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Global Health: Science and Practice. 2015 Sep 10; 3(3):352-357.Contraceptive effectiveness is the leading characteristic for most women when choosing a method, but they often are not well informed about effectiveness of methods. Because of the serious consequences of “misinformed choice,” counseling should proactively discuss the most effective methods-long-acting reversible contraceptives and permanent methods-using the WHO tiered-effectiveness model.
Indian Journal of Medical Research. 2012 Sep; 136(3):370-1.Add to my documents.
[Washington, D.C.], Population Council, Frontiers in Reproductive Health, 2007 Dec. 21 p. (USAID Cooperative Agreement No. HRN-A-00-98-00012-00)Much of the programmatic and research experience gained over the past two decades has focused on increasing understanding of supply-side factors that limit the provision and use of the IUD, for example, developing training programs, demonstrating the ability of lower level medical staff to provide the method, and assessing the interaction between IUDs, STIs and, more recently, HIV. There is now sufficient empirical evidence from a range of settings to allow program managers and technical assistance organizations to develop guidelines and plans for strengthening the systems necessary to support country-level introduction or 'rehabilitation'; of the IUD within a program offering a range of contraceptive choices. The objectives were: To conduct a meeting of researchers and program managers from three continents and several international organizations to review reasons for under-utilization of the IUD and recent experiences in increasing awareness about the IUD; To develop proposals for operations research projects to test the most promising interventions to introduce and expand access to IUD services and to implement the projects with national partner organizations; To disseminate results of the successful strategies. (Excerpts]
[WHO updates medical eligibility criteria for contraceptives] OMS reactualizeaza criteriile medicale de eligibilitate pentru utilizarea contraceptivelor.
Targu-Mures, Romania, Institutul Est European de Sanatate a Reproducerii, 2006. 15 p. (Actualitati in planificarea familiala No. 1)The World Health Organization (WHO) has issued new family planning guidance, including the following: Most women with HIV infection generally can use IUDs. Women generally can take hormonal contraceptives while on antiretroviral (ARV) therapy for HIV infection, although there are interactions between contraceptive hormones and certain ARV drugs. Women with clinical depression usually can take hormonal contraceptives. More than 35 experts met at WHO headquarters in Geneva, Switzerland, in October 2003 and developed this and other new guidance. The new guidance updates the 2000 Medical Eligibility Criteria (MEC) for Contraceptive Use. (excerpt)
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)
[Arlington, Virginia], JSI, DELIVER, 2006 Feb.  p. (USAID Contract No. HRN-C-00-00-00010-00; USAID Development Experience Clearinghouse DocID / Order No. PN-ADI-092)For individually packaged devices, the expiration date on package refers to sterility of product, assuming packaging is not damaged. IUDs should be protected from heat and direct sunlight. Any break or perforation of sterile package makes the product nonsterile. Copper IUDs sometimes tarnish; copper tarnish does not affect IUD efficacy or safety and does not indicate that the package seal has been broken. Shelf life should not be confused with use life; for example, FEI Products Inc. Copper T 380As inserted at any time during their shelf life (7 years from date of manufacture) have a use life that is at least 12 years from the date of insertion. Because different brands may have different insertion instructions, it is essential that all devices be clearly labeled. (excerpt)
Contraception Report. 1998 Sep; 9(4): p..Current recommendations suggest IUDs should not be the first method of choice for women with HIV infection. The World Health Organization and International Planned Parenthood Federation recommend that HIV-infected women not use the IUD for contraception. These recommendations are based upon theoretical concerns about an increased risk of infection and possible increased risk of female-to-male HIV transmission from increased menstrual blood loss. The recommendation also reflects concern about behavioral characteristics that may make some HIV-positive women more susceptible to STDs and PID. Research conducted in Kenya by Family Health International suggests that carefully selected HIV-infected women may safely use the IUD for contraception. Researchers enrolled 649 women who otherwise met eligibility criteria for IUD insertion, including a low risk of STDs. Women came from two family planning clinics in Nairobi, Kenya. (excerpt)
