Family planning and population policy.
This article attempts to analyze the following issues that concern family planning and population policy in India: the 1971 Census; law of population and socioeconomic systems; the need for a fundamental change in the socioeconomic system; population policy; and population planning and contraceptives. The 1971 census is discussed in reference to the increasing growth rate, literacy rate, and % of workers (male-female) of the total population. A critical appraisal of the economic system is given. It is proposed that new social dynamics must be created, developed and applied in order to transform the economy and stop the growth rate of the population. Population policy should be framed in concrete terms and with due regard for the specific conditions and problems of each major constituent unit and sector of the country. It is necessary to survey both population and economic growth and promote and realize the planned inter-relation between them. Because contraceptives are a matter of personal choice, they do not seem to be the answer to the problem India is facing today. Without any socioeconomic changes, there can be no population limitation in India.
A critical evaluation of the family planning programme and some recommendations.
This article proposes to examine the Family Planning Program right from its inception, which is almost 25 years ago, through all its subsequent developments that took place in India. From 1951 to 1956, nothing was attempted nor achieved during this period. During the Second Plan period (1956-1961), the performance of the Program was no better with the exception that for this plan period, financial allocations were raised. From 1961-66, the turning point of the program, there was still no fall in the birth rate (41/thousand) and the growth rate of the population was still at 2.5. The great bane of the Family Planning Program in India is that it is imbued with Malthusian ideas and that it is functioning in a compartmental framework. A major criticism of the Indian Government is that it views poverty and unemployment as a consequence of high density population rather than as products of a social system. The status of women as well as the responsibilities of Trade Unions are discussed in regard of the Family Planning Program. A series of recommendations are made in regard to: population education, status of women, reform of the civil code, abolishment of incentives and disincentives, religious and social prejudices, contraceptive research and role of Trade Unions.
Western countries have established relationships between employment, education, wages and costs of production which have helped in the forumlation of proper labor and population policies and brought proper legislation in their countries. Since India is lacking such studies, this article raises the issue of population policy in regard to the labor force in India. A general review of world population growth is analyzed in regard to such factors as infectious diseases, agricultural production, per capita expenditures, education and especially women's education and labor force. Many examples of Western countries are given in regard to their labor force and population growth. It is argued that women's employment will reduce the number of dependents. This will result in better standards of living and more income. It is assumed that the reduced rate of growth of population that is anticipated will not adversely affect the labor force and the economic growth of the country, at least not for 15 years to come. Therefore, a series of suggestions are made in regard to age of marriage, family size limitation, role of labor unions, contraceptive sale and research, education, and a totally different approach to family planning in rural villages than that in the cities. Family planning should be converted from a program to a popular movement.
Family planning services in industry: a survey.
This article presents the results of a national survey conducted by the Employers' Federation of India regarding family planning services in industry. This survey is based on a total of 345 replies. Several tables are presented in regard to medical facilities available, year of starting family planning services, types of family planning services provided, nature of incentives, supply of contraceptives, motivational activities, progress achieved in family planning, marital status of workers and expenditure on family planning. The proportion of units providing family planning services is higher among the relatively larger units, but there is a relative paucity of medical facilities in units without family planning serivces. Family planning services in the industrial sector are of recent origin, confirmed by 93 out of 132 plantations where services were introduced in or after 1965. The IUD appears to be the most popular method among plantations. Incentives and conventional contraceptives were the 2nd most popular services in plantations. Only 3 out of 68 plantations reported giving cash incentives as well as paid leave; 6 reported giving paid leave only for sterilization. Government, including municipal bodies and government hospitals, was the primary source of conventional contraceptives. Company funds were used mainly to buy pills. Most of the plantations and other units reported having undertaken various motivational activities to promote family planning among their workers. Family planning methods have changed in both plantations and other units. Expenditures were larger in the other units compared to plantations.
A practical view of family planning in the industrial set-up.
This article discusses in 3 parts the early efforts, the wider recognition and the continuation of programs of the Family Planning Association of India (FPAI). Early efforts, starting in 1949, include financing, education, training, provision of contraceptives and facilities for family planning purposes. The FPAI gained a wider and more popular recognition nationally when it developed its action programs specifically aimed at men working in industries such as factories and plantations. This increased recognition helped to reinforce a series of governmental policies, such as extending the family planning grant-in-aid scheme to industrial concerns. The FPAI's continuation programs include a series of feasibility surveys between 1967 and 1971, motivation and education programs, contraceptive services and follow-up studies. The FPAI's requirements for these programs deal with management cooperation, time allocation for education, managerial staff members and their role in the program, provision of facilities, leave pay allocation, and contraceptive availability.
Some comments on family planning programme.
This article summarizes general recommendations and conclusions that were made during the National Symposium on Labor and Population Policies of India, in New Delhi from April 15-18 1974. The outlook of family planning as a solution to India's poverty is wrong; mainly responsible are the bankrupt policies of the government. A major defect of the program so far is its one-sided emphasis on the contraceptive aspect. Another major deficiency is that the affluent of India want to foist family planning on the poor and toiling population only. A major problem is also associated with incentives and disincentives. If the workers cannot be made conscious enough to restrict family size through proper education and propaganda, it is foolish to offer them baits taking advantage of their poverty. It cannot be expected that the trade unions accord family planning popularization as their primary plan of work.
Power and visibility: the invention of teenage pregnancy.
The term "teenage pregnancy" replaced the morally loaded terms "illegitimate child" and "unwed mother" around 1970. This change in terminology marks a shift in the kind of attention society shows the pregnant adolescent, and is accompanied by changes in patterns of care which have become more "liberal" and "humanized." It is argued that assessments like these do not help us understand what is involved. From a moral problem, pregnant adolescents are now a technical one; different kinds of solutions are therefore needed, as technical problems require analysis and knowledge. Power organized around a moral discourse punishes by exclusion and brings with it a kind of freedom: the deviant is left alone by being placed on the other side of a moral boundary. Power organized around a scientific discourse on sexual desire, makes its objects of knowledge visible and subject to unending inquiry. A scientific discourse knows no boundary since it incorporates everything in the name of seeking "scientific truth." The new idea of "teenage pregnancy" is not simply a fact; it is part of the discourse on desire that organizes a practice of power that is inclusionary and relentless. This paper examines the political implications of the emergence of this new form of power which no longer calls upon punishment and obeying the law, but disciplines its subjects to become true to their own nature, a nature known by scientific experts. The truth of desire is now located in the individual nature of the woman herself. By analyzing the sexual deviant as an object of knowledge, the "challenge" she presents to herself, to her parents and to the community, disappears. The emergence of "teenage pregnancy" is traced through the treatment given pregnant adolescents in Reader's Digest and the American Journal of Publi Health from 1940 to 1980. The analysis shows that, prior to the mid 1960s, pregnant adolescents were shut away; they had no publicly visible face until the early 1970s, when they reappear in the context of a neutralized sexuality and become an increasingly visible social problem.
This is a report on the Sub-regional Workshop on Population Communication Planning with special reference to broadcast media, conducted from 1/9/78-1/18/78 and organized by the Asia-Pacific Institute for Broadcasting Development in collaboration with the UNESCO Regional Population Communication Unit and the Ministry of Information and Broadcasting, Sri Lanka. The objectives of the workshop were to share experiences in promoting the small family size norm by the countries in the sub-region and to formulate the effective role of media, especially broadcasting, in achieving this goal through systematic communication planning. The specific objectives were: 1) to examine the ways in which communication systems can support national family planning/population programs; 2) to plan for the most effective use of communication resources and systems, especially broadcasting, for the promotion of family planning programs; 3) to discuss critical issues of development, communication, planning, and evaluation; and 4) to formulate an integrated plan through which population communication could be effectively integrated with other development programs/projects. Participants included population communicators, broadcasters and those in the field of labor and telecommunications. The report lists names and addresses of resource personnel and participants and describes in brief the program of the workshop.
Demographic surveillance system--MATLAB. Volume eleven. Vital events and migration--tables 1981.
This is the 11th volume in the series of scientific reports produced by the International Centre for Diarrhoeal Disease Research, Bangladesh (formerly Cholera Research Laboratory), presenting basic tabulations from the registration of births, deaths, marriages, divorces and migrations in the Demographic Surveillance System of the Matlab Field Station. The present volume presents results as obtained from the surveillance area for the calendar year 1981. ICDDR,B is an autonomous, international, philanthropic and non-profit center for research, education and training as well as clinical service. The activities of the institution are to undertake and promote study, research and dissemination of knowledge in the diarrheal diseases and directly related subjects of nutrition and fertility with a view to develop improved methods of health care and for the prevention and control of diarrheal diseases and improvement of public health programs, with special relevance to developing countries.
A microprocessor revolution in data collection?
The possibility of using microprocessors in census and survey data production is studied. Currently there is a bottleneck in census and survey data production in the stage where the information on the questionnaires is transformed into computer-medium records for further processing. This includes coding, data entry, and manual editing. Field operations are completed in a matter of weeks or months, as are computer tabulation and offset printing. Yet it is not uncommon to have to wait 1 year for the results of a survey and 2 or more years for the majority of census reports. Much of the time is accounted for by coding, editing, and data entry operations. If a microprocessor were used, it might be possible for final survey results to be available within a week of the end of field operations. The article envisions a scenario where an enumerator device is used. Such a device is within reach of current technology and something similar is already being used in telephone surveys. The technical challenge lies in packaging such a system for use by enumerators in the field, and at a cost that is not prohibitive. For the last 20 years the cost of information processing has been declining rapidly; another 20 years of comparable development would put enumerator devices within easy reach. The extent of the market is another important consideration, since production volume is necessary to reduce costs. The market would be large since every world government and every large business is more or less continually engaged in collecting information. The use of microprocessors in survey data collection would increase both the data quality and the speed with which data could be produced. Moreover, these effects might reduce costs, making another cost argument in their favor.
Although most women in Australia are breastfeeding their newborns on discharge from hospital, many discontinue before their infants are 6 months old. Since breastfeeding is socially learned, a survey of a convenience sample of 305 female and male secondary school students in the Australian Capital Territory (ACT) was carried out to ascertain knowledge and attitudes about breastfeeding. The results show that over 50% think breastfeeding is an instinct and 87% believe it is the most healthful infant feeding. Most have noticed at least 1 infant being breastfed and 64% believe themselves to have been breastfed. 80% intend to breastfeed their own children in the future. Although only 15.6% feel embarrassed to see an infant breastfeeding, in the presence of non-family males it is reported as unacceptable by about 80% of the respondents. Such results have implications for the inclusion of information about breastfeeding into formal and informal education, particularly if students lack models and knowledge. Primary or secondary school courses in health and nutrition could include information about the superiority of breast milk for nourishment, economy, and the prevention of illness and infection. Family health courses could include breastfeeding as part of child care, noting its bonding characteristics. Another clear implication from this study is the political issue of whether or not a government wants its mothers to breastfeed and the legislative actions to take against the active promotion of alternatives to breastfeeding.
