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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)
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.
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.
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.
[Voluntary sterilization in France and in the world] La sterilisation volontaire en France et dans le monde.
Paris, Masson, 1981. 277 p.This monograph, directed not only to medical and paramedical personnel but to sterilization seekers as well, touches upon all aspects of voluntary sexual sterilization. The history of sterilization is follwed by a review of female and male anatomy and physiology, and of present available and reversible methods of contraception. All surgical, laparoscopic, tubal, electrocoagulation, culdoscopic, or hysteroscopic methods of female sterilization are described, and results, including morbidity and mortality, complication rates, side effects, and failure rates are presented. This part of the monograph is illustrated with clear and schematic drawings. Problems related to demand for reversal of sterilization are discussed. The same is done for male sterilization, its techniques and complications. The monograph discusses the ever increasing demographic problem in the world , and the role and the extent of voluntary sexual sterilization in industrialized countries and in third world countries, stressing the efforts of those international agencies, such as WHO, IPPF, the Population Council, the European Council, UNFPA, and the World Federation of Associations for Voluntary Sterilization, which promote sterilization around the world, and offer sterilization services. The authors then investigate the role of the physician in the decision to recur to sterilization as a permanent contraceptive method, and in deciding the proper surgical technique. A special chapter discusses the psychological conflicts related to sterilization, especially those which arise before the intervention, and which may very well represent the strongest contraindication to sterilization. A final chapter is devoted to France and to the sociocultural aspects which make sterilization more or less acceptable, the existing legislation, and the professional problems linked to sterilization interventions.
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.
Guide to equipment selection for M/F sterilization procedures. Guide du materiel utilise pour les procedures de sterilisation des hommes et des femmes.
Population Reports. Series M: Special Topics. 1977 Sep; (1): p.This is a guide to aid in selecting and maintaining the proper equipment used in the following sterilization procedures: 1) minilaparotomy, 2) laparoscopy, 3) conventional laparotomy, 4) colpotomy, 5) culdoscopy, and 6) vasectomy. Prototype, experimental, or infrequently used instruments are not discussed. Colpotomy, minilaparotomy, and conventional vasectomy are low-technology procedures requiring relatively simple, locally produced instruments, e.g., retractors, forceps, and scalpels. High-technology equipment consists of specialized items, e.g., laparoscopes and culdoscopes. These are produced in a limited number of technically advanced countries. Equipment donor agencies are discussed. The following factors must be considered in selecting equipment: 1) suitability for the intended procedures, 2) quality of the instrument, 3) ease of repair, and 4) initial cost. Each type of equipment is pictured, diagrammed, described, and charted against others of its kind. Maintenance and repair guidelines are provided.
Conclusions and recommendations of the IPPF Central Medical Committee (CMC) and its panel of experts on sterilization.
In: Kleinman, R.L., ed. Male and female sterilization. A report of the meeting of the IPPF Panel of Experts on Sterilization, Bombay, January 11-14, 1973. London, International Planned Parenthood Federation, 1973. p. 8-12The conclusions and recommendations fall into 3 categories, i.e., policy, administrative and technical. Important points in the 1st category include; that sterilization be available and avilable on request, that it be voluntary, and that facilities for reversal procedures be free and avilable. Administrave recommendations include; that no arbitrary hospital stay be assinged to vasectomy patients, that no arbitrary selection criteria concerning previous training or surgical skill be used in accepting personnel for vasectomy patients, that no arbitrary selection criteria concerning previous training or surgical skill be used in accepting personnel for vasectomy training, and that endoscopic techniques should not be done without an anesthetist. Among the technical recommendations were: that postpartum sterilization under local anesthesia by laparotomy be encouraged, as that is the simplest of all female procedures; taht vaginal procedures should only be done with proper operative and anathestic facilities; that division of the uteirne tubes by the Pomeroy technique using 0 chromic catgut should be employed in mass programs of female sterilization; the removal of part of the uterine tube for biopsy and histological examination as a check on the success of the operation should not be done; general anesthesia should never be used for a simple vasectomy unless there are complications; and that tetanus toxoid should not be given to avoid infection.
[Unpublished] 1983. Paper presented at International Conference on Voluntary Sterilization, 5th, Santo Domingo, Dominican Republic, December 5-8, 1983. 5 p.This paper discusses the needs in surgical contraception for the 80's. Specifically, in order to meet the population increase in 1990, 163,150,000 sterilizations will have to be done in the developing countries, nearly 5 times the number of sterilized women by 1980. A total of 10.8 billion dollars will be needed to carry out this enormous task. Of this total sum, 58% of this amount will be to pay salaries and social benefits, the rest will be for expendable materials, equipment, remodelling of operating rooms, training, supervision, communications, repair, and maintenance. Also discussed is the building of international commitments regarding surgical contraception. The role of Planned Parenthood, World Federation, UNFPA, and WHO are emphasized in recommending influencial strategies for governments in order to favor family planning, maternal and child health, and promotion of contraceptive research.