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World Health Organization Technical Report Series. 1981; (670):1-120.This report includes the collective views of a World Health Organization (WHO) Scientific Group on Research on the Menopause that met in Geneva during December 1980. It includes information on the following: 1) the endocrinology of the menopause and the postmenopausal period (changes in gonadotropins and estrogens immediately prior to the menopause and changes in gonadotropin and steroid hormone levels after the menopause); 2) the age distribution of the menopause (determining the age at menopause, factors influencing the age at menopause, and the range of ages at menopause and the definition of premature and delayed menopause); 3) sociocultural significance of the menopause in different settings; 4) symptoms associated with the menopause (vasomotor symptoms, psychological symptoms, disturbances of sexuality, and insomnia); 5) disorders resulting from, or possibly accelerated by, the menopause (osteoporosis, atherosclerotic cardiovascular disease, and arthritic disorders); 6) risks, with particular reference to neoplasia, of therapeutic estrogens and progestins given to peri- and postmenopausal women (endometrial cancer, breast cancer, and gallbladder disease); 7) fertility regulating methods for women approaching the menopause (fertility and the need for family planning in women approaching the menopause, problems of family planning in perimenopausal women, and considerations with regard to individual methods of family planning in women approaching the menopause); and 8) estrogen and the health care management of perimenopausal and postmenopausal women. At this time some controversy exists as to whether there is a menopausal syndrome of somatic and psychological symptoms and illness. There are virtually no data on the age distribution of the menopause and no information on its sociocultural significance in the developing countries. The subject of risks and benefits of estrogen therapy in peri- and postmenopausal women is of much importance in view of the large number of prescriptions issued for this medication in developed countries, which indicates their frequrnt use, and the different interpretations and opinions among epidemiologists and clinicians on both past and current studies on this subject. Specific recommendations made by the Scientific Group appear at the end of each section of the report. The following were among the general recommendations made: WHO sponsored research should be undertaken to determine the impact on health service needs of the rapidly increasing numbers of postmenopausal women in developing countries; uniform terminology should be adopted by health care workers with regard to the menopause; uniform endocrine standards should be developed which can be applied to the description of peri- and postmenopausal conditions and diseases; and descriptive epidemiological studies of the age at menopause should be performed in a variety of settings.
London, England, International Planned Parenthood Federation [IPPF], 2001 Jun. 28 p.This International Planned Parenthood Federation Advocacy Guide focuses on the application of advocacy to HIV/AIDS prevention. Specifically, this booklet concerns the protection of human rights to safeguard human dignity in the context of HIV/AIDS and to ensure an effective, rights-based response to HIV/AIDS. Other topics are promotion of male and female condom for dual protection against sexually transmitted disease/HIV/AIDS and unwanted pregnancy; and educating children and young people on sexual and reproductive health issues, including HIV/AIDS. It addresses advocacy for different groups of people at higher risk, such as the sex workers, injecting drug users, men who have sex with men, migrants and refugees, armed forces, and prisoners.
[World Health Organization (WHO) eligibility criteria for oral contraceptive use. Part 2] Criterios de la OMS de elegibilidad para el uso de anticonceptivos(segunda parte).