Rural and urban population changes and the stages of economic development: a unified approach
The long-term aspects of the process of economic development and urbanization are examined. A model is presented that shows the dynamics of economic development from the earliest to the more advanced stages. "The model is able to explain not only the occurrence of a downturn in the rural population after the initial phase of population growth both in rural and urban areas, but also the delayed occurrence of such a downturn in many present-day developing countries. The author then focuses [on] the later stages of economic development and explains two alternative courses of urbanization, namely, the reversal process and the continual-growth process, as special cases of the general model; which of the courses occurs depends on the value of the elasticity of urban agglomeration-economies." (EXCERPT)
Strategies in population distribution
A review of spatial distribution policies in developing countries is presented. It is noted that "aggregate rates of population growth and net migration rates remain high in developing countries causing a large increase in the absolute numbers moving to cities, especially in areas where the level of urbanization is still very low." It is suggested that "the criterion of slowing down primate city growth should not be the test of success for spatial distribution policies and that a superior criterion would stress raising the living standards of all the national population, regardless of whether they live in the primate city, other cities and towns, or in rural areas." (EXCERPT)
Demographic dilemma of the Soviet Union
Demographic trends in the USSR and their impact on Soviet economic development are examined for selected years from 1970 to 2000. The data are U.S. Bureau of the Census estimates derived from official Soviet sources. Tables and charts are included showing "18-year-old males and total population by age, by region; fertility and infant mortality rates; life expectancy; and non-Russians with Russian as a native or second language, by ethnic group; selected years 1960-80 with population projections for 2000." (EXCERPT)
Household and family characteristics: March 1982
This report contains information on changes in the composition, size, and characteristics of U.S. households and families between 1970 and 1982. Data are from the March 1982 supplement to the Current Population Survey. (ANNOTATION)
Population sciences: inventory of private agency population research, 1979 and 1980.
This inventory provides information on population research supported by the Ford Foundation, the Rockefeller Foundation, the Population Council, and the Andrew W. Mellon Foundation in 1979 and 1980. The projects listed are grouped under five major headings: Reproductive processes, Contraceptive development, Contraceptive evaluation, Social and behavioral sciences, and Center grants. An index of investigators is included, as well as a statistical analysis of the projects listed. (ANNOTATION)
Migration in late working age and early retirement
"The publication of population forecasts for small areas has highlighted the primitive basis for their migration components, while a recent growth of interest in the migration of elderly people has revealed pronounced differentials by age, sex and marital status. The paper presents a detailed examination of these differentials from United States and British census sources. It shows that improved forecasts of the volume of internal migration are produced by combining age specific participation rates with population forecasts for single or quinquennial years of age. Different series, based on different elderly cohorts, diverge in their forecasts by as much as 20%. Illustrative forecasts are presented and some implications for migration theory are discussed." (EXCERPT)
Labor force migration, non-labor force migration, and non-employment reasons for migration
"This paper documents the extent and nature of non-employment factors in migration. The labor force status of over 18 million recent interstate migrants in the United States and stated reasons for moving reported in several surveys in the U.S. are examined. Labor force migrants are heterogeneous in terms of the relationships between acquisition of employment and the migration decision, and in terms of the influence of decision makers outside of the migrant household including firms and the government. Numerically important categories of migrants not traditionally captured in migration models exist, including the elderly, the military, and movers from abroad." The author notes that "whereas non-employment reasons are secondary to employment reasons for a majority of labor force migrants, non-employment factors are singularly important or operate in combination with employment factors for the majority of all migrants. The heterogeneity of migrant types and migration reasons needs to be better captured in migration models." (EXCERPT)
"This paper is concerned with the modelling of demographic-economic change within an input-output framework. Several different modes of such change are identified and iterative and simultaneous mechanisms representing their effects are explored in detail. Analytical methods are developed to measure the consequences of demographic-economic change: particular attention is paid to the problem of assessing the regional impact of transfer payments such as unemployment benefit and old age pensions. The application of these methods is demonstrated using a modelling framework constructed for the Merseyside metropolitan county in North West England." (EXCERPT)
Regional economic-demographic forecasting models: a case study of the Washington and Hawaii models
"This paper presents a case study of two regional economic-demographic models: the Washington Projection and Simulation Model and the Hawaii Economic-Population Projection and Simulation Model. A discussion of model specification focusses attention on the interdependence of economic and demographic variables. Ex ante prediction tests demonstrate the models' forecasting capabilities. Simulations with the Washington model are conducted to show more clearly the interaction between economic and demographic activity in a region." (EXCERPT)
Modeling demographic-economic interactions: micro, macro and linked micro/macro strategies
"This paper addresses the issue of choosing the most appropriate approach to regional demographic-economic modeling by emphasizing once again the severe limitations of group-based macro models for representing population behavior, advocating instead the use of sample-based micro models for representing population behavior and suggesting that a linked macro/micro strategy for modeling demographic-economic interactions might combine the advantages of both modeling methodologies." (EXCERPT)
Dynamics of growth of secondary cities in developing countries
The dynamics of growth of secondary cities in developing countries is examined from the point of view of the policies that have been developed to divert the focus of urbanization away from capital cities. The data concern 31 secondary cities. The author identifies the factors that have influenced their growth, examines the dynamics of their present growth, and suggests policy guidelines concerning their future growth. (ANNOTATION)
[Nuptiality of divorced persons in Czechoslovakia]
Trends in the remarriage patterns of divorced persons in Czechoslovakia are examined over the past 20 years using official data. Differences over time and between men and women are analyzed. (summary in ENG, RUS) (ANNOTATION)
[Calculations of projections of the number and structure of households]
Data from the 1980 census of Czechoslovakia are used to examine the number and structure of households and to make some projections of household trends up to the year 2000. Two alternative methods of making such projections are compared. Differences in the projections for regions, districts, and large towns are considered. (summary in ENG, RUS) (ANNOTATION)
[Basic tendencies in the long-term development of survivorship function of the Czech population]
Changes in life expectancy in the population of Czechoslovakia over the past 100 years are examined using indicators from complete life tables. Mortality trends over this period are analyzed for both males and females. (summary in ENG, RUS) (ANNOTATION)
Update: mortality and health policy
An overview of current mortality conditions around the world is presented, with particular reference to the successes and failures of strategies that countries have adopted to reduce mortality. Consideration is given to progress made toward achieving the goals for mortality reduction set in the World Population Plan of Action, to the relationship between health and development, and to the management and financing of health programs. (ANNOTATION)
Fertility and mortality in Latin America
The author examines the extent to which a decline in fertility can help bring about a reduction in infant mortality in Latin America. It is concluded that the answer depends on the nature of infant mortality in the country concerned. In Costa Rica and Chile, the structural changes in births in relation to the decline in fertility were favorable to a decrease in total infant mortality, but in countries where family planning is primarily practiced by those of higher socioeconomic status, the opposite was true. (ANNOTATION)
Primary care: rhetoric and reality
The strategy adopted at the Alma-Ata Conference of 1978 that development of primary health care is the best way to reduce infant and child mortality in developing countries is reviewed. It is noted that because of different conditions encountered among developing countries, this strategy has produced an uneven record. A model is proposed that could be used both to measure the effectiveness of primary health care programs and to improve them as well. (ANNOTATION)
New plans to save children in hard times
The group of low-cost programs that have been developed by UNICEF to assist governments of developing countries in reducing infant and child mortality despite financial constraints is described. Such programs include growth monitoring, oral rehydration, breast-feeding, immunization, child-spacing services, food supplements, health education, water and sanitation, and female education. (ANNOTATION)
Projecting the net migration rate of the school age population
The net migration rate of the school age population in the United States is analyzed at the sub-state level for the period 1960-1970 using a series of estimation procedures. "The estimation procedures are unbiased techniques (ordinary least squares and maximum R [squared] improvement), biased techniques (ridge regression, generalized ridge regression and principal components regression), as well as robust techniques (least absolute deviation and Hill-Holland). For each of these estimation procedures, a model was developed, based on a sample of 50 minor civil divisions in the State of New Jersey." (EXCERPT)
Determinants of female labor force migration are investigated using recent studies on migration trends in selected countries. The role of migrant women is analyzed in terms of sociocultural and psychological integration as well as the traditional division of labor between males and females. (summary in FRE) (ANNOTATION)
[Evolution of the role of women in temporary emigration in Friuli-Venezia Giulia]
Changes in the characteristics of female migrants are analyzed using data from a 1982 survey in which 1,489 returning families in the Friuli region of Italy were interviewed. "The survey identifies three main periods of this temporary emigration: the first period shows first generation migrants, whose family structure is still traditional and women's role enters into conflict with the new socio-economic reality." The second period is characterized by an increase in the percentage of married female emigrants; in the third period an increase in the percentage of single females is noted. (summary in ENG, FRE) (EXCERPT)
[Female employment and emigration: from the countries of Africa and Asia to Rome]
Recent trends in female labor migration from third world countries to Rome, Italy, are analyzed. The impact of the demand for various types of labor and of religious background is considered. (summary in ENG, FRE) (ANNOTATION)
The sex distribution of migrants to France is examined using data from the 1975 census. Possible reasons for the recent increase in the percentage of female migrants are considered. (summary in ENG) (ANNOTATION)
[Women in regional migration in France]
The role of women in the context of internal migration in France is examined. The changing age and sex composition of the population is noted, and possible causes and consequences of increased female mobility are considered. (summary in ENG) (ANNOTATION)
"In this paper the author introduces a population-projection framework that incorporates interregional migration and intraregional residential mobility streams to project future population sizes both across and within regions in a manner that is consistent with existing migration theory. The author presents a general matrix model of the framework, shows how its parameters can be estimated from fixed-interval census migration data, and discusses how the framework can be employed to 'update' population projections when recent, more limited data sets become available. These features of the framework are demonstrated with intrametropolitan central-city-suburb projections for selected US Standard Metropolitan Statistical Areas over the period, 1970-2020." (EXCERPT)
Marriage, divorce, and remarriage from retrospective data: a multiregional approach
"In this paper the author applies the framework of multiregional population analysis to marital status changes as revealed by longitudinal retrospective data on marital histories collected as part of the June 1975 [U.S.] Current Population Survey supplement. Four marital statuses are used: never married, presently married, divorced, and widowed. Marital status life tables are computed for three periods: 1960-1965, 1965-1970, and 1970-1975, and, for each period, differences between males and females and between whites and blacks are described." Consideration is given to "the proportion of a life-table cohort ever marrying, the mean age at first marriage, the number of marriages per person marrying, the proportion of marriages ending in divorce, the average duration of a marriage (or a divorce, or a widowhood), and the like." (EXCERPT)
Selected principles of teaching and learning applied to nurse-midwifery clinical education.
The types of teaching and learning are discussed and applied to nurse-midwifery. The 3 types of knowledge to be learned and taught are psychomotor (physical), affective (social), and cognitive (logico-math). It is important to identify what type of knowledge needs to be taught, as teaching methods differ depending on learning goals for the student. The author reviews extensively the principles of teaching and learning used by the clinical educator in nurse-midwifery. The 3 major phases are acquisition of knowledge, transfer of knowledge, and internalization of learning. Clinical teaching is a vital component of any practice discipline and comprises almost 2/3 of the teaching time for any nurse-midwife educator. Yet, clinical educators (academic or preceptor) often have had little or no preparation for their important role in preparing the nurse-midwives of the future. It has often been assumed that good clinicians make good teachers, but this assumption has left both teachers and students frustrated, or worse, afraid to pursue any further teaching or learning. The article is a synthesis of ideas and practical experience related to teaching and learning in the clinical setting, specifically based on the knowledge of how adults learn, what constitutes knowledge, and how learning principles can guide the clinical teacher in her or his teaching efforts. The author concludes that the best teaching is based on how people learn and blends the talents and skills of the teacher with an understanding of the nature of human beings, the functioning of the human mind, and the nature of human development and learning.
