Your search found 17 Results
Progress in Reproductive Health Research. 2005; (68):2-3.Service providers need to know what choice of contraceptive methods they can offer to clients, and what medical conditions or personal characteristics might make use of a particular method more of a health risk. While the final specification of criteria for medical eligibility has to be made at country and programme level, to take into account the local situation and setting, WHO’s broad recommendations provide a sound basis for decision-making. The third edition of Medical eligibility criteria for contraceptive use, published in 2004, contains some 1700 recommendations, organized by method of contraception and known pre-existing medical condition or individual characteristic. (excerpt)
Progress in Reproductive Health Research. 2005; (68):3-4.No contraceptive is both 100% effective and totally free of side-effects. In practice, therefore, the choice of a family planning method almost always involves a trade-off between the desired level of protection against pregnancy and the client’s willingness to tolerate the risks and disadvantages associated with any particular method. The level of protection for some methods, however, is a function not only of the method itself but also of how consistently and correctly it is used. Furthermore, the perceived disadvantages of certain methods can be overcome, or at least alleviated, through appropriate counselling. WHO’s Selected practice recommendations for contraceptive use provide guidance on the use of contraceptives, with the goal of maximizing effectiveness and managing side-effects and other problems. The recommendations are not intended for direct application in countries. Rather, they should be used as a basis for the development of national and local guidelines that take into account existing policies, needs, priorities and resources. (excerpt)
Safe Motherhood Initiative: meeting of interested parties, World Health Organization, Executive Board Room, Geneva, Thursday, 7 July 1988.
[Unpublished] 1988. 25 p. (FHE/SMI/MIP/88.2)Given the multiple causes of maternal mortality, the World Health Organization's (WHO) Program of Maternal and Child Health addresses 4 factors: 1) social equality for female children and women; 2) universally accessible family planning to avert high-risk or unwanted pregnancies; 3) adequate prenatal care, including nutrition, with early recognition and referral of women with high-risk pregnancies; and 4) access to required obstetric care for women with emergencies that occur during pregnancy, delivery, or in the immediate postpartum period. WHO's Safe Motherhood activities are aimed at reducing maternal mortality by at least 50% by the year 2000. Toward this end, WHO is working to assist countries to determine the magnitude of their maternal mortality problem, identify the immediate underlying causes of maternal deaths, reach decisions about action priorities, evaluate innovations in maternal health care, conduct staff training, and support resource mobilization by national authorities so that programs can be implemented adequately. Research, information analysis and dissemination, technical support, and training comprise the foci of WHO's interventions in maternal health at present. If the Safe Motherhood Initiative is to be achieved, greater coordination and technical support at the global level and collaboration among agencies and national authorities at the country level will be required. The lack of sensitivity and responsiveness on the part of health staff to the perceived needs and perspective of women still comprises an obstacle to women's use of available maternal health services and must be addressed through training. To maintain the pace of its Safe Motherhood activities, WHO required US $4.5 million in extrabudgetary support.
New York, New York, United Nations Children's Fund [UNICEF], 1990. 24 p.In some parts of Africa, the acquired immunodeficiency syndrome (AIDS) has infected between 1/5 and 1/4 of otherwise healthy adults of reproductive age. This is a calamity. Those who are fighting AIDS in Africa believe that changes in behavior are the only way to stop the human immunodeficiency virus (HIV). WHO estimates that already 6.5 million people are infected; at least 2 million are women. By the year 2000, there will be 6 million AIDS cases. The UN International Children's Emergency Fund (UNICEF) has been fighting to protect children and women from AIDS since 1987. Looked at here is the predicament of children and women in 3rd world countries. Also, the damage that AIDS is doing to families and communities and the need to contain it are discussed. Most AIDS cases in children are perinatal in origin. Barrier contraception is important in preventing the spread of AIDS. Deliberate family planning (FP) with modern contraceptive methods is unusual in most low-income African communities. Women frequently have less access to medical services than do men. The number of AIDS orphans is already beginning to affect family life. UNICEF estimates that worldwide 30 million children spend most of their time on the streets. They are then ripe for getting AIDS. Nongovernmental organizations (NGOs) are being formed in response to AIDS. The primary health care structure is important for counselling and health education. During 1990 UNICEF plans to spend over US $6 million on special AIDS projects in Africa and almost US $2 million on global projects and projects elsewhere. In many countries UNICEF has helped develop information and education materials. UNICEF wants to reach young people. In Tanzania, workshops have been held to improve the accuracy of data given about AIDS.
