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Long-acting and permanent contraception: An international development, service delivery perspective.
Journal of Midwifery and Women's Health. 2007 Jul-Aug; 52(4):361-367.Recent scientific findings about long-acting and permanent methods of contraception underscore their safety, effectiveness, and wide eligibility for individuals who desire them. This has led to new guidance from the World Health Organization to inform national policies, guidelines, and standards for service delivery. Although developing countries have made much progress in expanding the availability and use of family planning services, the need for effective contraception in general (and long-acting and permanent methods in particular) is large and growing because the largest cohorts in human history are entering their reproductive years. More than half a billion people will use contraception in developing countries (excluding China) by 2015, an increase of 200 million over levels of use in 2000. The health, development, and equity rationales that historically have underpinned and energized the international family planning effort remain valid and relevant today. Despite the other compelling challenges faced by the international health community, the need to make family planning services more widely available is pressing and should remain a priority. (author's)
BMJ. British Medical Journal. 2006 Aug 26; 333(7565):410.A group of Czech Roma women who said that they were forcibly sterilised have, on 17 August, outlined their stories in person to a United Nations committee in New York. They hope this will exert pressure on the Czech government to apologise. On the same day, many Roma women staged a protest outside a hospital in the east of the Czech Republic to raise awareness for their cause. About 30 women carrying banners stating "we want children" and "sterilise gherkins not women" protested outside the municipal hospital in Ostrava in an attempt to get a public apology from the government. A report by the Czech ombudsman released several months ago found that at least 50 women had been unlawfully sterilised as recently as 2003. Eighty women had lodged complaints with the ombudsman, alleging they underwent operations to be sterilised against their will. (excerpt)
BMJ. British Medical Journal. 2004; 328: p..A Roma woman who alleges she was sterilised without her consent during an emergency procedure at a Hungarian hospital is taking her case to the United Nations. Records show that the woman, then aged 28, who was undergoing labour pains and bleeding heavily, was taken by an emergency vehicle to Szatmár-Beregi Hospital in Fehérgyarmat in northeastern Hungary on 2 January 2001. Examinations determined that the placenta had ruptured and that her unborn infant had died, said Dr András Kanyó, who, with other members of the hospital's emergency team, had been alerted by emergency medical personnel to the woman's imminent arrival. "Following the ultrasound and a physical examination, I asked her about her family, and she said she had three children. I asked if she planned to have any more, and she said no," said Dr Kanyó, a gynaecologist, anaethesiologist, and intensive care specialist. (excerpt)
Journal of Family Planning and Reproductive Health Care. 2004 Jan; 30(1):29-42.This Guidance provides information for clinicians providing women with copper-bearing intrauterine devices as long-term contraception. A key to the grades of recommendations, based on levels of evidence, is given at the end of this document. Details of the methods used by the Clinical Effectiveness Unit (CEU) in developing this Guidance and evidence tables summarising the research basis of the recommendations are available on the Faculty website (www.ffprhc.org.uk). Abbreviations (in alphabetical order) used include: acquired immune deficiency syndrome (AIDS); actinomyces-like organisms (ALOs); automated external defibrillator (AED); blood pressure (BP); British National Formulary (BNF); confidence interval (CI); copper-bearing intrauterine contraceptive device (IUD); emergency contraception (EC); Faculty Aid to Continuing Professional Development Topic (FACT); levonorgestrel-releasing intrauterine system (IUS); human immunodeficiency virus (HIV); Medicines and Healthcare products Regulatory Agency (MHRA); non-steroidal anti-inflammatory drugs (NSAIDs); odds ratio (OR); pelvic inflammatory disease (PID); relative risk (RR); Royal College of Obstetricians and Gynaecologists (RCOG); Scottish Intercollegiate Guidelines Network (SIGN); sexually transmitted infection (STI); termination of pregnancy (TOP); World Health Organization (WHO); WHO Medical Eligibility Criteria (WHOMEC); WHO Selected Practice Recommendations (WHOSPR). (author's)
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.
