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PubMed2002

Women on waves: where next for the abortion boat?

Women on Waves was founded to contribute to the prevention of unwanted pregnancy and unsafe abortions throughout the world by direct action. Because national penal laws, including those governing abortion, generally extend only as far as territorial waters (12 miles), Women on Waves made plans to provide reproductive health services on a ship with a mobile clinic, including abortions, outside the territorial waters of countries where abortion is illegal. We went to Ireland first because it was nearby and there was a dedicated pro-choice community with immediate interest in and commitment to the project. Although we encountered problems that meant we could not do abortions, we were contacted by more than 300 women in five days and provided reproductive health information, contraception, workshops and information on where to obtain legal abortions in Europe. In many parts of the world an anti-abortion backlash is taking place. To safeguard our reproductive rights in the face of anti-abortion activities, it is crucial to recapture a pro-active, pro-choice role. Women on Waves helped to make visible the need for legal abortion services in Ireland, and the extensive class and other differences between women able to access abortions abroad and those who could not. We are currently attempting to resolve our status under Dutch law, but until women everywhere have the right to reproductive freedom, we will continue to make waves.

Abortion, Induced↗
PubMed2002

Wild intersex roach (Rutilus rutilus) have reduced fertility.

Endocrine-disrupting chemicals, known to be present in the environment, have great potential for interfering with reproductive health in wildlife and humans. There is, however, little direct evidence that endocrine disruption has adversely affected fertility in any organism. In freshwater and estuarine fish species, for example, although a widespread incidence of intersex has been reported, it is not yet known if intersexuality influences reproductive success. The purpose of this study was, therefore, to determine gamete quality in wild intersex roach (Rutilus rutilus) by assessing sperm characteristics, fertilization success, and ability to produce viable offspring. The results clearly demonstrate that gamete production is reduced in intersex roach. A significantly lower proportion of moderately or severely feminized fish (17.4% and 33.3%, respectively) were able to release milt compared with normal male fish from contaminated rivers (in which 97.6% of the males were able to release milt), reference male fish (97.7%), or less severely feminized intersex fish (experiment 1: 85.8%, experiment 2: 97%). Intersex fish that did produce milt produced up to 50% less (in terms of volume per gram of testis weight) than did histologically normal male fish. Moreover, sperm motility (percentage of motile sperm and curvilinear velocity) and the ability of sperm to successfully fertilize eggs and produce viable offspring were all reduced in intersex fish compared with normal male fish. Male gamete quality (assessed using sperm motility, sperm density, and fertilization success) was negatively correlated with the degree of feminization in intersex fish (r = -0.603; P < 0.001) and was markedly reduced in severely feminized intersex fish by as much as 50% in terms of motility and 75% in terms of fertilization success when compared with either less severely feminized intersex fish or unaffected male fish. This is the first evidence documenting a relationship between the morphological effects (e.g., intersex) of endocrine disruption and the reproductive capabilities of any wild vertebrate. The results suggest that mixtures of endocrine-disrupting substances discharged into the aquatic environment could pose a threat to male reproductive health.

Animals↗
PubMed2006

Development and validation of the Infertility Self-Efficacy scale.

OBJECTIVE: To develop and validate a scale of perceived self-efficacy for people coping with infertility treatment. DESIGN: Self-efficacy scale development involved: [1] item generation with medical experts in reproductive health; [2] a principal components analysis with varimax rotation to identify underlying item components; [3] test-retest reliability and construct (convergent and discriminant) validity with infertility patients, who were administered the Infertility Self-Efficacy (ISE) scale with other measures; and [4] expert acceptability, as determined by reproductive health professionals. SETTING: Recruitment at a fertility center, a national infertility organization, and medical trials web pages. PATIENT(S): A total of 213 participants (159 women; 54 men) with a diagnosis of infertility in the past 2 years were recruited for the various study phases. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Participants' infertility self-efficacy was assessed with an online assessment battery using the ISE scale; comparison mental health measures assessed current levels of fertility problem distress, perceived stress, and coping style. Reliability, validity, and component structure of the ISE was assessed. RESULT(S): Measurement development yielded a brief 16-item ISE scale that taps an infertility patient's perception about his or her ability to engage in a set of cognitive, emotional, and behavioral skills related to the medical treatment of infertility. The single component of "cognitive/affect regulation" suggests this core set of skills is relevant to successfully managing the experience of infertility. The ISE correlations with comparison mental health measures were as expected, suggesting good convergent and discriminant validity. CONCLUSION(S): The ISE scale appears to be a reliable and valid measure of an individual's self confidence in areas related to health promotion during infertility treatment. Assessing an infertility patients' self-efficacy with the ISE may be useful in clinical research and as a counseling tool to help guide patients in actively managing their fertility treatment.