A consideration of abortion survivors.
It is hypothesized that children who have siblings terminated by abortion have similar psychological conflicts to those children who survive disasters or siblings who die of accident of illness. There is evidence that children are aware of their mother's pregnancy termination. Having been chosen to survive, these children may have considerable conflicts regarding their existence. Since their life depended upon being wanted, they may become obsessively determined to please or they may feel a deep sense of obligation to their parents. If children have already lost a parent the child may look upon his new unborn sibling as a potential attachment. To be deprived by his mother's choice may stir latent hostility within the child the expression of which would be inhibited by the child's determination to stay wanted. Abortion survivors may be overprotected by parents attempting to deal with their unresolved guilt. As a substitute child the abortion survivor may have placed upon himself impossible expectations. It is contended that since approximately 50% of Western children are abortion survivors there is need to analyze their individual and collective responses. (author's modified)
Discusses family planning in Puerto Rico. Because of its close ties with the United States, Puerto Rico experienced full modernization and its consequences. Family planning dates back to the 1920's, and the population problem has been recognized by the government since the 1930's. Despite substantial emigration to the United States, the population doubled between 1910 and 1950. The reason was the rapid decrease in mortality which was not compensated for by a proportionate decrease in fertility. In the late 1940's, family planning met with Church opposition and sterilization was vigorously attacked. Some politicians and physicians were opposed to family planning measures as well. Despite Church opposition, and although 85% of Puerto Ricans are Catholic, sterilization is popular in the country. Although the government stayed away from a birth control policy, it never hindered private enterprise from introducing contraception and promoting it on a small scale. These private clinics have been functioning for 50 years, but only in the last 15 years has birth control been accelerated in Puerto Rico, and only since 1973 has the government taken an active part in the promotion of birth control. Female sterilization is favored, although the use of the contraceptive pill has risen in the last few years. Family planning measures have already resulted in a decline in fertility. It can be expected that in Puerto Rico, birth control will be the key to solving the population problem.
Post coital contraception--a study.
This paper looks retrospectively at 511 patients who have received ethinyl estradiol 200 mg plus dl-norgestrel 2 mg, given in 2 divided doses within 72 hours of unprotected intercourse, as post coital contraception at Brook Advisory Centre (Avon) from January 1979 to April 1980. Specific follow-up appointments were kept by 298 patients. 97 patients were seen again at a later date (varying from 1 month to 18 months later) and had obviously not become pregnant. 11 pregnancies occurred, 8 of these were in patients who had had unprotected intercourse at midcycle. The pregnancy rate for midcycle in this series is 5%, the overall pregnancy rate being 2%. The possibility of returning to the previous regimen of 5 mg ethinyl estradiol for 5 days, for those patients exposed at midcycle, is indicated, despite the higher incidence of side effects and the increased severity of nausea and vomiting in some patients. (author's modified)
[Tenth report on the demographic situation in France]
The present report consists of two parts. Part 1 provides information on recent demographic trends in France, including trends in nuptiality, fertility, abortion, causes of death, and population structure. Part 2 focuses on regional variations and includes data on population density and redistribution, net migration and natural increase, internal migration, population structure, marital and non-marital fertility, premarital conceptions, fertility trends, general and infant mortality, and excess male mortality by age. (summary in ENG, SPA) (ANNOTATION)
The authors examine trends and differentials in legal abortions in the state of Karnataka, India, in the period since abortion was legalized in 1972. About 8,000 abortion patients are covered by the study, and data are included on socioeconomic status, demographic characteristics, and contraceptive practice.
[Migration and underdevelopment in Upper Volta: a typological study]
The authors present the most important results of a national migration study undertaken in Upper Volta in 1974-1975. They describe the historical background to migration, present a theoretical framework for the study of current migration processes, and develop a typology of migration based on geographic and economic factors. They then use data on migration flows by socio-occupational status to illustrate this typology. (ANNOTATION)
Stimulating management in South-East Asia.
The 1st management training course in the South-East Asia region was held in 1966 to make administrators aware of health and its relationship to development. In the 1970's, health project formulation and country programming were introduced; in 1976 regional seminars were added as a type of training. Health management must be recognized as a continuous process extending through implementation and evaluation into replanning, and the effort initially put into planning should eventually shift to other phases. Since 1978 the promotion of country health programming has altered. In that year the World Health Organization adopted the goal for health for all by the year 2000. Developing health services of the type that require more staff may not necessarily improve health. Stress has been laid on the need for carrying out reforms within national administrative structures. Policy-makers and planners must pay attention to the economic feasibility of health plans. The health-for-all strategies necessitate a redesigning of the health system to ensure that those most in need receive proper help.
An evaluation of the Sri Lanka Anti-Malaria Campaign (AMC) program is presented. It begins with a review of the findings and recommendations made by the previous evaluation team in 1982; issues covered include: 1) case detection and treatment, including the establishment of voluntary treatment centers, the training of family health workers (FHWs), and treatment of fever cases; 2) program planning; 3) field applied research; 4) supervision; 5) logistics, including the storage of insecticides and the condition of spray equipment; 6) safety precautions; and 7) community participation. These issues are dealt with in the present assessment as well. An epidemiological and entomological review describes the area of parasitic infestation and rate of contagion. Various management and operational components are then summarized, including: spray operations, surveillance, funding, transport, data management, supply (of drugs), storage, and networks. Health education needs are briefly discussed. Research and training operations occupies the next section of the study, including an analysis of the impact of larvivorous fish on malaria vector density. Other anti-malarial projects are described, and the operational objectives of one of them, the Sarvodava-Oxfam-Anti-Malaria Campaign project, is outlined. A summary of community participation programs follows, and the evaluation concludes with a number of recommendations. Appendixes provide data on blood smears by month and health division; epidemiological situation; laboratory performance; fiscal position; AMC budget; transport position; supply position; terms of reference for 1st evaluation; and personnel, including team composition.
A simple but comprehensive model for the relationship between the proximate determinants and a set of aggregate fertility measures, including the total fertility rate (TFR) and total marital fertility rate (TM) are presented. 4 of the proximate variables--marriage, contraception, induced abortion, and postpartum infecundability--are considered the principal determinants of fertility, whereas the remaining 3 proximate variables--natural fecundability, spontaneous intrauterine mortality, and permanent sterility--are treated as generally much less important determinants. A test of the model with data from 41 developing, developed, and historical populations indicates that the 4 principal proximate determinants explain 96% of the variance in the observed TFRs of these populations, thus confirming the general validity of the model and the hypotheses about the operation of the reproductive process incorporated in it. The effects of variations in the proximate variables on levels of overall, marital, and natural fertility were examined with the model. This analysis demonstrates that each of the principal proximate variables can have a large impact on fertility and that any given level of fertility can be obtained by a variety of combinations of the proximate determinants. As a consequence, populations with the same TFR do not necessarily, and in fact only rarely, have the same set of proximate determinants. It is also noted that marital fertility may temporarily rise during an early phase of the demographic transition if the fertility enhancing effect of a decline in breastfeeding or postpartum abstinence is not offset by a sufficiently rapid increase in the practice of contraception or induced abortion.
Family size control has 2 main aspects: attaining the number of children desired and holding family size to that level. Subfertility constitutes a failure to achieve the first objective. When youthful marriage combines with modest family size aspirations to assure that the mother potentially completes her childbearing before age 30, the proportion subfertile remains well below 10%. Under these conditions, whether or not the couple deliberately space their desired births, and thereby prolong intervals between consecutive children by 1 or 2 years, has little influence on the fraction subfertile. Only when marriage age approaches 30, and 2 or 3 children are wanted rather than 1, do spacing goals appreciably differentiate the incidence of subfertility. The incidence of subfertility associated with seeking a specified number of boys (or a predesignated number of girls) is nontrivially higher than the subfertility associated with the goal of having twice that number of children but without regard to sex composition. This inequality arises from the large chance variations in the number of sons and daughters required to reach a given number of children of the same sex. The combination of youthful marriage and modest family size goal, which reduces the risk of subfertility thanks to a relatively early completion of desired childbearing, at the same time increases the length of the "risk period" from attainment of desired family size to onset of fertility, and consequently contributes to excess fertility. In a series of REPMOD runs simulating modern conditions, risk period length is explored in relation to marriage age, number of children wanted, spacing goals, and effectiveness of contraception employed for spacing purposes. Respecting excess fertility, 3 standards of family limitation were investigated by means of REPMOD in an American context. These stanards involve averages of .20, .38, and .50 excess births per couple whose first marriage remained intact until past menopause. The most demanding standard of .20 corresponds to what was claimed by married respondents in the middle 1970s. The medium standard of .38 constituted the counterpart for the early 1970s. The more lax standard of .50 excess births/couple represents an upward adjustment of the latter in order to encompass the estimated incidence of induced abortion and associated unreported accidental pregnancies. 3 further issues were addressed, 2 of them applicable to the American setting. First, assuming that induced abortion is eschewed, highly efficient contraception can be counted on to lower the fraction of family limiters who suffer an unwanted birth, but unfortunately that same highly efficient contraception also raises the likelihood of an inconveniently long interval to any first unwanted birth that does occur. Secondly, when a marriage is precipitated by a premarital conception allowed to go to term, the risk period is augmented, with a correspondingly higher expectation of excess fertility. The Bangladesh context is invoked in order to demonstrate a final point. Prolonged, as opposed to brief postpartum anovulation, significantly reduces fertility when contraception is absent or least efficient.
Sex preselection represents a potential extension of fertility control. The governing of sex composition and sequencing of children are considered. The issue of number control, with its twin problems of subfertility and excess fertility, has been laid aside and attention reserved for the management of sex composition and attendant implications for birth spacing. A basic distinction has been drawn between compositional and sequential goals. The former entails a desired sex composition of children but with indifference about the order in which that composition is realized. A sequential goal, by stipulating a single preferred order of sons and daughters sets a more challenging target. Respecting compositional goals, in the absence of any sex control technology, there is roughly 50% chance of realizing a single desired son or a single desired daughter or else a balanced son/daughter composition. The probabilities of realizing a compositional goal by luck alone decreases as the number of children increases, and the decrease is all the more rapid as the objective is made more unbalanced. None of the current techniques for raising the probability of a boy when a son is wanted or of a girl when a daughter is wanted seem to be efficient enough to elevate appreciably the probabilities of attaining specified compositional goals. This broad approach of trying to augment probabilities of each pregnancy representing the sex wanted at present leaves the odds not greatly changed. In its favor, as its technique does not require additional pregnancies, it has no adverse consequences for birth spacing. The very different approach of amniocentesis and selective abortion affords a highly efficient means by which to attain compositional and sequential goals, but at the price of a variably larger number of pregnancies. Besides their direct economic, physical, and emotional costs, these additional interrupted pregnancies impair the couple's control over the spacing of their births. A source of control over sex composition is paid for with a loss of control over birth spacing. To limit this adverse consequence by imposing a low ceiling on the number of diagnoses of fetal sex or of selective abortions is to lower the probability of attaining compositional goals. Nor would development of a reliable first trimester diagnosis of fetal sex to replace the current midtrimester ones greatly improve the situation. This substitution would not reduce the additional pregnancies, but rather might slightly enhance their number. It is concluded that widespread control of sex composition will have to wait on the development of more efficient techniques for raising the probabilities that each pregnancy represents the sex preferred--a state of affairs that does not appear to be in the immediate offing.
