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BMJ Sexual and Reproductive Health. 2018 Jan; 44(1):66-68.Following publication of the author's trial on the effects of postnatal depot medroxyprogesterone acetate (DMPA) compared with the copper intrauterine device (IUD) on postnatal depression in this journal in July 2016, they have sought to evaluate contraceptive discontinuation in our study sample. Postnatal contraception is promoted as part of the WHO strategy to reduce the unmet need for family planning in low- and middle-income countries (LMICs) and to reduce preventable maternal and child mortality. However, little is known about discontinuation rates associated with postnatal contraception use in these settings. From the trial, 75 of 242 participants were contactable two or more years after randomisation and 54 consented to a follow-up interview, which was conducted by a Masters student from the University of Fort Hare (NDY). Twenty-three women had received DMPA and 31 women an IUD. In the DMPA and IUD arms, respectively, 48% (11/23) and 42% (13/31) had discontinued their contraceptive methods by the time of the interview. All participants who discontinued did so within the first year, 10 within 3 months of allocation (DMPA=4, IUD=6), and 17 within 6 months (DMPA=7, IUD=10). Six of the participants allocated to DMPA (26%) and five allocated to the IUD (16%) became pregnant following discontinuation.
Indian Journal of Medical Research. 2012 Sep; 136(3):370-1.Add to my documents.
Does insertion and use of an intrauterine device increase the risk of pelvic inflammatory disease among women with sexually transmitted infection? A systematic review.
Contraception. 2006 Feb; 73(2):145-153.Concerns exist as to whether the insertion of copper and levonorgestrel-releasing intrauterine devices (IUDs) increases the risk of pelvic inflammatory disease (PID) among women with sexually transmitted infection (STI). We searched the MEDLINE database for all articles published between January 1966 and March 2005 that included evidence relevant to IUDs and STIs and PID. None of the studies that examined women with STIs compared the risk of PID between those with insertion or use of an IUD and those who had not received an IUD. We reviewed indirect evidence from six prospective studies that examined women with insertion of a copper IUD and compared risk of PID between those with STIs at the time of insertion with those with no STIs. These studies suggested that women with chlamydial infection or gonorrhea at the time of IUD insertion were at an increased risk of PID relative to women without infection. The absolute risk of PID was low for both groups (0-5% for those with STIs and 0-2% for those without). (author's)
Geneva, World Health Organization, 1966. (Technical Report Series NO. 332).The value and possible hazards of IUDs are discussed. Grafenberg developed a metal ring IUD in 1928. There was initial enthusiasm about the device, but it became discredited and interest was not revived in the method until 1959. Today, various shapes, sizes, and materials are employed in making IUD'S. No single cause or mechanism of action of an IUD has so far come to light. In sub-human primates the IUD causes accelerated passage of ova through the tube and the rest of the reproductive tract appears to be the major, but not necessarily the only, mechanism, of action. In ruminants, the contraceptive action of the IUD is exerted, at least in part, at the ovarian level. In rats, mice, rabbits, and ferrets, the main effect of the IUD is suppression of the implantation. It is concluded that the action of the IUDs in the human species is exerted before the stage of implantation. The most effective devices are associated with an incidence of 1.8 to 2.9 pregnancies per 100 insertions during the first year of use. The frequency of spontaneous expulsion ranges from about 5% to over 20% depending on the type of device. About one half of all expulsions occur in the first 3 months and comparatively few after the first year. The incidence of removal for medical reasons ranges from approximately 10% to 25% of first insertions during the first year. The method can be used successfully by almost 3 out of every 4 women who adopt it. Side effect and complications include bleeding and pain and less frequently pelvic inflammatory disease and perforation. The only absolute contraindications to the use of IUDs are: (1) active pelvic inflammatory disease, and (2) pregnancy, proven or suspected. Research needs are noted.