Contraception Report. 1998 Sep; 9(4): p..In 1995, the World Health Organization (WHO) released revised medical eligibility criteria guidelines to assist family planning agencies and clinicians prescribe contraceptives. By eliminating overly restrictive barriers to use, WHO hopes to increase access to and use of birth control methods. This article briefly reviews some of the important WHO guidelines concerning intrauterine devices. Introduction WHO researchers evaluated the benefits and risks of using IUDs in healthy women and in women with certain medical conditions or individual characteristics, such as parity and exposure or susceptibility to sexually transmitted diseases. A previous article describes WHO's methods for devising the criteria in detail. Briefly, the eligibility criteria were developed by international experts from many organizations. WHO experts reviewed the medical literature from the past 10 years and devised recommended medical eligibility criteria for different contraceptive methods. One main concern was to address outdated contraindications. WHO notes that "The contraindications for many contraceptives tend to become very rigid, resulting in denial of contraceptive access to many women. Relative contraindications tend to become absolute." (excerpt)
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)
Baltimore, Maryland, Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Information and Knowledge for Optimal Health Project [INFO], 2004 Aug. 8 p. (INFO Reports No. 1; USAID Grant No. GPH-A-00-02-00003-00)The World Health Organization (WHO) has issued new family planning guidance, including the following: Most women with HIV infection generally can use IUDs. Women generally can take hormonal contraceptives while on antiretroviral (ARV) therapy for HIV infection, although there are interactions between contraceptive hormones and certain ARV drugs. Women with clinical depression usually can take hormonal contraceptives. More than 35 experts met at WHO headquarters in Geneva, Switzerland, in October 2003 and developed this and other new guidance. The new guidance updates the 2000 Medical Eligibility Criteria (MEC) for Contraceptive Use. (excerpt)
In: WHO updates medical eligibility criteria for contraceptives, by Ward Rinehart. Baltimore, Maryland, Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Information and Knowledge for Optimal Health Project [INFO], 2004 Aug. 5. (INFO Reports No. 1; USAID Grant No. GPH-A-00-02-00003-00)Considering depressive disorders for the first time, the October 2003 MEC meeting concluded that there is no need for restriction on use of hormonal contraceptives for women with depression. A variety of studies have found no increase in symptoms among depressed women using combined or progestin-only oral contraceptives, DMPA injectable, or Norplant implants. A single study reported that taking fluoxetine (Prozac) for depression did not reduce the effectiveness of combined or progestin- only oral contraceptives. Conclusions cannot be reached concerning postpartum depression or bipolar disorder because current evidence is inadequate. (excerpt)
Journal of Family Planning and Reproductive Health Care. 2004 Jan; 30(1):29-42.This Guidance provides information for clinicians providing women with copper-bearing intrauterine devices as long-term contraception. A key to the grades of recommendations, based on levels of evidence, is given at the end of this document. Details of the methods used by the Clinical Effectiveness Unit (CEU) in developing this Guidance and evidence tables summarising the research basis of the recommendations are available on the Faculty website (www.ffprhc.org.uk). Abbreviations (in alphabetical order) used include: acquired immune deficiency syndrome (AIDS); actinomyces-like organisms (ALOs); automated external defibrillator (AED); blood pressure (BP); British National Formulary (BNF); confidence interval (CI); copper-bearing intrauterine contraceptive device (IUD); emergency contraception (EC); Faculty Aid to Continuing Professional Development Topic (FACT); levonorgestrel-releasing intrauterine system (IUS); human immunodeficiency virus (HIV); Medicines and Healthcare products Regulatory Agency (MHRA); non-steroidal anti-inflammatory drugs (NSAIDs); odds ratio (OR); pelvic inflammatory disease (PID); relative risk (RR); Royal College of Obstetricians and Gynaecologists (RCOG); Scottish Intercollegiate Guidelines Network (SIGN); sexually transmitted infection (STI); termination of pregnancy (TOP); World Health Organization (WHO); WHO Medical Eligibility Criteria (WHOMEC); WHO Selected Practice Recommendations (WHOSPR). (author's)
[Unpublished] 1987. 2 p. (SPA/INF/87.9)Research needs on the possible interactions between contraceptive methods and HIV infection were discussed by participants attending a June 1987 joint meeting of WHO's Special Programme on AIDS and Special Programme of Research, Development of Research Training in Human Reproduction. The 16 participants from 9 countries represented the fields of epidemiology, immunology, sexually transmitted disease control, reproductive physiology, and gynecology. Participants examined all current contraceptive methods, but focused in detail on IUDs, combined oral contraceptives, and progestogen-only contraceptives. Condoms and spermicides will be reviewed at a later date. Theoretical interactions between contraceptive methods and HIV infection were discussed, but the participants drew no firm conclusions due to lack of sufficient data. They recommended that WHO conduct additional research, particularly in developing countries, on: the influence of oral contraceptives and IUDs on susceptibility to HIV infection, infectiousness of HIV-infected women, the development and course of HIV- related illness, the mechanism of HIV transmission and modification by contraceptive methods, and the influence of pregnancy on the development and courses of HIV-related illness. They also advised that condoms always be used when there was any risk of HIV infection.
