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Washington, D.C., World Bank, 1989. 55 p. (World Bank Technical Paper No. 102)After a brief explanation of the impact of breastfeeding on fertility worldwide, inaccurate assumptions about the decline of breastfeeding are explored to point out the need for renewed promotion of breastfeeding by World Bank projects. Breastfeeding, by inhibiting fertility through lactational anovulation, is one of the most important determinants of fertility, especially for 83% of couples in developing countries who do not use modern contraception. Many believe that breastfeeding does not need promoting in areas where it is the norm, yet this belief does not take into account the need for supporting breastfeeding women, teaching them to breastfeed exclusively and frequently for the 1st 4 months. The belief that declines in breastfeeding are inevitable is belied by recent evidence in developed countries. The reliability of breastfeeding as a contraceptive for individual women varies: poor, undernourished women who breastfeed extensively may be protected up to 21.7 months (Bangladesh). Advantages of breastfeeding include significant savings of money, foreign exchange, scarce contraceptive supplies, medical treatment of diarrhea and malnutrition in infants, and possibly mothers' time. In contrast, other caregivers can prepare milk substitutes, but breastfeeding can be encouraged in the work setting, or milk expressed for later use. A review of 68 World Bank Projects revealed that 37% of all Population, Health and Nutrition projects, enumerated in an appendix, contained explicit actions to promote breastfeeding. 10 recommendations for promoting breastfeeding end the report.
Design of studies for the assessment of drugs and hormones used in the treatment of endocrine forms of female infertility.
In: Diczfalusy, E., ed. Regulation of human fertility. (Proceedings of the WHO Symposium on Advances in Fertility Regulation, Moscow, USSR, November 16-19, 1976) Copenhagen, Denmark, Scriptor, 1977. p. 135-154The lack of uniformity in diagnostic selection of women for treatment of infertility, in choice of therapy, in monitoring of therapy, and in follow-up, frequently does not allow a meaningful comparison of results reported from different centers. To design studies assessing effectiveness of therapy of endocrine forms of female infertility, it is essential to consider: 1) mechanism controlling reproductive functions (e.g., process of ovulation); 2) cause(s) responsible for infertility (mechanical factors, ovarian failure, and pituitary failure); and 3) the mechanism of action of agents used for therapy (e.g., gonadotropins stimulate gonadal function, clomiphene stimulates gonadotropin secretion, and ergoline derivatives inhibit prolactin secretion). Patients selected for therapy should be grouped according to etiology: 1) hypothalamic-pituitary failure; 2) hypothalamic-pituitary dysfunction; 3) ovarian failure; 4) congenital or acquired genital tract disorder; 5) hyperprolactinemic patients with a space-occupying lesion in the hypothalamic-pituitary region; 6) hyperprolactinemic patients with no space-occupying lesion; and 7) amenorrheic women with space-occupying lesion. Ideally, an infertile couple should be diagnosed and treated as a unit.