New York, IP, 1980. 171 p. (Contract AID/pha-G-1128)With funds from a contract with the USAID, the International Prpject of the Association for Vuluntary Sterilization (IPAVS) has published this annual report to justify its expenditures and delineate its achievements as they relate to the contract goals. In 1979, the quantifiable program achievements were that: 1) voluntary sterilization services were provided to 78,873 men and women worldwide (30% increase over the previous year); 2) 674 physicians were trained in the techniques of surgical contraception (60% increase); 3) 249 health support personnel were trained by IPAVS auspices (4-fold increase); 4) IPAVS helped establish National associations based on its own philosophy in 28 developing countries in 1979; 5) 53 of 81 subgrants allotted included information service components; 6) 17 conferences on voluntary steilization or related health topics were attended by IPAVS, and the organization sponsored 1 regional, 3 national, and 1 international conference during 1979; 7) 57 of 73 countries attending the 4th International Conference on Voluntary Sterilization in Korea sponsored by IPAVS were developing nations; and 8) an IPAVS regional office for Asia was opened in Bangladesh. Other topics covered include grant management and policy development, program development, program accomplishments, information and education, and program support functions for management activities. This large volume publishes standards required by the IPAVS for medical procedures and minimal equipment.
Obstetrics and Gynecology. 2002 Jun; 99(6):1100-1112.The objective of this study is to review new evidence regarding 10 controversial issues in the use of contraceptive methods among women with special conditions and to present WHO recommendations derived in part from this evidence. The authors searched MEDLINE and PREMEDLINE databases for English-language articles, published between January 1995 and December 2001, for evidence relevant to 10 key contraceptive method and condition combinations: combined oral contraceptive (OC) use among women with hypertension or headaches, combined OC use for emergency contraception and adverse events, progestogen-only contraception use among young women and among breastfeeding women, tubal sterilization among young women, hormonal contraception and IUD use among women who are HIV positive, have AIDS, or are at high risk of HIV infection. Search terms included: "contraception," "contraceptives, oral," "progestational hormones," "medroxyprogesterone-17" acetate," "norenthindrone," "levonorgestrel," "Norplant," "contraceptives, postcoital," "sterilization, tubal," "IUDs," "hypertension," "stroke," "myocardial infarction," "thrombosis," "headache," "migraine," "adverse effects," "bone mineral density," "breastfeeding," "lactation," "age factors," "regret," and "HIV". From 205 articles, the authors identified 33 studies published in peer-reviewed journals that specifically examined risks of contraceptive use among women with pre-existing conditions. Combined OC users with hypertension appear to be at increased risk of myocardial infarction and stroke relative to users without hypertension. Combined OC users with migraine appear to be at increased risk of stroke relative to non-users with migraine. The evidence for the other eight method and condition combinations was either insufficient to draw conclusions or identified no excess risk. Of the 10 contraceptive method and condition combinations assessed, the evidence supported an increased risk of cardiovascular complications with combined OC use by women with hypertension or migraine. As a new evidence becomes available, assessment of risk and recommendations for use of contraceptive methods can be revised accordingly. (author's)
Lancet. 1999 Apr 10; 353(9160):1251.In Andhra Pradesh, India, women's groups have formed a Group Against Targeted Sterilization (GATS) to protest the creation of sterilization camps created by government officials in Hyderabad and Secunderabad, where 20,000 people, mostly women, were sterilized to meet a quota deadline. GATS charges that the women were offered incentives to undergo sterilization and that those who resisted were threatened with disconnection of their household utilities. GATS does not oppose family planning or female sterilization but opposes the dehumanizing use of incentives and threats. The impoverished women who are targeted for mass sterilization undergo the procedures in unhygienic settings. Many are anemic, which is a contraindication to any surgical procedure, and they receive no postoperative care. The targeted sterilizations were performed under the banner of the Indian Population Project (IPP), which is funded by the World Bank. GATS fears that the entire IPP will be diverted from the intention of its donor (the World Bank is committed to a target-free approach) and will become subservient to population control efforts.
Geneva, Switzerland, [WHO], Division of Family Health / Unit of Family Planning and Population, 1994. , 35 p. (WHO/FHE/FPP/94.2 Rev.1)Female sterilization represents a viable option for women who are certain they want no more children. It is critical, however, that family planning programs offering female sterilization provide careful counseling that highlights the permanence of the procedure and the availability of safe, effective alternatives for couples who desire long-term reversible protection from pregnancy. This booklet provides health workers with basic information on how female sterilization works, its advantages and disadvantages, its risks and benefits, and how to help women make informed choices. It also provides answers to the most commonly asked questions about the procedure. Ample illustrations and charts are included. Appendices present a sample informed consent form and suggested pre- and postoperative instructions for sterilization acceptors.
