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Geneva, Switzerland, World Health Organization [WHO], 2006. 37 p.Recommendations for birth spacing made by international organizations are based on information that was available several years ago. While publications by the World Health Organization (WHO) and other international organizations recommend waiting at least 2-3 years between pregnancies to reduce infant and child mortality, and also to benefit maternal health, recent studies supported by the United States Agency for International Development (USAID) have suggested that longer birth spacing, 3-5 years, might be more advantageous. Country and regional programmes have requested that WHO clarify the significance of the USAID-supported studies. With support from USAID, WHO undertook a review of the evidence. From 13 to 15 June 2005, 37 international experts, including the authors of the background papers and WHO and United Nations Children's Fund (UNICEF) staff , participated in a WHO technical consultation held at WHO Headquarters in Geneva. The objective of the meeting was to review evidence on the relationship between different birth-spacing intervals and maternal, infant and child health outcomes and to provide advice about a recommended interval. Six background papers were considered, along with one supplementary paper. Prior to the meeting, the six main papers were sent to experts for review. Thirty reviews were received: 10 from staff in international organizations and 20 from experts from 13 countries. The reviews were compiled and circulated to all meeting participants. At the meeting, the authors of the background papers presented their work, and selected discussants presented the consolidated set of comments, including their own observations. Together, the draft papers and the various commentaries formed the basis for the discussions of the evidence and for the recommendations made by the group at the meeting for spacing after a live birth and after an abortion. (excerpt)
Geneva, Switzerland, WHO, 2006.  p. (Policy Brief)The World Health Organization (WHO) and other international organizations recommend that individuals and couples should wait for at least 2-3 years between births in order to reduce the risk of adverse maternal and child health outcomes. Recent studies supported by the United States Agency for International Development (USAID) suggest that an interval of 3-5 years might help to reduce these risks even further. Programme managers responsible for maternal and child health at the country and regional levels have requested WHO to clarify the significance of the new USAID-supported findings for health-care practice. To review the available evidence, WHO, with support from USAID, organized a technical consultation on birth spacing on 13-15 June 2005 in Geneva, Switzerland. The participants included 35 independent experts as well as staff of the United Nations Children's Fund (UNICEF), WHO and USAID. The specific objectives of the meeting were to review evidence on the relationship between different birth-spacing intervals and maternal, infant and child health outcomes, and to provide advice on recommended birth-spacing intervals. (excerpt)
[Unpublished] 1994. Presented at the Conference on Unsafe Abortion and Post Abortion Family Planning in Africa, Mauritius, March 24-29, 1994. 2 p.A representative of USAID addressed the International Planned Parenthood Federation Conference on Unsafe Abortion and Postabortion Family Planning (FP) in Africa, which was held in Mauritius in March 1994. She noted that USAID's population and health sector strategy has the following priority objectives: 1) to promote the rights of individuals and couples to determine freely and responsibly the number and spacing of their children; 2) to improve individual health, with special attention to the reproductive health needs of women and adolescents and the general health needs of infants and children; 3) to establish programs which are responsive and accountable to the people who use them; and 4) to achieve population growth rates which are consistent with sustainable development. The goal of halving the current maternal mortality rate within a decade is consistent with these objectives, and, thus, unsafe abortion is an area of critical interest. First of all, unsafe abortion is among the five primary causes of maternal death and leads to serious morbidity. Secondly, treatment of the complications of unsafe abortion consumes large amounts of the health resources in many developing countries. USAID will continue to make access to voluntary FP services a priority and will give increasing emphasis to the provision of postabortion FP counseling and services.
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.
In: World Health Organization (WHO). World Health Organization expanded programme of research, development, and research training in human reproduction: fourth annual report. Geneva, Switzerland, WHO, November 1975. 33-36. (HRP/75.3)Methods of tubal occlusion being studied for use in developing countries are summarized. A comparative clinic trial will be undertaken in the CCCR network to assess safety of tubal occlusion by surgery when performed postpartum through a vertical miniincision and when performed as an interval procedure by minilaparotomy, laparoscopy, colpotomy, or culdoscopy. 8 chemical tubal occluding agents are being studied at the Central Drug Research Institute in India. Postcoital birth control methods are being investigated including: methods to alter the rate of ovum transport, methods of changihg oviduct motility (including the effect of steroids, catecholamine stimulating and blocking agents, prostaglandins, ergot derivatives, and oxytocics), and methods affecting ovum survival. A WHO Symposium on "Ovum Transport and Fertility Regulation" was held in June 1975 in San Antonio, Texas, to present the work of these various scientists.