Your search found 42 Results

  1. 1
    340897

    Emergency contraception. Fact sheet.

    World Health Organization [WHO]

    [Geneva, Switzerland], WHO, 2016 Feb. [6] p.

    Emergency contraception can prevent most pregnancies when taken after intercourse. Emergency contraception can be used in the following situations: unprotected intercourse, contraceptive failure, incorrect use of contraceptives, or in cases of sexual assault. There are 3 methods of emergency contraception: emergency contraceptive pills (ECPs), combined oral contraceptive pills or the Yuzpe method, and copper-bearing intrauterine devices (IUDs). A copper-bearing IUD is the most effective form of emergency contraception available when inserted within 5 days of unprotected intercourse. The emergency contraceptive pill regimen recommended by WHO is either: a. 1 dose of levonorgestrel 1.5 mg, or 1 dose of ulipristal 30 mg, taken within 5 days (120 hours) of unprotected intercourse; or b. 2 doses of combined oral contraceptive pills (also known as the Yuzpe regimen).
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  2. 2
    345122
    Peer Reviewed

    Ulipristal acetate for emergency contraception?

    Piaggio G; von Hertzen H

    Lancet. 2010 May 8; 375(9726):1607-8; author reply 1608.

    This author's reply defends their report on a randomized non-inferiority trial to compare the efficacy and safety of ulipristal acetate with levonorgestrel for emergency contraception. It concludes that there is good evidence that ulipristal acetate is much more effective than levonorgestrel at preventing ovulation at the time in the cycle when conception is most likely to occur.
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  3. 3
    340170
    Peer Reviewed

    Implantable contraceptives for women.

    Meirik O; Fraser IS; d'Arcangues C

    Human Reproduction Update. 2003 Jan-Feb; 9(1):49-59.

    Progestogen-only implantable contraceptives are used by increasing numbers of women worldwide. This review outlines the evidence accumulated on these methods to date. Reviews of toxicological evaluations, clinical trials, endocrinological, epidemiological and social science studies, as well as operations research and economic evaluation were undertaken in preparation for an Expert Consultation convened by the World Health Organization in 2001. At the meeting, these reviews were further evaluated and the research results summarized in this consensus paper. A large body of evidence demonstrates the high contraceptive effectiveness and safety of the 5-year levonorgestrel-releasing implants Norplant and Jadelle. Information on the 3-year etonogestrel-releasing implant Implanon is more limited, but suggests that this implant has a high contraceptive effectiveness and a satisfactory safety pro®le. Information available on levonorgestrel-releasing implants manufactured and approved in China suggests that their clinical performance is satisfactory, but was insufficient to allow their full safety assessment. For all implants, there is insufficient information on their use by women with medical conditions. Provision of contraceptive implants requires good quality family planning services and specific provider training.
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  4. 4
    307971

    [World Health Organization updates guidance on how to use contraceptives] OMS reactualizeaza recomandarile de practica pentru utilizarea contraceptivelor.

    Salem RM

    Targu-Mures, Romania, Institutul Est European de Sanatate a Reproducerii, 2006. 7 p. (Actualitati in planificarea familiala No. 2)

    The World Health Organization (WHO) issued new guidance in 2004 on how to use certain contraceptives safely and effectively, including the following: A woman who misses combined oral contraceptive pills should take a hormonal pill as soon as possible and then continue taking one pill each day. This basic guidance applies no matter how many hormonal pills a woman misses. Only if a woman misses three or more hormonal pills in a row will she need to take additional steps (see p.3). The new guidance simplifies the missed-pill rules issued by WHO in 2002. Men should wait three months after a vasectomy procedure before relying on it. Previous guidelines advised men to wait either three months after the procedure or until they had had at least 20 ejaculations, whichever occurred first. Recent studies have shown, however, that the 20-ejaculation criterion is not a reliable gauge of vasectomy effectiveness. (excerpt)
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  5. 5
    307970

    [WHO updates medical eligibility criteria for contraceptives] OMS reactualizeaza criteriile medicale de eligibilitate pentru utilizarea contraceptivelor.

    Rinehart W

    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)
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  6. 6
    312831

    Levonorgestrel alone for emergency contraception.

    Contraception Report. 1999 Jan; 9(6):[4] p..

