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Directions in Global Health. 2007 Sep; 4(2):1-11.The health of women in the developing world is a growing priority for the global community. We are increasingly aware of women's vulnerability to AIDS and other diseases-and the cultural factors that can reduce their opportunities to live healthy lives. At the same time, there is ever-greater recognition of women's enormous influence on the health and well-being of their communities. PATH has been a front-runner in the race to offer women better health solutions since our first project, in the late 1970s-helping manufacturers in China set up facilities for producing high-quality condoms and other contraceptives. Today PATH's work extends across the spectrum of women's health. The projects highlighted in this issue of Directions range from better care for mothers and infants to new options for woman-initiated protection against HIV to programs that help give women an equal chance at a healthy life. We anticipate that over the next decade, the investment in women among PATH and organizations like us will only continue to deepen. When women are healthy, so are their families and communities-the starting point for a stronger, more stable world. (excerpt)
London, FPA, 1972. 48 p.Currently, public authorities pay for almost 2/3 of the family planning consultations conducted by the Family Planning Association, and this is the most significant development since the publication of the last Family Planning Association Report. Additionally, more local health authorities are operating direct clinic and domiciliary services. The Family Planning Association handed over the management of 39 clinics to public authorities in the 1971-1972 year. However, despite this progress, family planning service provision by public authorities throughout England continues to be uneven in quality and extent. Spending by local health authorities for each woman at risk varies from 1 penny per woman at risk in Burnley (excluding the city of London) to 179 pence at Islington. In addition to the problem of inconsistency in spending, there appears to be no immediate prospect of a comprehensive family planning service - one that is available to all, is free of charge, and is backed by an adequate education campaign. Although government help for the extension of domiciliary family planning service is impressive, it should not obscure the false economies in spending on other contraceptive delivery services such as general practitioners, specialist clinics, and specialized advisory centers. Until the government announces the details of its plans for family planning services within the National Health Service beginning April 1974, the Family Planning Association's own detailed planning cannot be exact. The Association's basic policy continues to be to turn over the responsibility for the management of clinic and domiciliary contraceptive services as quickly and as smoothly as possible to the public authorities. Already there is concern that some clinic services managed by public authorities may become less attractive, particularly to young people, and that differences in the quality of service will increase under local public management as well as that backup services will be neglected. Also existing is the realization that the public authorities do not do enough to attract people to the use of contraception.
Geneva, Switzerland, WHO, 1987. vii, 80 p.This WHO manual on barrier contraceptives and spermicides covers all methods, their effectiveness, advantages and disadvantages, non-contraceptive advantages, uses in special cases, family program considerations, the logistics of supply, monitoring shelf-life and quality control, and application of condoms in AIDS prevention programs. Condoms and foaming tablets are the most appropriate methods for developing countries, especially those in the tropics. Other methods present problems such as expense (diaphragms, foams, sponges), unavailability outside the U.K. and U.S. (caps, sponges), bulk and expense (canned foams). Certain individuals are particularly good candidates for barriers and spermicides: lactating women, people using abstinence or natural family planning, adolescents, older women, women waiting to start using other methods, and those at risk for contracting sexually transmitted diseases. Program officials should consider providing supplies in their special environments, with limitations such as transport, reliability of shipments, storage requirements, cultural sensitivity, multiple outlets for supplies, and cost both to the program and to the users. Methods of insuring steady supply and techniques of testing condoms are described. Barrier methods, condoms in particular, help stop the spread of gonorrhea, syphilis, Chlamydia, Candida, Trichomonas and HIV. An appendix describes basic information about AIDS and the relevance of barriers and spermicides, as well as monogamy and abstinence, in preventing AIDS transmission. Other appendices list sources of supply for developing countries, addresses of manufacturers and sources of further information, techniques for using these methods, and teaching methods for illiterates and semi-illiterates.
London, England, International Planned Parenthood Federation, 1985. 48 p. (IPPF Medical Publications.)This booklet, published by the International Planned Parenthood Federation (IPPF), discusses the mode of action of barrier methods of contraception--their advantages, disadvantages, and effectiveness. Each method is dealt with in detail under the headings of 'application,' 'instruction to users,' 'advantages,' 'disadvantages and side-effects' and 'effectiveness.' Areas of research and safety issues are also discussed. The various types of barrier contraceptives are: 1) spermicides--creams, jellies, melting suppositories, foaming suppositories or tablets, and aerosol foams; 2) unmedicated mechanical barriers--vagnial diaphrams and cervical caps, including cavity-rim, Vimule and vault caps; 3) medicated mechanical barriers--vaginal sponges; and 4) condoms. When used properly and conscientiously, the contraceptive agents are both safe and effective, although their mode of action may be more complex than has been assumed in the past. The function of barrier contraceptives is to block the passage of sperm into the cervical mucus; the condom prevents sperm from being deposited in the vagina, whereas the vaginal barriers interfere with sperm transport after semen has entered the vagina. In addition to blocking the intial wave of sperm form entering the cervix, the spermicidal preparations also kill the sperm within the vagina; most products now in use contain a nonionic surface active agent as a spermicide. Favorable attributes of barrier methods are: 1) few local side effects, 2) no highly skilled medical intervention is needed, 3) they are applied locally in the vagina, 4) they may inhibit sexually transmitted diseases, 5) there are few medical contraindications to their use, and 6) most are available without prescription. Disadvantages are: 1) they are generally less effective than most hormonal contraceptive and IUDs, 2) strong motivation is required for successful use, 3) they require manipulation of the genitalia, 4) some types are inconvenient or messy, and 5) most must be applied at or near the time of sexual intercourse. New spermicides, custom fitted cervical caps, and enzyme inhibitors are some of the new methods being researched and developed. The appendix includes the IPPF policy statement on barrier methods of contraception.