[Unpublished] . 9 p.IPPF relies on its International Medical Advisory Panel (IMAP), formed in 1979, for advice on safety and acceptability of contraceptive methods; service delivery; training of service delivery staff; and scientific aspects of the manufacture of contraceptives. The specializations of IMAP members include contraceptive technology, gynecology endocrinology, public health, and family planning program management. Whereas there was a relatively high demand in the first couple of years after IPPF issued its statement approving Norplant in 1985, and Norplant was added to the commodities list, after 1989 the requests by FPAs for Norplant have diminished, as it is now (1991) considered to be too expensive. The cost of training doctors to insert and remove Norplant is also high and many FPAs are reluctant to train doctors because of the expense. In Pakistan the nearly 100% effectiveness of this method makes it an ideal contraceptive and it can be compared with the IUD, which has 2-4% failure rate. The FPA of Bangladesh Annual Report 1990 stated that 304 cases had been recruited in Rangpur and 308 cases in Dhaka, of which 549 were continuing for 1-3 years. The Thai government is aware that Norplant is expensive and is limiting its use to the rural hilly areas. On an optimistic note, PROFAMILIA, Colombia, plans to expand access to Norplant services at its clinics, which will require additional trained personnel and Norplant implants. The plan is to start this project in January 1992. In Eastern Europe, the Bulgarian FPA expressed an interest in introducing Norplant into its programs. Although the trials concluded that it is an acceptable, long-acting and effective method of contraception, IPPF has only had requests from three countries in 1991 for the supply of Norplant (Indonesia, Bahamas and Kenya). The major constraints on the use of Norplant are its cost, lack of trained personnel, and difficulties in licensing.
[Unpublished] 1991 May 9.  p.Norplant is an effective, long-lasting, reversible contraceptive that provides protection for five years. It consists of six thin, flexible Silastic capsules filled with 36 mg of levonorgestrel, inserted just under the skin of a woman's upper arm in a minor surgical procedure. To date (1991), more than 55,000 women in 46 countries have used it in clinical trials and pharmacological evaluations. The pregnancy rate is 0.2 per 100 continuing users for the first year. The most frequently reported side effect is change in the menstrual bleeding pattern. In addition, headache, nervousness, nausea, dermatitis, acne, weight gain, and some effects on hair as hirsutism and hair loss may be associated with Norplant use. The net continuation rate is over 77% of new acceptors the first year and 35% after five years. Any specially trained physician, nurse, nurse-midwife, or trained health worker can do insertions and removals. To make sure the woman is not pregnant, Norplant should be inserted within seven days after the onset of menstrual bleeding or immediately postabortion. Norplant may be used by almost any woman who is in good health. It is particularly suited for women who want long-term birth spacing or cannot use contraceptives that contain estrogen. It can also be an appropriate method for lactating women starting at least six weeks after childbirth. At present more than half a million women have used Norplant in countries where it has been approved for widespread distribution: Finland (1983); Sweden, Ecuador, Indonesia (1985); Thailand, Dominican Republic, Colombia (1986); Peru, Venezuela, Sri Lanka (1987); Chile (1988); and Kenya, China, Czechoslovakia (1990). Among several other countries, Haiti, Nepal, and Tunisia have also authorized Norplant in their national family planning program. With approval of Norplant by the United States Food and Drug Administration in 1990, the method faces potentially greater demand in the future.
New York, New York, AVSC, 1993 Sep. 8 p.Neither the US Food and Drug Administration nor WHO have yet endorsed intrauterine insertion of quinacrine for tubal occlusion in women. Quinacrine is very inexpensive and easy to produce and insert, which make it open to abuse. Free and informed choice and safety must be upheld as well as quality of care in family planning services. The few studies of quinacrine use for nonsurgical sterilization have small sample sizes and very short-term follow-up. They have largely occurred in Chile, Egypt, and Indonesia. One study suggests that quinacrine increases the risk of cancer. Recently a field trial of 31,781 women undergoing nonsurgical sterilization with quinacrine pellets was conducted in Viet Nam. The pregnancy rate at 1 year was 2.63. At 2 years it was 4.31 for cases with 2 insertions. At 5 years, for women with just 1 insertion, it was 5.15. There were 19 ectopic pregnancies. Major complications included 2 cases of severe bleeding, 2 hysterectomies (severe pain and amenorrhea, adhesions in the cervical canal), 1 case of premenstrual pain and dysmenorrhea, 1 case of pelvic inflammatory disease, and 1 allergic reaction. Only minor side effects occurred. The study methodology was flawed, however. For example, the researchers did not bide by the inclusion criteria they claim to have used. They also extrapolated failure rates and side effects based on subsets to the whole group. Thus, this study cannot be used to conclude that quinacrine pellets are safe and effective. Further, well-designed studies addressing short and long-term safety are warranted. If studies find quinacrine pellets to be safe and effective, their low cost and ease of insertion make it a promising method in areas of high maternal mortality, with low access and availability of family planning services, and great unmet need for permanent methods.