Prototype home-based mother's record: a guideline for its use, and adaptation in maternal and child health/family planning programmes and a reference manual for field testing and evaluation.
[Unpublished] 1985. , 119 p. (MCH/85.13)There is a need for a simple, home-based maternal record that can monitor breastfeeding and family planning practices during the interpregnancy period, identify high-risk women, and guide health care workers in the timely management of care to be provided in the home and at the next referral level. This record should further serve as an educational tool that promotes the concept of participation in self- care. Maternal cards used in clinics and hospitals are difficult for primary health care workers with limited education to complete and are not designed to be adapted to the changing health problems and health needs in a given community. In response to this situation, the World Health Organization's Maternal-Child Health Unit has designed a prototype home-based mother's record that can serve as a starting point for the design of more area-specific ones. The record contains 6 panels: 1 for data and risk conditions suggested by past history; 3 for data on past pregnancies, deliveries, and postpartum periods; 1 to monitor health progress before the 1st pregnancy or during the interpregnancy interval; and 1 for recording recommendations to the referral center. It is important that any mothers' records developed should be field tested to evaluate the physical condition of the card after 1 year of use, the extent of use of the record, the quantity of information collected and its usefulness, the assessment of health workers about the value of the record, risk factors identified, utilization of referral sources and family planning services, and linkages with other health records.
Geneva, Switzerland, WHO, 1991. vii, 72 p.Members of WHO's Technical Working Group on Essential Obstetric Functions at First Referral Level have prepared a book geared towards district, provincial, regional, national, and international decision makers, particularly those in developing countries, whose areas of expertise include planning, financing, and organization and management of obstetric services. The guidelines should allow them to improve referral services' standards at the district level. They should also help them decide how far and by what means they may possibly expand some of these services to more peripheral levels, e.g., renovating facilities and improving staff. When developing these guidelines, WHO took in consideration that many countries confront serious economic obstacles. The book's introduction briefly discusses maternal morbidity and mortality in developing countries and maternity care in district health systems. The second chapter, which makes up the bulk of the book, addresses primary components of obstetric care related to causes of maternal death. This chapter's section on surgical obstetrics examines cesarean section and repair of high vaginal and cervical tears among others. Its other sections include anesthesia, medical treatment, blood replacement, manual procedures and monitoring labor, family planning support, management of women at high risk, and neonatal special care. The third section provides guidelines for implementation of these services, including cost and financial considerations. It emphasizes the need at the first referral level to have the least trained personnel perform as many health care procedures as possible, as long as they can do so safely and effectively. Other implementation issues are facilities, equipment, supplies, drugs, supervision, evaluation, and research. Annexes list the required surgical and delivery equipment, materials for side ward laboratory tests and blood transfusions, essential drugs, and maternity center facilities and equipment.
Geneva, Switzerland, World Health Organization [WHO], Division of Family Health, Maternal Health and Safe Motherhood Programme, 1992. 74 p. (Safe Motherhood; WHO/MSM/92.4)Women in Africa face a lifetime risk of maternal mortality 500 times greater than that of women in developed countries. This lifetime risk is also considerably higher for women in other developing regions compared to that for those in developed countries. Many health professionals believe that antenatal care in developing countries decreases the likelihood of women dying pregnancy and childbearing as well as significant maternal morbidity, yet no one has systematically assessed its potential to actually improve maternal health. The WHO Maternal Health and Safe Motherhood Programme plans to support research to examine antenatal care's potential. It has reviewed the effectiveness of antenatal interventions compared to poor maternal health in developing countries. The review reveals that good quality data are scarce and that health providers have not accurately tested many interventions. For example, the US, UK, and Sweden have all achieved low case fatality rates for eclampsia using a different anticonvulsant therapy for severe preeclampsia (magnesium sulfate; diazepam or other benzodiazepines; and hydralazine with at least chlorpromazine, pethidine, diazepam, and chlormethiazole, respectively), but few trails have compared the different treatments. This review begins with an overall look at antenatal care programs. It then examines interventions of the leading causes of maternal mortality and morbidity (hemorrhage and anemia, hypertensive disorders of pregnancy, obstructed labor, and puerperal sepsis and genitourinary). The most effective interventions are those that deal with chronic conditions rather than acute conditions which arise near delivery. The review concludes with a table of effective antenatal interventions and tables of research questions about potentially effective antenatal interventions against various maternal conditions.