An association between herbal medicine ingestion and renal failure in Zambian infants.
A syndrome of renal failure and cerebral irritability in infants following the ingestion of a herbal medicine used (apparently effectively) in the treatment of diarrhea is described. The coincidence of the use of medicine made from roots and renal failure is highly suggestive of a direct cause and effect. Optimal management would appear to be rehydration with fluids appropriate to the blood chemistry, care being taken not to overload the circulation; cautious maintenance therapy; and dialysis in the event of serious biochemical disturbance. Phenobarbitone would appear to be indicated to prevent convulsions, the dose being adjusted to take account of the degree of renal failure. It is not possible from the cases studied to give a true estimate of prognosis from this rather biased series of 10 children. With frank renal failure it would appear to be poor. About 50% of such children die. However, a much higher proportion of children with gastroenteritis receive herbal medicines and do not show evidence of renal failure--so the children presented in this series may only represent those who have received an overdose. However, no children with this clinical picture have been seen who have not received herbal medicines orally.
The new biology and the question of personhood: implications for abortion.
Opposition to abortion is based in part on the assumption that personhood is achieved at or shortly after fertilization of the egg. This interpretation of personhood arises from a contemporary application of the ancient doctrine of preformationism, a doctrine which holds that there is a preformed individual, in an ontological sense, within the developing entity. The assumption that the fertilized egg is unique in its capacity to develop into a human being is at least in part responsible for the opinions of those opposed to abortion. Yet, the uniqueness of the zygote in its capacity to develop into an adult organism is qualified by the discovery that development may be possible in a number of other ways. Consideration of the phenomena of cloning, parthenogenesis and chimerism can relieve moral ambiguity about abortion and may reduce opposition to that practice. (author's modified)
Teachers and health workers: partners in primary health care. Experiences from Papua New Guinea.
Primary health care (PHC) involves community health education. When health priorities in rural communities are focused on the vulnerable under-5-years-of-age group then one has to examine who actually cares for this age group and what are the most appropriate means of reaching them through health education programs. In the context of rural communities in Papua New Guinea the linking of school and community health programs has been taking place. Examples and insights from programs where teachers and health workers attempted to find appropriate channels for integrating child and adult education in order to improve the health status of the very young child are described. The school programs used a child to child approach to develop in children a sense of shared responsibility with adults towards better health for themselves, younger children in their care and the environment of the community. The goal was a health program that applied to the whole community, where division between child and adult learning activities was not so sharply drawn, and where formal school programs and nonformal community education programs were to complement and contribute to each other. A campaign against infant diarrhea and death through dehydration was implemented. As a result of a 3-day planning workshop a program was drawn up for schools and communities. The workshop covered causes of diarrhea, fluid loss and dehydration, simple preventive and curative measures, essential hygiene habits and current community practices. Teachers, health workers and community leaders fashioned a program of activities for school children and adults. It was discovered that adults often feel a barrier between themselves and the child's school learning. Also, a gap often exists between what is taught in school and what is needed and can be applied to community health priorities. Thus, an effective community health education program that includes both children and adults in an integrated program will need to cover the varying ages and groups of community members who, with different degrees of responsibility, take care of themselves and others.
The survival of traditional medicine in a Peruvian barriada.
Current trends in population dynamics reflect increasing movement from rural to urban environments. As a result the provision of health care for migrants has become a national priority in many developing countries. Information describing the extent to which traditional medical beliefs and practices persist is crucial to the formation of systems of health care for migrant communities. This paper describes the dynamics of medical conservatism. Data analysis obtained from a comparative study of 52 Peruvian women living in a rural highland province and 50 Peruvian women from a migrant squatter settlement, a barriada, indicates that length of exposure to an urban environment is less of a determinant in medical conservatism than age of enculturation. Medical conservatism has 2 faces. On the positive side it offers a means of preserving cultural and ethnic solidarity. On the negative side medical conservatism tends to remove participants from opportunities offered by available Western health services. Underutilization of available health facilities in countries in development is sometimes a direct result of the negative effects of medical conservatism. The result is that services such as immunizations, sanitation, emergency health care, pediatric care, family planning, obstetric and gynecological services and antenatal clinics are not utilized by those for whom these services are planned. In countries undergoing development, such as Peru, coordination between the introduction of health programs in semiurban areas and continuing mass media community health education programs will markedly improve the chances of success of primary health care programs. (author's modified)
Health care in Swaziland involves traditional and modern systems and, hopefully, their integration. The author goes into extensive detail about methods of acquiring the skills of traditional healing and suggests that written records on all aspects of traditional diagnosis and treatment of disease be compiled. Contrasts of the spiritual and medical perspectives of both systems in regard to diagnosis are presented. Methods of traditional treatment of disease are illustrated along with contexual ways of referring to diseases that are particular to Swazi culture. There is an appendix of medicinal plants of Swaziland.
Government sterilization services acceptors' characteristics and its demographic impact.
Since the inception of a family planning program in 1962, the national program has played a part in both the reduction of the fertility rate and the wide spread use of contraception. The population census indicated that the total fertility rate of women aged 15-44 declined from 6.0 to 2.7 in 1982, and that the family planning practice rate increased from 9% in 1964 to 57.7% in 1982. During the last 2 decades, 11.7 million acceptors have received contraceptive services under the national program. The IUD has been the principal method since 1976, at which time the female sterilization program was introduced. Considering the popularity of female laparoscopic sterilization since 1976, the government has emphasized sterilization and deemphasized other methods since 1977. The use of the IUDs, pills, and condoms have declined while there has been a sharp increase in female sterilization. Between 1962 and 1981, a total of 1,478,000 acceptors, which consist of 501,300 vasectomy procedures and 977,500 tubectomy procedures, have received sterilization services through the government program. Comparing the practice rate between 1979 and 1982, the rate of female sterilization increased drastically from 14.5% in 1979 to 23.0% in 1982 while the practice rates for IUD, vasectomy, pill methods have declined. Of the total practice rate of 57.7%, the proportion of vasectomy users was 51.1% in 1982. According to acceptors' coupon data, the women's age of vasectomy and tubectomy acceptors fell steadily to 31.1 and 31.9 in 1981 respectively, and the number of children went down to 2.5 and 3.2 in the same year. However, the demographic characteristics of sterilization acceptors are far from adequate to attain the government's new population goal of replacement level fertility by the year 1988. The Standard Couple Years of Protection (SCYP) was used to compute the number of births averted by government sterilization programs. The results showed that: the total number of births averted between 1962 and 1981 is estimated at 902,778 during the period of 1962 through 2005. The coefficient of birth prevention, which is the ratio of the number of births averted to the number of acceptors, is estimated to be .7 for vasectomy and .6 for female sterilization during 1962 through 2005. At the same time, a total of 1,820,300 induced abortions will be prevented during 1962-2011 through the sterilizations provided during 1962 to approximately 1981. Of the total number of abortions prevented, 507,386 were made possible by the vasectomy program, and 1,312,914 abortions were prevented by the female sterilization program. The coefficient of abortion prevention is estimated to be 1:2 for sterilization. The programs have greatly contributed to the improvement of maternal health through prevention of induced abortion as well as reduction in fertility rate of the married women. There is a strong need for the national program to recruit more sterilization acceptors in their 20s in order to continue the high acceptance of sterilization. Innovative social support policy measures to encourage smaller families and reduce sex preference should be supported. (author's modified)
Induced abortion performed to wives of vasectomy acceptors.
Vasectomy is one of the simplest operations for permanent sterilization. However, it is not perceived as simple by vasectomy acceptors. Urologists often encounter vasectomy volunteers who hesitate to accept vasectomy until their wives have another induced abortion. These people usually use a simple contraceptive method and resort to abortion when it fails. After a few abortions, these women usually get lumbago and are unable to stand for long hours. Finally, the husband accepts vasectomy. The abortion clinic can be a catchment area, if properly administered. Data issued by the Korea Institute for Population and Health concerning induced abortion performed on wives of vasectomy acceptors, and induced abortion carried out in acceptors of other methods in 1980 are useful to estimate some factors. The overall average frequency of induced abortion in acceptors of family planning was 1.6 times, and acceptors in urban areas had a frequency of 0.6 times greater than that of acceptors in rural areas. Urban population accepted sterilization at a younger age, with less children in number, and with more frequent experience in induced abortion than the rural population. The average frequency of induced abortion carried out in the candidates of tubal ligation is 1.9, and the urban acceptors' frequency is 2.2, which is approximately 0.7 to 0.8 more than that of rural acceptors. The average frequency of induced abortion performed on the wives of vasectomy acceptors was 1.2 and this increases to 1.6 in Seoul. In rural areas, it decreases to 0.9. The survey throughout the whole country shows that 28.3% of the wives of vasectomy acceptors did not receive induced abortion while 38.0% did receive induced abortion, making the ratio 1:1.3. In Seoul, this ratio is 1:2.3. In cases of tubal ligation, this ratio is 1:2.9 in the whole country, and 1:5.3 in Seoul. In conclusion, abortion clinics can be a catchment area of vasectomy volunteers, and it is a good idea to have good public relations for this program. (author's modified)
Restricting federal funds for abortion: another look.
Explores the future economic costs of the decrease in the number of Medicaid-funded abortions among indigent women. The 1973 Roe v. Wade Supreme Court decision gave the right of choice to all women in the U.S. regardless of their economic well-being. Federal funds allowed poor women to exercise their right to an abortion. However, in 1976, Congressman Hyde observed that the federal government was paying for about 30,000 abortions a year at a cost of U.S. $45 million. As a result, the Hyde Amendment was proposed, which forbade expending federal funds for abortion except where life of the mother is endangered. Debate surrounding the controversial amendment continued until June 30, 1980, when the Supreme Court affirmed the constitutionality of the Amendment. As a result, Federal funds were withdrawn for most abortions obtained by indigent women eligible for Medicaid. It would seem that the 99% reduction in the federal budget for Medicaid-funded abortions would show large savings to taxpayers. However, for indigent women who carry their pregnancies to term, Medicaid pays childbirth expenses and welfare pays childrearing expenses. Thus, the end to public funding of abortions for indigent women may cost taxpayers more money rather than saving them money. When the Hyde Amendment was put into effect, no attempt was made to measure the future public costs which would be incurred throughout the dependent years of the unwanted child. According to some studies, restriction on medicaid funding of abortions in 1978 probably compelled 14,000 to 30,000 women to have births they would otherwise have terminated by abortion. The children of these women will impose sizeable costs on society in the form of higher expenditures on health, education, and welfare. These added costs will eventually be passed on to taxpayers. Thus, no public funds are saved by forbidding abortions among indigent women.
Reports conflict on link between hysterectomy, prior tubal sterilization.