ADVANCES IN CONTRACEPTION. 1994 Jun; 10(2):121-31.The World Health Organization's prospective IUD study at 47 centers in 23 (mostly developing) countries among 22,908 women found an elevated IUD-related risk of pelvic inflammatory disease (PID) during the 1st 20 days after IUD insertion. It also showed that the likely major determinant of PID among IUD users is the risk of exposure to sexually transmitted diseases (STDs). Long-term IUD use is related to a uniformly low PID risk. These findings support measures already practiced by most service providers: aseptic conditions and techniques during IUD insertion, close monitoring of women for signs of infection during the early stage of IUD use, IUDs not recommended for women at risk of STDs, use of long-lasting IUDs, and removal before the end of the IUD's life span. Additional research is recommended to strengthen the validity of the findings, to further reduce IUD-related PID incidence, and to expand indications for IUD use. Cohort IUD studies should ascertain women's sexual behavior at baseline and during the study period. Other cohort studies should examine the natural history of IUD insertion-related PID. Clinical trials should examine the protective effects of antibiotics administered during IUD insertion against PID. IUD use in nulliparous and nulligravid women should be studied. Studies should clarify the link between IUD use and nongonorrheal infections (chlamydial infection, HIV infection, and actinomycosis). Research is needed to examine IUDs that claim to protect against PID (e.g., levonorgestrel-releasing IUDs). After family planning researchers clear IUD use from its alleged association with PID and its sequelae, they can advance to studies on how to improve the quality of life of IUD users (e.g., reducing distressing symptoms such as bleeding) and to increase access to IUDs by removing the programmatic and medical barriers.
CONTRACEPTION. 1993 Apr; 47(4):359-66.To determine whether the known adverse effects of IUD use were kept to a minimum, 432 doctors were asked to complete questionnaires about their training and practice in IUD insertion, providing information about the insertion and the patient during a 3-month period. 349 doctors returned the first questionnaire. 93% of doctors had received some formal training in IUD insertion, although 54% had performed fewer than 5 supervised insertions before carrying out an unsupervised insertion. Only 8% had performed 10 or more supervised insertions. 58% had performed only 1 or no insertions in the month before the study period. 91% of respondents carried out more than 1 pelvic examination per week. Only 12% of doctors reported always prescribing prophylactic antibiotics. More doctors routinely took vaginal and cervical swabs for culture and cervical smears. 66% of doctors routinely arranged follow-up appointments. 98% of doctors routinely gave some information to women after IUD insertion. 90% of doctors provided a description of symptoms of infection. Information about women using an IUD was obtained from 129 doctors in 460 completed questionnaires about IUD insertions. Relative contraindications to IUD use included nulliparity, a history of suspected or proven pelvic inflammatory disease (PID), a significant risk of sexually transmitted disease (STD), and uncompleted family. Excluding uncompleted family, there were 126 insertions (27%) with at least 1 relative contraindication. Gynecologists performed 30% of the insertions in cases with relative contraindications compared with 48% for other doctors. 35 women who had IUDs inserted were nulliparous, and 4 of these were aged under 20, 11 women (2%) had an IUD inserted despite a history of suspected or proved PID. 12% of the women with IUDs were not in a stable sexual relationship; 9% had a history of STD, and 28% intended to have children in the future. 5% had both a risk factor for PID and an uncompleted family.
PID risk for IUD users highest in first 20 days after insertion; risk then falls sharply and remains low.