ENTRE NOUS. 1996 Sep; (33):12-3.A consultation of experts convened in July 1994 by the UNDP/UNFPA/WHO/World Bank Special Program of Research, Development, and Research Training in Human Reproduction reviewed the status of female sterilization and identified promising approaches for use in developing countries. The experts concluded that the ideal method of female sterilization would be a safe, simple, and effective one-time procedure for occlusion of the Fallopian tubes that costs little, involves only local anesthesia, causes minimal damage, and is both individually and culturally acceptable. Emphasized as well were the needs for adequate training of sterilization providers and thorough counseling of potential acceptors about the full range of contraceptive choices to ensure informed consent. Of the 153 million women worldwide who have selected sterilization, 138 million are in developing countries.
New York, New York, United Nations, Dept. for Economic and Social Information and Policy Analysis, Population Division, 1994 Aug.  p. (ST/ESA/SER.A/143)This wall chart shows the 1994 level of contraceptive use (percentage) for the entire world. Data are presented for less developed and more developed regions and for individual countries grouped according to region. The number of couples of reproductive age is given in millions, and the data are broken down into year; age range represented; and percentage of the total, of female sterilization, of male sterilization, of oral contraceptive use, of IUD use, of condom use, and of use of other supply and non-supply methods. In addition, trends are indicated by showing the time period and the annual increase in percentage using any method. These data are further illustrated in pie charts indicating the entire world, more developed regions, and less developed regions as a whole and for Africa, Latin America and the Caribbean, Eastern Asia, and other countries in Asia and Oceania.
New York, New York, AVSC, 1993 Mar 16. vi, 43, 108, 47, 15 p.The March 1993 Association for Voluntary Surgical Contraception (AVSC) workplan outlines strategic plans to expand services to USAID priority developing countries while reducing services in other countries and to add all contraceptive methods requiring a medical procedure to its services. AVSC plans on continuing to focus on voluntary sterilization. Its guiding principles still are expanding access to services, guaranteeing free and informed choice, and ensuring the safety and effectiveness of services. AVSC plans to develop comprehensive country programs and to take on special or global programs. Some anticipated special programs include medical quality assurance, voluntarism and well-informed clients, client-centered service systems, and vasectomy and male involvement. Managerial plans are country level planning and evaluation, continuous strategic planning, annual workplan development, decentralization, strengthening technical capacity, interagency collaboration and strategic alliances, and diversification of funding. AVSC's 1993 funding sources are dominated by USAID (57% from USAID central office and 27% from USAID missions). UNFPA and the World Bank together comprise 8% and private sources make up another 8%. AVSC plans to provide services in some countries for which USAID does not provide funding: Iran, Vietnam, the former Soviet Union, and the US. Specific issues that AVSC faces in fiscal year 1993 are insufficient USAID funding, resistance by other agencies to collaborate, addressing the highly competitive bidding game related to requests for proposals with the USAID Office of Population, assuring partners and supporters of its continued emphasis on voluntary sterilization, confronting the effect of adverse press coverage on vasectomy and prostate cancer, and remaining mindful of contraceptive choice issues.
[Unpublished] . 10,  p.Based upon United Nations medium population projections, the population of developing countries will grow from 4,086 million in 1990, to 5,000 million by the year 2000. To meet this medium-level projection, 186 million contraceptive users must be added for a total 567 million in addition to increased contraceptive prevalence of 59% from 51%. This study estimates the number of contraceptive users, acceptors, and cost of contraceptive commodities needed to limit growth to this medium projection. Needs are estimated by country and method for 1990, 1995 and 2000, for medium, high, and low population projections. The number of contraceptive users required to reach replacement fertility is also calculated. Results are based upon the number of women aged 15-49, percent married, number married ages 15-49, and the proportion of couples using contraception. Estimation methodology is discussed in detail. Estimated users of respective methods in millions are 150 sterilizations, 333 IUD insertions, 663 injections, 7,589 cycles of pills, and 30,000 condoms. Estimated commodity costs will grow from $399 million in 1990 to $627 million in 2000, for a total $5.1 billion over the period. Pills will be the most expensive at $1.9 billion, followed by sterilizations at $1.4 billion, condoms $888 million, injectables $594 million, and IUDs $278 million. Estimated costs for commodities purchased in the U.S. show IUDs and condoms to be significantly more expensive, but pills as cheaper. With donors paying for approximately 25% of public sector commodity costs, developing country governments will need to pay $4.2 billion of total costs in the absence of increased commercial/private sector and donor support.