BOLETIN INFORMATIVO. 1996 Nov-Dec; (26):4-9.New medical criteria for IUDs and barrier methods defined by the World Health Organization in 1995 to reflect development of safer methods are presented. Health conditions are classified into four categories. Category 2 conditions need not restrict use of a method but should be considered when a method is chosen. Category 3 conditions require careful consideration of the gravity of the case, the availability of alternative methods, and access to emergency services, as well as careful follow-up. Many conditions that had been considered contraindications to IUD use are no longer regarded as risk factors with copper IUDs. Use is unrestricted for women over 20, smokers, the obese, lactating women, those with a history of preeclampsia, ectopic pregnancy, epilepsy, diabetes, and many other conditions. Age under 20 and nulliparity are category 2 conditions because of the risk of expulsion. Severe menstrual bleeding, under 48 hours postpartum, uterine-cervical abnormalities not deforming the uterus, and a few other conditions are in category 2. Category 3 conditions in which risks outweigh advantages include 48 hours to 4 weeks postpartum, benign gestational trophoblastic disorders, elevated risk of HIV/AIDS or HIV infection. Category 4 conditions precluding use of IUDs include pregnancy; puerperal sepsis or septic abortion; uterine abnormality incompatible with insertion; vaginal bleeding of unknown cause; gestational trophoblastic malignancy; cervical, endometrial, or ovarian cancer; pelvic tuberculosis; and sexually transmitted disease within three months. Almost all conditions are in category 1 and none are in category 4 for use of barrier methods, but their relatively high failure rates should be kept in mind. Allergy to latex is a category 3 condition for condoms and diaphragms and history of toxic shock syndrome is a category 3 for diaphragms.
International Planned Parenthood Federation medical and service delivery guidelines for family planning.
London, England, International Planned Parenthood Federation [IPPF], 1992. xviii, 169 p.The International Planned Parenthood Federation has developed these guidelines to help persons working in family planning services and education ensure adequate levels of quality of care. The guidelines conform to the three dimensions of technology assessment needed for any project: it must be scientifically, socially, and operationally sound. Providers should adapt the service delivery guidelines to local realities. They should consider the needs and resources of the various sites in which the guidelines will be applied. The guidelines can also be developed into educational and training materials. They serve as a guide to the delivery of family planning services, a reference document for assessing quality of care, a training instrument, and a tool for supervision. The first chapter addresses the rights of the client, ranging from the right to information to the right of opinion. The second chapter is dedicated to contraceptive counseling, while chapter 3 is dedicated to family planning training. Chapter 4 discusses hormonal contraception (combined oral contraceptives, progestagen-only pills, service management, progestagen-only injectables, and the subdermal implants, Norplant). IUDs are covered in detail in chapter 5. The barrier methods addressed in chapter 6 include condoms, diaphragms, cervical caps, and spermicides. Chapter 7 covers both male and female voluntary surgical contraception. Natural family planning methods are addressed in chapter 8 entitled Periodic Abstinence. These methods include the basal body temperature method, the cervical mucus method (Billings method), the calendar or rhythm method, and the sympto-thermal method. The guidelines conclude with a detailed statement on diagnosis of pregnancy and a list of suggested reading material.
IPPF MEDICAL BULLETIN. 1990 Apr; 24(2):2-4.Breast milk provides infants with their nutritional requirement plus antibodies to combat certain infections. Prolonged breast feeding and concurrent postpartum amenorrhea contribute to natural infertility, but considerable variability occurs among different populations. Further, certain variables exist that contribute greatly to the length of amenorrhea and infertility. They include nutritional status of the mother; length of breast feeding; giving supplements to the infant; frequency and duration of suckling; and geographic, social, and cultural factors. Many studies indicate that the longer a woman breast feeds, the longer she will experience amenorrhea. Anovulation is contingent on the frequency and distribution of nursing episodes day and night and the time of the infant feeds at the breast. Feeding an infant supplementary milk or food also reduces the inhibitory affect of breast feeding on ovarian activity and fertility, especially when supplements are introduced early. Educating mothers about the value of child spacing, breast feeding, maternal nutrition, and contraception should be done during pregnancy and the postpartum period, the times when mothers most often visit health clinics. Mothers should also be informed that it is not possible to anticipate how long they will be infertile while breast feeding, so contraceptive use should be encouraged. If possible, nursing mothers should avoid using hormonal contraceptives because they can interrupt lactation or pose a risk to the infant. IUDs are highly efficacious. If a woman is in a hospital to deliver, postpartum sterilization is another option. Barrier methods are effective, if used regularly, especially during this time of reduced fertility. Since the reoccurrence of menses is unpredictable and the efficacy is not know, nursing mothers should not rely on periodic abstinence.