Family Planning Perspectives. 1992 Sep-Oct; 24(5):235-6.Researchers analyzed data on 22,908 women obtained from randomized WHO studies from 23 countries to determine whether the IUD increases the risk of pelvic inflammatory disease (PID). 35% of the women used the TCu220C IUD, 39% other copper releasing IUDs, 16% a hormonal IUD, and 9% the Lippes Loop. The overall PID incidence rate was 0.4% of all IUD insertions or 1.6 cases/1000 woman years. The incidence was greatest during the 1st 20 days after insertion (9.7 cases/1000 women years) and then declined to 1.4/1000 woman years. In fact, the risk of PID was >6 times greater within 20 days after insertion than it was >20 days after insertion. This high risk immediately after insertion was evident in every region where PID existed, at all insertion times, and in all age groups. The higher risk within the 20 days after insertion was attributed to contamination of the uterus during insertion. Women who had an IUD inserted after 1980 experienced PID 50% less often than those who had had it inserted earlier, e.g., the rate ratio for 1977-80 was 1.5 but was 0.5 for 1981-83 and 0.34 for 1984 and after. This may have been due to physicians being more aware of contraindications for IUD use, particularly past infection with sexually transmitted diseases )STDs). The rate ratio was higher in Africa (2.6) than it was in Europe (1) but lower in Asia (0.46) and in the Americas (0.39). None of the subjects in China experienced PID. Older women were at lower risk of PID than 15-24 year olds (0.44 for 25-29 year olds, 0.38 for 30-34 year olds, and 0.35 for =or> 35 year olds). The researchers believed the higher risk life styles of the younger group accounted for this difference. Risk of PID decreased with family size (2.5 for 0 children, 0.56 for 2 children, and 0.39 for at least 4 children). The risk of PID did not differ with IUD type. The researchers concluded that the major determinant of PID is exposure to an STD rather than type of IUD.
SINGAPORE MEDICAL JOURNAL. 1989 Aug; 30(4):390-2.In the 1980s, a study showed an association between IUD use and pelvic inflammatory disease (PID) and subsequent infertility. About the same time, 2 major manufacturers of IUDs stopped making IUDs. These 2 events caused a decline in IUD use worldwide. In Singapore, however, the decline began in the 1960s when the Family Planning Board withdrew the IUD from its 5 year plan. After that, researchers in Singapore 1st conducted randomized prospective trials of most new IUDs. For example in the late 1980s, they began a prospective trial of the MLCu380 with a complicated insertion system. Multicenter trails have demonstrated that at least 5 of the newest copper IUDs have a failure rate of <2/100 woman years and <1/100 for 3 other new copper IUDs. Some manufacturers have increased the area of exposed copper from 200-250mm to 375-380mm to increase efficacy, but a prospective trial in Singapore did not show an increase. A large multicenter trial has shown that the levonorgestrel releasing IUD (LNg20) has a very low failure rate (.12/100) and reduces menstrual loss, unlike the copper IUDs. Due to legal concerns over the medical grade plastic, however, the manufacturer stopped distributing it in the late 1980s. WHO hoped to identify a manufacturer for the plastic so further trials could begin around 1991. In the late 1980s, WHO studied the silver cored copper wire IUD used to prevent fragmentation. Since IUDs change the endometrium which suppresses intrauterine pregnancies but not extrauterine pregnancies, the risk of an ectopic pregnancy is 10 times that of a nonuser. The risk is lower in copper IUDs suggesting that copper ions reduce the chance of fertilization in the Fallopian tubes. The risk of PID in IUD users ranges from 1.5-2.6. The majority of IUD associated PID occurs within 4 months following insertion and in nulliparous patients with several sexual partners.
A randomized comparative study of interval insertion of three intrauterine devices: the copper T 220c, the Nova T and the WHO levonorgestrel 2 ug IUD.