World Health Organization Technical Report Series. 1981; (670):1-120.This report includes the collective views of a World Health Organization (WHO) Scientific Group on Research on the Menopause that met in Geneva during December 1980. It includes information on the following: 1) the endocrinology of the menopause and the postmenopausal period (changes in gonadotropins and estrogens immediately prior to the menopause and changes in gonadotropin and steroid hormone levels after the menopause); 2) the age distribution of the menopause (determining the age at menopause, factors influencing the age at menopause, and the range of ages at menopause and the definition of premature and delayed menopause); 3) sociocultural significance of the menopause in different settings; 4) symptoms associated with the menopause (vasomotor symptoms, psychological symptoms, disturbances of sexuality, and insomnia); 5) disorders resulting from, or possibly accelerated by, the menopause (osteoporosis, atherosclerotic cardiovascular disease, and arthritic disorders); 6) risks, with particular reference to neoplasia, of therapeutic estrogens and progestins given to peri- and postmenopausal women (endometrial cancer, breast cancer, and gallbladder disease); 7) fertility regulating methods for women approaching the menopause (fertility and the need for family planning in women approaching the menopause, problems of family planning in perimenopausal women, and considerations with regard to individual methods of family planning in women approaching the menopause); and 8) estrogen and the health care management of perimenopausal and postmenopausal women. At this time some controversy exists as to whether there is a menopausal syndrome of somatic and psychological symptoms and illness. There are virtually no data on the age distribution of the menopause and no information on its sociocultural significance in the developing countries. The subject of risks and benefits of estrogen therapy in peri- and postmenopausal women is of much importance in view of the large number of prescriptions issued for this medication in developed countries, which indicates their frequrnt use, and the different interpretations and opinions among epidemiologists and clinicians on both past and current studies on this subject. Specific recommendations made by the Scientific Group appear at the end of each section of the report. The following were among the general recommendations made: WHO sponsored research should be undertaken to determine the impact on health service needs of the rapidly increasing numbers of postmenopausal women in developing countries; uniform terminology should be adopted by health care workers with regard to the menopause; uniform endocrine standards should be developed which can be applied to the description of peri- and postmenopausal conditions and diseases; and descriptive epidemiological studies of the age at menopause should be performed in a variety of settings.
London, FPA, 1972. 48 p.Currently, public authorities pay for almost 2/3 of the family planning consultations conducted by the Family Planning Association, and this is the most significant development since the publication of the last Family Planning Association Report. Additionally, more local health authorities are operating direct clinic and domiciliary services. The Family Planning Association handed over the management of 39 clinics to public authorities in the 1971-1972 year. However, despite this progress, family planning service provision by public authorities throughout England continues to be uneven in quality and extent. Spending by local health authorities for each woman at risk varies from 1 penny per woman at risk in Burnley (excluding the city of London) to 179 pence at Islington. In addition to the problem of inconsistency in spending, there appears to be no immediate prospect of a comprehensive family planning service - one that is available to all, is free of charge, and is backed by an adequate education campaign. Although government help for the extension of domiciliary family planning service is impressive, it should not obscure the false economies in spending on other contraceptive delivery services such as general practitioners, specialist clinics, and specialized advisory centers. Until the government announces the details of its plans for family planning services within the National Health Service beginning April 1974, the Family Planning Association's own detailed planning cannot be exact. The Association's basic policy continues to be to turn over the responsibility for the management of clinic and domiciliary contraceptive services as quickly and as smoothly as possible to the public authorities. Already there is concern that some clinic services managed by public authorities may become less attractive, particularly to young people, and that differences in the quality of service will increase under local public management as well as that backup services will be neglected. Also existing is the realization that the public authorities do not do enough to attract people to the use of contraception.