[Unpublished] . 100 p. (WHO/MCH/MSM/91.6)The Maternal Health and Safe Motherhood Programme under WHO's Division of Family Health has compiled maternal mortality data in its 3rd edition of Maternal Mortality Ratios and Rates. The report contains data up to 1991. These data come from almost all WHO member countries. 1988 estimates reveal that 509,000 women die each year from causes related to pregnancy and childbirth. Most die from preventable causes such as aseptic abortions and lack of adequate health care. 4000 of these maternal deaths occur in developed countries. Thus developing countries, where 87% of the world's births occur, experience 99% of maternal deaths. In fact, the lifetime risk of death from causes related to pregnancy and childbirth in developing countries is 1:57 compared to 1:1825 in developed countries. Women in countries of western Africa have the greatest risk (1:18) and those in North America the smallest risk (1:4006). Even though the maternal mortality ratio for developing countries fell from 450-520 per 100,000 live births between 1983-1988, it increased in western African countries (700-760). This report consists mainly of tables of maternal mortality estimates for each country and in some cases certain areas of each country, for the world and various regions and subregions, and changes in maternal mortality since 1983 for the world and various regions and subregions. The world comparison table includes live births, maternal deaths, maternal mortality ratios and rates, lifetime risk, and total fertility. Country tables list year, data sources, maternal mortality ratio, indication if abortion deaths were included or not, and reference.
[Blood pressure complications of pregnancy: through collaborative studies, WHO seeks solutions] Les troubles tensionnels de la grossesse: par des etudes collectives, l'OMS cherche des solutions.
MATERNITE SANS RISQUES. 1991 Jul-Oct; (6):8.Eclampsia, an obstetrical emergency described in medical texts going back over a century, is characterized by convulsion, loss of consciousness, and high risk of death in the absence of careful medical treatment. Many cases can be prevented if the signs are recognized and treated in time. High blood pressure often giving rise to severe headaches, proteinuria, and edema causing abnormal swelling of the arms, legs, and face are precursors. The possibility of preventing eclampsia led the World Health Organization to undertake a collaborative study of the prevalence, causes, and effects of hypertensive disorders of pregnancy in different parts of the world. The principal investigators of 7 countries who met in Singapore to compare their findings noted strikingly different rates of eclampsia and preeclampsia in the 4 Asian countries represented. Edema was found to be a useful indicator of increased risk where health resources are scarce and the incidence of hypertension and edema are low. A study of maternal mortality in Jamaica around this time found that about 1/3 of deaths from direct obstetrical causes resulted from hypertensive disorders, most often eclampsia. The Jamaican researchers proposed a research project using techniques developed during the collaborative study. Data on more than 10,000 pregnant women allowed detailed study of hypertension, preeclampsia, and eclampsia. Among the women, .72% had had a crisis of eclampsia and 10.4% had hypertension, accompanied by proteinuria in about half the cases. Primigestes, women over 30, and those gaining more than normal amounts of weight during pregnancy were identified as at increased risk. The best indicator of risk was the coexistence of at least 2 out of 3 factors: edema, diastolic pressure of 80 mmHg or over, and proteinuria. The findings caused Jamaica to launch 2 programs, the 1st to screen pregnant women for risk factors for eclampsia and provide special care, and the 2nd to provide small doses of aspirin to half of pregnant women and a placebo to the other half to verify whether small doses of aspirin are an effective means of preventing eclampsia. The World Health Organization is supporting a controlled study of the efficacy of calcium tablets in preventing eclampsia in Peru and is considering a study comparing 2 different regimes for treating eclampsia in Argentina.