Geneva, Switzerland, WHO, 1987. vii, 80 p.This WHO manual on barrier contraceptives and spermicides covers all methods, their effectiveness, advantages and disadvantages, non-contraceptive advantages, uses in special cases, family program considerations, the logistics of supply, monitoring shelf-life and quality control, and application of condoms in AIDS prevention programs. Condoms and foaming tablets are the most appropriate methods for developing countries, especially those in the tropics. Other methods present problems such as expense (diaphragms, foams, sponges), unavailability outside the U.K. and U.S. (caps, sponges), bulk and expense (canned foams). Certain individuals are particularly good candidates for barriers and spermicides: lactating women, people using abstinence or natural family planning, adolescents, older women, women waiting to start using other methods, and those at risk for contracting sexually transmitted diseases. Program officials should consider providing supplies in their special environments, with limitations such as transport, reliability of shipments, storage requirements, cultural sensitivity, multiple outlets for supplies, and cost both to the program and to the users. Methods of insuring steady supply and techniques of testing condoms are described. Barrier methods, condoms in particular, help stop the spread of gonorrhea, syphilis, Chlamydia, Candida, Trichomonas and HIV. An appendix describes basic information about AIDS and the relevance of barriers and spermicides, as well as monogamy and abstinence, in preventing AIDS transmission. Other appendices list sources of supply for developing countries, addresses of manufacturers and sources of further information, techniques for using these methods, and teaching methods for illiterates and semi-illiterates.
AIDS WATCH. 1988; (1):8.In 1987 the African Family Planning Associations (FPAs) requested 7 million condoms from the International Planned Parenthood Federation Aids Prevention Unit to meet their additional requirements for condoms as they work to incorporate Acquired Immune Deficiency Syndrome (AIDS) and human immunodeficiency virus (HIV) prevention into their programs. The FPAs that anticipated the greatest increase in demand were Ethiopia, Kenya, and Zimbabwe, none of which received any condoms via IPPF channels during 1986. One of the IPPF AIDS Prevention Unit's 1st steps has been to prepare a manual to help senior staff to plan their action programs. The manual covers counseling, training, service delivery, health education, and youth. Both an illustrated booklet for FPA field workers and a video currently are in production. The IPPF AIDS Prevention Unit, established in June 1987 with funds from the British Overseas Development Administration, will be giving regular reports on its activities in "AIDS Watch".
Lancet. 1985 May 4; 1(8436):1046.As part of a study on acute febrile pelvic inflammatory disease and IUDs, reported elsewhere, a significantly lower risk of PID was observed in women using injectable contraceptives. The World Health Organization coordinated the multinational case-control study in 1979-79. Diagnostic criteria were fever, suprapubic tenderness with guarding, cervical or adnexal tenderness or a pelvic mass. 319 cases and 639 matched controls were matched for age, parity, marital status and hospital status. Data were taken from questionnaires. 10 cases (3.1%) currently used injectable contraceptives, mainly Depo-Provera, compared to 38 controls (6.0%). Thus the risk of getting PID was half as great among injectable users, similar in magnitude to risks reported for women using oral contraceptives, barrier methods and sterilization in developing countries.
[Unpublished] 1987 Jun. 2 p.The provision of condoms is an integral part of the strategy for control of acquired immunodeficiency syndrome (AIDS) being developed by the US Agency for International Development (AID) in conjunction with the World Health Organization (WHO). Condoms are now available from USAID for AIDS prevention activities, and data are being collected to help prioritize condom requests and maximize effective distribution on a worldwide basis. It is expected that condom distribution will be most effective in cases where condoms are provided to those at highest risk of AIDS transmission through an effective service delivery system with adequate storage and logistical support. AIDS prevention efforts should be coordinated with WHO efforts whenever possible. Logistical support is especially important since AIDS is prevalent in many countries with weak public health infrastructures and limited experience in providing condoms. An AIDS technical support program now being developed by USAID will assist in this area. Further analysis is required to determine whether a distinction should be made at the programmatic level between distribution of condoms for AIDS prevention and for family planning; it may be that combination of these 2 aims will have a synergistic effect. Information is requested from countries on the number of condoms desired, the proposed distribution system, the logistical capacity available, and the strategy for reaching individuals at risk of AIDS infection.