Adaptation, Psychological↗
PubMed2002

Oriéntame: preventing and solving problems related to unwanted pregnancy for 25 years in Colombia.

For over 25 years, the Oriéntame Foundation in Bogotá, Colombia, has been providing reproductive health services to women, regardless of their socio-economic or marital status, race, age or religious affiliation. Oriéntame started by focusing primarily on unwanted pregnancy and treatment for incomplete abortion, which has contributed to the reduction of maternal mortality in Bogotá. Oriéntame now provides comprehensive sexual and reproductive health services, including sexual health education, Pap smears, gynaecological problems, STIs and sexual violence, with a continuing emphasis on unwanted pregnancy, treatment for incomplete abortion and post-abortion care. The women that come to Oriéntame, some 18,000 per year in recent years, are from all socio-economic levels, and are increasingly more informed. The services are regularly re-evaluated so as to accommodate their changing needs. There is a sliding scale of fees, so that the 40% of women patients with higher incomes subsidize the 60% with lower incomes; this also allows the clinics to be self-supporting. Services are offered in an atmosphere of respect for women and their decisions, with professional staff who are trained to take care of both the medical and emotional needs of each woman. Since 1992, Oriéntame has also been doing outreach to the slum areas of Bogotá, providing education and information, to contribute to the empowerment of the poorest inhabitants of the city.

Colombia↗
PubMed1993

Organisation of perinatal/neonatal care.

There is no single system, whether state run, private or mixed, that consistently produces superior perinatal results (131), although these usually emanate from jurisdictions with regionalised or centralised comprehensive antenatal and natal care, as opposed to haphazard systems of care. Again the literature is "more description than evaluation, possibly because the latter requires comparative studies or audits which have not caught up with the new technology" (132). Changes in the organisation and delivery of reproductive health care since 1960, combined with advances in treatment, have apparently had an impact on the outcome of pregnancy and newborn care, resulting in reductions in perinatal mortality, mainly through their influence on birthweight-specific mortality. The latter is a major marker of the quality of hospital reproductive health care. Changes in the distribution of weights at birth have been relatively small; consequently the proportional numbers of infants born weighing less than 1500 g, who contribute most to morbidity and mortality, has roughly tracked the birth rate and has changed little. The proportion of babies born of low weight due to prematurity and/or intrauterine growth restriction, which are mainly influenced by socioeconomic and environmental factors, has seen only a marginal reduction in most developed countries and cannot explain the fall in mortality. Many reviews (e.g. 31, 36-38, 40, 41, 43-45, 47-52, 54, 55, 66, 67, 90, 93-95) of perinatal care now accept the cause and effect relationship between enhanced perinatal care and decline in perinatal mortality. Reduction in the incidence of low birthweight between 1500 and 2500 g is attributed more to the influence of environmental and lifestyle factors, including the standard of living, housing and nutrition, the level of education and the prevalence of infections in the population. On the other hand, the incidence of infants born weighing less than 1500 g, the major contributors to perinatal morbidity and mortality in developed societies, is relatively stable across time and across different jurisdictions. It forms about 1% of all births, but is responsible for 60-75% of morbidity and mortality. It appears relatively insusceptible to improvements in standards of living and other environmental factors. It may be more dependent on biological factors controlling the onset of premature labour, the incidence of genetic or chromosomally determined disease and the prevalence of teratogens. The only way to influence these factors is through a better understanding of the mechanisms by which they operate, which should lead to the appropriate strategy for their elimination.(ABSTRACT TRUNCATED AT 400 WORDS)

Child↗
PubMed2006

Sexual behaviors and procreational intentions of adolescents and young adults with perinatally acquired human immunodeficiency virus infection: experience of an urban tertiary center.

