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In: Issues in reproductive technology I: an anthology, edited by Helen Bequaert Holmes. New York, New York, Garland Publishing, 1992. 11-30. (Garland Reference Library of Social Science Vol. 729)The progestin, levonorgestrel, suppresses ovulation and thickens the cervical mucus. The 1-year pregnancy rate is 0.2/100 users and the 5-year rate is 3.9/100 users. Contraindications of Norplant include abnormal bleeding, cardiovascular conditions, liver tumors, and breast cancer. The most frequent side effect is changes in bleeding patterns. A main concern of women's health advocates is that women are dependent on the medical establishment for insertion and removal of Norplant which affects the provider-client relationship. Family planning programs that do not recognize a woman's right to free choice of existing contraceptives and her right to have Norplant removed at any time may abuse Norplant. Health workers still do not know the long term effects of Norplant and Norplant's effect on the fetus in case of method failure or insertion while pregnant. Most acceptability studies occurred at university-based health clinics or at clinics in urban areas. The clinic environment may affect women's answers. These studies should occur in the community and home of users and nonusers. Another bias of these studies was clinic staff chose women who would tend to continue using Norplant. Thus subjects were not representative of the population. Researchers did not attempt to understand the women's perception of reproduction physiology and mode of action, the women's cost benefit analysis used to determine what method to use, or the consequences of menstruation changes. They also did not report on the information women received about contraceptive choices. The issue of abuse has arisen in Kansas where a state legislator proposed paying any mother on welfare US$500 if she uses Norplant. In California, a judge ordered a woman convicted of child abuse to use Norplant after release from jail and throughout her probation period.
JOURNAL OF STEROID BIOCHEMISTRY. 1979 Jul; 11(1B):461-7.This report succinctly summarizes Phase I and II clinical trials of intravaginal and intracervical delivery systems for fertility control agents (both steroidal and spermicidal) performed at World Health Organization (WHO) Centres internationally. The WHO Special Programme has conceived of and developed a number of vaginal rings (silastic), which are capable of achieving constant release rates of progestogenic steroid for periods of 90 or more continuous days of use. The local administration rules out the possibility of systemic side effects while the constant release is capable of inhibiting sperm migration through the cervical mucus efficacy of these devices incorporating norethisterone, levonorgestrel, and progesterone is in progress. The vaginal ring has also been incorporated with nonoxynol-9, a potent spermicidal agent. Constant daily release of this spermicidal agent also inhibits sperm migration in the cervical mucus, and use-effectiveness studies are underway. An inert intracervical device, designed and manufactured by WHO, is described (figures depict its manufacturer), and though it is suitable for constant release contraception, no such studies have been performed as yet. Numerous tables report particular release rate data for the vaginal rings impregnated with various dosages of progestogen or spermicide.