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ADVANCES IN CONTRACEPTION. 1990 Sep; 6(3):169-76.Clinical trials of vaginal rings containing progestins or ethinyl estradiol and progestins by WHO, the Population Council and private firms are reviewed. Contraceptive steroids can be formulated into Silastic vaginal rings because they are released continuously from this material (zero-order kinetics). Vaginal rings have the advantage of avoiding the 1st pass effect on the liver, as well as self- administration, unrelated to the timing of coitus and regulation of withdrawal bleeding with removal for 7 days per cycle. The shell vaginal ring, with an inert core, a layer of Silastic containing the progestogen, and an outer Silastic layer is designed to regulate release by the thickness of the outer layer. The WHO tested rings releasing 200 mcg norethisterone/day resulting in too many menstrual side effects; and 50 mcg/day with too high a failure rate. A ring releasing 20 mcg levonorgestrel is expected to perform well. The Population Council designed rings releasing 152 mcg ethinyl estradiol and 252 mcg levonorgestrel, and 183 mcg ethinyl estradiol and 293 mcg levonorgestrel. These resulted in pregnancy rates of 2/100 woman years, and continuation rates of 50%, but unacceptably adverse lipid effects. Women discontinued for vaginal symptoms. Compared to a similar combined oral pill, the rings offered no advantage. WHO subsequently introduced a ring releasing 20 mcg levonorgestrel: efficacy was 3.8 and continuation over 50%. A new segmented ring with desogestrel is causing fewer androgenic effects and bleeding complaints. Another ring in current trials gives off 120 mcg desogestrel and 30 mcg ethinyl estradiol with no pregnancies and good acceptability in 100 women to date. Availability of Silastic material and quality control in manufacture are seen as obstacles to overcome for mass production of these vaginal rings.
In: Zatuchni GI, Sobrero AJ, Speidel JJ, Sciarra JJ, ed. Vaginal contraception: new developments. Hagerstown, Md., Harper and Row, 1979. 66-81.Although condoms are still produced from a variety of materials, the popularity of the condom increased mainly after the dipped latex process was developed in the 1930s. Condoms went with US troops all over the world during World War Two. It is only in recent years that strict quality standards were established. Many countries, including the US, measure quality in the number of pinholes acceptable per unit, the number of acceptable holes varying considerably between countries. Japan has made a standard based on leakage as measured by sodium ion concentration. Various types, colors, names, and sizes of condoms are popular in different countries. Large scale distribution in recent years has raised the question of shelf life. It is generally thought that a condom kept in a sealed tinfoil package will stay good indefinitely. Nonetheless, for management as well as safety purposes smaller shipments are preferred over large shipments in mass distribution programs. Condom popularity is partly associated with the number and accessibility of distribution points; therefore, it has become more prevalent to use both government units and regular commercial distribution points for popularizing the condom, and there is reason to believe that this type of program will grow. In light of the current interest in integration of contraceptive programs with health care and development efforts, population specialists should look closely at the condom and the commercial resources available for its distribution. A series of tables gives gross numbers of condoms supplied by international donor agencies in the developing countries, 1975-78.
New York, UNFPA, June 1979. (Report No. 13) 151 pThis report is intended to serve, and has already to some extent so served, as part of the background material used by the United Nations Fund for Population Activities to evaluate project proposals as they relate to basic country needs for population assistance to Thailand, and in broader terms to define priorities of need in working towards eventual self-reliance in implementing the country's population activities. The function of the study is to determine the extent to which activities in the field of population provide Thailand with the fundamental capacity to deal with major population problems in accordance with its development policies. The assessment of population activities in Thailand involves a 3-fold approach. The main body of the report examines 7 categories of population activities rather broadly in the context of 10 elements considered to reflect effect ve government action. The 7 categories of population activities are: 1) basic data collection; 2) population dynamics; 3) formulation and evaluation of population policies and programs; 4) implementation of policies; 5) family planning programs; 6) communication a and education; and 7) special programs. The 10 elements comprise: 1) decennial census of population, housing, and agriculture; 2) an effective registration system; 3) assessment of the implications of population trends; 4) formulation of a comprehensive national population policy; 5) implementation of action programs integrated with related programs of economic and social development; 6) continued reduction in the population growth rate; 7) effective utilization of the services of private and voluntary organizations in action programs; 8) a central administrative unit to coordinate action programs; 9) evaluation of the national capacity in technical training, research, and production of equipment and supplies; and 10) maintenance of continuing liason and cooperation with other countries and with regional and international organizations.
In: Watson, W.B., ed. Family planning in the developing world: a review of programs. New York, Population Council, 1977. p. 54-55The government of Honduras included a population policy in its National Development Plan for the period 1974-1979. This policy will be implemented by providing information regarding responsible parenthood, by using natural and technical resources to produce a well-nourished and creative population, and by applying the principles of voluntary participation in family planning programs. The 2 family planning programs in Honduras are the government maternal and child health program and the Family Planning Association of Honduras program. The government program, initiated in 1968, operates 34 clinics which offer family planning along with prenatal and postnatal care, child care, and nutrition education services. The Family Planning Association, established in 1961, operates 2 clinics and served 42,000 people during 1975. 9000 of this group were 1st acceptors. Oral contraceptives were chosen by 80% of the new acceptors; 13% chose IUDs and 5% chose injectables. The Association's information and education activities included conferences, talks, courses, seminars, and home visits. Additionally, the Association is operating a demonstration community-based distribution program with financial assistance from the International Planned Parenthood Federation. 40 workers in each of 2 cities provide contraceptives in their own neighborhoods.