London, England, International Planned Parenthood Federation, 1985. 48 p. (IPPF Medical Publications.)This booklet, published by the International Planned Parenthood Federation (IPPF), discusses the mode of action of barrier methods of contraception--their advantages, disadvantages, and effectiveness. Each method is dealt with in detail under the headings of 'application,' 'instruction to users,' 'advantages,' 'disadvantages and side-effects' and 'effectiveness.' Areas of research and safety issues are also discussed. The various types of barrier contraceptives are: 1) spermicides--creams, jellies, melting suppositories, foaming suppositories or tablets, and aerosol foams; 2) unmedicated mechanical barriers--vagnial diaphrams and cervical caps, including cavity-rim, Vimule and vault caps; 3) medicated mechanical barriers--vaginal sponges; and 4) condoms. When used properly and conscientiously, the contraceptive agents are both safe and effective, although their mode of action may be more complex than has been assumed in the past. The function of barrier contraceptives is to block the passage of sperm into the cervical mucus; the condom prevents sperm from being deposited in the vagina, whereas the vaginal barriers interfere with sperm transport after semen has entered the vagina. In addition to blocking the intial wave of sperm form entering the cervix, the spermicidal preparations also kill the sperm within the vagina; most products now in use contain a nonionic surface active agent as a spermicide. Favorable attributes of barrier methods are: 1) few local side effects, 2) no highly skilled medical intervention is needed, 3) they are applied locally in the vagina, 4) they may inhibit sexually transmitted diseases, 5) there are few medical contraindications to their use, and 6) most are available without prescription. Disadvantages are: 1) they are generally less effective than most hormonal contraceptive and IUDs, 2) strong motivation is required for successful use, 3) they require manipulation of the genitalia, 4) some types are inconvenient or messy, and 5) most must be applied at or near the time of sexual intercourse. New spermicides, custom fitted cervical caps, and enzyme inhibitors are some of the new methods being researched and developed. The appendix includes the IPPF policy statement on barrier methods of contraception.
[Stockholm, Sweden], ISO, 1980 Oct 1. 4 p. (International Standard ISO 4074/9; Ref. No. ISO 4074/9-1980 (E))This determination of tensile properties of rubber condoms reviews the scope and field of application, principle, apparatus, the preparation of sample specimens, the procedure, expression of results, and the test report. Part 9 of International Organization for Standardization (ISO) 4074 specifies a method for the determination of the tensile properties of rubber condoms. The test is only applicable to condoms having a sufficiently large smooth area no more than 90 mm from the open end from which a test piece 20 mm in width can be obtained. The principle is: cutting of a test piece from a condom and stretching it until it breaks and, following this, measuring of the tensile force and elongation. The apparatus include cuting die, micrometer dial guage, and tensile testing machine. The condom shall be laid flat with its length at right angles to the cutting edges of the die and the test piece shall be obtained by cutting, with 1 stroke of the press, from a region 80 mm from the open end. Only test pieces which have been completely separated at the 1st attempt shall be used. The procedure involves: measure, to the nearest 0.001 mm, the single wall thickness of the test piece at not less than 4 equivalent points around the ring; dust the test piece with talcum powder, lat it flat, and measure, to the nearest millimeter, the distance between the 2 folded edges; place the test piece over the rollers and stretch it until it breaks; and at break, measure the load, to the nearest 0.1 N, and the separation distance (between the centers of the rollers) to the nearest millimeter. The test report shall include: the identification of the sample the number of samples tested; the tensile strength and elongation at break of each test piece; and the date of testing.
