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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[Unpublished] 1988 Oct 26.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)
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.
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.
Advances in Planned Parenthood. 1980; 15(3):77-81.In 1977 the PPAN (Planned Parenthood Association of Nashville) began providing minilaparotomy sterilization services on an outpatient basis. The experience of 218 women who received sterilizations at the clinic between 1977-1979 indicated that it was feasible and safe to provide this service on an outpatient basis. The historical development of the program, the procedures and instruments used to perform the sterilizations, and the sterilization outcomes for the 218 patients were described. Prior to program initiation, the Medical and Executive Directors of PPAN attended a workshop on outpatient female sterilizations conducted by AVS (Association for Voluntary Sterilization) and the Planned Parenthood Federation of America. Subsequently a protocol for minilaparotomy sterilization was submitted to the National Medical Office of the Federation by the PPAN. The protocol was approved and the program was implemented. Based on the success of the 1st 18 months of operation PPAN received a grant from AVS to train personnel from other clinics to provide similar services. During the 1st clinic visit patients are thoroughly counseled and given a pelvic examination. During the 2nd visit the patient is given a complete physical examination and laboratory tests, including a pregnancy test, are performed. During the 3rd visit the patient receives additional counseling and the sterilization is then performed. A modified Pomeroy procedure is performed under local anesthesia. Patients were discharged 2 hours after surgery. 96% of the patients returned for suture removal and 50% returned for a later recommended check-up. A follow-up survey indicated that more than 90% of the patients were satisfied with the service. For 4 of the 218 patients the sterilization was not completed. In 2 cases the round ligament was mistaken for the tube and sterilization was not achieved, in 1 case the patient became upset and the procedure was halted, and in another case adhesions prevented ligation. At the time of the operation it was discovered that 2 patients had luteal phase pregnancies. There were no major immediate complications but there were 1) 2 cases of subcutaneous hematomas; 2) 1 brief episode of postoperative thrombophlebitis, 3) 2 cases of wound abscesses; and 4) 3 cases of mild cystitis and endometritis.
MARYLAND STATE MEDICAL JOURNAL. 1980 May; 29(5):68-9.In response to the growing public demand for non-hospital sterilization services, the Planned Parenthood Clinic in Baltimore began providing vasectomy services in April, 1971. Between 1971-1979, 4117 vasectomies were performed at the clinic under local anesthesia. Prior to vasectomy the patient is given a medical exam and a medical history is obtained. The patient is also interviewed by a counselor. Vasectomies are generally performed on Friday afternoons, and follow-up appointments are made until a negative semen analysis is obtained. The clinic has performed 73 minilaparotomies. Patients who wish to have a minilaparotomy must make 4-5 visits to the clinic. During the first visit the patient is seen by a counselor. During the 2nd visit a medical exam is given and a medical history is obtained. Blood, urine, and gonorrhoea tests are performed and a pap smear is obained. The counselor then explains all the risks involved in the procedure and an appointment for the operation is made if the patient wishes to continue. Operative procedures include: 1) inserting a Hulka tenaculum sound; 2) administering a local anesthesia; 3) making a 2-5 cm incision; and 4) performing a Pomeroy ligation. The operation takes 20-30 minutes and the patient is usually discharged 2 hours later. The patient is told to call the physician at any time if she experiences any difficulties and to return for a follow-up visit 2-4 weeks later.
New York, International Planned Parenthood Federation, Western Hemisphere Region, September 1975. 149 pThe primary focus in this 4th edition in the series of annual "overviews" of the contraceptive services in the Western Hemisphere Region of the International Planned Parenthood Federation is on clinical facilities, medical and paramedical services, and on the delivery of contraceptive methods by family planning programs. Family planning services link information on methods for spacing or limiting children to their availability, and they provide education on the advantages of contracepting. They seek to motivate acceptors to continue their chosen method. Counseling and information and education activities, although an integral component of family planning programs, are not included among the topics considered in the "Overview." In the Western Hemisphere Region, the most notable innovation has involved the community-based distribution of contraceptives (CBD), and for the 1st time, non-clinical distribution of contraceptives by associations in the region is a part of the "Overview." The Annual Reports submitted by IPPF affiliates and published and unpublished data from other programs are the primary sources of statistics for this report. Information for 1973 encompassed 29 associations related to IPPF and 4 other programs, and for 1974, 28 associations and 5 other programs could be covered. As for clinical input of family planning programs, the affiliates reported to the Regional Office of IPPF the number and types of clinics, weekly session hours, hours of medical and paramedical personnel. Data on the output of clinical activities of family planning programs for the calendar year were limited to 1st visits or new acceptors by methods, 1st revisits of the year or continuing (old) acceptors by method, number of revisits by old and new acceptors by method, demographic characteristics of new acceptors by method, and voluntary male and female sterilization performed or referred. Data on contraceptive services and clinical activities are summarized and presented in the form of tables.
