following variables were included: demographic characteristics, reproductive health history, personal and perceived partner attitude about the negative pregnancy test result, perceived parental influences, and teens' suggestions for health care services to prevent unintended pregnancy. RESULTS: Health history data revealed high risk status for unintended pregnancy and sexually transmitted infections (STI); 28.5% of participants were ambivalent or disappointed with their negative result, 71.4% were pleased and the majority felt that their partners would be more disappointed with the negative result than they were. Health care services that teens felt would be most helpful were one-on-one contraceptive education and discussion sessions with their own health care provider. CONCLUSIONS: Sexually active teen women with negative pregnancy test results are at high risk of subsequent pregnancy and STIs, and present important opportunities for preventive reproductive health care during visits with health care providers.

Adolescent↗
PubMed2004

A woman's choice.

Abortion is now the most common gynaecological operation in New Zealand and Australia. Early legal abortion is a safe procedure whether carried out surgically or medically. In contrast, the traditional use of abortifacients has been mostly unscientific, illegal and shrouded in secrecy. Mifepristone as an option for induced abortion has only recently become available in New Zealand and is not yet available in Australia. The reasons for the delay in introducing a significant new abortion technique are political, professional, legal, socioeconomic and commercial. Istar, a not-for-profit company, was formed in New Zealand in 1999 to import mifepristone. The drug was approved for use in New Zealand on 30 August 2001. It was first used in October 2001 in Wellington for mid-trimester abortions and in April 2002 for early medical abortions. Legal ambiguities were clarified in a High Court Judgment on 10 April 2003. The experience with mifepristone raises concerns about the introduction of new drugs for reproductive health care, given the commercial risks associated with their development. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists has a role to play in ensuring that safe abortion services are available for women. Advocates of women's rights in reproductive health care have made a significant impact in the last three decades and the conclusion that abortion must be the woman's choice is strongly supported.

Abortifacient Agents↗
PubMed2004

Vaginal douching: personal practices and public policies.

BACKGROUND: Vaginal douching is associated with adverse reproductive health outcomes, yet both health providers and women are often poorly informed about details of this practice. METHODS: We searched the English language articles in the MEDLINE database (1965-March 2004) to describe vaginal douching products, policies of professional organizations, predictors of douching practice, douching methods used, timing of use, and motivation. A key report was obtained from the Food and Drug Administration (FDA) via the Freedom of Information Act. Additional product information was obtained from manufacturers. Primary key terms for the literature search included (vagina OR vaginal) and (douche OR douching). Health effects of douching are reviewed briefly; personal practices and public policies are highlighted. RESULTS: From the literature search, we identified 432 papers, of which 150 were reviewed in detail. Contrary to the assumptions of many health professionals, douching products are only loosely regulated by the FDA. Few professional organizations have clearly stated policy statements regarding douching. In the United States, the prevalence of douching varies considerably by race (more common among African Americans) and age cohort (more common in women born earlier). Internationally, vaginal douching is common in some cultures and is rare in others. Opinions of mothers, peers, and health professionals, in addition to marketing of commercial products, affect douching behavior. CONCLUSIONS: Regulation of vaginal douching products and public education efforts on douching behavior need to be reassessed. Because of the preponderance of evidence that suggests an association between vaginal douching and adverse reproductive health outcomes, professional and public health associations should consider educational and policy activities to discourage women from douching.

Age Distribution↗
PubMed2005

Prevalence of STI/HIV co-infections among special treatment clinic attendees in Ibadan, Nigeria.