Several recent research reports have aroused concern over the possibility that women who have had tubal sterilizations may suffer from abnormal menstrual bleeding and other gynecologic problems, which in turn may lead to higher-than-normal incidence of hysterectomy. 1 case-control study in Scotland and another British record-linkage study and preliminary findings from a U.S. Centers for Disease Control (CDC) analysis show higher-than-expected levels of hysterectomy among sterilized women. However, none of these studies control for some important confounding factors. On the other hand, a large prospective British study, which included controls for a number of important variables including age and parity, found no major differences in the rates of a number of gynecologic problems. In another study, poststerilization changes in women's menstrual patterns appear to have been due to cessation of pill or IUD use prior to the operation. In addition, no excess of menstrual complaints could be traced to electrocoagulation, the method most often cited in connection with sterilization-related menstrual problems. A 2nd CDC study reports no important menstrual problems among sterilized women.
[Infant mortality and infant care in Hungary]
The reasons why infant mortality remains comparatively high in Hungary despite the provision of modern health care services are explored. The authors note that a campaign to reduce neonatal and infant mortality was started in 1979. (ANNOTATION)
Theories of city size distribution and Indian urban structure--a reappraisal.
The relative growth rates of different sizes of towns in India are examined using census data for 1961, 1971, and 1981. A general tendency for the fastest rates of growth to occur in the largest cities is noted. (ANNOTATION)
Carbon monoxide yield of cigarettes and its relation to cardiorespiratory disease.
The relationship between the carbon monoxide yield of cigarettes and cardiorespiratory disease is analyzed. The data concern 4,910 smokers aged 40 to 64 included in the Whitehall study, which was conducted among civil servants in the United Kingdom during the period 1967-1969. The results provide no evidence that a smoker can reduce the risk of death by smoking a brand with a low carbon monoxide yield. (ANNOTATION)
The People's Republic of China is promoting the policy of the one-child family; it is an unprecedented social experiment. Daily women come to have abortions to end second pregnancies. In 1981 in a commune of 44,000 people there were 8686 married women of reproductive age and 7294 were potentially fertile. All except 4 used a method of contraception, had accepted sterilization, or were currently pregnant; 1937 had been sterilized, 2087 wore IUDs, 2326 used oral contraceptives (OCs), 609 used condoms, and 35 used monthly injectable contraceptives. Only 9 of the men had had vasectomies. When a family signs a 1-child family certificate, they receive a monthly bonus of about 10% of their total income until the child is 14; they are also given living space equal to that of a 2-child family. In the commune monitored 2782 couples had signed the certificate. The 1-child family policy is designed to help China reach zero population growth by the year 2000. A monthly injectable contraceptive has been perfected and there are 8 years of accumulated research on a once-a-month OC, yet there are over 5.5 million legal abortions yearly.
The Hyde Amendment, which restricted the use of federal funds for abortion in the US, was implemented in August 1977 and remained in effect for the subsequent 2 1/2 years. The Hyde Amendment primarily affects the Medicaid program (Title 19 of the Social Security Act), which uses combined federal and state funds to pay the cost of medical care for indigent populations. Low income pregnant women are directly affected by this policy. Focus in this discussion is on the health impact of the Hyde Amendment during the period when it was in effect, August 1977-February 1980. In fiscal year 1977, the year before the Hyde Amendment, approximately 1/4 of the 1.3 million abortions in the US were obtained by low income women and were financed by a combination of state and federal Medicaid funds at a total estimated cost of US$87 million. Approximately 295,000 low income women actually obtained publicly funded abortion. Assuming no increase in the number of abortions desired by low income women, this figure represents the minimum estimate of the women that were affected by the Hyde Amendment. Another 132,000 Medicaid eligible women were estimated to be in need of abortion services before the Hyde Amendment, but these were not included in the population at risk. In fiscal year 1978, the 1st year of implementation, an estimated 2100 abortion qualified under the limited conditions for federal matching funds. During the 2nd year of the Hyde Amendment, approximately 4000 abortions were performed for which federal reimbursement was claimed. The restrictive legislation lowered the number of federally financed abortions for Medicaid eligible women to about 1% of the prerestriction level. Although the Hyde Amendment was effective in nearly eliminating federally financed abortions, an estimated 94% of pregnant, low income women "at risk" obtained a legal abortion, 65% with state funds and 29% with other funding sources. About 5% of low income women continued their pregnancies to term. An estimated 1% resorted to illegal abortion. The results are contrary to both "prolife" and "prochoice" advocacy group predictions.
Town drift: social and policy implications of rural-urban migration in eight developing countries.
Launched by the International Association for Metroplitan Research and Development (Intermet) in November 1969, the project involved study groups in Indonesia, Korea, Malaysia, Nigeria, Peru, the Philippines, Turkey, and Venezuela who conducted studies on patterns of internal migration, conditions in metropolitan areas receiving rural-urban migrants, conditions in rural areas where migrants are coming from, and policies and programs in the public and private sectors that influence the pattern of internal migration directly or indirectly. The research project was action oriented. The studies were conducted with a view toward translating research findings to policy recommendations with the focus on the problems created by the rapid movement of people from rural to urban areas. In all the 8 cities in this study, urban population had been growing at high rates, ranging from 5-10% per year. Metropolitan areas were growing faster than smaller cities. The rapid growth of metropolitan areas was due to rural-urban migration, although natural increase was also becoming an important element in such growth. High population growth rates in metropolitan areas were creating serious problems in housing, transportation, health, education, and other services. Local governments and national governments were finding it more and more difficult to formulate and implement policies and programs to cope with problems arising from urbanization. Solutions should form an integrated set of policies and programs constituting a national strategy. Although the most prevalent pattern of migration was rural-urban, rural-rural migration was also an important stream in the 8 countries studied. Due to rapid rates of rural-urban migration, policies attempting to discourage it by closing off the city to migrants were usually unsuccessful. Policies that deflect internal migration to other urban alternatives or even to rural areas were relatively expensive and difficult to manage, yet they promise to be more successful than programs that work to keep potential migrants on the farm or stop migrants from flocking to the cities. Back to the land schemes, where they try to encourage people already in cities to move to rural or frontier areas, have not been very successful. Colonization, settlement, or transmigration schemes were found to be effective but expensive in relation to the number of persons actually moved. Such schemes need to be assessed in terms of the direct and indirect influences they have on the actual movement of people.
Some comments on the process of counterurbanization in Europe
The process of counter-urbanization in Western Europe is analyzed using the rank-size rule. Three major groups of countries are identified: those in which the decentralization of population began in the 1960s, those in which decentralization began in the 1970s, and those that still showed urban concentration in the 1970s. Comparisons are made among different types of counter-urbanization patterns. (ANNOTATION)
[Family planning and family counseling in Austria]
The author discusses abortion trends and changing social conditions in Austria and the establishment and nature of the Austrian family counseling system. Included is information on attendance at family planning centers in Salzburg during the period 1977-1979. These data are analyzed with reference to type of center; reasons for attendance; and age, sex, occupation, marital status, and family size of those visiting the centers. (summary in ENG) (ANNOTATION)
Family limitation in American culture, 1830-1900
This dissertation is concerned with the dissemination of information about contraception and abortion in the United States during the nineteenth century, a period when legal prohibitions against family limitation were coming into force. Topics considered include the safety, reliability, and acceptability of specific birth control methods; male methods of contraception; female methods of contraception; various rhythm methods used between 1850 and 1900; and abortion. The role of literature, advertisements, and itinerant lecturers in disseminating birth control information is then discussed. Finally, the author examines the acceptability of birth control and the emergence of organized opposition to family limitation.
Abortion in Indonesia: a review of the literature
This publication consists of a review of the available literature on induced abortion in Indonesia. The review was undertaken in 1980-1981 and is in two parts. Part 1 contains a synthesis of the ideas, arguments, and opinions expressed in the literature reviewed, and Part 2 provides annotated bibliographic citations to the relevant literature, arranged alphabetically by author. Topics covered in the synthesis include abortion laws, the incidence of abortion, health consequences, abortion and contraceptive usage, demographic aspects, opinions, and abortion around the world.
This book is concerned with how Members of Parliament in the United Kingdom voted on John Corrie's Abortion (Amendment) Bill of 1979-1980, which was designed to make abortion legislation more restrictive than it had been before. The authors note that in this instance, MPs were free to vote according to conscience and were not bound to follow an official party line. In particular, the book is concerned with the process by which MPs arrived at their decisions concerning how to vote, with the various pressure groups lobbying for their support, and with the extent to which they changed their opinions during the course of the debate.
This is a report on changes in the reproductive behavior of women after the passage of the 1978 act that legalized abortion in Italy. Data are taken from the clinic records of 2,096 patients hospitalized in the Obstetrical and Gynecological Division of the University of Bologna in 1979. Comparisons are also made with data on 5,499 women hospitalized in the same unit in 1976-1977. Variations by residence, age, marital status, and number of children are analyzed. The extent of induced abortion before 1978 and the degree to which it was recorded as spontaneous abortion are considered. (summary in ENG, FRE)
[Abortion and contraception seen through the pages of "Population" (1970-1981)]
A summary of articles published in the journal Population and other INED publications between 1970 and 1981 on abortion and contraception topics is presented. Topics covered include how to measure the number of abortions, public attitudes toward contraception, the need for legislative reform on abortion, the impact of abortion law reform on practices and attitudes, and how French legislation compares with other laws around the world. (ANNOTATION)
The socio-economic determinants of recourse to legal abortion
"This study of the determinants of legal abortion examines the interconnections between human reproduction and social organization. The hypothesis is that in the context of liberalized abortion laws, the incidence of abortion is determined by the socio-economic circumstances of women. A simple model of this relationship is tested using international data drawn from a sample of countries." The policy implications for welfare and birth control planning are considered, as well as the implications for feminist action. (EXCERPT)
These are the proceedings of a workshop held in Paris in December 1980 to examine fertility, population policies, and the effectiveness of these policies in the countries of Eastern Europe and France. The proceedings are in two parts. In the first part, chapters are included on the current demographic situation and recent trends in Bulgaria, Czechoslovakia, France, the German Democratic Republic, Hungary, Poland, and Romania. The second part contains chapters on the population policies of those same countries. A series of comparative statistics for the countries concerned is provided in an appendix. Wherever possible, the statistics cover single years from 1946 to the present. Data are included on population, marriages, marriage rates, and divorces; legitimate and illegitimate births, birth rates, and illegitimate birth rates; age-specific fertility and synthetic measures of fertility; and spontaneous and induced abortions and abortion rates.
The Which? guide to birth control
The author examines differences among various methods of contraception, their modes of action, effectiveness, and availability, with the aim of enabling the consumer to make informed and sensible choices of contraceptive methods and services. Chapters are included on traditional methods of contraception, including breast-feeding and withdrawal; barrier methods, including condoms, diaphragms, cervical caps, and spermicides; various types of oral contraceptives; injectables; IUDs; periodic abstinence; post-coital contraception; sterilization; and abortion. In addition, new developments in contraceptive research are discussed. The geographical focus is on the United Kingdom.
Fertility and family planning in Yugoslavia
This report contains the results of a project on fertility in Yugoslavia and an evaluation of family planning activities carried out by the Demographic Research Centre with UNFPA funding assistance between 1977 and 1979. Data are taken from a variety of official statistics, surveys, and published studies. The methodology of the various fertility surveys considered is first discussed. Separate chapters are then presented on fertility in Yugoslavia as a whole and in Bosnia-Herzegovina, birth intervals and maternal age at birth, fecundity of married couples, family planning, attitudes toward family size and abortion, demographic aspects of contraception, birth control by means of abortion, and medical aspects of contraception and abortion. Particular attention is paid to regional variations with regard to the topics discussed. This publication is also issued simultaneously in Serbo-Croatian.