London, England, Bodley Head, 1984. 286 p.This biography of the British family planning pioneer Helena Wright, who lived from 1887-1981, is based on her books, letters, and papers and on a series of personal interviews, as well as on the recollections and writings of her friends, colleagues, and critics. Considerable attention was given to her background and early life because of their strong influence on her later works and attitudes. Wright was the only physician among the small group of women who founded the British Family Planning Association, and was a founder and officeholder of the International Planned Parenthood Federation. She helped gain acceptance of the principle of contraception from the Anglican clergy and the medical establishment, and was an early worker in the field of sex education and sex therapy. Among Wright's books were works on sexual function in marriage, sex education for young people, contraceptive methods for lay persons and for medical practitioners, and sexual behavior and social mores. This biography also contains extensive material on the history of contraception and of the birth control movement, including the development of the British Family Planning Association and the International Planned Parenthood Federation, as well as important early figures in the movement.
London, IPPF, 1981 Dec. 24 p.This paper discusses Community-Based Distribution (CBD) programs as a strategy for delivering family planning services at the community level whether through health and other extension workers or lay distributors. Commercial marketing is not discussed. IPPF member family planning associations (FPAs) have been pioneers in establishing CBD programs. In 1979, approximately 40 FPAs were involved in CBD, representing about 80 projects and accounting for 34% of all new acceptors. About half of the projects and half of the new acceptors were in the Western Hemisphere region, where 95% chose oral contraceptives (OCs). OCs were selected by 68% of all new nonclinical clients. The cost per new acceptor in 1979 in CBD programs (with one exception) ranged from 78Z in Thailand to $16.50 in Mexico. Program issues involving the availability of CBD services include: 1) a comprehensive approach to service delivery including adequate and appropriate back up; 2) community participation in the design and delivery of CBD programs; 3) expanding coverage to reach less accessible and disadvantaged populations; and 4) monitoring and evaluating the impact of CBD programs through data collection and constant communication with program participants. The credibility of the distributor in the community is a key factor in ensuring the program's success. The report recommends that OCs of 50 mcg or less be used. Screening of potential acceptors by checklist is adequate; pelvic examination is not needed. CBD projects in Brazil, Colombia, India, Lebanon, South Korea, Thailand, China, Egypt, and the Philippines are described as are projects for 1979. The November 1981 IPPF policy statement supporting community-based family planning services is included.
In: Kleinman RL ed. Medical handbook. Pt. 1. Contraception. 2nd ed. London, International Planned Parenthood Federation, 1964. 69-77.In order to standardize results of spermicidal testing among various countries, the IPPF published this handbook; this chapter describes, step-by-step, tests appropriate for various aspects of testing spermicidal agents. Tests for total spermicidal power included: 1) alkaline test of total spermicidal power (Baker); 2) the Sander-Cramer method; and 3) the IPPF agreed test for total spermidical power (1964). 1 test of foaming capacity is outlined. Tests for local harmlessness include, for animals: 1) Rhesus monkey vagina, Birmingham screening test, and 2) the rabbit vaginal irritation test; for women, they include: 1) Government of India contraceptive testing unit 24-hour cap test, and 2) the Margaret Sanger Research bureau 21-day test. Tests of acceptability include the 1) Government of India Contraceptive testing unit clinical test, and 2) Exeter acceptability test (United Kingdom). A test for stability on storage of spermicidal agents is also outlined. Also of interest to the IPPF are tests for determining standards for rubber products, specifically, the condom and vaginal diaphragm. Tests for these rubber devices are outlined, and apparatus used in the testing for burst (condom) and rubber quality (diaphragm) are depicted. It is recommended that all rubber goods bear the manufacturer's name and the date beyond which they should not be used.