CEYLON MEDICAL JOURNAL. 1990 Dec; 35(4):136-42.The story of the Sri Lankan Family Planning movement is told from its inception in 1953, prompted by a visit by Margaret Sanger 1952. The Family Planning Association of Sri Lanka was founded with the health of women and children, and both contraception and infertility treatment as its policies. The first clinic, called the "Mothers Welfare Clinic," treated women for complications of multiparity: one woman was para 26 and had not menstruated in 33 years. The clinic distributed vaginal barriers, spermicides and condoms, but the initial continuation rate was <5% year. Sri Lanka joined the IPPF in 1954. In 1959, after training at the Worcester Foundation, and a personal visit by Pincus, the writer supervised distribution of oral contraceptives in a pilot project with 118 women for 2 years. Each pill user was seen by a physician, house surgeon, midwife, nurse and social worker. In 1958 Sweden funded family planning projects in a village and an estate that reduced the birth rate 10% in 2 years. The Sri Lankan government officially adopted a family planning policy in 1965, and renewed the bilateral agreement with Sweden for 3 years. In 1968 the government instituted an integrated family planning and maternal and child health program under its Maternal and Child Health Bureau. This was expanded in 1971 to form the Family Health Bureau, instrumental in lowering the maternal death rate from 2.4/1000 in 1965 to 0.4 in 1984. During this period IUDs, Depo Provera, Norplant, and both vasectomy and interval female sterilizations, both with 1 small incision under local anesthesia, and by laparoscopic sterilization were adopted. Remarkable results were being achieved in treating infertile copies, even from the beginning, often by merely counseling people on the proper timing of intercourse in the cycle, or offering artificial insemination of the husband's semen. Factors contributing to the success of the Sri Lankan planned parenthood program included 85% female literacy, training of health and NGO leaders, government participation, approval of religious leaders, rising age of marriage to 24 years currently, and access of all modern methods.
STUDIES IN FAMILY PLANNING. 1991 Jan-Feb; 22(1):1-18.A study investigative the pros and cons of financial payments for sterilizations to clients, medical personnel, and agents who motivate and refer clients was conducted by the government of Bangladesh in conjunction with the World Bank. Results indicate that Bangladeshi men and women opt to be sterilized both voluntarily and after consideration of the nature and implications of the procedure. Clients were also said to be knowledgeable of alternate methods of controlling fertility. A high degree of client satisfaction was noted overall with, however, 25% regret among those clients with less than 3 children. Money is a contributing factor in a large majority of cases, though dominating as motivation for a small minority. Financial payments to referrers have sparked a proliferation of many unofficial, self-employed agents, especially men recruiting male sterilization. Targeting especially poor potential clients, these agents focus upon sterilization at the expense of other fertility regulating methods, and tend to minimize the cons of the process. Examples of client cases and agents are included in the text along with discussion of implications from study findings.
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.