[Unpublished] 1985 May. 5 p. (Project: 82901)The objective is to compare the effectiveness and acceptability of 3 IUDs inserted in 300 health women, aged 24-38. All have had at least 1 full-term delivery. Subjects were randomly allocated to 1 of the 3 IUDS: the Copper T 220C (Tcu 220c), the Nova T, and the World Health Organization levonorgestrel 2 ug IUD. Insertion was done from the 3rd to the 5th day of menstruation between Feb. and Sept. 1984 and followed up at 48 hours, 3, 6, 12, and 24 months after IUD insertion. 12 month data was collected for cumulative rates, based on life table procedures and analyzed with log-rank test. There was no loss to follow up and no insertion failure. All levonorgestrel IUDs have been removed because the levonorgestrel-releasing IUD has a relatively high risk of ectopic pregnancy. The use-related discontinuation rates of Tcu 220c, Nova T, and levonorgestrel IUD during 12 months of use, were 11.1, 2.4, and 12.7, respectively. The difference between Tcu 220c and Nova T were statistically significant (p.<0.01). The continuation rates of Tcu 220c, Nova T, and levonorgestrel during 6 months of use were 94.0, 99.0, and 96.0, respectively. During 12 months of use, they were 88.9, 97.6, and 87.3 respectively. 1 ectopic pregnancy occurred with the levonorgestrel IUD after 7 months of use. No pregnancy occurred in Nova T users. The pregnancy rates of Tcu 220c and levonorgestrel IUD during 12 months of use were 1.0 and 1.3, respectively. Removal rates for bleeding with Tcu 220c and levonorgestrel IUD during 12 months of use were 3.1 and 1.0, respectively. The removal rate for pain with Tcu 220c during 12 months of use was 2.0. The duration of bleeding and spotting with 3 IUDs, 3, 6, 9, and 12 months of use are illustrated. Preliminary results show that the Nova T is superior to Tcu 220c and levonorgestrel IUDs. Expulsion is the main event in both Nova T and Tcu 220c. More attention should be paid to the insertion technique. The duration of bleeding and spotting of levonorgestrel IUD were longer in the last 3 months after insertion, but was shortest at 1 year of use when compared with Tcu 220c and Nova T.
ENTRE NOUS. 1988 Oct; (12):10-2.Beginning in the 1960s, the Turkish government placed a emphasis on the importance of family planning in an effort to improve maternal and child health (MCH) services. While the IUD has proven adequate for women in Turkey, insertion and proper use have created problems. The IUD program has had difficulty in gaining the acceptance of male physicians in Turkey, and because there are few female physicians in the country, a problem with implementation of the program arose. 1 solution suggested that non-physician personnel learn to insert the IUD and be able to examine IUD patients. Assistant nurse-midwives were surveyed in a 3-phase project carried out by the staff of the Department of Public Health of Hacettepe University in Ankara with WHO. In the 1st phase, a training method was created with competence comparison of the assistant midwives to physicians following in the 2nd phase. The 3rd phase of the project studied the use of non-physician services throughout the country. It was found that assistant nurse-midwives were equally capable of IUD insertions and check-ups and that IUD services can now reach rural areas of the country beyond the range of traditional medical services.
IN POINT OF FACT 1986; (39):1-2.In 1986, the IUD was the contraceptive method chosen by over 60 million women throughout the world. In response to years of controversy related to the IUD, a World Health Organization Scientific Group met in Geneva in 1986 and determined that this contraceptive device is safe, sound, and reliable. The complications causing public concern have involved older IUDs. The new generation of copper-bearing IUDs--Multiload devices, the Copper T 220C and 380, and Nova T--are effective in preventing pregnancy for at least 5 years, and possibly for more than 10 years. Menstruation is the usual time for IUD insertion; however, the device can be safely inserted after a normal pregnancy and delivery, or after an uncomplicated miscarriage. There is no empirical evidence suggesting an association between IUD use and subsequent ectopic pregnancy. Women who use the modern copper IUDs have the lowest rates of ectopic pregnancy among IUD acceptors.
International Planned Parenthood Federation adds Norplant implants to its commodities list of approved contraceptives. News release.