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.
The blurred line between aiding progress and sanctioning abuse: United States appropriations, the UNFPA and family planning in the P.R.C.
New York Law School Journal of Human Rights. 2000; 17(3):1063-1104.This note discusses the trend in People's Republic of China programs, international standards of human rights, legislative trends, and the United States budget for fiscal years 2000 and 2001 as they apply to family planning programs. Specifically, this discussion shows why Congress should condition funding of these programs based on assurances of compliance with human rights standards. Part I presents an overview of the P.R.C. programs. Part II reviews internationally accepted standards of human rights concerning reproduction and population control, as well as China's violations of these rights. Part III describes UNFPA funding of the P.R.C.'s programs, emphasizing their latest 4-year program. Part IV discusses the legislative trend since 1985 of limiting or halting funding to the programs, and the current state of the federal budget regarding these appropriations. Part V discusses the global gag rule and the necessity of its removal. Part VI considers recently proposed legislation regarding funding family planning. Finally, the conclusion proposes a possible solution to the family planning dilemma in the face of both the continuing need for assistance and the continued existence of human rights abuses. (excerpt)
[Contraceptive fact sheets. A tool for advisors in logistics] Fiches factuelles sur les contraceptifs. Un outil pour les conseillers en logistique.
Arlington, Virginia, JSI, Family Planning Logistics Management Project, 1998.  p. (USAID Contract No. CCP-C-00-95-00028-04)This guide lists the visual indicators of eventual quality problems, special considerations, donors, manufacturers, brands, shelf life, primary and secondary conditioning, units per shipping crate, and the dimensions and weights of boxes of the following contraceptive methods: condoms, oral contraceptive pills, IUDs, injectables, contraceptive implants, spermicides, and other vaginal barrier methods. These methods are presented in different categories according to donor: USAID, IPPF, or FNUAP. These data are provided as a tool to consultants in logistics. References are given for additional information on each method discussed.
[World Health Organization (WHO) eligibility criteria for oral contraceptive use. Part 2] Criterios de la OMS de elegibilidad para el uso de anticonceptivos(segunda parte).
BOLETIN INFORMATIVO. 1996 Nov-Dec; (26):4-9.New medical criteria for IUDs and barrier methods defined by the World Health Organization in 1995 to reflect development of safer methods are presented. Health conditions are classified into four categories. Category 2 conditions need not restrict use of a method but should be considered when a method is chosen. Category 3 conditions require careful consideration of the gravity of the case, the availability of alternative methods, and access to emergency services, as well as careful follow-up. Many conditions that had been considered contraindications to IUD use are no longer regarded as risk factors with copper IUDs. Use is unrestricted for women over 20, smokers, the obese, lactating women, those with a history of preeclampsia, ectopic pregnancy, epilepsy, diabetes, and many other conditions. Age under 20 and nulliparity are category 2 conditions because of the risk of expulsion. Severe menstrual bleeding, under 48 hours postpartum, uterine-cervical abnormalities not deforming the uterus, and a few other conditions are in category 2. Category 3 conditions in which risks outweigh advantages include 48 hours to 4 weeks postpartum, benign gestational trophoblastic disorders, elevated risk of HIV/AIDS or HIV infection. Category 4 conditions precluding use of IUDs include pregnancy; puerperal sepsis or septic abortion; uterine abnormality incompatible with insertion; vaginal bleeding of unknown cause; gestational trophoblastic malignancy; cervical, endometrial, or ovarian cancer; pelvic tuberculosis; and sexually transmitted disease within three months. Almost all conditions are in category 1 and none are in category 4 for use of barrier methods, but their relatively high failure rates should be kept in mind. Allergy to latex is a category 3 condition for condoms and diaphragms and history of toxic shock syndrome is a category 3 for diaphragms.
