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Selected practice recommendations for contraceptive use. Third edition 2016. Web annex: Development of updated guidance for the third edition.
Geneva, Switzerland, WHO, Department of Reproductive Health and Research, 2016. 50 p.Over the past 40 years, there have been significant advances in the development of new contraceptive technologies, including changes in formulations and dosing, schedules for administration and novel delivery systems. However, current policies and health-care practices in some countries are based on scientific studies of contraceptive products that are no longer in wide use, on long-standing theoretical concerns that have never been substantiated or on the personal preference or bias of service providers. These outdated policies or practices often result in limitations to both the quality of and the access to family planning services for clients. The goal of this document is to improve access to and quality of family planning services by providing policy-makers and decision-makers with a set of recommendations on how to use family planning methods safely and effectively once they are deemed medically appropriate. Because country situations and programme environments vary so greatly, it is inappropriate to set firm international guidelines on criteria for contraceptive use. However, it is expected that national programmes will use these recommendations for updating or developing their own contraceptive guidelines according to national health policies, needs, priorities and resources, while reflecting upon local values and preferences. There are a total of four World Health Organization (WHO) guidance documents (cornerstones) pertaining to contraception: two focusing on evidenced-based recommendations (primarily targeted towards policy-makers and programme managers) and two focusing on application of the recommendations (primarily targeted towards health-care providers). All four cornerstones are best interpreted and used in a broader context of reproductive and sexual health care. These documents are updated periodically to reflect changes in medical and scientific knowledge. (excerpt)
Geneva, Switzerland, WHO, Department of Reproductive Health and Research, 2016. 72 p.This document is part of the process for improving the quality of care in family planning. Specifically, it is one of two evidence-based cornerstones (guidance documents) of the World Health Organization’s (WHO’s) initiative to develop and implement family planning guidelines for national programmes. The first cornerstone, the Medical eligibility criteria for contraceptive use (MEC, now in its fifth edition), provides thorough information and guidance on the safety of various contraceptive methods for use in the context of specific health conditions and characteristics. This document, Selected practice recommendations for contraceptive use, third edition (SPR third edition), is the second cornerstone; it provides guidance for how to use contraceptive methods safely and effectively once they are deemed to be medically appropriate. For recommendations issued in the SPR, safety considerations include common barriers to safe, correct and consistent use of contraception and the benefits of preventing unintended or unwanted pregnancy.
Long-acting and permanent contraception: An international development, service delivery perspective.
Journal of Midwifery and Women's Health. 2007 Jul-Aug; 52(4):361-367.Recent scientific findings about long-acting and permanent methods of contraception underscore their safety, effectiveness, and wide eligibility for individuals who desire them. This has led to new guidance from the World Health Organization to inform national policies, guidelines, and standards for service delivery. Although developing countries have made much progress in expanding the availability and use of family planning services, the need for effective contraception in general (and long-acting and permanent methods in particular) is large and growing because the largest cohorts in human history are entering their reproductive years. More than half a billion people will use contraception in developing countries (excluding China) by 2015, an increase of 200 million over levels of use in 2000. The health, development, and equity rationales that historically have underpinned and energized the international family planning effort remain valid and relevant today. Despite the other compelling challenges faced by the international health community, the need to make family planning services more widely available is pressing and should remain a priority. (author's)
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.