New York, New York, Population Council, 1985 Oct 5. 3 p.On December 5, 1985, the Population Council announced that the International Planned Parenthood Federation (IPPF) has approved the inclusion of Norplant implants on its commodities list of contraceptives available to its affiliates. This action means that the Norplant method will be available to the 120 IPPF-affiliated national family planning associations once the contraceptive has been approved for distribution by regulatory authorities in each country. IPPF has indicated that it will supply the implants to agencies that: 1) have a sufficient number of health workers who have been formally trained in Norplant insertion, removal, and counseling techniques; 2) have suitable clinic facilities and adequate back-up and referral systems; and 3) can arrange training so that additional health workers will qualify to use this method. The Norplant method was approved by the IPPF Advisory Panel on September 8, 1985, following an 18-month period of review of all available scientific data. The Norplant system has been used in clinical trials in 25 countries involving over 25,000 acceptors. The Population Council has cited the inclusion of Norplant implants in the IPPF program as an important step in the worldwide availability of this contraceptive method. The Population Council has established regional training centers in Indonesia, Egypt, Chile, Brazil, and the Dominican Republic where health care personnel can be trained in techniques of insertion and removal of the impants as well as in counseling potential acceptors.
In: Zatuchni GI, Goldsmith A, Shelton JD, Sciarra JJ, ed. Long-acting contraceptive delivery systems. Philadelphia, Pa., Harper and Row, 1984. 621-7. (PARFR Series on Fertility Regulation)Progestasert (Alza Corporation, Palo Alto, California) achieves relatively high rates of contraceptive effectiveness through the release of a sex hormone--progesterone. Currently, it is recommended that Progestaserts be replaces every 12 months and most copper-bearing IUDs, every 3 years. To improve on Progestasert's 1-year replacement interval, Alza Corporation modified the Progestasert by increasing the amount of pregesterone contained in the IUD (from 38 to 52 mg) without changing the average daily release of 65mg. This long-acting progestasert, called the Intrauterine Progesterone Contraceptive System (IPCS), was designed to have a useful life of 3 years before replacement was required. The IPCS is identical in appearance to the Progestasert, and its contraceptive action in the same as that of the Progestasert. The effectiveness of either is through the effects of an intrauterine foreign body and through the effects of the progesterone on the encometrium. The IPCS system was designed to provide maximum contraceptive protection over a 3-year period and to reduce IUD-related bleeding, pain, and expulsion problems. Results from Alza monitored trials of the IPCS in the US and Mexico indicate that the cumulative life-table pregnancy rate increased from 3.6/100 women after 25 to 30 months of use to 10.6/100 women after 30 to 36 months of use. Laboratory evaluations of removed IPCS devices indicates that after 30 months of IPCS use the release rate of progesterone may not be adequate to prevent pregnancy effectively. The World Health Organization (WHO) evaluated the IPCS in 2 multiclinic studies. Postinsertion complications and complaints for the IPCS and T Cu-200 are shown. The include cervical perforation, ectopic pregnancy, pelvic inflammatory disease, dysmenorrhea, bleeding, spotting, and pelvic pain. The IPCS seemingly offers no particular advantages for use in developing countries.
IPPF Medical Bulletin. 1981 Dec; 15(6):1-3.These policy statements and guidelines from the International Planned Parenthood Federation's (IPPF) International Medical Advisory Panel (IMAP) concern IUDs. The following contraindications to IUD use are recognized: 1) pelvic inflaminatory disease, 2) known or suspected pregnancy, 3) history of previous ectopic pregnancy, 4) gynecological bleeding disorders, 5) suspected malignancy of the genital tract, 6) congenital uterine abnormalities or fibroids distorting the cavity, and 7) anemia, blood coagulation, severe cervical stenosis, copper allergy, Wilson's disease, and others. Generalities regarding appropriate IUDs are: 1) non-medicated devices (e.g. Lippes Loop) are studied for women who may not return for regular check-ups, 2) smaller medicated devices usually cause less menstrual blood loss than the non-medicated devices, 3) smaller devices are better for a smaller uterus and larger devices for the larger uterus, and 4) when a smaller device is expelled it is advisable to try a larger one and vice versa. Dalkon Shields should not be used by the IPPF system and all women using them should have the device removed. Correct insertion of IUDs is important and should be done by properly trained personnel. The timing of insertion is best during the menstrual period. Withdrawal of the applicator while leaving the device in place is the recommended insertion technique. Sterilization of IUDs should follow instructions on bulk-packaged IUDs. Complications include perforation, bleeding and pain, infection, and ectopic pregnancy. IUD removal should be done during menstruation. Good clinical management and follow-up care are recommended.