SOUTHEAST ASIAN JOURNAL OF TROPICAL MEDICINE AND PUBLIC HEALTH.. 1997; 28 Suppl 2:144-7.Much of the recent work to develop new fertility regulating agents has been conducted by the public sector. Although current existing options in modern contraception are broad enough to suit many different people and needs, additional methods are nonetheless being developed to expand services and improve quality in the future. The author describes some of the methods being developed by the World Health Organization's program of research in human reproduction, and how they can expand choices for both sexually active men and women. Immunocontraceptives, or anti-fertility vaccines, antiprogestins, IUDs, the inhibition of sperm production, interference with sperm function, interruption of sperm transport, prevention of sperm deposition, and the prevention of sperm-egg interactions are discussed.
Lancet. 1998 Dec 19-26; 352 Suppl 4:SIV3.The otherwise slow pace of contraceptive research developments has recently quickened, with new products developed, more on the way, and encouraging new data emerging about existing methods. While the 1995 UK pill scare called attention to a differential in the risk of venous thromboembolism (VTE) between pills containing levonorgestrel or norethisterone and those containing desogestrel or gestodene, there is only an extremely small level of excess mortality attributable to third-generation progestogens, less than 2 per million women per year. Tentative evidence suggests that pills with less anti-estrogenic progestogens are neutral with regard to coronary artery disease. The pill remains extremely safe for healthy young women, although additional research with larger numbers of participants is warranted. Salient research findings are that the combined oral contraceptive pill may protect against colon cancer, the pill appears to offer no protection against bone fractures, new products contain less estrogen and have a shortened pill-free interval, a WHO paper showed no significant association between cardiovascular disease and the use of oral or injectable progestogens, a UK study showed no correlation between bone density and plasma estrogen concentrations among long-term users of depot medroxyprogesterone acetate, and a WHO controlled trial found a progestogen-only method of emergency contraception to be considerably more effective in preventing expected pregnancies than the Yuzpe regimen. The T 380 copper IUD provides very high protection against intrauterine and extrauterine pregnancies for 10 years and is now available in an improved inserting mechanism, the Mirena levonorgestrel-releasing IUD system is now licensed for 5 years, and the GyneFIX IUD implant is a frameless device fixed during insertion to the fundal myometrium.
Leiden, Netherlands, Rijks Universiteit, Leiden, Wetenschapswinkel, 1995 Feb. 67 p.After initiating public debate in the Netherlands about how and to what extent UN Population Fund (UNFPA) policies respect women's autonomy and reproductive rights, the cooperating research groups investigated the UNFPA policy dealing with incentives and disincentives to accept family planning (FP) and goals for FP providers. Interviews were held in 1994 in Bangladesh with 125 women and men in rural Bogra and in suburban Dhaka to determine 1) the extent to which incentives influence contraceptive choice, 2) decision-making roles within families, 3) the extent to which health workers are rewarded and the amount of influence they exert over contraceptive choices, and 4) the extent to which service provider disincentives affect attempts to reach service goals. This report of that study provides background information on the research and on the development of population control policies in Bangladesh, the organization of the FP program, and contraceptive methods available. Part 2 traces the incentive program from its probable introduction in India in 1956 through the Bangladeshi Financial Incentive System starting in 1976. Arguments in favor of the use of incentives are summarized. The third part of the report provides an analysis of the data gained from focus group discussions and from interviews with potential users, with women who had undergone a tubectomy more than two years earlier, with vasectomized men, with IUD users, with longterm IUD users, with Norplant users, with women who rely on menstrual regulation, and with service providers. The final section compares findings from Bogra and Dhaka and provides a discussion of the findings in light of other reports in the literature in terms of such issues as quality of care, voluntary and informed choice, and women's status. Recommendations from the study include protecting the human and reproductive rights of women by prohibiting the use of incentives in favor of improving health care, contraceptive availability, and women's status.