IPPF MEDICAL BULLETIN. 1993 Jun; 27(3):1-2.Sterilization consists of occlusion of the vas deferentia or the Fallopian tubes to prevent the sperm and ovum from joining. Counseling is important since voluntary surgical and contraception is a permanent contraceptive method. Trained counselors should know about and discuss other contraceptive methods, the types of anesthesia available, and the different sterilization procedures and stress the permanent nature of sterilization and the minimal risk of failure. Counseling must maintain voluntary, informed consent and not coerce anyone to undergo sterilization. It is best to counsel both partners. Vasectomy should be encouraged because it is simpler and safer than female sterilization. Most sterilization techniques are simple and safe, allowing physicians to conduct them on an outpatient basis. Local anesthesia and light sedation are the preferable means to reduce pain and anxiety. In cases where general anesthesia is required, the patient should fast for at least 6 hours beforehand and the health facility must have emergency resuscitation equipment and people trained in its use available. Aseptic conditions should b maintained at all times. Vasectomy is not effective until azoospermia has been achieved, usually after at least 15 ejaculations. The no-scalpel technique causes less surgical trauma, which should increase the acceptability of vasectomy. Vasectomy complications may be hematoma, local infection, orchitis, spermatic granuloma, and antisperm antibodies. Spontaneous recanalization of the vasa is extremely rare. Postpartum sterilization is simpler and more cost-effective than interval sterilization. Procedures through which physicians occlude the Fallopian tubes include minilaparotomy, laparoscopy, and vaginal sterilization via colpotomy or culdoscopy. They either ligate the Fallopian tubes or apply silastic rings or clip to them. Vaginal sterilization is the riskiest procedure. Reversal is more likely with clips. So complications from female sterilization are anesthetic accidents, wound infection, pelvic infection, and intraperitoneal hemorrhage. About 1% of all sterilization clients request reversal. Pregnancy rates are low with reversal.
INTERNATIONAL JOURNAL OF ANDROLOGY. 1992 Dec; 15(6):455-9.Bilateral vasectomy for contraceptive purposes is one of the most frequently performed minor operations; an estimated 50 million men have had it done to themselves. Vasectomy remains unacceptable in some countries, however, due to religion-imposed constraints or fear of side-effects or trauma. A 100% effective, reversible vasectomy without complications or side-effects would allay the fears of potential candidates for the procedure. To that end, the Male Task Force of the World Health Organization Special Program of Research, Development, and Research Training in Human Reproduction is supporting studies on reversible vasectomy. One-third of marriages in many developed countries end in separation, and many separated men tend to request a reversal of their vasectomies. The current least traumatic, effective vasectomy is the no-scalpel method developed in China. Minimal though it may be in terms of tissue disruption, this type of vasectomy is no less easy to reverse than any other surgical method. The practice of chemical vas occlusion using a carbolic acid-cyanoacrylate glue has potential, but is again no easier to reverse. Research has led to the consideration of whether an inert substance could be equally capable of plugging the vas, yet more easily reversible. Zhao et al, have successfully restored fertility in 130 men after removing polyurethane elastomer plugs 3-5 years after vasectomy. Efficacy studies are needed. The use of silicone plugs is also being evaluated. 9 months or more after insertion, however, may be required to secure azoospermia using either the polyurethane or silicone plugs. There may also be a prolonged period of leakage of viable spermatozoa around an inert plug which does not cause sclerosis. Finally, further study needs to be conducted to find the ideal size and shape of a silicone plug or plugs which may be used and whether secondary testicular or epididymal changes will make reversal difficult. It is pointed out, however, that secondary changes may take many years to develop and may not be relevant, since most reversals are requested within 5-10 years of vasectomy.
BRITISH MEDICAL BULLETIN. 1993 Jan; 49(1):210-21.The search for new, safe, effective, and reversible contraceptive methods for men as pursued by several agencies and probable future developments until the year 2000 is reviewed. A WHO consultation between vasectomy and the risk of cancer of the prostate or testis is unlikely and changes in family planning policies are unwarranted. Research in China has led to the ligation of the vas by percutaneous injection of sclerosing agents through a puncture opening. The suppression of secretion of either both luteinizing hormone and follicle-stimulating hormone (FSH) or of FSH alone; the recovery of circulating androgen to physiological levels; and the assessment of the functional capacity of residual sperm. Hormonal methods comprise the contraceptive efficacy of testosterone enanthate-induced azoospermia and oligozoospermia; and gonadotropin-releasing hormone analogue-androgen combinations. A large number of non-hormonal chemical agents lead to total spermatogenic arrest and to irreversible sterility. Gossypol was studied as an antifertility agent in clinical studies on more than 8000 Chinese men, but its use for contraception was halted owing to the high incidence of irreversibility and serious side effects such as hypokalemia. Among drugs and plant products for inhibition of sperm maturation, Chinese investigation showed that a multiglycoside extract of the plant Tripterygium wilfordii caused reductions in sperm motility and concentration in patients. A program established between Chinese, Thai, and UK centers aims to isolate pure compounds extracted from the plant for antifertility actions. In regard to contraceptive vaccines, passive or active immunization against FSH has resulted in significant decreases in sperm counts in macaque monkeys with inconsistent effects on fertility.