Sexually transmitted infections (STIs) are poorly recognised and inadequately treated in Nigeria despite the fact that they constitute a major risk factor for sexual transmission of HIV infection. This study was carried out to ascertain STI/HIV co-infection rates and also to obtain relevant socio-demographic and reproductive health data associated with STI/HIV infections among special treatment clinic (STC) attendees. This information is urgently needed for designing STI/HIV control strategies. All consenting patients who attended the STC clinic from March to November 2001 were interviewed to obtain their socio-demographic and reproductive health data. Urethral, high vaginal and endocervical swabs and urine specimens were obtained and processed by standard methods. HIV screening was done by double ELISA tests. Of the 210 patients seen, 98 (46.7%) were male and 112 (53.3%) were female (p > 0.05). The majority, 171 (81.4%) were aged 20-39 years, while only ten (4.8%) were adolescents. One-hundred-and-eighty (85.7%) had an STI, of which 41 (22.8%) were co-infected with HIV. Thirty (16.7%) patients with nongonococcal urethritis/cervicitis and five (2.8%) with gonorrhoea were also positive for HIV. Five patients were HIV positive but had no other STI. Patients with gonorrhoea, non-gonococcal urethritis/cervicitis, trichomoniasis and bacterial vaginosis were more likely than those with warts, candidiasis and herpes to have co-infection (chi2 = 12.5, p = 0.04). The study's HIV prevalence rate was 21.9%. STI/HIV co-infection rate was significantly higher among unskilled and unemployed patients compared with professional and skilled workers (p < 0.05). This study shows a high STI/HIV co-infection rate indicating that there is need for proper management of STI, as this will help curb the spread of HIV infection in Nigeria.

Adolescent↗
PubMed2006

Knowledge, attitudes and behaviors related to sexuality and family planning in adolescent women with and without diabetes.

BACKGROUND: Sexually active adolescents with diabetes are at high risk for unplanned pregnancies and reproductive complications. OBJECTIVE: Knowledge, attitudes, intentions, and behaviors regarding diabetes and reproductive issues, sexuality, and contraception were examined in teens with diabetes in relation to a non-diabetic group. METHODS: A multisite, case-control, theory-based structured telephone interview was conducted on adolescent women: 80 with diabetes mellitus (DM) and 37 matched controls without diabetes (non-DM). RESULTS: Teens with diabetes appeared to lack an understanding of critical information that could prevent unplanned pregnancies and pregnancy-related complications. Although they scored significantly higher than the non-DM group on diabetes-related information, the DM group had their lowest mean average of 59% for the diabetes and pregnancy score. They did not appear to have greater protective attitudes regarding reproductive health issues than the non-DM group. The DM group felt that they were only moderately susceptible to becoming pregnant and that severe complications would not happen to them. The DM group perceived greater severity to sex-related outcomes (p = 0.001). The DM group did not report safer and more effective family planning behaviors (mean age coitus = 15.7 yr), which for them could be more detrimental. Similar trends were noted between groups regarding contraceptive methods; only a single method (e.g., pill only) rather than a dual method (e.g., pill and condom) was most frequently used. CONCLUSION: Having diabetes did not appear to significantly decrease the risk-taking behavior of the teens. Early and some unsafe sexual practices may increase their risk for an unplanned pregnancy that could result in pregnancy-related complications. Enhancing awareness, knowledge, and attitudes through preconception counseling and reproductive health education may reduce these risks by empowering young women to plan healthy future pregnancies.

Adolescent↗
PubMed1995

Human immunodeficiency virus disease in pregnancy.

Since the early 1990s, the number of women diagnosed with the human immunodeficiency virus (HIV) has exploded. Heterosexual women have become one of the fastest-growing populations of newly diagnosed cases. However, the full impact of HIV infection and acquired immunodeficiency syndrome (AIDS) on women's health and the optimal management of symptomatic and asymptomatic cases have yet to be delineated. The urgency to establish effective management protocols is underscored by the fact that AIDS has recently become the leading cause of death for minority women in many urban areas. The administration of antepartum and intrapartum zidovudine (azidothymidine, AZT) has advanced efforts to minimize perinatal transmission and produced promising results. However, important issues pertaining to prevention of HIV infection in women, mandatory testing of women of reproductive age, and the management of HIV-positive women during the interconceptional period remain controversial. Addressing HIV throughout the continuum of reproductive health is a major priority and a concern of all health care providers. Women's health care must assume the lead in counseling all women about their risk of HIV, ensuring that HIV-positive women make informed decisions about their reproductive health and that HIV-negative women modify high-risk behavior to avoid becoming infected. Since obstetricians and gynecologists, nurse practitioners, and midwives are often the first care providers whom at-risk and HIV-infected women contact, they must be able to identify, assess, and optimally manage these patients. This article reviews the epidemiology, virology, pathology, preconceptional counseling/testing, and management of women with HIV infection in pregnancy, thereby providing the practitioner with information and tools to enhance women's health.

Female↗