PURPOSE: To assess sexual knowledge, behaviors, and procreational intentions of adolescents and young adults with perinatally acquired human immunodeficiency virus (PNA HIV) infection. Increasingly, children with PNA HIV infection survive to adolescence and become sexually active. Understanding their procreational intentions could aid in designing reproductive health and secondary prevention programs. METHODS: A cross-sectional survey of adolescents and young adults with PNA HIV infection at an urban tertiary center was conducted. From June 2003 through September 2004, participants completed a questionnaire that inquired about their sexual knowledge and behaviors. Participants aware of their diagnoses also completed items regarding procreational intentions. RESULTS: Seventy-four percent (57/77) of eligible participants completed the survey. Thirty-three percent (19/57) of participants reported having had penile-vaginal intercourse, 89.4% of them after learning of their HIV status. Fifty percent (5/10) of sexually active female participants had been pregnant. Among the 50 participants who were aware of their diagnosis, 70% (n = 35) expressed intent to have children. A majority of those aware of the risk of maternal-to-child transmission (MTCT) (71.1%) expressed intent to procreate. Participants who perceived MTCT as low were more likely to express intent to procreate than those who perceived the risk of MTCT as high. CONCLUSIONS: Adolescents with PNA HIV infection are becoming sexually active and express intent to have children. This has important implications for secondary prevention of HIV infection. These adolescents need innovative intervention programs offering reproductive health education including procreational choices and considerations.

Adolescent↗
PubMed1999

Family planning perspectives at the beginning of the next century.

Looking back over the past 40 years or so, family planning has indeed been the success story of development; it has made an extraordinary difference to the lives of tens of millions of women. Globally speaking, the unmet needs for family planning and reproductive health still exist. Meeting these challenges would require better and improved methods of contraception, addressing issues such as sexually transmitted infections, unsafe abortions, cultural, religious, legal and political barriers. Better utilization of communication channels and investment in 'human capital'--informing people, opening a dialogue to reach consensus for action, are crucial. Finally, changes at policy and administrative level, including improvements in financial and human resource management, and making family planning and reproductive health programs sustainable will be important as we move into the 21st century.

Adolescent↗
PubMed2000

Barriers to implementing South Africa's Termination of Pregnancy Act in rural KwaZulu/Natal.

INTRODUCTION: South Africa's Termination of Pregnancy Act, the most liberal abortion law in Africa, took effect early in 1997. In spite of the anticipated benefits to women's health, however, public reaction has been mixed. In the country's most populous province, KwaZulu/Natal, opposition is strong and most health care providers have refused to provide the service. This study explored attitudes and beliefs about abortion and the Termination of Pregnancy Act among primary care nurses and community members in a rural district in order to better understand barriers to implementation of the new law. METHODS: As part of a community survey on women's reproductive health (n = 138), questions on knowledge, attitudes and beliefs about abortion were asked, as well as awareness of the provisions of the Termination of Pregnancy Act. To better understand the perspectives of health care workers, a survey among primary care nurses on duty (n = 25) was also conducted. In-depth interviews were conducted with both nurses and women in the community to further pursue issues raised in the two surveys. RESULTS: Support for the Act was low (11%) among both community members and nurses, and few supported abortion on request (18 and 6%, respectively). Within each group, however, a clear hierarchy of support was observed: a majority of nurses (56%) and community members (58%) supported abortion in the case of rape or incest, or if the continued pregnancy would endanger a woman's health (61 and 56%, respectively), but few supported abortion for social or economic reasons. In-depth interviews revealed that abortion is seen as contrary to prevailing community norms; nurses were poorly informed about the Termination of Pregnancy Act and felt confused in their professional responsibilities. CONCLUSIONS AND RECOMMENDATIONS: Legalization alone cannot ensure implementation of abortion services. In South Africa, extensive media coverage prior to passage of the law ensured almost universal awareness of the Act, but little public education took place at the same time. In spite of general opposition to the law, however, there is an encouraging level of support for abortion in some circumstances. These findings suggest that abortion services can be implemented, even in conservative rural areas, but that a process of information dissemination and community consent prior to implementation is essential. Locating abortion within broader reproductive health services could be an effective way to improve access and acceptability.