New York, New York, AVSC, 1993 Mar 16. vi, 43, 108, 47, 15 p.The March 1993 Association for Voluntary Surgical Contraception (AVSC) workplan outlines strategic plans to expand services to USAID priority developing countries while reducing services in other countries and to add all contraceptive methods requiring a medical procedure to its services. AVSC plans on continuing to focus on voluntary sterilization. Its guiding principles still are expanding access to services, guaranteeing free and informed choice, and ensuring the safety and effectiveness of services. AVSC plans to develop comprehensive country programs and to take on special or global programs. Some anticipated special programs include medical quality assurance, voluntarism and well-informed clients, client-centered service systems, and vasectomy and male involvement. Managerial plans are country level planning and evaluation, continuous strategic planning, annual workplan development, decentralization, strengthening technical capacity, interagency collaboration and strategic alliances, and diversification of funding. AVSC's 1993 funding sources are dominated by USAID (57% from USAID central office and 27% from USAID missions). UNFPA and the World Bank together comprise 8% and private sources make up another 8%. AVSC plans to provide services in some countries for which USAID does not provide funding: Iran, Vietnam, the former Soviet Union, and the US. Specific issues that AVSC faces in fiscal year 1993 are insufficient USAID funding, resistance by other agencies to collaborate, addressing the highly competitive bidding game related to requests for proposals with the USAID Office of Population, assuring partners and supporters of its continued emphasis on voluntary sterilization, confronting the effect of adverse press coverage on vasectomy and prostate cancer, and remaining mindful of contraceptive choice issues.
[Unpublished] 1988 Oct 14.  p.This concept paper discusses an initiative planned for 1989-91 to redirect family planning (FP) program efforts so that vasectomy increasingly becomes of a method choice. The availability and acceptance of vasectomy is considerably less than for female sterilization. It is thought that the reason for the decline in numbers of vasectomy may be unfamiliarity with the method and lack of knowledge on the part of doctors of the best methods to use when performing vasectomies. Internationally, there has been concern about increasing the role of the male in FP. New developments such as increased vasectomy use in Africa and other unlikely countries suggest that this is an appropriate time to begin this initiative. The Chinese "no scalpel technique" has been recognized as having distinct advantages over other techniques. The WHO has produced a program and technical guide on vasectomy services for FP program managers. The objectives are 1) to introduce the Chinese method systematically through training activities; with the cooperation of the Chinese; 2) to set up demonstration projects in vasectomy services in several countries where vasectomy is not available; 3) to develop and conduct operations research projects on the best way of introducing vasectomy services; 4) to encourage clinical research on factors affecting safety, effectiveness, and satisfaction; 5) to promote dialogue on vasectomy at country and regional and international levels; and 6) to encourage donor agencies to become involved in the effort. The plan for action is to be implemented in 3 stages during a period of 3 years and is directed toward solving unanswered questions, which will be generated during an idea generation period. The approach will be multidisciplinary and will involve service and training programs, social science research, and clinical research. Other agencies must be involved. An international symposium will occur at the end of the period to relate and synthesize the experiences of the preceding 3 years. Phase I will generate ideas at, for instance, the World Fertility Rio meeting. Phase II will involve implementation, and phase III the analysis and synthesis of the experiences.
POPULI. 1993 Mar; 20(3):4-5.A study published in the Journal of the American Medical Association linked vasectomies to a 66% elevated risk of prostate cancer among men 15-20 years after the surgery, although a causal relationship between vasectomy and prostate cancer was not proven. Although 2 previous studies found no linkage, the study by Edward Giovannucci of Boston drew broad attention in the medical community. Prostate cancer in the industrial world is quite high: about 1 in 11 males in the US will develop prostate cancer for unexplained reasons. But the US-based Association for Voluntary Surgical Contraception (AVSC) warns that the public or medical professionals should not overreact to this new information. In 1991 a group of experts convened by WHO concluded that based on existing biological and epidemiological evidence any causal relationship between vasectomy and the risk of prostate or testicular cancer was unlikely and changing policies concerning vasectomy was unjustified. In contrast to the author's conjecture, experts at AVSC pointed out that models of cancer development suggest that a decrease in prostatic secretions following a vasectomy actually would reduce cancer risks. The cases of prostate cancer are unknown, and vasectomy is not associated with any increase in mortality. Family Health International (FHI) is concerned about the effect of perceptions in developed countries on policy in developing countries. However, the risks associated with vasectomy are still less than the risks of pregnancy. In India health risks linked to pregnancy and childbearing are 400 times greater than those linked to contraception. Further research, the continuation of vasectomy policies, and annual examinations for prostate cancer among men who have undergone vasectomies and for all men aged 50-70 years are recommended. The American Urological Association urges men who have had vasectomies not to have them reversed to try to prevent cancer.