Meeting of principal investigators of risk approach study in MCH care, report of an intercountry meeting, Rangoon, Burma, 30 December 1985-3 January 1986.
[Unpublished] 1986 Sep 5. ii, 42 p. (SEA/MCH/183; RAS/85/P23)Objectives of the intercountry meeting of principal investigators of risk approach study in maternal-child health (MCH) care were: 1) to review the results of the risk approach studies in Burma, India, and Thailand that have been done to identify research design and method problems, and to propose solutions for improved study; 2) to identify research issues relevant to study, and applying the risk strategy; 3) to explore the devices for application of the risk approach results in delivery of MCH/family planning (FP); and 4) to find further areas for research. In Burma, some problems were: there were no proper patient records; and staff was not being scheduled properly. There was a drop in the overall incidence of low birth weight deliveries from 21% in 1977-78 to 10-16% in 1983-83. The Indian project was started in January 1981, and lasted until the end of December, 1984. Study design was a "before and after" model. The overall risk detection rate was 80%. In Thailand a "before and after" model was used in 136 villages of 18 subdistricts in the Bang Pa In district of Ayuthaya Province. The before intervention situation took place in 1977-78; the after period runs from May, 1980 to April, 1983. Overall results show better coverage of prenatal, natal, and child care; and improvement in diarrhea and tetanus morbidity in newborns. The Amphur Nong Rua area of Khon Kaen was chosen as the 2nd Thailand project area. Its population is 77,209 (1983) living in 116 villages. A stratified random sampling technique was used. All women who miscarried or delivered from January 1, 9182 to December 31, 1983 and all infants born to these mothers were included. The health system of Bhutan is discussed, as well as health organization in Burma, India, Indonesia, Nepal, Sri Lanka, and Thailand. Researchable issues include low birth weight, social-behavioral, nutritional deficiency, and mental health studies. An action program is described.
IPPF MEDICAL BULLETIN. 1989 Apr; 23(2):1-2.This article discusses the need for family planning (FP) as part of the development process, applauds its successes and rallies continued momentum of the FP movement. 500,000 women die each year from pregnancy- or labor-related conditions, and 10s of millions of women suffer pregnancy-related illnesses and impairments that undermine their social and economic productivity. Moreover, the 4 major factors that lead to high-risk pregnancies, namely, becoming pregnant before the age of 20, after the age of 35, after 4 or more pregnancies, and < 2 years after an earlier pregnancy, all reveal the need for FP. These tragedies could be avoided by assuring better nutrition, primary health care for all, good antenatal attention and proper facilities and help in childbirth, access to good obstetric care in emergency situations, and universally available FP services. FP organizations must empower women with the knowledge of FP and the means to put it into practice. Developing countries, such as China, India, Indonesia, Thailand and Mexico, in addition to affluent industrialized countries have made strides in FP with the help of such organizations as the International Planned Parenthood Federation (IPPF). IPPF has helped to motivate large numbers of men and women to determine their ideal family size. It has provided the means for them to reach such goals and has ensured that acceptance of FP has been on a voluntary basis. IPPF has also advised and cajoled governments into becoming involved in FP. In the future, national strategies must produce the building blocks for better policies to help women become more responsible for their lives. The education of women will be vital to achieving this objective as well as other aspects of development.