Data concerning approximately 200 women who had induced abortions at an abortion clinic in Brussels, Belgium, in 1979 are presented and analyzed. The inadequacies of the data are first considered. Information is then provided on nationality, religion, marital status, occupation, educational level, residence, language, number of children, parity, age, reasons for abortion, period of gestation, complications, and contraceptive methods used. (ANNOTATION)
This work explores consequences of the decline of fertility to below replacement levels in the developed capitalist countries for 3 planning sectors: education, employment, and housing. The natality decline occurred in stages in different regions: from 1961-73 in North America, from 1964-76 in Northern and Western Europe, and since 1973-74 in Southern Europe and Japan. The total fertility rate fell below replacement level, but large fluctuations occurred in the number of births each year, which will have repercussions throughout the socioeconomic structure and the life cycles of the affected cohorts. Total educational enrollment, especially for the years of compulsory attendance, is determined by the size of cohorts and the rate of attendance. The lower the rate of attendance, the greater the possibility of compensating for declining cohort size by increasing enrollment rates. The size of the 6-11 year cohorts increased through the late 1960s in the overseas Anglo Saxon countries and until 1973-74 in Northern and Western Europe, subsequently declining regularly through 1984 or 1986, when they were smaller than in 1957. These age groups in Japan declined in size throughout the 1960s, grew again until the early 1980s and then renewed their decline. The decline was greatest in 1974-84, with the age groups shrinking by an average of 2.9%/year. In many countries in the 1980s the decline in numbers of school age children will probably be compensated to some extent by earlier school entrance and longer attendance, which may help alleviate youth unemployment. The need for educational facilities and teachers will not decline in proportion to the declining enrollment. The shrinking enrollments may allow an opportunity to redefine the role of the educational system within society. Despite the fact that new entrants into the work force during the next 2 decades have mostly been born, future labor force predictions are hazardous. It appears likely however that especially in countries such as West Germany and Japan, the customary surplus of entrants into the labor force over withdrawals will be replaced by a surplus of withdrawals over new entrants. More women and elderly workers may be attracted and retained in the labor force as a consequence of the reduced number of new entrants. A chronic lack of younger workers may result in reduction of mobility, blocking of career progress, and higher labor costs. In housing, it is likely that capital formation will be reduced, but other factors may compensate to some extent. Although fluctuations in numbers of births will create problems, they may stimulate attention to social change in a time when approaching stationary population is associated with a certain social stagnation.
Seminar on family welfare (planning) in India
These are the proceedings of a seminar on family welfare and family planning in India, held in Dharwad, India, on March 21-22, 1980. The 23 papers included are grouped under five substantive topics: characteristics of family planning acceptors; the effect of the family planning program on population growth, including case studies of Karnataka, Maharashtra, and West Bengal and a study of the effect of induced abortion; general aspects of the family planning program in India; health aspects, including integrated services, malaria, and urbanization; and social aspects, including knowledge of and attitude toward the program, the status of women, public participation, and the role of family planning as an instrument of social change.
Abortion and M.T.P. cases: a study of hospital admissions from 1971 to 1979
This paper is a study of incidence of abortion, spontaneous and induced, over a 9-year period (1971-79) in Jipmer Hospital, Pondicherry, India. There were 1958 cases of septic and spontaneous abortions with an average of 217/year. Septic abortions (425) constituted 21.7% of the total. Most of the septic abortions belonged to women in the age group 25-39, with the same age distribution of medical termination of pregnancy (MTP) cases while in spontaneous abortions there were 71% in age group 15-29. 80% of the septic abortion cases came from rural areas, 70% of MTP cases; 70% of septic abortion cases were 4th or more gravida, 70% of spontaneous births were 3rd or less. 80% of cases of septic abortions belonged to females in poor socioeconomic situations. Case fatality rate from septic abortion ranged from 8.9-23.2 with the average being 14.3. In the case of spontaneous abortions there were 2 deaths in 9 years; there were no deaths in spontaneous abortions and MTP cases.
[Voluntary interruption of pregnancy in the Europe of nine: the study day of October 23, 1979]
These are the proceedings of a one-day seminar held in October 1979 to examine the current status and extent of induced abortion in the nine countries of the European Community. Separate papers are included on Belgium, Denmark, the Federal Republic of Germany, Ireland, Italy, Luxembourg, the Netherlands, and the United Kingdom. The text of the appropriate legislation is included for selected countries, including France. (ANNOTATION)
This book, written by a physician who has been in the forefront of the struggle for safe, legal abortion in Canada, is aimed at raising the general public's knowledge of the facts and issues endemic to abortion and contraception. It begins with a clear, simplified overview of the biology of reproduction, embryonic development, and diagnosis of pregnancy which is intended to raise public debate on abortion to a more rational level. Subsequent chapters focus on the medical and psychological reasons for seeking abortion; the implications of restrictive versus liberalized abortion laws; a comparison of the different methods of abortion; the physical and emotional sequelae of the abortion procedure; and the legal, religious, and ethical aspects of abortion. The book concludes with a discussion of the various methods of contraception which is aimed at reducing the need for abortion. An appendix gives the text of the Canadian abortion law, and a glossary of terms is included.
Parental costs, role strain and fertility regulation: some Ghanaian evidence
The focus of this paper is on the parental and domestic roles of men with respect to resources, power, division of labor, and demographic issues. The data concern a sample of 398 male primary school teachers in Ghana. Factors related to differences in family size preferences, fertility behavior, aspirations for quality of children, infant mortality, and family planning are analyzed. (ANNOTATION)
Abortion and the early church: Christian, Jewish and pagan attitudes in the Greco-Roman world
Opposition to abortion was consistent and pronounced during Christianity's 1st 400 years. Early Christian writings on abortion stress 3 themes: 1) the fetus is a creation of God, 2) abortion is murder, and 3) God's judgment falls on those guilty of abortion. The influence of these views may have led to the 1st Roman antiabortion statutes, enacted in the 3rd century following widespread practice of abortion. In contrast to the utilitarian approach of the Romans, which stressed the rights of the state and the paterfamilias, the Christian perspective was based on the rights of the fetus as an independent living being. The Christian ethic was influenced by the love for life and hatred of bloodshed expressed in the Jewish Scriptures. Violence against the fetus became equated with violence against one's neighbor. Christianity did not at first distinguish between legal and ethical perspectives on the fetus. This lack of concern with legal definition led to a more blanket moral condemnation of abortion than is found in Judaism. The 1st ecclesiastical laws against abortion emerged in the 4th and 5th centuries. The Council of Ancyra meted out 10 years of excommunication for abortion and drew no distinction between formed and unformed fetuses. The theme of forgiveness of those who abort was later introduced. Contemporary evaluation and application of the beliefs of early Christians should be based on 4 questions: 1) Is the historical belief or practice based on Scripture? 2) Does it stand the test of universality? 3) Does it stand the test of time? and 4) Is the past situation analogous to the current situation? The early church offers contemporary Christians a model for a logical, consistent pro-life position which opposes all forms of violence. It is inconsistent for Christians to oppose abortion yet support the nuclear arms race. The reverse is also true. Early Christian literature is full of themes which could serve as a starting point for the development of a new ethic on behalf of the unborn.
Data are presented on induced abortions in the Federal Republic of Germany in 1982. Information is included on regional distribution, reasons for abortion, woman's age and marital status, period of gestation, type of procedure, complications, length of hospital stay, and the number of German women obtaining abortions in other countries. Some comparative data for earlier years are also included. (ANNOTATION)
[The demographic situation in 1981]
Statistics are presented on the demographic situation in France in 1981, together with selected data for previous years. Data are included on total population by department and region; population by sex, age, and marital status; natural increase; marriages; divorces; births; induced abortions; deaths, including infant mortality; trends and monthly variations in vital statistics; international migration; and population and natural increase by department and region. (summary in ENG, SPA) (ANNOTATION)
Significance of the 8th National Fertility Survey (National Survey on Marriage and Fertility)
A description of the 8th National Fertility Survey of Japan, which was scheduled to be conducted in June 1982, is presented. A brief analysis of recent fertility trends is first provided, and the methodology of the survey is outlined. The main topics covered by the survey include trends in marriage patterns; attitudes toward marriage, including age at marriage; factors affecting age at marriage; changes in marital fertility, fertility attitudes, and birth intervals; ideal family size; contraceptive knowledge among the unmarried; and induced abortion among the married.
[Projection of primary school enrollments for the Taiwan-Fukien area, 1983-1987]
A projection of the population of school age in Taiwan is presented for the period 1983 to 1987. Special emphasis is given to the effects of recent fertility trends on educational needs. The projections include information on "(1) births corresponding to each academic year, (2) the survival ratio from birth to age at entrance, (3) projections of the grade 1 enrollments, (4) estimates of median grade-to-grade progression ratios, (5) primary school enrollments at each grade, (6) annual increase of students, (7) annual increase in number of classes, and (8) annual increase of teachers." The implications for future government spending are considered. Changes in educational plans to conform to available resources are discussed. (summary in ENG) (EXCERPT)
The impact of fertility decline on the family is investigated from a social-anthropological perspective. The emphasis is on industrialized societies such as Austria. A general discussion of human reproductive behavior and its consequences for natural population change is presented in the first part of the book. The second part focuses on specific family-related topics, including the family as an institution, the family household, women's status, the child-rearing and economic functions of the family, consensual unions and divorce, and abortion. Conclusions are presented in the third section.
The Calcutta couples: a biosocial profile
This is a collection of eight papers concerned with various aspects of fertility behavior in Calcutta. Topics considered include the effects of occupation, religion, and language group on family planning; trends in the percentage of primiparous deliveries; seasonal variations in deliveries; sterilization acceptance; analysis of abortions performed after implementation of the Medical Termination of Pregnancy Act; changes in marital patterns; and fetal and neonatal mortality. (ANNOTATION)
[Abortion in tumor patients from a legal viewpoint]
Legal abortion is still punishable when there is insufficient justification. Abortion requires the patient's informed consent and authorized indication, assessment and preabortion counseling. Indications can be criminal or social (time limit up to 12th pregnancy week), eugenic (not more than 22nd week), and medical (no time limit). For tumor patients the indication is exclusively medical; lacking this indication (e.g. benign tumor or completely cured malignancy) the pregnant tumor patient is legally treated as any other pregnancy. Informed consent is predicated upon mental competence. The informed patient must fully understand the impact and risk of the procedure in relation to his own health and the rights of the fetus. This holds true also for minors; as long as there appears to be full understanding, the minor's consent alone is sufficient in a tumor-threatened pregnancy. The medical indication for tumor patients holds in that abortion is the only means to prevent endangerment to life, physical, and/or mental health; all other means must be exhausted. An additional social indication is the prevention of severe hardship to the woman when no other means of avoiding this are available. Any qualified physician (not only a gynecologist) may perform the procedure provided conditions for diagnosis procedure and aftercare are met. The procedure must be done in a hospital or authorized facility. The latter may be a physician's office or ambulatory care facility provided facilities for hospitalization are available when needed. According to law a physician is obligated to perform (or assist in) an abortion only when the procedure is necessary to prevent death or serious physical harm. In all other cases the physician may refuse to do this without explaining his motivation.