Abortion, Legal↗
PubMed2001

Estrogens and falling sperm counts.

Extravagant claims have been made repeatedly in recent years that human sperm counts are falling and that global exposure to environmental estrogens are responsible. The basis for these two distinct claims is reviewed. The claims of falling human sperm output, reviving an old debate, are prompted by a paper by Carlsen et al. (1992). This meta-analysis, however, is marred by numerous flaws that invalidate its claims. Major defects include severe heterogeneity of component studies, rendering them unsuitable for aggregation, and defective data analysis based on arithmetic mean rather than median, which showed no significant changes over time. This debate is likely to remain unresolved until valid, representative population-based studies of human sperm output can be achieved. None have been reported, or seem feasible in the near future, and so alternative strategies, based on surrogate variables for human male fertility not requiring sperm counts, need to be developed and validated. The plausible hypothesis that prenatal estrogen exposure might influence development of the human testis through effects on Sertoli cell replication and sperm carrying capacity has, however, been conclusively refuted by studies of boys born to women exposed to high doses of oral diethylstilbestrol during pregnancy. Neither fertility nor sperm output were adversely influenced by massive maternal estrogen exposure during pregnancy, although minor urogenital malformations did occur. The still wider claims of deteriorating male reproductive health, notably changes in prevalence or incidence of hypospadias or cryptorchidism, also lack convincing population-based evidence, although cancer registry data indicate a gradual increase in testis cancer in some countries. In summary, the available evidence does not support claims of falling sperm counts or any general deterioration in male reproductive health. Population-based studies of valid surrogate variables for male fertility not requiring semen analysis are needed. If population-based evidence regarding male fertility or sperm output could be generated, it is highly unlikely that prenatal estrogen exposure could be a valid explanation of any deterioration as massive maternal exposure to oral estrogen has negligible effects on male fertility or sperm output.

Estrogens↗
PubMed2004

Natural family planning revisited.

The article focuses on the role of natural family planning NFP as a component of reproductive health. It distinguishes NFP from the concept of fertility awareness method. Furthermore, the effectiveness of NFP as determined by previous studies is presented and the advantages and disadvantages of NFP are highlighted. Additionally, factors that influence the use of NFP methods are examined. Finally, delivery strategies and options for mainstreaming NFP into reproductive health services are identified and discussed.

Cervix Mucus↗
PubMed2003

Knowledge and practice of breast self examination and Pap smear screening among a group of electronics women workers.

A total of 486 Malaysian women electronics workers participated in a study of reproductive health knowledge and cancer screening. The practice of Breast Self Examination (BSE) was found to be related to educational attainment; while ever having had a Pap smear was found to be related to being older than 30 years old, being ever married, living with family or relatives, and not staying in hostels. Knowledge on reproductive health was found to be higher for older women, married women, living with family or relatives, not staying in hostels, ever having done BSE and ever having had a Pap smear.

Adult↗
PubMedDate not supplied

Chronically homeless women's perceived deterrents to contraception.