CHILD SURVIVAL ACTION NEWS. 1988 Apr; (9):1-2.Present thinking regarding the control of neonatal tetanus (NT) suggests that the accepted protocol in the past, i.e., immunizing pregnant women with tetanus toxoid (TT) during antenatal care, is not sufficient in countries where antenatal care may be unavailable. Current control strategies, experts, and official World Health Organization (WHO) recommendations now indicate that efforts should reach beyond immunization of pregnant women and the training of traditional birth attendants in hygienic cord care practice to immunization of all women of childbearing age. Babies continue to die form NT because it is so difficult to reach women during pregnancy for immunization. Lack of commitment to expanding immunization programs as Who recommends stems in part from failure at both national and local levels to acknowledge the extent of the neonatal tetanus problem. NT is vastly underreported for several reasons: cultural practices often include the seclusion of women and their babies during the period after birth; people in developing countries have a fatalistic attitude because so many children die within the 1st year of life; newborns are rarely taken to health centers for treatment; health workers may fail to report NT for fear that their superiors will blame them for failure to immunize or for poor care of the umbilical cord; Western medicine and research has a curative rather than a preventive focus; and gathering information on NT by asking mothers to recall deaths of newborns with symptoms of NT is difficult because many women are ashamed or otherwise unwilling to report the event. The WHO believes that conventional reporting systems in developing countries identify only 2-4% of actual NT cases. Without sound documentation of the problem, it is difficult to gain financial and political commitment to eradicating NT. The VIII International Conference on Tetanus that occurred in Leningrad during 1987 outlined WHO's recommendation for a mixed strategy to control and eliminate tetanus: immunize all women of childbearing age, with special emphasis on pregnant women and women known to belong to high risk groups; assure hygienic delivery and umbilical care through training and supervision of birth attendants; and investigate cases to determine what action could have prevented them.
In: High risk mothers and newborns: detection, management and prevention, edited by Abdel R. Omran, Jean Martin and Bechir Hamza. Thun, Switzerland, Ott Verlag, 1987. 355-60.Today the UN Fund for Population Activities (UNFPA) is working in 8 main areas: 1) basic data collection, 2) population dynamics, 3) formulation of population policies and programs, 4) implementation of policies and programs, 5) family planning, 6) communication and education, 7) special programs, and 8) multisector activities. UNFPA has always been convinced of the health benefits of family planning or of the negative effects of unregulated fertility on maternal, perinatal, neonatal, infant, and child health. In countries which remain unconvinced of the need for family planning, UNFPA has provided assistance for conducting studies which tend to demonstrate the negative health effects of unregulated fertility. In countries convinced of the need for providing family planning services, on the basis of studies of the type just mentioned or of demographic or socioeconomic evidence, a shift typically occurs in UNFPA assistance patterns toward greater support for family planning service-related activities. Such services may take a variety of forms in accordance with national desires and still be eligible for UNFPA support, so long as all couples and individuals have the basic right to decide freely and responsibly the number and spacing of their children. UNFPA will support both high-risk-only family planning programs and those open to all comers, but movement toward wider availability is always welcomed. Regarding modes of service delivery, UNFPA is willing to support 1) specialized free-standing, nonintegrated family planning programs; 2) family planning integrated with maternal and child health in the context of primary health care; 3) family planning integrated in socioeconomic development programs; 4) community based distribution programs, and 5) commercial marketing programs.
World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1985; 38(3):302-16.Tables present data on the prevalence of anemia in the world. Anemia may be defined as a state in which the quantity or the quality of circulating red cells is reduced below the normal level. The most common way to diagnose anemia is by measuring the hemoglobin concentration in the blood which is controlled by a homeostatic mechanism. It varies slightly among normal subjects. In 1959, the World Health Organization (WHO) proposed levels of hemoglobin concentrations for different groups of individuals that could be considered as the lower limits of normality. Subjects with values below these levels were considered to be anemic. The causes of anemia, which are multiple, include a deficiency of hemopoietic factos, genetic disorders causing hemolytic anemias, infections including malaria, and increased losses of blood caused inter alia by infections such as ankylostomiasis or schistosomiasis. A survey of the prevalence of anemia in women in developing countries was published by WHO in 1982. It estimated the prevalence of nutritional anemia in developing countries (other than China) at 60% in pregnant women and 47% in non-pregnant women. The prevalence of anemia in all women of reproductive age was estimated at 49%. It appears that studies on the prevalence of anemia were conducted regularly during the 1960-84 period, with the exception of studies on elderly people most of which were conducted before 1970. Most studies included from 100 to 300 subjects. Studies on adolescents usually covered fewer than 100 subjects. The tables provide no data on the severity of anemia, i.e., the percentage of subjects with a hemoglobin concentration below a specific level. On the basis of the present review, the total prevalence of anemia in the world is most likely about 30%. Expressed in absolute numbers this means some 1300 million people of the estimated world population of 4440 million in 1980. For the developing regions of the world, the prevalence of anemia is probably about 36% or 1200 million people, and for the more developed regions about 8% or just under 100 million people. Young children and pregnant women are the most affected groups with an estimated global prevalence of 43% and 51%, respectively. The regions with the highest overall prevalence of anemia are South Asia and Africa. With the exception of pregnant women, the prospects for the prevention of iron deficiency anemia in a population are poor at the present time. Iron fortification and the daily administration of an iron supplement present great problems in developing countries, and they will not be resolved easily.