    A recent WHO-sponsored study has demonstrated that the progestin levonorgestrel, used alone, is a highly effective and well-tolerated form of emergency contraception. With the proportion of pregnancies prevented up to 95% - depending on the timeliness of administration - the levonorgestrel regimen proved more effective than the most commonly used regimen, the Yuzpe method. The Yuzpe method employs a dual-hormone (ethinyl estradiol plus levonorgestrel) approach to preventing pregnancy. Despite the Yuzpe regimen's 75% efficacy rate (a weighted average from 10 studies) the method has been associated with drawbacks. About 50% of users experience nausea and 20% report vomiting, which can reduce patient compliance. (excerpt)
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  7. 7
    297642

    World Health Organization updates guidance on how to use contraceptives.

    Salem RM

    Baltimore, Maryland, Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Information and Knowledge for Optimal Health Project [INFO], 2005 Apr. 8 p. (INFO Reports No. 4)

    The World Health Organization (WHO) issued new guidance in 2004 on how to use certain contraceptives safely and effectively, including the following: A woman who misses combined oral contraceptive pills should take a hormonal pill as soon as possible and then continue taking one pill each day. This basic guidance applies no matter how many hormonal pills a woman misses. Only if a woman misses three or more hormonal pills in a row will she need to take additional steps (see p.3). The new guidance simplifies the missed-pill rules issued by WHO in 2002. Men should wait three months after a vasectomy procedure before relying on it. Previous guidelines advised men to wait either three months after the procedure or until they had had at least 20 ejaculations, whichever occurred first. Recent studies have shown, however, that the 20-ejaculation criterion is not a reliable gauge of vasectomy effectiveness. (excerpt)
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  8. 8
    279320

    WHO updates medical eligibility criteria for contraceptives.

    Rinehart W

    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)
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  9. 9
    093224

    Clinical pre-introduction study of the subdermal contraceptive implant Norplant in Bolivia.

    Bolivia. Caja Nacional de Salud. Hospital Obrero No. 1. Servicio de Ginecologia; Population Council

    In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar. [2] p. (BOL-03)

    Longterm contraceptive methods, such as Norplant, are receiving broader acceptance, particularly among women who are not yet ready to consider sterilization. In countries such as Bolivia, where the availability of family planning (FP) methods remains limited, the introduction and diffusion of a culturally acceptable, safe, and effective method should contribute to an increase in contraceptive acceptance and prevalence. Therefore, in 1990, the Population Council allotted US $35,700 to a 3-year prospective clinical study of Norplant with the Hospital Obrero No. 1 of the Bolivian Caja Nacional de Salud (CNS). The project is intended to evaluate local experience in the use of Norplant to facilitate its introduction. Ultimately, it is hoped that a high quality FP clinic and training center will be established to facilitate expansion of Norplant. The project has 4 major objectives: 1) to assess the demand for Norplant; 2) to compare the sociocultural, health, and psychological characteristics of Norplant and IUD (CuT380A) acceptors; 3) to compare the clinical performance of Norplant with CuT380A; and 4) to compare the cost effectiveness of Norplant with CuT380A. The project entails 3 research components: 1) a preintroduction study to gather socioeconomic, medical, and previous contraceptive use data on all prospective and actual Norplant users (at periodic intervals, beginning when a sufficient number of volunteers have completed at least 6 months of use, statistical analysis of the method's performance will be undertaken); 2) a comparative study of Norplant and CuT380A performance; and 3) a comparison of the cost-effectiveness of the 2 methods. Results of this comparison are expected to provide the CNS with information to decide on the appropriateness of including Norplant within its FP service delivery program. It is hypothesized that the impact of this method on a FP program will be greater if Norplant does not replace other highly effective contraceptives and if acceptors are young and of low parity. Research to date indicates that the cost of Norplant insertion at CNS, including only materials and physician time, averages US $13.95, while the cost of an IUD insertion is estimated at $9.49. Adding product costs of US $22 for Norplant and $1.25 for the CuT380A yields a total insertion cost of $35.95 and $10.74, respectively. Based on these figures, the only point at which costs would approach parity is where IUD continuation averaged less than 2 years and Norplant continuation approached the maximum 5 years. Between the start-up of clinical activities in February and August 1991, 106 Norplant insertions had been performed by CNS (more than half the insertions projected for the project). The project will be expanded in 1992 to involve Servicios de Investigacion y Accion en Poblacion, a private program with extensive experience in social science research.
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  10. 10
    158153

    Norplant's safety is confirmed.

    POPLINE. 2001 May-Jun; 23:3.