International Planned Parenthood Federation medical and service delivery guidelines for family planning.
London, England, International Planned Parenthood Federation [IPPF], 1992. xviii, 169 p.The International Planned Parenthood Federation has developed these guidelines to help persons working in family planning services and education ensure adequate levels of quality of care. The guidelines conform to the three dimensions of technology assessment needed for any project: it must be scientifically, socially, and operationally sound. Providers should adapt the service delivery guidelines to local realities. They should consider the needs and resources of the various sites in which the guidelines will be applied. The guidelines can also be developed into educational and training materials. They serve as a guide to the delivery of family planning services, a reference document for assessing quality of care, a training instrument, and a tool for supervision. The first chapter addresses the rights of the client, ranging from the right to information to the right of opinion. The second chapter is dedicated to contraceptive counseling, while chapter 3 is dedicated to family planning training. Chapter 4 discusses hormonal contraception (combined oral contraceptives, progestagen-only pills, service management, progestagen-only injectables, and the subdermal implants, Norplant). IUDs are covered in detail in chapter 5. The barrier methods addressed in chapter 6 include condoms, diaphragms, cervical caps, and spermicides. Chapter 7 covers both male and female voluntary surgical contraception. Natural family planning methods are addressed in chapter 8 entitled Periodic Abstinence. These methods include the basal body temperature method, the cervical mucus method (Billings method), the calendar or rhythm method, and the sympto-thermal method. The guidelines conclude with a detailed statement on diagnosis of pregnancy and a list of suggested reading material.
New York, New York, United Nations, Dept. for Economic and Social Information and Policy Analysis, Population Division, 1994 Aug.  p. (ST/ESA/SER.A/143)This wall chart shows the 1994 level of contraceptive use (percentage) for the entire world. Data are presented for less developed and more developed regions and for individual countries grouped according to region. The number of couples of reproductive age is given in millions, and the data are broken down into year; age range represented; and percentage of the total, of female sterilization, of male sterilization, of oral contraceptive use, of IUD use, of condom use, and of use of other supply and non-supply methods. In addition, trends are indicated by showing the time period and the annual increase in percentage using any method. These data are further illustrated in pie charts indicating the entire world, more developed regions, and less developed regions as a whole and for Africa, Latin America and the Caribbean, Eastern Asia, and other countries in Asia and Oceania.
STUDIES IN FAMILY PLANNING. 1994 Nov-Dec; 25(6 Pt 1):362-7.International Program in Population and Family Planning, Pathfinder International, and other organizations providing support to family planning organizations in developing countries, generally recommend that women who use intrauterine devices (IUDs) go for an initial revisit at four to six weeks postinsertion, a second revisit at one year, and subsequent revisits at yearly intervals. However, ministries of health and family planning organizations in developing countries generally recommend more frequent revisits. This study examined the effect of reducing the recommended number of IUD follow-up visits using data from clinical trials of the TCu380A and other widely used IUDs conducted by Family Health International (FHI) during 1986-89. The clinical studies were conducted in 13 clinics in 9 countries (Cameroon, Egypt, El Salvador, Mexico, Pakistan, Peru, Philippines, Sri Lanka, and Venezuela) among sexually active and healthy women aged 18-40. Over 11,000 follow-up forms were analyzed to estimate the number of health problems that would escape detection if women with no or mild symptoms had not made recommended visits. Less than 1% of woman-visits with no or only mild symptoms had an underlying health risk that could have gone undetected if the follow-up visits that were made in the clinic trial setting had not been made. Results suggest that a reduction in the number of recommended follow-up visits is safe, when measured according to selected conditions. Clinic policy and practice in family planning probably could move toward encouraging fewer recommended follow-up visits, while simultaneously encouraging those who feel they need assistance to seek medical attention. Additional research is, however, needed to determine whether any revisits should be recommended in the absence of sign and symptoms.