Ob. Gyn. News. September 1, 1977; 12(17):1, 24-25.According to data from Planned Parenthood-World Population, there has been an increase in the use of the diaphragm among women in the U.S. In 1975, 5.7% of new patients chose the diaphragm; this figure rose to 10.4% in 1976. Preference for the IUD remained at a constant 7.7% level among new patients for 1975 and 1976; however, the oral contraceptive declined in popularity from 79.2% in 1975 to 72.4% in 1976. When used correctly, the diaphragm is as effective a method as it competitors. Unfortunately, the definition of correct usage and the instructions given vary greatly among physicians. Dr. Louise B. Tyrer, vice-president fror medical affairs and director of medical services for Planned Parenthood, New York, indicates that repeated applications of spermicide should be administered with each coitus because it is the spermicide, not the diaphragm, that is so effective against pregnancy. Dr. Tyrer predicts a further increase in diaphragm use unless other efficacious and safe methods of contraception are developed. Additionally, she suggests that nurses be trained to instruct patients in the use and care of the diaphragm so physicians would be more willing to offer diaphragms and fit patients for the device.
London, International Planned Parenthood Federation, June 1971. 83 pThis is a comprehensive listing of available contraceptives worldwide compiled by the International Planned Parenthood Medical Dept. Contraceptives are listed by brand name and by country, and are categorized by: 1) caps, i.e. diaphragms and others; 2) condoms; 3) spermicides; 4) IUDs; and 5) oral contraceptives. Codes indicate the composition of all oral contraceptives. No assessment of quality has been made. Most oral contraceptives have been approved by the national governments. The IUDs have been clinically tested. There is 1 national standard for diaphragms, several national standards for condoms, and the International Planned Parenthood Federation test for spermicidals.
Presented at Expert Group Meeting on the Production and Distribution of Contraceptives in the Developing Countries (sponsored by United Nations Industrial Organization and United Nations Fund for Population Activities), New York, November 22-24, 1971. 10 pThe paper examines in the developing nations patterns of contraceptive demand, present trends in the growth of demand, and opportunities for generating an even more rapid expansion of demand. While the commercial sector has a tremendous importance in the supply of contraceptive demand in more developed areas of the world, its importance is very much less in the less developed areas. The consumer-oriented approach of the commercial sector is successful in generating contraceptive demand. Even the noncommercial sectors could employ the consumer-oriented approach with success. A new type of family planning program, the social/commerical effort, utilizes both noncommerical and commerical sectors. This combined approach rectifies the problem of low sales performance of the commerical sector, a problem associated with the rough economic going in developing nations when no aid is given by noncommerical groups. India's Nirodh Marketing Program, a social/commercial effort, has already produced a 500% increase in consumer condom purchases and is already responsible for perhaps 1,000,000 new users. Total demand for contraceptives is probably growing on the order of 5-10% annually in the developing nations.
IPPF Medical Bulletin. 1983 Jun; 17(3):2-4.At least 12 countries have regulations for condoms, and because of the complicated regulations relating to condoms the International Organization for Standardization (ISO) was asked to create a committee for contraceptives. Its objective is to promote the development of standards throughout the world to help the international exchange of goods and services. Following discussions between the World Health Organization (WHO) and ISO it was decided in 1974 to establish a technical ISO committee that would deal with international standards for mechanical contraceptives, comprising condoms, diaphragms, and IUDs. It was also decided that spermicides and oral contraceptives (OCs) should be excluded from the ISO effort, but that they should fall within the responsibility of WHO. The committee, entitled ISO/TC 157 Mechanical Contraceptives, was represented by 35 member countries in 1982. The object of standardizing condoms is to obtain a satisfactory quality that can be accepted throughout the world. To achieve that purpose, acceptable test methods and associated limit requirements and values must be determined, along with rules for storage, packaging, and labeling. The most important factors in determining condom quality are the need to reach agreement on an acceptable number of holes in the condom and the ability to establish limit values for the mechanical properties of the condom. Specific requirements regarding dimensions, resistance to storage, packaging, labeling, and appropriate storage are also important. Up to 1982 the work of ISO for condoms resulted in 8 published international standards, of which 6 deal with test methods, 1 with packaging and labeling, and 1 with storage. Agreement has also been reached within the ISO committee on an additional 3 draft standards. Due to the comparatively small use of diaphragms, standardization efforts in this area do not have the highest priority. ISO/TC 157 has formulated 10 drafts which are being prepared for distribution to the ISO member countries for purposes of voting. 7 of these standards deal with test methods, 1 with sampling and requirements, 1 makes storage recommendations, and 1 refers to packaging and labeling. A working group for standardizing IUDs was established in 1976. It was agreed within ISO/TC 157 after almost 3 years to publish a Technical Report (TR 7439) for IUDs. The report deals with such things as the definition of IUDs, general requirements for type approval, batch inspection, storage recommendations, and packaging and labeling. The report shall constitute the basis for continued standardization efforts for IUDs.