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[Unpublished] 1993. , 23,  p.In 1993 in Tanzania, the Association for Voluntary Surgical Contraception (AVSC) helped the Tanzania organization UMATI and the Ministry of Health (MOH) evaluate the 5-year Permanent and Long-Term (P<) Contraception Program. The program planned to use the findings to develop action workplans to address the issues and to expand services. The assessment team visited sits in Dar es Salaam, Iringa and Mbeya, and Arusha and Moshi. In 4 years, the program had expanded from 2 sites to 35 sites nationwide. It trained 250 family planning providers in tubal ligation. P< providers performed more than 9000 tubal ligations (90,000 couple years of protection). The program has surpassed all its service objectives, which contributed to a lack of resources. It established a national network of interested health providers and administrators. Demand for services outpaces the supply countrywide. Since clients and providers have accepted tubal ligation, the government has incorporated sexual sterilization into its national family planning program. It is now preparing to introduce the contraceptive implant Norplant. USAID/AVSC and UMATI/IPPF, (International Planned Parenthood Federation) support 3 full-time staff positions and plan on adding staff in area offices. Other than the 3 AVSC-funded positions in UMATI, UMATI, and MOH have provided all staff time. Other donors to the P< Contraception Program include the development agencies of the UK and Germany and perhaps the World Bank. The MOH has requested future goods from UNFPA for the Interim Norplant Expansion Program. The 2 major outcomes of the assessment were realization of the need to support full-time physician-nurse teams in each UMATI area office and MOH agreement to integrate training for P< methods into the national training strategy. UMATI and USAID planned to add 2 more area offices. Service obstacles were insufficient trained staff, expendable supplies, and equipment to expand to the 35 sites (25 were planned). The key management problem was failure to completely integrate the P< program into the UMATI mainstream.
FAMILY PLANNING WORLD. 1992 Jan-Feb; 2(1):7, 21.Even though Brazil's BEMFAM program stopped providing sterilization services over a year ago, many sources hostile to BEMFAM in the Brazilian government are still accusing it of misconduct. BEMFAM is sponsored by the International Federation of PLANNED Parenthood and was investigated and cleared of any wrong doing by the Brazilian government. In Brazil it is against the law to perform sterilization for the purposes of birth control, yet it is estimated that there are between 6-20 million such operations each year. Over 65% of the births in Brazil are by Caesarian section and it is common for women to ask their doctors to perform a tubal ligation at the same time. Abortion is illegal in Brazil, but there are an estimated 1.4-2.4 million abortions each year. 56% of Brazilian women use contraceptives, with 90% using either the pill or illegal sterilization. 90% of those who use the pill obtain it over the counter at pharmacies with inadequate knowledge on how to use it. 80% of the people receive their health care from the Brazilian government.
JOURNAL OF THE TENNESSEE MEDICAL ASSOCIATION. 1986 Feb; 79(2):75-6.275 laparoscopic tubal ligations were done safely and economically at the Planned Parenthood of Memphis outpatient clinic from May 1983 to June 1985. Patients were carefully selected and counselled, eliminating those with previous abdominal surgery, excluding cesarean section, and those with ongoing pregnancy or serious gynecological or medical problems. The trained staff of experienced laparoscopic surgeons and certified registered nurse anesthetists practiced emergency procedures before surgery. Anesthesia was a minimal amount of nalbuphine (Nubain) 20 to 40 mg and droperidol (Inapsine) 1.25 to 2.5 mg; or fentanyl 0.1 to 0.25 mg and droperidol 1.25 to 2.5 mg; occasionally nitrous oxide inhalation. Some women received droperidol 1.25 to 2.5 mg or diazepam 2.5 to 5 mg beforehand. The laporoscopic procedure, performed through a small intraumbilical incision, employed the fallop ring. The incision was closed with 000 Dexon subcuticular sutures. There were minor side effects in 23: nausea in 20, vomiting in 2 and wound infection in 1. Two pregnancies occurred: 1 was not detected in the preliminary pregnancy test and the other was a procedure failure. The sterilization program is considered safe and resonably priced, $450 compared to $1150 to 1469 in area hospitals outpatient clinics.