In: Intrauterine contraception: advances and future prospects, edited by Gerald I. Zatuchni, Alfredo Goldsmith, and John J. Sciarra. Philadelphia, Pennsylvania, Harper and Row, 1985. 354-64. (PARFR Series on Fertility Regulation)Little data is available from developing countries on the incidence of ectopic pregnancy and the associated risk factors: pelvic inflammatory disease (PID), sexually transmitted diseases (STDs), intrauterine devices (IUDs), and abortion. To address this problem, the World Health Organization conducted a multinational case-control study between 1978 and 1980 of factors associated with ectopic pregnancy in 12 centers, 8 in developing countries and 4 in developed countries. Results suggest that risk factors are similar in women from developing and developed countries. The only exceptions were increased risks of ectopic pregnancy associated with spontaneous abortion or smoking in developing but not developed country centers. This may reflect misreporting of illegal induced abortion or postabortion complications, and behavioral differences between smoking and nonsmoking women in developing countries. All methods of contraception prevent pregnancy and so provide protection against ectopic pregnancy. This protective effect is least with the IUD, however, and accidental conceptions during IUD use or after sterilization carry an increased risk of ectopic pregnancy. With the IUD, this probably reflects both differential protection against intrauterine and extrauterine pregnancy and an increased risk of IUD-related PID resulting in tubal damage. The risk of ectopic pregnancy is also increased in women with a previous history of PID or a prior pregnancy. However, cesarean section was found to reduce the risk of ectopic gestations in all comparison groups.
[Perinatal assistance of a basic level in Latin America in 1978: description of projects under execution in 1978] Asistencia perinatal a nivel primario en areas rurales de America Latina en 1978: descripcion de proyectos en ejecucion en 1978.
Montevideo, Uruguay, Centro Latinoamericano e de Perinatalogia y Desarrollo Humano, 1979 Feb. 128 p. (Publicacion Cientifica del C.L.A.P. No. 790.)This report investigates the status of maternal-infant services in the rural areas of 18 Latin American countries, and presents statistics on fetal, infant, and maternal mortality in the same countries. Methods and types of personnel used for the attention of pregnancy and delivery are described, together with recommendations for improvements from such international organizations as WHO and PAHO. The important role of practical midwives in all Latin American countries is stressed, as is the need for their training, especially for what concerns the identification of high risk pregnancies. The report includes a brief description of programs already implemented in 14 countries, and compares them to similar ones existing in the U.S., Holland, Nigeria, Tanzania, Thailand, China, and Ethiopia. The report concludes with recommendations from the Latin American Center for Perinatology and Human Development on simplifying perinatal care in Latin American countries.
(London, IPPF), May 1975. 15 p.Population data was gathered by the International Planned Parenthood Federation (IPPF) to use for budgetary purposes. Statistical population tables are presented for 222 countries grouped into 8 large regions. The tables show: total population, growth rates and birthrates for the countries and regions for each year since 1970. Based on these figures, projections for 1976 are made. The number of women in the 15-44 year age group for each country and region is given. A standard formula yields the number of women at risk, correcting for sterile couples, sexually inactive women, and those not having 3 children yet. IPPF figures are compared with the latest United Nations projections.