[Unpublished] 1988 Oct 26. Paper presented at the "Meet the Experts" panel sponsored by The World Federation for Voluntary Surgical Contraception, at the XII World Congress of Gynecology and Obstetrics sponsored by The International Federation of Gynecology and Obstetrics [FIGO], October 26, 1988, Rio de Janeiro, Brazil. 25 p. (ME62/ME21)Brazil, the largest country in area and population in Latin America, has not had the benefit of a government-sponsored family planning program and until recently such activities were sensitive and done with much constraint. The Centro de Pesquisas de Assistencis Integrada a Mulher e a Crianca (CPAIMC) which began offering family planning in its clinics in 1978, joined with Johns Hopkins Program for Education in Gynecology and Obstetrics (JHPIEGO), in 1980, to train medical doctors in the techniques of voluntary surgical contraception. It was followed by the support of the Association for Voluntary Surgical Contraception (AVSC) and Development Associates. During the years that followed the 1st project with JHPIEGO, AVSC and Development Associates, more than 125 courses were performed, 180 for nurses and 210 for auxiliary nurses and administrative personnel delivered by CPAIMC, ABEP and BEMFAM, and more than 350 institutions received technical assistance in voluntary surgical contraception. In recent national studies done by BEMFAM in contraceptive method prevalence, the most common methods were oral and surgical contraception. 65% of married women report they or their husbands are currently using contraceptives. Nationally, 27% of couples are using female sterilization and 25% oral contraceptives. Female sterilization is the most common method in all regions except the South, where pills are the most prevalent method. About 7% of the males have had vasectomies. Sterilization is more common in urban areas and increases in accordance with a woman's age, reaching prevalence rate of 73% between the age of 25 to 39. Average age was 31.4 years but 40% of the women were sterilized before age 29. Data is given on duration of marriage with sterilization, place of operation, complications, client profile, medical/surgical data, and sterilization failure. It was found that cumulative failure rates for sterilization in Brazil are comparable to or somewhat lower than those reported elsewhere; they decreased significantly as age at sterilization increases; failure during training periods are not significantly different, and cumulative failure rates increased, although not significantly, as the number of sterilizations per surgeon/day increased (author's modified)
[Unpublished] 1987. 7 p.During the July 21-24 trip to Burundi, discussions were held about possible Association for Voluntary Surgical Contraception (AVSC) assistance in creating a training center at the University Hospital which could serve as a site for training medical personnel from Burundi and other French-speaking African nations. Practical training is urgently needed at this time to allow health personnel to feel comfortable about dispensing a wide range of contraceptive methods/information. A great need exists for the training of nurses in IUD insertion and for copper-T commodities. Family planning method acceptance is growing steadily: the number is said to double every 6 months. As yet, voluntary surgical contraception plays a minor role and is available only at a limited number of centers. As previously reported, several donors, including the UN Fund for Population Assistance, World Bank, and the African Development Bank, are involved in activities/proposals related to maternal/child health and family planning. The major objective of AVSC assistance to the Ministry of Public Health is to increase access to VSC by integrating quality services into ongoing maternal/child health/family planning activities in 4 regional referral hospitals. The project is expected to last for 4 years with a total budget of slightly over $200,000. During this visit, the basics were worked out for a program in which AVSC would provide assistance for training 10 physicians/year in minilap (both postpartum and interval) using local anesthesia. Trainees would be residents and interns and, if possible, physicians from government facilities. It is hoped that a training program document can be developed for presentation at the December 1987 meeting of AVSC's International Committee. The site visit was useful to the effort of moving the pending project with the Ministry of Public Health along and for discussing possible cooperation with the University Hospital. Program success is likely for several reasons: the Ministry of Public Health generally is favorable and supportive; chances for "institutionalization" are good; the basic hospital infrastructure is sound; and the rising demand for VSC is recognized by health officials and service providers.
Association for Voluntary Sterilization - Consultant Team. Trip report: the People's Republic of China, Beijing, Chongqing, Wuhan, Guangzhou, June 19-30, 1985.
[Unpublished] 1985. 41,  p.The Association for Voluntary Sterilization consultant team visited Beijing, Chongqing, Wuhan and Guangzhou, China in June 1985, to review innovative nonsurgical methods of male and female sterilization. There are 2 variations on vasectomy, performed with special clamps that obviate a surgical incision. The 1st is a circular clamp for grasping the vas through the skin, and the 2nd is a small, curved, sharp hemostat for puncturing the skin and the vas sheath, used for ligation. Vas occlusion with 0.02 ml of a solution of phenol and cyanoacrylate has been performed on 500,000 men since 1972. The procedure is done under local anesthesia, and is controlled by injecting red and blue dye on contralateral sides. If urine is not brown, vasectomy by ligature is performed. The wound is closed with gauze only. Semen analysis is not done, but patients are advised to use contraception for the 1st 10 ejaculations. Pregnancy rates after vasectomy by percutaneous injection were reported as 0 in 5 groups of several hundred men each, 11.4% in 1 group and 2.4% in another group. The total complication rate after vasectomy by clamping was 1.8% in 121,000 men. 422 medical school graduates with surgical training have been certified in this vasectomy method. Chinese men are pleased with this method because it avoids surgery by knife, and asepsis, anesthesia and counseling are excellent. Female sterilization by blind transcervical delivery of a phenol-quinacrine mixture has been done on 200,000 women since 1970 by research teams in Guangzhou and Shanghai. A metal cannula is inserted into the tubal opening, tested for position by an injection of saline, and 0.1-0.12 ml of sclerosing solution is instilled. Correct placement is verified by x-ray, an IUD is inserted, and after 3 months a repeat hysteroscopy is done to test uterine pressure. Pregnancy rates have been 1-2.5%, generally in the 1st 2 years. Although this technique is tedious, requiring great skill and patient cooperation, it can be mastered by paramedicals. The WHO is assisting the Chinese on setting up large studies on safety and effectiveness, as well as toxicology studies needed, to export the methods to other countries.