    Norplant, the contraceptive implant, is as safe and effective as IUDs and female sterilization, according to the WHO. WHO reports that a 5-year international study of developing country users “confirms the safety with respect to serious disease and the high contraceptive efficacy” of Norplant use. Conducted by researchers from the World Bank, the UN Development Program, and the UN Population Fund, as well as WHO, the research is the first prospective post-marketing surveillance of a newly introduced contraceptive in developing countries. Research conclusions are based on investigations of 32 family planning clinics in 8 countries where researchers compared 8000 Norplant users with 8000 women who relied on IUDs or sterilization to determine the risk of rare adverse effects that might have been missed in previous clinical trials. The clinics involved in the study were located in Bangladesh, Chile, China, Colombia, Egypt, Indonesia, Sri Lanka, and Thailand. Paul Van Look, director of the WHO's department of reproductive health and research, said the study “demonstrates that all three methods are very safe” and provide excellent long-term protection against unplanned pregnancy. (full text)
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  11. 11
    152922

    [First reflection workshop of the research network "Gender, Reproductive Health and Population Policies (GRHPP), Maghreb region, Amsterdam, July 3-7, 1995. General report] Premier atelier de reflexion du reseau de recherche "Gender, Reproductive Health and Population Policies" (GRHPP), region Maghreb, Amsterdam, du 3 au 7 juillet 1995. Rapport general.

    Reysoo F

    Amsterdam, Netherlands, University of Amsterdam, Faculty of Political and Social-Cultural Sciences, Medical Anthropology Unit, 1996. 12 p.

    This paper reports upon the first workshop of the research network on gender, reproductive health, and population policies in the Maghreb, held in Amsterdam during July 3-7, 1995. The report is comprised of papers by various authors on gender, reproductive health, and population policies in the Maghreb; population policies in Morocco; population policies in Tunisia; population-related debates, including the new concepts introduced by the International Conference on Population and Development; the Rutgers Foundation’s activities with regard to reproduction and sexuality in Holland; the evolution from family planning to an integrated reproductive health approach; discourse on Norplant’s effectiveness; the research network on gender, reproductive health, and population policies in Latin America; identifying relevant research themes in the Maghreb; Internet-based research; a research project; and the decision to submit a project of concerted efforts designed to identify and strengthen research capacity in the countries of the Maghreb. The workshop’s activities are noted in the annex.
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  12. 12
    150033

    Emergency contraception with levonorgestrel: one hormone better than two [editorial]

    O'Brien PA

    British Journal of Family Planning. 2000 Apr; 26(2):67-8.

    This editorial comments on the superior efficacy of levonorgestrel as an emergency contraceptive. A comparative trial between levonorgestrel and the Yuzpe regimen conducted by the WHO indicated that levonorgestrel has a pregnancy rate one-third that of the comparison group. The result, however, has been questioned in several accounts. First, the Yuzpe regimen did not appear to perform particularly well in the trial, which might have influenced the comparison. Second, the method used to measure the true efficacy of emergency contraception, or proportion of pregnancies prevented, has limitations. Nevertheless, an interesting result of the WHO trial was the correlation between interval to treatment and pregnancy rate, where the shorter the coitus-to-treatment interval, the lower the pregnancy rate. With levonorgestrel, rates of unwanted pregnancies are expected to decrease. However, there are obstacles to the wholesale switch to levonorgestrel; namely, cost, difficulty in distribution relating to its new drug status, and resistance to change. The speed with which levonorgestrel has been introduced in the UK following a high quality randomized trial is impressive. However, the implementation of research findings remains a challenge. The use of levonorgestrel for emergency contraception may be an appropriate service standard for family planning in the future.
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  13. 13
    140773

    The use of a large-scale surveillance system in Planned Parenthood Federation of America clinics to monitor cardiovascular events in users of combination oral contraceptives.

    Burnhill MS

    International Journal of Fertility and Women's Medicine. 1999 Jan-Feb; 44(1):19-30.