[English abortion clinics in a bind]
Since the liberalization of legal abortion in West Germany it is no longer necessary for German women to travel to England to have an abortion performed. This leaves about 60 private abortion clinics in England and Wales in economic straights forcing them to look for alternative means to remain financially afloat. They did so by shifting their business to France and Spain where abortion laws are less liberal (illegal in Spain and only up to 10th pregnancy week in France). Advertising these services is officially prohibited and therefore not advisable. Instead the clinics send commercial representatives who introduce themselves to the relevant organizations in France where they, more or less discreetly, extol the quality of British services. This dubious practice has come to light recently and has been published in a British and a French newspaper. This has resulted in an official inquiry which may lead to closure of many of these clinics. Further revenue may be lost due to special interest groups working to restrict legal abortion, the competition of Dutch clinics and liberalization of abortion internationally.
A test of fitness for presidential appointment?
The shape of policy reflects the concerns and biases of persons appointed to high office as well as those elected. The Conssitution acknowledges the importance of appointed officers. It requires the advice and consent of the Senate in the appointment of nearly all policymaking officials of the federal government. Thus, 2 points of access in the appointment process--the president's designation of a nominee and the Senate's confirmation of that nominee's appointment--provide opportunities for individuals who want to see their policy issues reflected in personnel selection. A question that arises with the appointment process is what constitutes fitness for office. Constitutional theory and legal debate have provided no consensus on the determinants of "fitness;" 200 years of political practice have. Given the absence of compelling requirements to do otherwise, the politicians who have controlled the appointment process have shown little reluctance to treat policy considerations--including the policy preferences and personal opinions of potential appointees--as perfectly acceptable tests of fitness to serve. Participants in the appointment process frequently have declared themselves concerned only with the competence and integrity, and not with the political philosophy, of presidential appointees, but these claims are little more than lip service. It is only since the 1976 election that the issue of abortion has begun to have an effect on the appointment process, and it is uncertain how large and consequential role abortion will come to have in the appointment process. Thus far, its impact has been limited to a few notable but not unmanageable appointment controversies. Its unlikely that that will continue to be the case in the future. The abortion issue has become increasingly prominent in national policies, with advocates on both sides broadening their search for avenues of influence. The appointment process has come to be recognized as one of those. It is likely that more people will attempt to exploit it to their advantage in the future. If that happens, the future effectiveness of the appointment process may be jeopardized by contention over nominee's views on abortion. The primary jeopardy is that agreement on appointments may become so elusive that administrative and judicial positions may remain vacant for long periods, or that those who survive the appointment process and fill them may be so damaged by the effects of that process as to be unable to perform effectively in office. The plea here is for caution and realism.
A representative sample of the members of the Canadian Medical Association (CMA) were surveyed to determine physicians' opinions on the law that currently regulates the provision of abortion services and on how physicians think such services should be provided, regardless of the law. The questionnaires were mailed to a systematically stratified sample that included 1/5 of the members of the CMA, with the exception of undergraduate medical students and members living outside the country. A total of 1762 responses were received, a response rate of 79.7%. 1653 questionnaires are the basis of the analysis. Responses to the question as to whether abortions should be performed at the woman's request during the 1st trimester of pregnancy were evenly divided. There was support for abortion on socioeconomic grounds during the 1st trimester, from 61.5% of the physicians. Abortion beyond the 1st trimester was supported by a majority of the respondents only in cases in which the woman's life is in danger (73.9%) or in which there was evidence of a severe physical abnormality in the fetus (70.6%) or in cases in which the woman's physical health was in danger (55.5%). Physicians who indicated that they would not support abortion under any circumstances constituted, at most, 5.1% of the respondents. Support for the maintenance or the elimination of therapeutic abortion committees was addressed in 2 questions and in both instances the respondents were evenly divided. The responses to these 2 questions were compared and found to be logically consistent. Only physicians should perform abortions and they should be performed in hospitals with the woman either as an inpatient or during the 1st trimester as an outpatient. The performance of 1st trimester abortions in provincially approved abortion clinics was supported by 47.3% of the respondents. Of those 885 respondents who wanted to see some amendment of the Criminal Code, 409 stated that the term "health" as used in the Criminal Code relative to the legal grounds for therapeutic abortion should be defined. An appendix discusses age, sex, region, and type of practice of the physicians.
Moral dilemmas that are acute within a religious tradition. A Jewish perspective.
A person faces a moral dilemma when he/she has to choose between 2 morally good alternatives that are incompatible. 5 problems that seem to typify the acute moral dilemmas that are the subject of onging controversy within the Jewish community are identified and discussed. These problems are the subject of controversy not only between rabbis of different denominational or ideological religious movements in Judaism but even within each individual religious movement. An attempt is made to demonstrate the processes of ratiocination that lead some Jewish thinkers to take 1 position and others to take another position. As Tay Sachs disease occurs with a statistically greater frequency among Ashkenazic Jews than among any other group in the US population, the question is whether an effort should be made to contain this disease by lowering the frequency of Tay Sachs births. Although some Tay Sachs screening has been done in a number of communities, there has been sharp controversy as to whether screening that appears designed to achieve a good end does not also produce objectionable results, such as deep anxieties among the young people involved. Another problem is whether people should be deprived of the experience of marriage because they are mentally retarded, yet should the pool of retarded persons be increased. The problem of an affected newborn infant--one with spina bifida or Down's syndrome--who needs medical intervention for treatable problems is not so much a dilemma within Judaism but a conflict between the views of most Jewish thinkers and some of the prevalent ideas and practices in US culture. The painful dilemma is that if a couple has an affected newborn, should it be allowed to die to relieve the infant of years of pain and suffering, the parents of their painful burden, and society of its costs, or should there be adherence to the inflexible commitment to life that Judaism teaches. Considerable controversy exists among rabbinical authorities regarding the definition of death. Progress in medical technology has raised new ethical problems. The final controversial issue concerns prenatal diagnosis and amniocentesis. In Orthodox Judaism abortion is forbidden because the fetus is potential human life. It is not yet actual human life. When the pregnancy or the impending birth threatens the mother's life, it is mandatory to perform an abortion to save the mother's life. Amniocentesis can be viewed as a passageway to life, rather than as a gateway to abortion. In 95% of cases amniocentesis confirmed the presence of a healthy fetus.
Abnormal prolactin secretion in men and women.
Despite the advances that are cited to account for the expanding knowledge of prolactin secretion in women, normal and abnormal prolactin secretion in men continues to be a mystery. The physiological role of prolactin in men is unknown, but hyperprolactinemia is associated with a characteristic if rare endocrine syndrome. As of now, less than 100 cases have been carefully described. Yet, despite its rarity, the condition is important because the associated symptomatology is highly distressing and readily curable. To characterize the syndrome, a group of 29 men specifically selected because they had hyperprolactinemia and pituitary tumors were studied some years ago. Many of these patients had very long histories of their presenting complaints. Most had large pituitary tumors, and in 20 of the 26 who had lumbar air encephalography there was evidence of supra sellar extension. The clinical features mainly concerned the reproductive system. 17 complained of complete lack of libido and impotence and 6 complained of impaired libido and potency. Several gave a history of long term psychiatric treatment for sexual dysfunction and divorce and unhappy marriages were common. On examination there were often features of hypogonadism and the association of gynecomastia with small testicles had on occasion initially suggested a diagnosis of Klinefelter's syndrome. Endocrine investigation produced the following results: there was a clear association of impotence with the degree of hyperprolactinemia and the extent of suppression of testosterone secretion. Plasma testosterone concentrations were usually below normal in the impotent men and in some were actually in the prepubertal range. Despite this profound testosterone deficiency, the plasma concentrations of luteinizing hormone (and of follicle stimulating hormone) and their response to gonadotrophin releasing hormone were usually in the normal range. In regard to management, it is hoped that earlier recognition will improve the outcome and that anatomical regression of large pituitary tumors can be achieved by treatment with bromocriptine alone without the risks of hypopituitarism. In women the hyperprolactinemic syndrome is usually associated with amenorrhea. Symptomatically it is usually dominated by the consequences of estrogen deficiency, so that complaints of dyspareunia and dryness during intercourse are common. Libido is often lost. Galactorrhea is unusual. Some women with hyperprolactinemia have anovulatory menstrual cycles or impaired luteal phases. Hyperprolactinemia accounts for 20% of cases of amenorrhea. 40% of cases have pituitary tumors and about 10% of the pituitary tumor cases have supra sellar extension. Recently the long term outcome of treatment of hyperprolactinemia was studied. It was found that 14 of 36 cases of hyperprolactinemia that were treated by suppression of excessive secretion were "cured," that is, after discontinuing bromocriptine they maintained their ovulation cycles and had normal serum concentrations of prolactin. The only feature predictive of a cure was the pretreatment serum prolactin concentration.
Medical treatment of hyperprolactinemic states.
Current experience with bromocriptine and metergoline treatment of tumorous and idiopathic hyperprolactinemic disorders is reported in an effort to resolve some of the identified problems. Independently of the mechanisms that mediate the effects of the different prolactin (PRL) lowering drugs currently available, unresolved clinical problems in the medical treatment of hyperprolactinemic states include: choice of the drug and dose; risks of drug induced pregnancy; effects of drug treatment of PRL secretory dynamics; and effects of long term drug treatment on the disease process. 133 hyperprolactinemic women were studied and treated with PRL lowering drugs. The clinical presentation was secondary amenorrhea, with or without galactorrhea, in 108 cases, primary amenorrhea in 2, anovulation in 18, and isolated galactorrhea in 5. 2 patients also had acromegaly. Thyroid and adrenal function were normal in all subjects. After the initial evaluation, the patients were treated for 2-30 months with either bromocriptine or metergoline. 39 subjects were given separate courses of each drug. Treatment effectiveness was evaluated on clincial grounds and by measuring serum PRL concentrations at monthly intervals and serum progesterone in the presumed luteal phase whenever possible. The following were among the study findings: drug treatment reduced serum PRL levels toward the normal range and restored gonadal function in most hyperprolactinemic patients; bromocriptine appeared to be the most uniformly effective drug; metergoline was an excellent alternative which may sometimes be preferred for its lower incidence of side effects; the relatively lower success rate of metergoline may be dose related rather than drug related; the drug dose must be individualized because some patients are resistant to the PRL lowering action of the conventional doses; drug induced pregnancy carried little risk to either mother or fetus except for patients with pituitary macroadenomas; PRL secretory dynamics remained abnormal during PRL lowering treatment in most cases despite normalized basal levels; after drug withdrawal, cyclic menses and sometimes ovulation may persist for several months, but PRL levels rebound toward pretreatment values in the great majority of patients within 2 months; and as yet no signs of tumor shrinkage have been observed in patients treated for up to 2 years with either bromocriptine or metergoline.