WASHINGTON POST HEALTH. 1993 Jan 12; 11.In the United States a total of 490,000 men obtain vasectomies each year compared to more than 600,000 women who sought sterilization in 1992 via tubal ligation. Vasectomy is often permanent, and even monogamous men avoid the procedure, partly because of the misconception that vasectomies reduce sexual prowess, fear of emasculation, and its confusion with castration. Also, there have been suggestions that vasectomy may increase the risk of prostate cancer. The World Health Organization experts in 1991 concluded there was no reason to stop recommending vasectomies. However, 2 large studies at Harvard University in Boston have added to the controversy. The 1st study involved more than 23,000 husbands of women in the Nurses' Health Study and followed the men from 1976 until 1989. A preliminary analysis found that having a vasectomy appears to increase the risk for prostate cancer by 37%. The 2nd study involved more than 51,000 men in the Health Professionals Follow-up Study. Similarly, preliminary analysis indicated that vasectomized men appear to have a 21% increased risk for prostate cancer. These findings cause concern, since 4 million American men have had the procedure. A vasectomy involves severing each vas deferens, which carries sperm from the testicles into the penis. In the new, no-scalpel vasectomy technique the doctor makes 1 tiny puncture, and for the patient there is less swelling and bleeding. 300 US doctors are trained to perform the procedure, which was pioneered in China. Failure usually occurs because the vasa reconnect by themselves. Only a small percentage of men experience complications, most commonly excess bleeding or infections. Microsurgical techniques result in a 98% chance of reconnecting the vasa, if a reversal of the procedure is desired. But only about half of those who undergo a reversal succeed in fathering children, because after a vasectomy the immune system often produces antibodies against sperm.
Lancet. 1993 Feb 20; 341(8843):486-7.2 well-designed cohort studies involving 73,000 men found that the risk of prostate cancer increases after vasectomy. In the Health Professionals Follow-up Study vasectomized men had an age-adjusted relative risk of prostate cancer of 1.66. The risk was 1.85 among those who had had the operation at least 22 years previously. In the Nurses Health Study the age-adjusted relative risk of prostate cancer for vasectomized men was 1.56 overall and 1.89 for those who had had their vasectomy at least 20 years previously. The long-term safety of vasectomy raised by these reports could reduce its acceptability by about 42 million couples worldwide who rely on it. It is not clear whether the relation is causal. Prostate cancer develops in about 1 of 1 men in the US, and most of those affected would not have undergone vasectomy. Since the causes of prostate cancer are unknown, it is not sure whether true risk factors were equally distributed between vasectomized and control groups, a point supported by the finding that in the Nurses' Health Study the vasectomized group has a lower total mortality rate than did the controls. Further uncertainties are the weakness of the association, the lack of relation between vasectomy and prostate cancer in 3 other cohort studies, and the doubtful plausibility of the biological explanations. The experts convened by the World Health Organization in 1991 concluded, based on existing biological and epidemiological evidence, that a causal relation between vasectomy and prostate cancer was unlikely. However, the risk ought to be mentioned in prosterilization counseling, and vasectomized men aged 50-70 should consider annual checks for prostate cancer. The WHO Human Reproduction Program pointed to the up to 50-fold lower annual incidence of prostate cancer in developing countries compared to some parts of the US. WHO-supported pilot studies are under way, and the main case-control study is expected to start in 1994.