Sterilizations by sex and percentages of: male to female sterilizations and total number of sterilizations as percentage of total new acceptors. 1979-1984.
[Unpublished] . 3 p.This is an International Planned Parenthood Federation (IPPF) collection of data detailing numbers of sterilizations in each country of the western hemisphere from 1979 to 1985. The table presents sterilizations among males and females, total number of sterilizations, ratio of male to female expressed in percentages, and ratio of sterilizations to new acceptors also expressed as percentages. The countries with the numbers over 10,000 in 1986 were Columbia, Guatemala and the Dominican Republic. Countries with 1000 to 9999 were U.S., Honduras, Mexico, El Salvador, Ecuador and Brazil, in order. Most nations reported 5 to 10 times more female than male sterilizations. The exception was the U.S., with 10 times more vasectomies in the latter years. The total reported ranged from 63,400 in 1980 to 94,448 in 1985.
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.
JOURNAL OF THE TENNESSEE MEDICAL ASSOCIATION. 1986 Feb; 79(2):75-6.275 laparoscopic tubal ligations were done safely and economically at the Planned Parenthood of Memphis outpatient clinic from May 1983 to June 1985. Patients were carefully selected and counselled, eliminating those with previous abdominal surgery, excluding cesarean section, and those with ongoing pregnancy or serious gynecological or medical problems. The trained staff of experienced laparoscopic surgeons and certified registered nurse anesthetists practiced emergency procedures before surgery. Anesthesia was a minimal amount of nalbuphine (Nubain) 20 to 40 mg and droperidol (Inapsine) 1.25 to 2.5 mg; or fentanyl 0.1 to 0.25 mg and droperidol 1.25 to 2.5 mg; occasionally nitrous oxide inhalation. Some women received droperidol 1.25 to 2.5 mg or diazepam 2.5 to 5 mg beforehand. The laporoscopic procedure, performed through a small intraumbilical incision, employed the fallop ring. The incision was closed with 000 Dexon subcuticular sutures. There were minor side effects in 23: nausea in 20, vomiting in 2 and wound infection in 1. Two pregnancies occurred: 1 was not detected in the preliminary pregnancy test and the other was a procedure failure. The sterilization program is considered safe and resonably priced, $450 compared to $1150 to 1469 in area hospitals outpatient clinics.
Geneva, WHO, 1984 Dec. ix, 152 p.88 recommendations were formulated by the International Conference on Population held in Mexico City in 1984. 4 of these dealt specifically with research requirements in the population field and are reproduced in this report in their entirety. As a result of the changing perspectives and requirements of the scientific fields in which the Special Program of Research, Development and Research Training in Human Reproduction operates and taking into account the various suggestions resulting from recent reviews of the Program, several new developments have occurred. First is the attempt to distinguish more clearly between activities related to research and development and those related to resources for research. These 2 distinct but closely connected activities will be reorganized to interact in a complementary fashion. In the research and development component, the most notable changes relate to the creation of new Task Forces on the Safety and Efficacy of Fertility Regulating Methods and on Behavioral and Social Determinants of Fertility Regulation. The Program has been actively promoting coordination with other programs which support and conduct research in human reproduction. The research and development section of this report provides a technical review of the activities and plans of the various task forces, covering the following: new and improved methods of fertility regulation (long-acting systemic methods, oral contraceptives, post-ovulatory methods, IUDs, vaccines, plants, male methods, female sterilization, and natural methods), safety and efficacy of fertility regulating methods, infertility, and service and psychosocial research. The section devoted to resources for research describes some features of the network of centers, reviews the Program's institution strengthening activities in the different regions, and also considers research training and the program of standardization and quality control of laboratory procedures. The section covering special issues in drug development focuses on relations with industry, patents, and the role of the Special Program in the drug regulatory process.