World Health. 1980 Apr; 18-9.International collaborative research, conducted under the sponsorship of the WHO Special Programme of Research, Development and Research Training in Human Reproduction, led to the development of improved IUDs. Scientists from many disciplines and many countries were involved in these research activities. WHO centers in more than 20 countries conducted evaluation studies on different types of IUDs. The studies were designed so as to facilitate comparative analysis. The studies conducted at these centers indicated a need to develop IUDs which would be associated with less bleeding and IUDs which would be more effective. The mechanisms of IUD induced bleeding were examined and several drugs were identified which could be used to reduce the bleeding. The drugs were either given orally or used to impregnate the IUD. Efforts to produce more effective IUDs led to the development of a progesterone releasing IUD. Other WHO supported activities involved the development of new methods for delivering IUD services to the inhabitants of developing countries. Midwives were trained in IUD insertion techniques and their performance was evaluated. The performance level attained by the midwives was as high or higher than that attained by physicians.
Bangkok, Thailand, Ministry of Public Health, 1976. 52 p.Add to my documents.
International Family Planning Perspectives. 1979 Sep; 5(3):127-9.The International Fertility Research Program (IFRP) is sponsoring research in 30 developing countries and 13 developed nations in an effort to develop more effective contraceptive methods. Particular emphasis is being placed on developing contraceptives for women in developing countries where nutritional, health, and sanitation conditions make current methods either difficult or less effective to use. Trials of a pill regimen including vitamin supplementation are underway in Sri Lanka, and a progestogen-only pill for use by lactating women is being tested in Egypt and India. Progestogens apparently do not modify the content of maternal milk. Another study involves the testing of a Lippes loop which releases Trasylol, a bleeding suppressant, in an effort to overcome bleeding problems associated with IUD use. The IFRP has developed and is testing biodegradable appendages which can be attached to IUDs to help retain the device in postpartum women during the period when the uterus is enlarged. Other efforts are being directed toward improving and simplifying sterilization procedures. In Chile, pellets of quinacrine have been inserted into the upper area of the uterus. As the pellets dissolve the quinacrine enters the tubes and produces scar tissue which eventually closes the tube. This research may pave the way toward the development of a non-surgical sterilization method. Animal studies of a reversible sterilization procedure in which a condom-like device is fitted over the ends of the tubes are in progress. In another project a modified laparoscope, called the Laprocator, is being evaluated. The device does not use electricity and is particularly suitable for use in areas in which electricity is lacking or the source is unstable. The device is used in a procedure called suprapubic endoscopy in which only a small incision is needed. Insufflation of the abdomen is unnecessary, and elastic rings are used to close the tubes. IFRP will undertake an innovative motivational project in the Middle East during the coming religious holidays.
London, England, International Planned Parenthood Federation, (1968). (Working Paper No. 1) 34 pThe report covers all the main points pertaining to an IPPF questionnaire about mobile family planning units in 1967. An account is given of activities of the units in: 1) Korea, 2) Fiji, 3) pakistan covering 2 units in East and West Pakistan, 4) Rhodesia covering educaitonal and a clinic unit, 5) Sarawak, and 6) Hong Kong, 9 branch affiliates of the Planned Parenthood of America used mobile units in 1967, and details are given of those in: 1) Rochester and Munroe County, New York State; 2) Kansas City, Missouri; 3) Delaware League for Planned Parenthood, Inc., Wilmington, Delaware; 4) Planned Parenthood of St. Paul, Minnesota; and 5) Planned Parenthood of Cleveland, Inc., Maternal Health Association, Ohio. Korea also has some urban units used to serve the new suburbs. 1 of the most helpful factors in operating a mobile unit is cooperation with local family planning workers. Usually in that case there is a government family planning program, but without national suport the unit benefits from availability of premises and amenities such as water and electricity. Some of the factors operating againist the units are: 1) lack of local workers, 2) lack of premises and amenities, 3) geographical conditions and lack of roads, 4) climate, and 5) staff and maintenance costs. Appendix 1 is a report of the mobile unit in Lahore district, West Pakistan, and Appendix 2 contains instructions to the staff of an urban mobile clinic.