    In response to studies reporting an excess of thrombotic events in women who used oral contraceptives (OCs) containing third-generation progestins, the Planned Parenthood Federation of America (PPFA) launched a retrospective review of clients at all PPFA-affiliated centers during 1993-95. During the 3-year study period, 2,265,087 woman-years of OC use were recorded in clinic drug sale records. All OCs prescribed in this period contained 30 or 35 mcg of estrogen and either norgestimate (21.0%), desogestrel (8.9%), norethindrone (46.6%), or levonorgestrel (23.6%) as the progestin. 70 major thrombotic events among clients using OCs (3 vascular complications per 100,000 woman-years of OC use) were reported to PPFA's risk management division during 1993-95; these included 25 cases of deep vein thrombosis, 20 cases of pulmonary embolism, 22 cerebrovascular accidents, and 3 myocardial infarctions. There were 5 deaths (0.22/100,000 woman-years of use), all from pulmonary emboli. The thrombotic event rates were calculated as the relative risk of complication, comparing the risk of each event for one progestin relative to the other three classes of progestins. The overall risk varied from a low of 1.895 events/100,000 woman-years for norgestimate OC users to a high of 3.969 events/100,000 woman-years for desogestrel OC users, but these differences were not statistically significant. In the progestin comparison, desogestrel users showed elevated risks for pulmonary emboli and fatalities, norgestrel use was associated with an increased risk of deep vein thrombosis, and norgestimate an increased risk of deep vein thrombosis and pulmonary embolism. Generally, these four groups of low-dose OCs appear safer than any previously published study has indicated. In part, this may reflect PPFA's careful prescribing guidelines. In addition to following US Food and Drug Administration contraindications, PPFA affiliates do not provide OCs to women over 35 years of age who smoke more than 15 cigarettes a day.
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  14. 14
    140607

    Research on mifepristone and levonorgestrel in comparison with the Yuzpe regimen.

    von Hertzen H

    JOURNAL OF THE AMERICAN MEDICAL WOMEN S ASSOCIATION. 1998; 53(5 Suppl 2):222-4, 232.

    During the last decade, the UNDP/UNFPA/WHO/World Bank Special Program of Research, Development, and Research Training in Human Reproduction has been in the forefront of research on new methods of emergency contraception. This research has focused on both levonorgestrel and mifepristone. The results of large clinical studies suggest that both these compounds are better tolerated and even more effective than the Yuzpe regimen. This article, intended for purposes of continuing medical education, summarizes the findings of studies that have compared these three approaches to emergency contraception.
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  15. 15
    140260

    Timing of emergency contraception with levonorgestrel or the Yuzpe regimen [letter]

    Piaggio G; von Hertzen H; Grimes DA; Van Look PF

    Lancet. 1999 Feb 27; 353(9154):721.

    A World Health Organization (WHO) study of combined oral contraceptives (Yuzpe regimen) and levonorgestrel alone for emergency contraception found that the effectiveness of both treatments declined with increasing time since unprotected intercourse. An earlier review of primarily observational studies found no such timing effect, however. The authors' reanalysis of the WHO data revealed a consistent linear relationship between efficacy and time from intercourse to treatment. The pregnancy rate rose from 0.5% when treatment was given within 12 hours of treatment to 4.1% when 61-72 hours had elapsed. The odds ratio of pregnancy associated with either treatment at a given time compared with treatment 12 hours earlier was 1.46 (95% confidence interval, 1.20-1.77). This estimate was not affected by adjustment for confounding factors such as age, weight, cycle length, or cycle day in which unprotected intercourse took place. The consistency between the WHO trial and an earlier randomized controlled trial, the statistically significant temporal effect observed with both treatment regimens, and biologic plausibility all suggest that the effect of timing on emergency contraception efficacy is real.
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  16. 16
    138290
    Peer Reviewed

    Combined oral contraceptives versus levonorgestrel for emergency contraception.

    Strayer SM; Couchenour RL

    JOURNAL OF FAMILY PRACTICE. 1998 Dec; 47(6):417.

    A study supported by the World Health Organization's Task Force on Postovulatory Methods of Fertility Control compared the efficacy of the Yuzpe and levonorgestrel-only methods of emergency contraception (EC). Enrolled in this double-blind, randomized trial were 1998 women from 21 centers around the world who requested EC within 72 hours of unprotected intercourse. The pregnancy rate was 1.1% for levonorgestrel alone and 3.2% for the combined ethinyl estradiol-levonorgestrel regimen. The crude relative risk of pregnancy was 0.36 (95% confidence interval, 0.18-0.70) for levonorgestrel compared with the Yuzpe regimen. The former method prevented 85% of expected pregnancies, while the latter prevented only 57%. Finally, side effects such as nausea, vomiting, dizziness, and fatigue were significantly less common in the levonorgestrel group. Although these findings document the superiority of the levonorgestrel regimen for EC, the 0.75 mg tablets are not currently manufactured in the US.
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  17. 17
    135443
    Peer Reviewed

    Time for emergency contraception with levonorgestrel alone.