New York, New York, AVSC, 1989. 18 p.The Association for Voluntary Surgical Contraception (AVSC) is an international professional organization that works with governments, international organizations, medical schools, and family planning agencies to provide reproductive health services to people. It has been operational since 1972 in 50 developing countries. AVSC stressed quality surgical contraception. Approximately 120 mission people will need sterilization and other surgical contraception by 2000. The scarcity of family planning (FP) services, misinformation, and social and medical traditions obstruct its acceptance and the result is unwanted pregnancies. Private hospitals offer expensive and unaffordable surgical contraceptive service where vasectomy is often unavailable or of poor quality by inadequately trained physicians, while the informed decision of the client is not assured. AVSC offers professional technical and financial assistance to governments and nongovernmental organizations (NGOs) to expand surgical contraception. AVSC reviews on-site clinical training, trains doctors and nurses, and drafts protocols for counseling and informed consent procedures. It assists in reduction of costs and in the monitoring and supervision of programs. It introduces new technology (Norplant, no-scalpel vasectomy producing less bleeding and complications). AVSC promotes the quality and availability of vasectomy and postpartum FP through collaboration with the World Federation for Voluntary Surgical Contraception by developing international standards and guidelines. AVSC has regional offices in Bogota, Tunis, Bangkok, and Nairobi and country offices in Bangladesh, India, Nigeria, and the Philippines. It is headquartered in New York City with 5 divisions and a board of directors, a multilingual professional staff exceeding 60, and outside consultants.
New York, New York, AVSC, 1991. 28 p.The annual report for 1990-1991 of the Association for Voluntary Surgical Contraception (AVSC) enumerates changes that came about in 1990, accomplishments of the last decade, and then summarizes activities by region with a brief feature on 1 country in each. Some of the developments in 1990 included introduction of Norplant, a training workshop in Georgia for physicians from newly independent CIS states, and the Male Involvement Initiative. The Gulf War delayed major activities requiring travel. Overall, in 1990 the AVSC provided 133,328 sterilizations, 72% female and 28% male in 50 countries, trained 325 doctors, led 58 courses in counseling and voluntarism training 568 counselors, and published or collaborated on numerous professional articles and teaching materials. In-country work emphasized no-scalpel vasectomy and minilaparatomy female sterilization under local anesthesia. As an example of country projects in 20 African nations, a client-oriented, provider-efficient system for improving clinic management and quality of care called COPE, was the focus in Kenya. Male responsibility was an emphasis in Latin America. In India, where sterilization is the most popular contraceptive method, training centers were upgraded in 12 states. In the US, AVSC conducted training sessions for physicians in laparoscopy under local anesthesia.
[Unpublished] 1989. Presented at the First International Symposium on No-Scalpel Vasectomy, Bangkok, Thailand, December 3-6, 1989. 10 p.The paper describes the introduction and use of the no-scalpel vasectomy in the United States. Vasectomy is popular in the U.S., with 336,000 of them performed in 1987 almost exclusively buy urologists, family practitioners, and surgeons. Receiving no government funding for the new procedure's introduction in the U.S., the Association for Voluntary Surgical Contraception (AVSC) turned to family planning clinics, Planned Parenthoods, and medical schools to reach experienced vasectomists interested in co-sponsoring orientation seminars for other doctors. Programs were held in 1988, in California, Massachusetts and New York, in which attendees were provided self-training packages, and asked to report their experiences with the new technique. Field reports were received from 25 physicians on 2,237 vasectomies, and included both positive and negative comments. Even though the technique is uncomplicated, physicians generally found the technique difficult to master with only teaching materials. Accordingly, the U.S. training model was modified to include a rubbermodel f the scrotal skin and underlying was with the training packet, visits to practitioners' offices by clinical instructors, a compressed training period of 1 day, and hands on training. A minimum of 6-9 cases is generally required to properly learn the technique. 3-4 training seminars will be conducted over the next year in different regions of the U.S. in addition to other efforts aimed at meeting demand for training from interested doctors. Care is taken in choosing instructors and participants, with interest especially strong in training of trainers. Of central concern to the AVSC is their ability to keep pace with growing demand for training, while ensuring 6-12 month follow-up and high-quality instruction and practice of the technique.
