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  1. 1
    077236

    Voluntary surgical contraception in Brazil.

    Aguinaga H

    [Unpublished] 1988 Oct 26.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)
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  2. 2
    041926

    Association for Voluntary Sterilization - Consultant Team. Trip report: the People's Republic of China, Beijing, Chongqing, Wuhan, Guangzhou, June 19-30, 1985.

    Huber D; Fathalla M; Gojaseni P; Goldstein M; Lippes J; Minor K; Rauff M; Sciarra J; Rauff A

    [Unpublished] 1985. 41, [6] 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.
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