    Guillebaud J

    Lancet. 1998 Aug 8; 352(9126):416-7.

    The World Health Organization (WHO) multicenter, randomized trial reported in this issue of "The Lancet" confirms that levonorgestrel-only (two 750-mcg doses) is significantly more effective in preventing pregnancy after unprotected intercourse than the standard Yuzpe regimen (two doses of 500 mcg levonorgestrel and 100 mcg ethinyl estradiol) and is further associated with significantly less nausea and vomiting. When initiated within 24 hours of coitus, the failure rate was only 0.4% for levonorgestrel compared with 2.0% for the combined hormonal method. A further advantage of a progestogen-only emergency contraceptive method is avoidance of contraindications in women with past proven arterial or venous thrombosis or a current attack of migraine with focal aura. Although only one pharmaceutical company (Gedeon Richter in Budapest, Hungary) currently manufactures 750 mcg of levonorgestrel in a single tablet, others are likely to follow this example given the findings of the WHO study. Strong pressure exists to increase availability of postcoital contraception through trained nurses and retail pharmacists. However, potential users will still require counseling on the importance of selecting a long-term method of contraception and a family planning provider.
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  18. 18
    135442
    Peer Reviewed

    Randomised controlled trial of levonorgestrel versus the Yuzpe regimen of combined oral contraceptives for emergency contraception.

    World Health Organization [WHO]. Special Programme of Research, Development, and Research Training in Human Reproduction. Task Force on Postovulatory Methods of Fertility Regulation

    Lancet. 1998 Aug 8; 352(9126):428-33.

    A previous study suggested that provision of two 0.75 mg doses of levonorgestrel for emergency contraception caused less nausea and vomiting and was more effective than the Yuzpe regimen of combined oral contraceptives (two doses of 100 mcg of ethinyl estradiol and 0.5 mg of levonorgestrel). These two regimens were evaluated further in a double-blind, randomized World Health Organization study of 1998 women recruited from 21 centers worldwide who requested emergency contraception within 72 hours of unprotected intercourse. Among the 1955 women for whom the outcome was known, the crude pregnancy rate was 1.1% (11/976) in the levonorgestrel group and 3.2% (31/979) in the Yuzpe group. The crude relative risk of pregnancy for levonorgestrel compared with the Yuzpe regimen was 0.36 (95% confidence interval, 0.18-0.70). The proportion of pregnancies prevented was 85% in the former group and 57% in the latter group. Nausea and vomiting occurred significantly less frequently in the levonorgestrel group (23.1% and 5.6%, respectively) than in the Yuzpe regimen group (50.5% and 18.8%, respectively). The efficacy of both treatments declined significantly (p = 0.01) with increasing time since unprotected intercourse. These findings confirm that the levonorgestrel regimen may be more effective and is better tolerated than the current standard in emergency contraception.
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  19. 19
    129835

    WHO Scientific Group Meeting on Cardiovascular Disease and Steroid Hormone Contraceptives. Reunion du Groupe scientifique OMS sur les maladies cardio-vasculaires et les contraceptifs hormonaux steroidiens.

    WEEKLY EPIDEMIOLOGICAL RECORD. 1997 Nov 28; 72(48):361-3.

    More than 100 million women worldwide are thought to use steroid hormone contraceptive methods, with an estimated 93 million women using combined oral contraceptives (COCs). The composition and use of these contraceptive preparations, especially those of COCs, have changed dramatically over the years. The World Health Organization (WHO) convened a Scientific Group Meeting on Cardiovascular Disease and Steroid Hormone Contraception during November 3-7, 1997, to review current scientific data on the use of steroid hormone contraception as they relate to the risk of myocardial infarction, ischemic and hemorrhagic stroke, and venous thromboembolic disease. The group also reviewed the incidence of cardiovascular disease among women of reproductive age in general, how the effect of risk factors for cardiovascular disease may be changed using hormonal contraceptives, and whether different compositions of COCs have different cardiovascular risk profiles. The group was comprised of the authors of background papers prepared for the meeting and experts from around the world. The scientific group's conclusions are presented. The incidence and mortality rates of all cardiovascular diseases are very low among reproductive-age women. For women who do not smoke, who have their blood pressure checked, and who do not have hypertension or diabetes, the risk of myocardial infarction in COC users is not increased regardless of age. While current users of COCs have a low absolute risk of venous thromboembolism, their risk is still 3-6 times greater than that of nonusers, with the risk probably being highest during the first year of use.
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  20. 20
    106721

    Norplant: the IPPF experience.