Social Marketing Forum. 1984 Summer; 1(4):1,5.Sri Lanka's Family Planning Association has stopped selling its Preethi Regular condom, the backbone of its social marketing program for nearly a decade. Last year nearly 7 times as many Preethi condoms were sold as all other brands combined. The decision was reported to be caused by budget constraints following the International Planned Parenthood Federation's (IPPF) new policy of limiting the number of Preethi Regular condoms supplied to Sri Lanka. IPPF's Asian Regional Officer reported that the Preethi condom is a costly product, and that as many as needed of a US Agency for International Development (USAID) supplied product will be sent to Sri Lanka. The Contraceptive Retail Sales (CRS) program has devised a new sales strategy, based partly on the introduction of a high-priced condom to fill the gap left by the discontinuation of the Preethi Regular. The new Preethi Gold condom is expected to help the project become more financially self-reliant while taing advantage of Preethi's marketplace popularity. Preethi Gold is manufactured by the Malaysia Rubber Company and costs the project US $4.85/gross. It is sold for US $.14 for 3, about 3 times the price of a Preethi Regular. The project is also pushing the Panther condom, donated to IPPF by USAID. 2 Panther condoms sell for about 3.6U, about the cost of Preethi Regulars. The project also sells Moonbeam, Rough Rider, and Stimula condoms, the latter 2 at full commercial prices. A smooth transfer of demand from Preethi to Panther had been desired, but by the end of 1983 some retailers were hesitating to make the product switch because some Preethi Regulars were still available. Total condom sales in 1983 were down by nearly 590,000 from the approximately 6,860,000 sold in 1982. Total condom sales for the 1st quarter of 1984 were slightly over 1,218,000 pieces, compared to about 1,547,000 for the same quarter in 1983, a decline of 21%. The Family Planning Association is gearing up to reverse the downward trend. Panther sales increased from, 38,000 condoms in the 1st quarter of 1983 to 462,000 in the same period of 1984. The project is intensifying its market coverage by increasing the number of sales divisions from 5 to 7 to help maintain sales momentum for the new product.
IPPF Medical Bulletin. 1983 Jun; 17(3):2-4.At least 12 countries have regulations for condoms, and because of the complicated regulations relating to condoms the International Organization for Standardization (ISO) was asked to create a committee for contraceptives. Its objective is to promote the development of standards throughout the world to help the international exchange of goods and services. Following discussions between the World Health Organization (WHO) and ISO it was decided in 1974 to establish a technical ISO committee that would deal with international standards for mechanical contraceptives, comprising condoms, diaphragms, and IUDs. It was also decided that spermicides and oral contraceptives (OCs) should be excluded from the ISO effort, but that they should fall within the responsibility of WHO. The committee, entitled ISO/TC 157 Mechanical Contraceptives, was represented by 35 member countries in 1982. The object of standardizing condoms is to obtain a satisfactory quality that can be accepted throughout the world. To achieve that purpose, acceptable test methods and associated limit requirements and values must be determined, along with rules for storage, packaging, and labeling. The most important factors in determining condom quality are the need to reach agreement on an acceptable number of holes in the condom and the ability to establish limit values for the mechanical properties of the condom. Specific requirements regarding dimensions, resistance to storage, packaging, labeling, and appropriate storage are also important. Up to 1982 the work of ISO for condoms resulted in 8 published international standards, of which 6 deal with test methods, 1 with packaging and labeling, and 1 with storage. Agreement has also been reached within the ISO committee on an additional 3 draft standards. Due to the comparatively small use of diaphragms, standardization efforts in this area do not have the highest priority. ISO/TC 157 has formulated 10 drafts which are being prepared for distribution to the ISO member countries for purposes of voting. 7 of these standards deal with test methods, 1 with sampling and requirements, 1 makes storage recommendations, and 1 refers to packaging and labeling. A working group for standardizing IUDs was established in 1976. It was agreed within ISO/TC 157 after almost 3 years to publish a Technical Report (TR 7439) for IUDs. The report deals with such things as the definition of IUDs, general requirements for type approval, batch inspection, storage recommendations, and packaging and labeling. The report shall constitute the basis for continued standardization efforts for IUDs.