New York, International Planned Parenthood Federation, Western Hemisphere Region, Medical Division, September 1975. 49 pThis is a compilation of family planning services provided by associations operating in the Western Hemisphere Region. Separate tables are compiled for 1973 and 1974. A list of each family planning program included in the study is appended to the report. The report does not guarantee the completeness or accuracy of the data; problems with reliability of data point up the necessity for a system of standardized record-keeping. Tables cover program input in the form of clinical facilities, medical and paramedical services, and the delivery of contraceptive methods by family planning programs and community-based distribution systems. Charts on program output include information on acceptor characteristics, numbers of new and continuing acceptors, numbers of voluntary sterilizations, and percentages of other methods in use.
Overview 1972: medical and clinical activities, family planning associations, western hemisphere region, January 1 - December 31, 1972.
New York, International Planned Parenthood Federation, Western Hemisphere Region, Medical Division, 1973. 103 pInformation submitted by governmental programs and by International Planned Parenthood Federation member associations is compiled in this study and the analyzed data is summarized in the form of graphs, tables, etc. with the aim of providing a basis for comparison of the family planning associations in the Western Hemisphere region. This study essentially focuses upon the number and classification of attended visits and contraceptive services. The following statistics are presented: 1) clinics--number and categories, 2) female population of fertile age, 3) total number of visits, first visits, and revisits by method, 4) new acceptors by method, 5) hours devoted to contraceptive service, 6) male and female sterilizations. Analytical information is offered on the following: 1) new acceptors per female population of fertile age, 2) new accumulated acceptors for the same population subgroup, 3) average new acceptors per year, 4) contraceptive service per medical hours, 5) revisits per first visits, 6) percentage by total number of visits, and 6) percentage by methods for new accumulated acceptors. The countries included in the study are Antigua, Argentina, Barbados, Bermuda, Brazil, Canada, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, El Salvador, Grenada, Guadeloupe, Guatemala, Honduras, Jamaica, Mexico, Montserrat, Netherlands Antilles; Nicaragua, Panama, Paraguay, Peru, Puerto Rico, St. Kitts-Nevis-Anguilla, St Lucia, St. Vincent, Trinidad and Tobago, United States, Uruguay, and Venezuela.
Sterilizations by sex and percentages of: male to female sterilizations and total number of sterilizations as percentage of total new acceptors. IPPF/WHR, 1978-82.
[Unpublished] . 3 p.This paper presents data from 23 International Planned Parenthood Federation (IPPF) associations on the numbers of male and female sterilizations performed in 1978-82, the percentage of male to female procedures, and the number of sterilizations as a percentage of the total number of new acceptors. Countries covered include Antigua, Aruba, Barbados, Bermuda, Brazil, Colombia, Dominica, Dominican Republic, Ecuador, El Salvador, Grenada, Guatemala, Guyana, Honduras, Jamaica, Mexico, Montserrat, Nicaragua, Panama, St. Kitts-Nevis, St. Lucia, Trinidad and Tobago, and the US. In the 22 developing countries, sterilizations numbered 58,147 in 1978, 72,167 in 1979, 57,137 in 1980, 65,827 in 1981, and 90,087 in 1982. Male sterilizations represented only 3 or 4% of female procedures throughout this period, and sterilizations accounted for 10-13% of new acceptors. In the US, there were 9333 sterilizations performed in 1978, 7642 in 1979, 6479 in 1980, and 6637 in 1981. The corresponding percentages of male to female procedures were 945%, 702%, 527%, and 386%, respectively. The percentages of sterilizations to new acceptors was 2% in 1978 and 1% in 1979-81.