CEYLON MEDICAL JOURNAL. 1990 Dec; 35(4):136-42.The story of the Sri Lankan Family Planning movement is told from its inception in 1953, prompted by a visit by Margaret Sanger 1952. The Family Planning Association of Sri Lanka was founded with the health of women and children, and both contraception and infertility treatment as its policies. The first clinic, called the "Mothers Welfare Clinic," treated women for complications of multiparity: one woman was para 26 and had not menstruated in 33 years. The clinic distributed vaginal barriers, spermicides and condoms, but the initial continuation rate was <5% year. Sri Lanka joined the IPPF in 1954. In 1959, after training at the Worcester Foundation, and a personal visit by Pincus, the writer supervised distribution of oral contraceptives in a pilot project with 118 women for 2 years. Each pill user was seen by a physician, house surgeon, midwife, nurse and social worker. In 1958 Sweden funded family planning projects in a village and an estate that reduced the birth rate 10% in 2 years. The Sri Lankan government officially adopted a family planning policy in 1965, and renewed the bilateral agreement with Sweden for 3 years. In 1968 the government instituted an integrated family planning and maternal and child health program under its Maternal and Child Health Bureau. This was expanded in 1971 to form the Family Health Bureau, instrumental in lowering the maternal death rate from 2.4/1000 in 1965 to 0.4 in 1984. During this period IUDs, Depo Provera, Norplant, and both vasectomy and interval female sterilizations, both with 1 small incision under local anesthesia, and by laparoscopic sterilization were adopted. Remarkable results were being achieved in treating infertile copies, even from the beginning, often by merely counseling people on the proper timing of intercourse in the cycle, or offering artificial insemination of the husband's semen. Factors contributing to the success of the Sri Lankan planned parenthood program included 85% female literacy, training of health and NGO leaders, government participation, approval of religious leaders, rising age of marriage to 24 years currently, and access of all modern methods.
STUDIES IN FAMILY PLANNING. 1991 Jan-Feb; 22(1):1-18.A study investigative the pros and cons of financial payments for sterilizations to clients, medical personnel, and agents who motivate and refer clients was conducted by the government of Bangladesh in conjunction with the World Bank. Results indicate that Bangladeshi men and women opt to be sterilized both voluntarily and after consideration of the nature and implications of the procedure. Clients were also said to be knowledgeable of alternate methods of controlling fertility. A high degree of client satisfaction was noted overall with, however, 25% regret among those clients with less than 3 children. Money is a contributing factor in a large majority of cases, though dominating as motivation for a small minority. Financial payments to referrers have sparked a proliferation of many unofficial, self-employed agents, especially men recruiting male sterilization. Targeting especially poor potential clients, these agents focus upon sterilization at the expense of other fertility regulating methods, and tend to minimize the cons of the process. Examples of client cases and agents are included in the text along with discussion of implications from study findings.
New York, New York, IPPF, WHR, . 40,  p.The 1986 Annual Report of the International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR) documents the success of individual affiliates in providing well-managed family planning activities, improving the efficiency and effectiveness of services, and expanding program outreach through collaboration with other organizations. In 1986, new family planning associations were established in Haiti, Belize, and Venezuela. Innovative programs targeted at men were established in Colombia, Guatemala, and the Caribbean. In both Guatemala and Colombia, the number of vasectomy acceptors increased dramatically in 1986 as a result of male clinics that can dispel doubts and misconceptions associated with male sterilization and have convinced men who had heard of vasectomy and did not desire any more children to undergo the procedure. In the Caribbean, posters, pamphlets, and audiovisual materials bearing the message that fathers also plan their families have received a positive response from men. In Chile, the Dominican Republic, and the English- speaking Caribbean, a special effort has been directed toward the problem of adolescent pregnancy. Sex education courses in the schools, community distribution of educational materials, recruitment of adolescent peer counselors, and efforts to encourage teenagers to attend family planning clinics have formed part of this effort. Also in 1986, government support for family planning increased in the region. Argentina rescinded a 1974 law prohibiting family planning, Peru highlighted the centrality of family planning programs to achieving national development goals, and Brazil's social security system began to provide family planning services. The primary challenge for 1987 is to reach the 30 million couples in Latin America and the Caribbean who still lack access to family planning services.
Association for Voluntary Sterilization - Consultant Team. Trip report: the People's Republic of China, Beijing, Chongqing, Wuhan, Guangzhou, June 19-30, 1985.