CONTEXT: Despite the growing number of homeless women of reproductive age, little is known about their reproductive health and contraceptive use. METHODS: A representative sample of 974 currently homeless women surveyed in Los Angeles County in 1997 included 229 who were chronically homeless and at risk for unintended pregnancy. The relationships between perceived deterrents among these women and their frequency of contraceptive use were evaluated using chi-square tests. Logistic regression analyses were performed to identify independent predictors of contraceptive deterrents. RESULTS: The most commonly cited deterrents to contraceptive use were side effects, fear of potential health risks, partner's dislike of contraception and cost (20-27%). Women who reported substantial deterrents were significantly less likely than others to use contraceptives consistently. Perceived deterrents differed by women's characteristics: Hispanic women were more likely than whites to view not knowing how to use contraceptives or which method to use as a deterrent (odds ratios, 9.6-9.8); black women were more likely than whites to cite not knowing which method to use (4.0), lack of storage (5.5), health risks (6.0) and discomfort (3.3). Women with a history of drug abuse had elevated odds of citing not knowing how to use contraceptives, uncertainty about which method to use and cost as deterrents (5.2-7.7). CONCLUSION: Homeless women report substantial deterrents that reduce their contraceptive use. The multiplicity and heterogeneity of their perceived deterrents suggest a need for reproductive health services that are more integrated and culturally competent than those currently offered.

Adolescent↗
PubMedDate not supplied

Ethylene glycol monomethyl ether effects on health and reproduction in male rabbits.

Male Dutch rabbits were weighed and randomly assigned within each weight group to five groups of six animals each (plus one more in the highest dose group). They received 0, 12.5, 25.0, 37.5, or 50.0 mg of ethylene glycol monomethyl ether (EGME) per kg of body weight in the drinking water 5 d/week for 12 weeks. Feed and water consumption were monitored daily and body weight weekly. All animals consumed the water and feed, maintained body weight, and were in good health throughout the experiment. Semen was collected twice weekly for 12 weeks, and 96% of the ejaculates were obtained. By weeks 6 and 9, most males in groups receiving 50.0 or 37.5 mg of EGME per kg were oligospermic. Only minor changes in other characteristics of sperm obtained from treated animals were found, as measured by computer-assisted sperm analysis. Fertility of the males still producing sufficient sperm during week 12 to use for insemination was tested with 96 does producing 2839 oocytes, and fertility of treated males (41%) was not lower (P > 0.05) than 47% in controls. At necropsy, all vital organs were grossly normal, with no notable histopathology. However, the groups of animals receiving 37.5 and 50 mg of EGME per kg of body weight produced fewer sperm and had smaller testes than controls (P < 0.05). Although all rabbits appeared grossly normal, there was a marked disruption of spermatogenesis as ingestion of EGME increased above 25 mg/kg of body weight. Rabbit testes appear to be more sensitive to EGME than testes of rats or mice.

Animals↗
PubMed2002

Gender differences in cues that affect condom use among adolescents in Lomé, Togo.

A population-based sample study of adolescent women and men from Lomé, Togo, was conducted to examine their responses to personal experiences with AIDS. Information was obtained on youth reproductive health knowledge, attitudes and practices, including attitudes towards HIV/AIDS and personal experience with AIDS. Multivariate results demonstrate that an important factor that distinguishes adolescent male condom users from non-users of condoms is the knowledge of someone who died of AIDS. Conversely, personal experience with AIDS was unrelated to reported condom use among adolescent women. The results illustrate that reproductive health programmes directed towards adolescents need to target men with messages different from women. Sexually active men respond to personal experience with AIDS by adopting condoms whereas women may have less control over condom use and have other strategies such as abstinence and fidelity to protect themselves from AIDS and unintended pregnancies.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Germ cell cancer and disorders of spermatogenesis: an environmental connection?

Why is there a small peak of germ cell tumours in the postnatal period and a major peak in young age, starting at puberty? And, paradoxically, small risk in old age, although spermatogenesis is a lifelong process? Why is this type of cancer more common in individuals with maldeveloped gonads, including undescended testis, gonadal dysgenesis and androgen insensitivity syndrome? Why has there, during the past 50 years, been a quite dramatic increase in testicular cancer in many developed countries? These are just a few of many questions concerning testicular cancer. However, the recent progress in research in the early stages of testicular cancer (carcinoma in situ testis (CIS)) allows us to begin to answer some of these questions. There is more and more evidence that the CIS cell is a gonocyte with stem cell potential, which explains why an adult man can develop a non-seminoma, which is a neoplastic caricature of embryonic growth. We consider the possibility that CIS cells may loose their stem cell potential with ageing. Along these lines, a seminoma is regarded a gonocytoma where the single gonocytes have little or no stem cell potential. The Sertoli and Leydig cells, which are activated postnatally and during and after puberty, may play a crucial role for both the development of the CIS gonocyte and progression of the neoplasm to invasiveness. The reported increase in testicular cancer is not the only sign that male reproductive health is at risk. There are reports that undescended testis and hypospadias have become more common. Also semen quality has deteriorated, at least in some countries. The epidemiological evidence suggests that environmental factors may play a role. Are the environmental hormone disrupters (e.g. DDT, PCB, nonylphenol, bisphenol A) to be blamed for the apparently synchronised deterioration in these aspects of male reproductive health?

