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Best Practice and Research Clinical Obstetrics and Gynaecology. 2006; 20(3):323-338.Access to modern contraception has become a recognized human right, improving the health and well-being of women, families and societies worldwide. However, contraceptive access remains uneven. Irregular contraceptive supply, limited numbers of service delivery points and specific geographic, economic, informational, psychosocial and administrative barriers (including medical barriers) undermine access in many settings. Widening the range of providers enabled to offer contraception can improve contraceptive access, particularly where resources are most scarce. International efforts to remove medical barriers include the World Health Organization's Medical Eligibility Criteria. Based on the best available evidence, these criteria provide guidance for weighing the risks and benefits of contraceptive choice among women with specific clinical conditions. Clinical job aids can also improve access. More research is needed to further elucidate the pathways for expanding contraceptive access. Further progress in removing medical barriers will depend on systems for improving provider education and promoting evidence-based contraceptive service delivery. (author's)
Conclusions of the International Medical Advisory Panel (IMAP) on DMPA at its meeting on 14th October 1980.
London, England, IPPF, . 4 p.The International Planned Parenthood Federation (IPPF) supplies 400,000 3-monthly injections of depot medroxyprogesterone acetate (DMPA) each year; this use is estimated to prevent between 30 to 100 deaths per year. Up to 10 million women have used the drug at some time, and more than 1 million and a quarter use it currently. DMPA is registered as a therapeutic agent in cancer treatment in nearly all countries and as a contraceptive agent in over 80 developed and developing countries. The supply of DMPA has never kept pace with the demand in developing countries. Present information fails to indicate that DMPA causes endometrial cancer. It is too early to know if it will always prevent it. Both the WHO and the Biometrics and Epidemiological Methodology Advisory Committee of the U.S. Food and Drug Administration found no evidence of an increased risk of disease of the uterine cervix in women on DMPA. No evidence of increased breast cancer has been found in humans on DMPA. Investigations conducted in Chile, Egypt, Iraq, and Thailand have found that DMPA may increase both milk production and the duration of lactation. The question of possible consequences of the transfer of the steroid to the breast-feeding infant has yet to be resolved. The only clinical metabolic effect attributed to DMPA is weight gain.
Seoul, South Korea, PPFK, 1979 Jan. 26 p.The Korean government and the family planning organizations coordinate the distribution of contraceptives under the PPFK, funded by the IPPF. Import of oral pills must legally be permitted by the Ministry of Health and Social Affairs; distribution/sales is restricted to licensed pharmacists, unless a nonpharmacist is in the government family planning program. The Korean CBD project was launched as a 3-year program with $620,000 funding. The goal was to increase family planning practice from 45% in 1975 to 60% of all eligible couples by 1981. The approaches utilized were community-based, voluntary participation; full availability of contraceptives; convenience in obtaining contraceptives; unsophisticated procedure of delivery; personalization of distribution; and, self-help practice in family planning practice. Evaluations of the project conducted in November 1976 and December 1977 found that the majority of community leaders, 84.5% in 1976, recommended that the CBD program be expanded at the national level. 86.6% of the consumers in 1977 found the contraceptives conveniently obtained and inexpensive. Younger consumers preferred drug stores; older consumers preferred CBD distributors. Housewives were the primary purchasers. They bought oral pills in 99% of the cases.
Injectable progestogens - officials debate but use increases. Les progestatifs injectables : les autorites en debattent, mas l'usage s'en repand.
Population Reports. Series K: Injectables and Implants. 1975 Mar; (1): p.A report on the status of the injectable contraceptive agents, Depo-Provera (depot medroxyprogesterone acetate) and Norigest is presented. Depo-Provera is distributed in 64 countries, though it is not available in the U.S., the United Kingdom, and Japan. The drug is usually administered in single 150 mg injections every 3 months, and doses of 300-400 mg every 6 months have been studied. The contraceptive effect of Depo-Provera is primarily through its ability to inhibit ovulation. Norigest exerts its effect by altering the cervical mucus. The suppression of ovulation is most likely caused by action on the hypothalamus-pituitary axis, resulting in inhibition of the luteinizing hormone surge. Depo-Provera causes an atrophic endometrium, while Norigest has varying endometrial effects. The reported pregnancy rates for Depo-Provera are usually less than 1%, while those for Norigest are slightly higher. Most method failures occur either shortly after the 1st injection or at the end of an injection interval. Menstrual disorders have been the primary reason for discontinuation. The injectables can cuase shorter or longer cycles, increased or decreased menstrual flow, and spotting. Depo-Provera users experience increased amenorrhea with continued use, while normal cycles increasingly reappear in Norigest users. Cyclic estrogen therapy has been effective in treating excessive or irregular bleeding and amenorrhea. Long-acting estrogen injections have been administered in combination with Depo-Provera or Norigest, though the studies are limited in number. Weight gain of up to 9 pounds has been reported for users of Depo-Provera. Some researchers have found that Depo-Provera raises blood glucose levels, while others have reported it does not. No adverse effects have been reported for injectables on blood clotting, adrenal or liver function, blood pressure, lactation, and metabolic or endocrine functions. The continuation rate for Depo-Provera is reportedly higher than that for oral contraceptives. Generally, 60% of the acceptors will use the method for at least 1 year. Effective counseling on the menstrual alterations resulting from injectables can increase continuation of the method. The return of fertility in Depo-Provera users usually requires 13 months from the time of the last injection, while the afertile period in Norigest users is about 6 months from the time of the last injection. Instances of fetal masculinization as a result of Depo-Provera use have not occurred. The possibility that Depo-Provera can cause cervical carcinoma in situ has not been substantiated by the evidence; doubt about this possible association has prevented its approval as a contraceptive method in the U.S. Although Depo-Provera and Norigest have caused breast nodules in laboratory animals, there is no evidence to suggest that this effect would occur in human. Despite the advantages of injectables, family planning officials have been reluctant to permit its unrestricted use, primarily because it cannot be withdrawn guickly enough if problems arise and because the actual effect on fertility is not yet known. Nonetheless, the use of Depo-Provera has increased in recent years. The IPPF and the U.N. Fund for Population Activities currently supply the drug.