[Unpublished] 1985. 41,  p.The Association for Voluntary Sterilization consultant team visited Beijing, Chongqing, Wuhan and Guangzhou, China in June 1985, to review innovative nonsurgical methods of male and female sterilization. There are 2 variations on vasectomy, performed with special clamps that obviate a surgical incision. The 1st is a circular clamp for grasping the vas through the skin, and the 2nd is a small, curved, sharp hemostat for puncturing the skin and the vas sheath, used for ligation. Vas occlusion with 0.02 ml of a solution of phenol and cyanoacrylate has been performed on 500,000 men since 1972. The procedure is done under local anesthesia, and is controlled by injecting red and blue dye on contralateral sides. If urine is not brown, vasectomy by ligature is performed. The wound is closed with gauze only. Semen analysis is not done, but patients are advised to use contraception for the 1st 10 ejaculations. Pregnancy rates after vasectomy by percutaneous injection were reported as 0 in 5 groups of several hundred men each, 11.4% in 1 group and 2.4% in another group. The total complication rate after vasectomy by clamping was 1.8% in 121,000 men. 422 medical school graduates with surgical training have been certified in this vasectomy method. Chinese men are pleased with this method because it avoids surgery by knife, and asepsis, anesthesia and counseling are excellent. Female sterilization by blind transcervical delivery of a phenol-quinacrine mixture has been done on 200,000 women since 1970 by research teams in Guangzhou and Shanghai. A metal cannula is inserted into the tubal opening, tested for position by an injection of saline, and 0.1-0.12 ml of sclerosing solution is instilled. Correct placement is verified by x-ray, an IUD is inserted, and after 3 months a repeat hysteroscopy is done to test uterine pressure. Pregnancy rates have been 1-2.5%, generally in the 1st 2 years. Although this technique is tedious, requiring great skill and patient cooperation, it can be mastered by paramedicals. The WHO is assisting the Chinese on setting up large studies on safety and effectiveness, as well as toxicology studies needed, to export the methods to other countries.
Report of the Task Force II on research inventory and analysis of family planning communication research in Bangladesh.
[Dacca, Bangladesh, Ministry of Information and Broadcasting] Oct. 1976. 85 p.Topics relevant to family planning such as interpersonal relationships, communication patterns, local personnel, mass media, and educational aids, have been studied for this report. The central theme is the dissemination of family planning knowledge. The methodology of education and communication are major factors and are emphasized in the studies. While the object was to raise the effectiveness of approaches, the direct concern of some studies was to examine a few basic aspects of communication dynamics and different human relationship structures. Interspouse communication assumes an important place in the family planning program and a couple's concurrence is an essential precondition of family planning practice. Communication between husband and wife varies with the given social system. A study of couple concurrence and empathy on family planning motivation was undertaken; there was virtually no empathy between the spouses. A probable conclusion is that there was no interspouse communication on contraception and that some village women tend to practice birth control without their husband's knowledge. Communication and personal influence in the village community provide a leverage for the diffusion of innovative ideas and practices, including family planning. Influence pattern and flow of communication were empirically studied in a village which was situated 10 miles away from the nearest district town. The village was found to have linkage with outside systems (towns, other villages, extra village communication network) through an influence mechanism operative in the form of receiving or delivering some information. Local agents--midwives, "dais," and female village organizers are in a position to use interpersonal relations in information motivation work if such agents are systematically involved in the family planning program and are given proper orientation and support by program authorities. These people usually have to be trained. 7 findings are worth noting in regard to the use of radio for family planning: folksongs are effective and popular; evening hours draw more listeners; the broadcast can stimulate interspouse communication; the younger groups can be stimulated by group discussions; a high correlation exists between radio listening and newspaper reading; most people listen to the radio if it is accessible to them; approximately 60% of the population is reached by radio. A positive relationship was found to exist between exposure to printed family planning publicity materials and respondents' opinions toward contraception and family planning. The use of the educational aid is construed as an essential element to educating and motivating people's actions.
[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.
Sequelae of vasectomy. Report of a Meeting on Vasectomy, organized by the Special Programme of Research, Development and Research Training in Human Reproduction held at WHO, Geneva, 3-6 August 1981.