Planned parenthood and women's development in the Indian Ocean Region: experience from Bangladesh, India and Pakistan.
London, England, International Planned Parenthood Federation, 1984 Sep. 43 p.The Indian Ocean Region (IOR) of the International Planned Parenthood Federation (IPPF) has been involved in Planned Parenthood and Women's Development (PPWD) since the program was launched in 1976. This paper, which brings together the experience of the projects and approaches from 3 countries of the region -- Bangladesh, India, and Pakistan, aims to help the region analyze the progress made and assess strategies which can be more widely replicated. The Bangladesh Family Planning Association (BFPA) initiated PPWD projects in mid-1977, the majority in collaboration with well-established women's organizations. These projects generally provide income-generating activities, including training and assistance in the marketing of the products resulting from such activities. In 1979, together with the Mahila Samity (the national women's organization), the FPA was able to integrate women's development into its programs in 19 unions. Each union has a population of 20,000 and the FPA undertakes family planning motivation and services committees. Since 1977 the FPA has collaborated with the Chandpur Dedicated Women to promote family planning and women's development activities. A project to reach women through child-centered activities was initiated by the FPA in 1979 in response to the International Year of the Child. A case study is included of the Sterilized Women's Welfare Samity Project in Mymensingh. For some years the Family Planning Association of India (FPAI) has worked through existing women's clubs or Mahila Mandals as a way of reaching rural and semirural women. The Mahila Mandals have been instrumental in involving young women in development activities and in establishing youth clubs and also have been a focal point for mobilizing community resources. The use of government facilities by the integrated projects in Malur and Karnataka and the cooperation with various extension services is noteworthy. In 1977 the FPAI decided to launch a number of specific projects, including as the Pariwar Pragati Mandals (family betterment clubs) popularly know as PPM, and the Young Women's Development Program. Project case studies are included. The Family Planning Association of Pakistan launched its PPWD program in 1978 with the objective of creating conditions within which responsible parenthood could become a way of life, particularly among underprivileged rural women, and to strengthen links between family planning and other individual and community problems. Most of the original PPWD projects were initiated in 1978 and were conducted with other community development and womens's organizations. Since 1978, the PPWD program has undergone several changes and more emphasis is now placed on family planning and on involving young women. Case studies are included. Common features of the PPWD programs of Bangladesh, India, and Pakistan are identified.
Lancet. 1984 Jul 21; 2(8395):144-5.The objective of the World Health Organization (WHO) project, an international, prospective study conducted by centers in England, India, Columbia, Nigeria, and the Philippines, was to investigate the effects of tubal occlusion on the mental and physical health and psychosexual and menstrual functioning of women choosing to undergo the procedure for contraceptive purposes only. A subsequent report presents details and results of the English component of the study. 2 groups of healthy multiparous women having either interval sterilization (at least 6 months since an obstetric event) or postpartum sterilization (within 72 hours of delivery) were recruited. For each group, a control group was recruited from women using or planning to use nonpermanent contraceptive methods. All women were interviewed preoperatively and again 6 weeks and 6 months after the operation by standardized techniques. The results showed that sterilized women did not differ from the control samples in mental state, as assessed by the Present State Examination or in subjectively assessed mental or physical health or abdominal pain. More sterilization subjects than control subjects reported improvement in sexual satisfaction at the later follow-up. Many of the subjects reporting adverse effects at follow-up had revealed disturbances at the initial asssessment. All these women had at least 2 living children. They were women living in stable marriages or other relationships that had lasted an average of over 9 years. They were free from physical or mental ill health before sterilzation. They had their sterilizations voluntarily and solely for the purpose of keeping their families small. It comes as no surprise that, relative to a general population sample, the mental state of sterilized women in the study actually seemed to improve. A need exists for methodoloically sound studies that would identify social and psychological conditions under which sterilization might have ill effects.