365 patients who attended an endocrine-infertility service between January 1970-July 1980 were studied. The group was divided as to whether their amenorrhea occurred after using oral contraceptives (OCs) or whether it was unrelated to drug usage. Serum samples were obtained from all patients for follicle stimulating hormone (FSH) and luteinizing hormone (LH) determinations. At the initial visit 100 mg of progesterone in oil was administered intramuscularly (IM). Those patients who had no withdrawal bleeding within 2 weeks of the initial injection received an additional 200 mg. Of 100 patients who asked to conceive, 80 were treated with clomiphene citrate beginining at 50 mg/day for 5 days and then, if ovulation did not occur, the dose was sequentially increased in 50 mg/day increments to a maximum of 250 mg/day for 5 days. 30 patients who had amenorrhea and galactorrhea were tested with 2-Br-alpha-ergocryptine and 36 of those who did not ovulate following treatment with the highest dose of clomiphene plus HCG received Human Menopausal Gonadotropins (HMG)-HCG. Of the 64 with amenorrhea without galactorrhea 65.6% had uterine bleeding after IM progesterone administration. Patients with post OC amenorrhea have some characteristics similar to, and some different from, those of patients with secondary amenorrhea unrelated to OCs in that both have a large incidence of oligomenorrhea but only post OC users have galactorrhea and hyperprolactinemia. OCs were found to be linked with a risk of amenorrhea and galactorrhea and can stimulate the growth of a dormant pituitary microadenoma. Also the incidence of radiologic evidence of pituitary tumors was significantly higher in the post OC galactorrhea group than the amenorrhea-galactorrhea group not associated with OC use. High percentages of women in both groups had evidence of estrogen deficiency, in the post OC group 47.6% and in the non OC group 41.5%, but etiology was different in each group. The response to ovulation-inducing drugs was similar in the 2 groups with all but 1 of the 30 patients who received bromocryptine ovulating and all 36 who received HMG having ovulatory response. There was no significant difference in ovulation rates when the patients who had withdrawal bleeding following progesterone were compared. The optimal method of ovulation induction is best selected by determining whether the patient has galactorrhea and if there is evidence of estrogen deficiency as determined by failure, to have progesterone-induced withdrawal bleeding.
Attention in this discussion of the hirsute female is directed to the following: factors influencing hair growth (plasma androgens in hirsuitsm, sex hormone binding globulin--SHBG--in hirsutism, sources of androgen production in hirsutism, ovarian function in hirsutism, hyperprolactinemia and hirsutism, and calcitonin and hirsutism); investigation of hirsutism; and management of hirsutism. With the exception of the eyelashes and eyebrows, most other terminal pigmented body hair growth is androgen dependent. Observations of patients with male pseudohermaphroditism--both testicular feminization and 5a-reductase deficiency--have delineated testosterone and dihydrotestosterone dependent areas. The former, such as the lower pubic and axillary areas, are common to both sexes and reflect normal hair growth. Such dihydrotestosterone areas as the beard, the course hair of the trunk and limbs, and upper abdominal hair are normally present only in the male. In the hirsute female, the primary abnormality appears to be an increase in androgen production. This probably accounts for the increased utilization of androgens in the skin of hirsute women compared with normals, which might otherwise tend to suggest a primary skin abnormality. It has also been suggested that a relative deficiency of estradiol leading to a reduced estradiol/testosterone ratio may contribute to hirsutism by potentiating the effects of testosterone on hair growth. Wherever this is ever a primary phenomenon in hirsutism has not been established, but estrogen administration has been shown to inhibit the initiation of hair growth in animals. The fact that women occasionally complain of hirsutism at the menopause may be related to the decrease in circulating estradiol which occurs after ovarian failure. The goals of investigation should be to define an endocrine abnormality and to discover the reasons for an associated problem such as infertility. It also may be helpful to obtain a set of endocrine parameters as a baseline for any proposed therapy. When hirsutism is mild, local treatment alone may suffice. The goal of drug therapy should be 3 fold: to reduce the increased androgen production rate; elevate SHBG levels and thus increase the binding of testosterone and dihydrotestosterone, and reduce the growth rate of hairs in the follicle. A major problem of some therapies is that while they may decrease the androgen of some therapies is that while they may decrease the androgen production rate they have little or no effect on the growth of hair itself, which may be very variable and take place over very long cycles. Overall improvement in hirsutism has not been particularly encouraging.
Endocrinology of dysfunctional uterine bleeding: the role of endometrial prostaglandins.
This paper reviews the hormonal requirements for normal menstruation and the endocrine background of some of the common syndromes associated with dysfunctional uterine bleeding (DUB), and reports studies of the synthesis of prostaglandins (PGs) in the uteri of women with DUB. Normal ovarian function is totally dependent on adequate gonadotropin support from the anterior pituitary. As the levels of estradiol and progesterone decline during luteal regression, the endometrium degenerates and separates and menstrual bleeding starts, but the mechanism by which their withdrawal causes menstruation is unkown. Considerable evidence, described here, has accumulated to implicate PGs in the mechanism of menstruation. According to 1 rather speculative model, as levels of progesterone fall, free arachidonic acid is liberated from phospholipids under the influence of phospholipase enzyme. The main product of arachidonic acid metabolism in late secretory endometrium is PGF2alpha, which causes vasoconstriction and is probably responsible for the intense spasm of the spinal arterioles that precedes menstruation. PGF2alpha drains back to the myometrium via the venous drainage system causing the uterine contractions of menstruation. The maintenance of patency of the arterioles and the inhibition of vascular coagulation response could be due to release of PGI2 synthesized in the intima of the vessel wall from endoperoxides carried to the myometrium from the endometrium. Women with DUB fall into 2 general classes, the anovulatory associated with an inadequate signal such as occurs in polycystic ovary syndrome or insufficient follicle development, or with impaired positive feedback; and the ovulatory, associated with an inadequate or insufficient luteal phase or with idiopathic causes. The clinical conditions and endocrine bases of these disturbances are described. It is suggested that adequate vascular control of blood loss at menstruation is dependent on a pattern of PG production which favors PGF2alpha; the optimal hormonal conditions for PGF2alpha synthesis appear to be priming of the endometrium with both estrogen and progesterone. In the absence of progesterone the markedly reduced PGF2alpha/PGE2 ratio may account for the uncontrolled bleeding and absence of uterine cramps that occur in anovulatory cycles. If the hypothesis presented above regarding PGI2 synthesis is correct, the amount of menstrual blood loss would depend on the balance between PGF2alpha on the 1 hand and PGI2 and PGE2 on the other.
Statistics relating to legally induced abortions within England and Wales during 1980 are presented. The tables present information on the following: legal abortions; statutory grounds; operation; complications; deaths; geographic factors; and medical. In 1980 a total of 160,903 legal abortions were performed. 89,470 abortions were performed on unmarried women, 53,452 on married women, 16,393 on widowed/divorced/separated women with the marital status unknown for 1588 women. 1077 abortions were performed on women under age 15, 3066 on women age 15, 37,120 on women aged 16-19, 43,676 on women 20-24, and 29,020 on women 25-29, 23,994 on women 30-34, 15,511 on women 35-39, 6335 on women 40-44, 683 on women 45 and older, and the age not stated in 421 cases. There were 2 cases of sepsis reported for hysterotomy and hysterectomy performed under 9 weeks' gestation, 5 when performed at 9-12 weeks' gestation, and none at 13-16 weeks gestation. There was 1 case of hemorrhage reported for hysterotomy and hysterectomy performed under 9 weeks' gestation, 6 when performed at 9-12 weeks' gestation; and 1 when performed at 13-16 weeks' gestation. There were no complications reported for hysterotomy and hysterectomy performed under 9 weeks' gestation, 14 at 9-12 weeks, and 2 at 13-16 weeks. There were 2 cases of sepsis in vacuum aspiration procedures performed under 9 weeks' gestation, 1 case of hemorrhage, and 10 other complications. At 9-12 weeks with the vacuum aspiration procedure 7 cases of sepsis, 12 of hemorrhage, and 27 other complications were reported. For 13-16 weeks there were no cases of hemorrhage and 6 other complications reported for vacuum aspiration. With dilation and evacuation, there were 3 cases of other complications when the procedure was performed under 9 weeks, 1 case of hemorrhage and 2 of other complications when performed at 9-12 weeks, and 2 cases of hemorrhage and 6 of other complications when performed at 13-16 weeks. For the vacuum aspiration procedure with dilation and curettage there were 3 other complications when performed at under 9 weeks' gestation, 4 cases of sepsis and 4 of other complications when performed at 9-12 weeks, and 1 case of hemorrhage and 1 of other complications when performed at 13-16 weeks. For other procedures there was 1 case of hemorrhage when performed at under 9 weeks' gestation, 1 other complication when performed at 9-12 weeks, and 2 cases of hemorrhage and 3 of other complications when performed at 13-16 weeks.
Midtrimester abortion by hypertonic saline instillation experience in Ramathibodi Hospital.
A retrospective study of midtrimester abortions using the intraamniotic instillation of hypertonic saline solution was conducted. All 62 cases admitted to the Ramathibodi Hospital in Bangkok, Thailand for midtrimester abortion in 1980 were terminated by intraamniotic hypertonic saline instillation. The pregnancies were unwanted in 32 (51.6%) of the cases because of family problems, poor socioeconomic status, and deteriorated psychological health. 15 cases (24.2%) were preganancy from rape; 9 (14.5%) had rubella infection during the 1st trimester; and 3 cases (4.8%) were mentally retarded. There was 1 case of renal staghorn calculi post nephrostomy, 1 of multiparity with history of hemophilia in the family, and 1 of failed IUD contraception. The women were between 16-25 years of age in 39 cases, aged 15 or under in 4 cases (6.5%), and over age 35 in 4 cases. In 49 cases (79%) abortion was performed during 16-20 weeks gestation, in 12 cases (19.1%) at 21-24 weeks, and in 1 case at 25 weeks of gestation. The time interval from hypertonic saline instillation to abortion was analyzed in order to evaluate the effect of parity, amount of amniotic fluid withdrawn, and oxytocin augmentation. The mean instillation to abortion time (I-A) was 30.19 +or- 11.25 hours. There were 3 cases which did not receive oxytocin and who spontaneously aborted within 24 hours. Among cases which received oxytocin augmentation, there were 9 who received oxytocin immediately after instillation and 50 who received it 18-24 hours later. The I-A time was 31.22 +or- 11.63 hours in the group that received oxytocin immediately and 31.09 +or- 10.68 in the group receiving it later. There was no statistical difference between the 2 groups. Among the 50 cases which received oxytocin augmentation 18-24 hours later, there was no statistical difference between groups of nulliparity and multiparity. There were 46 cases in which the amount of amniotic fluid withdrawn was noted. In the group in which more than 200 ml of amniotic fluid was withdrawn, the I-A time was 26.81 +or- 7.28 hours. In comparison to the group in which less than 50 ml of amniotic fluid was withdrawn, the I-A time was 28.88 +or- 16.24 hours. There was no statistical difference between the 2 groups. The longer I-A times were found in groups in which 51-1000 ml and 151-200 ml of amniotic fluid were withdrawn. The most common complication was retained placenta (8 cases). There was only 1 case of hemorrhage. There were 2 cases of fever and 1 case of nausea and vomiting. On follow-up of 46.8% of the cases, 2 cases of cervicitis and 3 cases of vaginitis were found and treated with antibiotic suppositories. (summary in THA)
The effectiveness of intrauterine instillation of solutions for midtrimester abortions is well established, but the mechanism for triggering the onset of labor is unclear and represents a challenging problem for obstetricians and physiologists. Vaginal cytology reflects the hormonal status. Of the total of 78 cases in this study,