Contraception. 1982 Feb; 25(2):119-23.In response to enquiries received by the World Health Organization (WHO) from several countries, the WHO Special Program of Research, Development and Research Training in Human Reproduction convened a meeting of experts in Geneva during August 1981 to review the available animal, clinical, and epidemiological data on vasectomy, with particular emphasis on clinical implications of longterm sequelae of vasectomy in cardiovascular disease. The occurrence of circulating antibodies to sperm antigens has been demonstrated after vasectomy in all animal species studied thus far by various techniques. Prospective clinical studies of vasectomized and nonvasectomized men have been conducted at 4 centers in the U.S. involving clinical and laboratory evaluation of subjects before surgery and at intervals thereafter. A total of 412 vasectomized men were enrolled in these studies; most were followed for 2, 3, or 4 years. The only significant finding was the development of antibody to sperm antigens. Alexander and Clarkson first reported that vasectomy increases the extent and severity of diet-induced atherosclerosis in cynomolgus monkeys. In a 2nd study, Clarkson and Alexander extended their previous findings to evaluate the effects of vasectomy on naturally occurring atherosclerosis in rhesus monkeys. The mechanism by which vasectomy exacerbates atherosclerosis in monkeys has not been defined. At present epidemiological data which have been published come from observations in the U.S. and United Kingdom and in particular from 2 studies involving 4830 and 1764 vasectomized men studied at about 5-6 years after surgery. No health risks of vasectomy were detected in these early years. Other epidemiological projects are in progress in the U.S. Various options were discussed for further epidemiological studies which might be conducted in developing countries where large numbers of men have been vasectomized. The cohort approach and the case control method, the 2 main study options, are briefly reviewed.
Bangkok, Thailand, Ministry of Public Health, 1976. 52 p.Add to my documents.
MARYLAND STATE MEDICAL JOURNAL. 1980 May; 29(5):68-9.In response to the growing public demand for non-hospital sterilization services, the Planned Parenthood Clinic in Baltimore began providing vasectomy services in April, 1971. Between 1971-1979, 4117 vasectomies were performed at the clinic under local anesthesia. Prior to vasectomy the patient is given a medical exam and a medical history is obtained. The patient is also interviewed by a counselor. Vasectomies are generally performed on Friday afternoons, and follow-up appointments are made until a negative semen analysis is obtained. The clinic has performed 73 minilaparotomies. Patients who wish to have a minilaparotomy must make 4-5 visits to the clinic. During the first visit the patient is seen by a counselor. During the 2nd visit a medical exam is given and a medical history is obtained. Blood, urine, and gonorrhoea tests are performed and a pap smear is obained. The counselor then explains all the risks involved in the procedure and an appointment for the operation is made if the patient wishes to continue. Operative procedures include: 1) inserting a Hulka tenaculum sound; 2) administering a local anesthesia; 3) making a 2-5 cm incision; and 4) performing a Pomeroy ligation. The operation takes 20-30 minutes and the patient is usually discharged 2 hours later. The patient is told to call the physician at any time if she experiences any difficulties and to return for a follow-up visit 2-4 weeks later.
Family Coordinator. 1973 Jul; 22(3):331-8.Data collected on behalf of the Planned Parenthood/World Population (PPWP) affiliate to be used in planning a vasectomy education program came from a survey of 387 men and women in Hayward, California, to ascertain the levels of knowledge and prevalence of vasectomy and attitudes toward the operation. The sample was comprised of men and women in 3 income categories, and households were not preselected on a random basis. The survey instrument was a 1-page set of questions, primarily of the closed-ended type which the respondent completed in the presence of the interviewer. The major findings were: 1) PPWP was not identified as a source of aid; 2) most men and women have discussed vasectomy with their spouses; 3) men and women are influenced by attitudes and practices of others with regard to vasectomy; 4) physicians are seen as the main source of information about vasectomy; 5) irreversibility is the major concern of the men and women; and 6) eligible couples can be reached only by a community-side education program. Implications of the survey for a community education program are put into concrete, programmatic terms, indicating lines of direction, points of departure, and crucial ideas sometimes overlooked in service programs. It is concluded that in all areas of a community education program vasectomy should be presented as 1 or a range of alternatives, thus assuring the couple that does elect vasectomy that they really did make a free choice.