IPPF Situation Report, April 1969. 6 p.Demographic statistics and some information on the cultural situation in Thailand are presented. The history of interest in family planning and the current personnel of the Family Planning Association (FPA) and family-planning-related government personnel are listed. Various FPA-funded projects are summarized. The government started a 3-year family health program in 1968 which will include family planning services. Initial surveys indicated positive attitudes toward and interest in family planning in the country. IUD insertions have totaled 100,000 so far and sterilizations are averaging 10,000 yearly. The plan is to cover 20 million people by 1970. Current training and educational activities are sumarized. Other agencies active in the family planning field are mentioned.
IPPF Situation Report, June 1973. 10 p.The Indonesian Planned Parenthood Association (IPPA) was founded in 1957 and pioneered family planning services. It made little headway duri ng the pronatalist Sukarno regime, but in 1967 the present government announced an intensive family planning program and the IPPA was named as an implementing unit in 1971. 2 primary roles now are the training activities for fieldworkers and the development of community education and motivation programs. This complements the national mass media program. In 1970 the government took over all clinics except those in the Outer Islands (the islands outside Java, Bali, and Madura). The IPPA runs 150 clinics in the Outer Islands, is responsible for all supplies and maintenance, and has a number of model clinics in Java and Bali. The Community Education program has 8 components: speakers bureau, family planning clubs, mobile audiovisual units, exhibitions, tr aditional media, special events, local mass media support, and evaluatio n. In 1971 the 'ippa trained 2951 people; in 1972 this was increased by 25%. In 1973 the target is training 3000 fieldworkers with 16 centers for training and 16 field demonstration areas. An agreement with the U.N. Fund for Population Activities/International Development Association (UNFPA/IDA) will provide for building, equipping, and staffing. The research and evaluation function is also expanding to complement government activities. The government program aims to train 20,250 medical and paramedical personnel over 5 years and medical schools have incorporated the teaching of population and family planning. Government allowances are being curtailed for all children over 3 for government workers. An active clinic program aims to set up 1200 fully equipped and 1250 moderately equipped facilities by 1973. An active media campaign has been launched and for the 1st time in the population field the UNFPA and the IDA are helping to finance a project to expand a family planning program and broaden its activities. This su pport will provide for physical facilities, technical assistance, training, motivation, evaluation, research, and population education.
Studies in Family Planning. 1972; 3(7):151-156.In Thailand the family planning program is integrated into health services. During 1971 there were 404,187 new acceptors, the majority of which chose the pill since they are prescribed by midwives and are available in more than 3500 centers. The number of pill acceptors increased from approximately 8800 per month to more than 30,000 after auxiliary midwives were officially authorized to prescribe oral contraceptives. In 1972 a pilot program was started to train paramedical personnel to insert IUDs. In 1971 12-month continuation rates were 75% for the IUD (with the majority of women expelling them having reinsertions), 65% for the pill, with more than 20,000 sterilizations. A major effort will be made during 1972 to introduce vasectomy more widely. More than 80% of acceptors are from rural areas, with 90% having less than 4 years of education. Postpartum acceptors accounted for 16% of the national program. Since 85% of all deliveries occur at home, the postpartum concept should be adapted to these women. In a 1970 followup survey of 2597 acceptors in the 3 largest cities, among IUD users, expulsions were negatively correlated and removals positively correlated with age; pregnancies were 3%. Pills were more widely accepted than IUDs in all age groups, and younger women definitely preferred them. The source of family planning information was: husband, 47%; health personnel, 38%. It is estimated that 144,000 couple years of protection were provided in 1971, and 393,000 in 1972 -- 3% and 8% respectively of married women of reproductive age. Cost of the program is estimated to be US$.08 per capita or US$7.00 or $8.00 per acceptor. The greatest problem has been lack of effective supervision at the field level. The usefulness of family planning field workers is being studied.