Adult↗
PubMed2002

Quality of maternity care for adolescent mothers in Mbabane, Swaziland.

Early pregnancy and unplanned childbirth may have far-reaching physical, psychological and social consequences for the adolescent girl and her offspring and are therefore public health issues of concern. A number of evidence-based maternity practices might, if properly applied, prevent unnecessary health-related problems in mothers and newborns, postnatally. In order to identify the areas of maternity practice that require improvement in Swaziland, the overall aim of this study was to generate systematic data on the maternity care and social support provided by health professionals (for adolescent mothers and their children) on admission, in the labour ward, and during and after delivery. The study was carried out during a 3-month period from April to June 1998. All pregnant adolescents with an uneventful term pregnancy, admitted to the Mbabane Government Hospital maternity ward in the morning of the study days, were informed about the purpose of the study and asked if they would like to participate. A total of 33 pregnant adolescents agreed and in-depth interviews were conducted with those participants. Observations and checklists were used to assess the maternity care given to the study participants. Results revealed that on admission to the labour ward, verbal communication and interaction between the midwife and the adolescent were minimal, and none of the adolescents was encouraged to bring a social support person to remain with them during labour. During the progress of labour, nearly 50% of the adolescent mothers developed complications and approximately 27% had a lower-segment Caesarean section. Special attention should therefore be paid to adolescent sexual and reproductive health service needs. These should include contraceptive counselling in order to prevent pregnancy at a young age and also to improve their sexual and reproductive health statuses.

Adolescent↗
PubMed2004

Vaginal douching among adolescent and young women: more challenges than progress.

The practice of vaginal douching dates back centuries. Numerous studies have shown that douching is quite prevalent and often begins during adolescence. Motivation for the initiation and maintenance of this practice appears complex, and presents challenges to the intervention efforts. The practice of douching remains controversial. Douching has been implicated in numerous adverse reproductive health outcomes such as increased risk for pelvic inflammatory disease, ectopic pregnancy, reduced fertility, and bacterial vaginosis. However, recent studies in developing countries have suggested that in certain circumstances, douching may actually be beneficial. We summarize key findings from the review of published literature and ongoing research, as well as highlight research challenges to our understanding of the role of vaginal douching in reproductive health.

Female↗
PubMed2001

Single women's experiences of premarital pregnancy and induced abortion in Lombok, Eastern Indonesia.

Induced abortion is widely practiced in Indonesia by both married and unmarried women. This paper draws on ethnographic research, conducted between 1996 and 1998, which focused on reproductive health and sexuality among young single women on the island of Lombok in Eastern Indonesia. While abortion for married women is tacitly accepted, especially for women with two or more children, premarital pregnancy and abortion remain a highly stigmatised and isolating experience for single women. Government family planning services are not legally permitted to provide contraception to single women and their access to reproductive health care is very limited. Abortion providers were highly critical of unmarried women who sought abortions, despite their willingness to carry out the procedure. The quality of abortion services offered to single women was compromised by the stigma attached to premarital sex and pregnancy. Women who experienced unplanned premarital pregnancy faced personal and familial shame, compromised marriage prospects, abandonment by their partners, single motherhood, a stigmatised child, early cessation of education, and an interrupted income or career, all of which were not desirable options. Young women were only able to legitimately continue premarital pregnancy through marriage. In the absence of an offer of marriage, single women necessarily resorted to abortion to avoid compromising their futures.

Abortion, Induced↗