    Huezo C

    [Unpublished] [1991]. 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.
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  21. 21
    106722

    Technical note on Norplant.

    Hurtado F

    [Unpublished] 1991 May 9. [5] 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.
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  22. 22
    113611

    The incentive trap. A study of coercion, reproductive rights and women's autonomy in Bangladesh.

    Reysoo F; van der Kwaak A; Huq N

    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.
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  23. 23
    110325

    Technical guidelines for the introduction of Norplant subdermal contraceptive implants [memorandum]

    Sadik N

    [Unpublished] 1986 Jun 5. 3 p.

    By 1986 Norplant had undergone 10 years of clinical trials and had been used by more than 30,000 women in 25 countries. The contraceptive implant achieved effectiveness and continuation rates which equalled or exceeded all other forms of reversible contraception. The advantages of Norplant include the facts that it contains no estrogen, it is coitus-independent, it provides five years of protection in one simple procedure, and discontinuation is associated with a rapid return of fertility. The disadvantages are that a minor surgical procedure is required for insertion and removal and that menstrual patterns may be altered. The UN Population Fund issued the following guidelines to insure that clinical trials and introduction of Norplant proceed in the best manner possible: 1) such projects should be undertaken only with the full consent of the government involved as indicated in a formal agreement; 2) projects should be carried out in association with an executing agency such as the Population Council, one of the Population Council's Norplant introduction subcontractors, or the World Health Organization; 3) the executing agency will implement all inputs and activities involved in the clinical trials and/or introduction; 4) projects should be accompanied by widespread dissemination of full and accurate information about the method; and 5) projects should be accompanied by user attitude surveys.
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  24. 24
    110241

    Contraceptive implants: friend or foe?

    PHNFLASH: ELECTRONIC NEWSLETTER ON POPULATION, HEALTH, AND NUTRITION. 1995 Oct 25; (93):1.

    Many contraceptive implant specialists provided an overview of current contraceptive implant technology and practice to the staff of the World Bank on July 18, 1995. The Director of the UNDP/UNFPA/World Health Organization/World Bank Special Program of Research, Development, and Research Training in Human Reproduction informed the audience about the history of implant technology. The chief investigator of many clinical trials of contraceptive implants in Chile discussed the mechanisms of action of implants and the benefits and disadvantages of the various types of implants that are available or under development. The only contraceptive implant on the market is Norplant, which more than 3 million women currently use. Most Norplant users live in Indonesia, followed by users in the US. Providers insert the 6 progestin-releasing rods in the upper arm, which provides protection from pregnancy for 5 years. Norplant acceptors may request removal of rods at any time. Many people are concerned that Norplant users may not have timely access to removal of the implants when they want them to be removed. Another concern is the potential for coercion since Norplant requires assistance of a medical provider to start and end use. Many women's groups in developing countries share these concerns and have protested against Norplant. As a result, developers of contraceptive implants and representatives of women's groups have met to discuss these concerns. More discussions will be needed to make sure that developers adequately address these concerns.
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  25. 25
    096181

    The Norplant solution: population control Indonesian-style.

    Helwig M

    PEOPLE'S PERSPECTIVES. 1994 Jan-Feb; (6-7):27-8.

    Massive distribution of the contraceptive implant Norplant is the focus of a UN Fund for Population Assistance-supported fertility control project in Indonesia. Although information on the project's activities is limited, there are concerns that Norplant is being used specifically to reduce the East Timor population. Depo-Provera was aggressively promoted in East Timor in a 1987 government campaign, and health care workers dispensing injections were reportedly accompanied by soldiers to enforce compliance. Occupied East Timor has the highest rates of infant and maternal mortality in Indonesia. At present, two-thirds of all Norplant implants produced worldwide are sent to Indonesia, and the national family planning program is phasing out more acceptable methods such as condoms and oral contraceptives that are under the user's control. Indonesia's birth control program has been criticized for its coercive aspects, lack of range of contraceptive options, and failure to provide women with accurate information about procedures performed as part of clinical trials.
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