[Voluntary sterilization in France and in the world] La sterilisation volontaire en France et dans le monde.
Paris, Masson, 1981. 277 p.This monograph, directed not only to medical and paramedical personnel but to sterilization seekers as well, touches upon all aspects of voluntary sexual sterilization. The history of sterilization is follwed by a review of female and male anatomy and physiology, and of present available and reversible methods of contraception. All surgical, laparoscopic, tubal, electrocoagulation, culdoscopic, or hysteroscopic methods of female sterilization are described, and results, including morbidity and mortality, complication rates, side effects, and failure rates are presented. This part of the monograph is illustrated with clear and schematic drawings. Problems related to demand for reversal of sterilization are discussed. The same is done for male sterilization, its techniques and complications. The monograph discusses the ever increasing demographic problem in the world , and the role and the extent of voluntary sexual sterilization in industrialized countries and in third world countries, stressing the efforts of those international agencies, such as WHO, IPPF, the Population Council, the European Council, UNFPA, and the World Federation of Associations for Voluntary Sterilization, which promote sterilization around the world, and offer sterilization services. The authors then investigate the role of the physician in the decision to recur to sterilization as a permanent contraceptive method, and in deciding the proper surgical technique. A special chapter discusses the psychological conflicts related to sterilization, especially those which arise before the intervention, and which may very well represent the strongest contraindication to sterilization. A final chapter is devoted to France and to the sociocultural aspects which make sterilization more or less acceptable, the existing legislation, and the professional problems linked to sterilization interventions.
Advances in Planned Parenthood. 1980; 15(3):77-81.In 1977 the PPAN (Planned Parenthood Association of Nashville) began providing minilaparotomy sterilization services on an outpatient basis. The experience of 218 women who received sterilizations at the clinic between 1977-1979 indicated that it was feasible and safe to provide this service on an outpatient basis. The historical development of the program, the procedures and instruments used to perform the sterilizations, and the sterilization outcomes for the 218 patients were described. Prior to program initiation, the Medical and Executive Directors of PPAN attended a workshop on outpatient female sterilizations conducted by AVS (Association for Voluntary Sterilization) and the Planned Parenthood Federation of America. Subsequently a protocol for minilaparotomy sterilization was submitted to the National Medical Office of the Federation by the PPAN. The protocol was approved and the program was implemented. Based on the success of the 1st 18 months of operation PPAN received a grant from AVS to train personnel from other clinics to provide similar services. During the 1st clinic visit patients are thoroughly counseled and given a pelvic examination. During the 2nd visit the patient is given a complete physical examination and laboratory tests, including a pregnancy test, are performed. During the 3rd visit the patient receives additional counseling and the sterilization is then performed. A modified Pomeroy procedure is performed under local anesthesia. Patients were discharged 2 hours after surgery. 96% of the patients returned for suture removal and 50% returned for a later recommended check-up. A follow-up survey indicated that more than 90% of the patients were satisfied with the service. For 4 of the 218 patients the sterilization was not completed. In 2 cases the round ligament was mistaken for the tube and sterilization was not achieved, in 1 case the patient became upset and the procedure was halted, and in another case adhesions prevented ligation. At the time of the operation it was discovered that 2 patients had luteal phase pregnancies. There were no major immediate complications but there were 1) 2 cases of subcutaneous hematomas; 2) 1 brief episode of postoperative thrombophlebitis, 3) 2 cases of wound abscesses; and 4) 3 cases of mild cystitis and endometritis.
Bangkok, Thailand, Ministry of Public Health, 1976. 52 p.Add to my documents.
World Health Organization, Technical Report Series.. 1970; 50.Add to my documents.