[Medical and sociocultural barriers and contraception] Barreras medicas y socioculturales y anticoncepcion.
Over half of couples in developing countries lack access to family planning services and are at risk of unwanted pregnancy, illegal abortion, and maternal mortality. Improvement of the reproductive health and quality of life of couples are considered the main goals of family planning. Barriers hampering access to family planning may be of many kinds. Among the most frequent medical barriers are prohibition of oral contraceptives (OCs) to women over 35, limitation of progestin-only OCs to breast feeding women, delaying initiation of use by waiting for a menstrual period or a prolonged postpartum interval, and requiring unnecessary laboratory tests or an excessive number of visits. Extensive application procedures for sterilization, exaggerated contraindications in establishing age or parity limits for specific methods, and excessive requirements for family planning personnel, such as restricting prescription of OCs or insertion of IUDs to physicians, constitute other barriers. Many medical barriers to family planning originate in a lack of adequate information among program officials and failure to recognize outdated or erroneous information, such as the belief that OCs increase risks of gynecological cancers. Peruvian family planning legislation regards abortion and sterilization as similar when in fact they are not. Among steps to reduce barriers to family planning should be improved provision of information to health workers and the general population, increasing the variety of methods available, improving access to family planning, revising standards and norms of care as necessary, and improving the quality of services.