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Obstetrics and Gynecology. 2008 Sep; 112(3):572-8.OBJECTIVE: To estimate how well a convenience sample of women from the general population could self-screen for contraindications to combined oral contraceptives using a medical checklist. METHODS: Women 18-49 years old (N=1,271) were recruited at two shopping malls and a flea market in El Paso, Texas, and asked first whether they thought birth control pills were medically safe for them. They then used a checklist to determine the presence of level 3 or 4 contraindications to combined oral contraceptives according to the World Health Organization Medical Eligibility Criteria. The women then were interviewed by a blinded nurse practitioner, who also measured blood pressure. RESULTS: The sensitivity of the unaided self-screen to detect true contraindications was 56.2% (95% confidence interval [CI] 51.7-60.6%), and specificity was 57.6% (95% CI 54.0-61.1%). The sensitivity of the checklist to detect true contraindications was 83.2% (95% CI 79.5-86.3%), and specificity was 88.8% (95% CI 86.3-90.9%). Using the checklist, 6.6% (95% CI 5.2-8.0%) of women incorrectly thought they were eligible for use when, in fact, they were contraindicated, largely because of unrecognized hypertension. Seven percent (95% CI 5.4-8.2%) of women incorrectly thought they were contraindicated when they truly were not, primarily because of misclassification of migraine headaches. In regression analysis, younger women, more educated women, and Spanish speakers were significantly more likely to correctly self-screen (P<.05). CONCLUSION: Self-screening for contraindications to oral contraceptives using a medical checklist is relatively accurate. Unaided screening is inaccurate and reflects common misperceptions about the safety of oral contraceptives. Over-the-counter provision of this method likely would be safe, especially for younger women and if independent blood pressure screening were encouraged.
The impact of changes on Latin American and Caribbean women: education, knowledge and demographic trends. Discussion note.
[Unpublished] 1992. Presented at the International Conference on Population and Development [ICPD], 1994, Expert Group Meeting on Population and Women, Gaborone, Botswana, June 22-26, 1992. 9 p. (ESD/P/ICPD.1994/EG.III/DN.10)Current theoretical and conceptual frameworks have included broader notions of social welfare and the quality of life within development discussions. Gender issues have been more easily integrated into development models. Modernization, as advances in economic conditions and the growth of technology, has rapidly changed societies. Although democracy has been included as a given for human development, a wider gap has appeared between the rich and poor. In Latin America expectations were set up for the social mobility of women and young people, when the debt crisis hit. Future models of women in development must eliminate the gender dichotomies and offer perspectives that explain the contradictions. A proposal was offered for achieving international competitiveness by changing production patterns, using innovation to achieve efficiency and equity, and creating possibilities for international cooperation. Gender equity means redistribution within socioeconomic groups and involvement of women in development. In Latin America, importance was placed on how women were integrated into development. Flexibility and innovation will be the goals of education, which should be compatible with the past traditional role women have carried. Specific measures will need to be introduced for maternal and child care, prenatal care, and flexible working hours. Child care must be part of a coordinated effort among public, private, business, and community sectors. The domestic burden of women will need to be lightened. Reproduction rights in Latin America and the Caribbean must be secured not only for women but also for men. Advances in medicine have reduced risk in childbirth, raised life expectancies, and provided options for women to control unwanted fertility. Excess female mortality due to preventable causes was highest among poor women. Access to education has increased but without a companion increase in labor market opportunity or income levels. In 1977, ECLAC adopted a Regional Plan of Action for the Integration of Women into Latin American and Caribbean Development which recognized women's vulnerability and the need for comprehensive, periodic assessments.
PLANNED PARENTHOOD CHALLENGES. 1994; (2):42-4.INPPARES, the International Planned Parenthood Federation affiliate in Peru, has provided family planning and other services to the Peruvian population since 1976. The organization concentrates upon interventions targeted to women of low socioeconomic status. One of the group's most important strategies has been to distribute contraceptives at the community level in rural and peri-urban areas of the country through a network of centers managed by promoters. These promoters are virtually all female. The organization in 1993 supplied 812 distribution centers. Promoters and their supervisors have received training in contraception, basic data recording, community work, and related topics. INPPARES, however, suspected that the quality of the project would be improved if promoters and supervisors were trained about the role of women in the community and their rights and identity as women. The personnel would then be able to better understand the role of contraception and reproductive health in women's lives. To that end, INPPARES in 1992-93 developed a project in coordination with the Manuela Ramos Association, a Peruvian women's organization. A questionnaire was given to forty promoters on issues related to women's roles, values, attitudes, the place of women in society and the family, family planning, sexual relations, and decision making. Their responses pointed to a real need to provide promoters and supervisors with more information through workshops on women in Peruvian society, women's identity and roles, women's sexual rights, and the quality of care in service provision. Four pamphlets were drafted from a seminar of fifty supervisors from both organizations to be used in a series of twelve workshops for 256 promoters. Post-intervention evaluation of the original forty participants confirm the significant effectiveness of both subjects covered and materials used in achieving desired project goals. Four workshops were subsequently held in which project results were presented to 261 promoters. Promoters and supervisors are now using flipcharts and pamphlets in their training activities.
Socio-economic development and fertility decline: an application of the Easterlin synthesis approach to data from the World Fertility Survey: Colombia, Costa Rica, Sri Lanka and Tunisia.
New York, New York, United Nations, 1991. ix, 115 p. (ST/ESA/SER.R/101)The relationship between fertility decline and development is explored for Colombia, Costa Rica, Sri Lanka, and Tunisia. The study applies Richard Easterlin and Eileen Crimmins; theoretical and empirical approach to analyzing World Fertility Survey (WFS) data in a comparative context. The paper specifically questions the strengths and weaknesses of the Easterlin-Crimmins framework when applied to developing country data, and what the framework implies about comparative fertility in these countries. 3 stages in all, an analyst 1st decomposes a couple's final number of children ever born through an intermediate variables framework. Stage 2 emphasized understanding the determinants of contraceptive use, while stage 3 explains the remaining stage-1 and stage-2 variables. A model linking the supply of children, the demand for children, and the cost of contraceptive regulation results. Stage 1 results were promising, stage 2 results were less encouraging, while stage 3 revealed a theoretically incomplete approach employing empirically weak WFS data. While the Easterlin-Crimmins approach may be promising, econometric, theoretical, and data quality and collection improvements are necessary. Among stage-3 variables open to manipulation, higher socioeconomic status was associated with delayed age at 1st marriage, lower infant and child death rates, lower numbers of children desired, increased knowledge of contraception, and reduced levels of breastfeeding. Apart from regional differences, the educational and occupational roles of women in the countries studied were of primary importance in understanding differential fertility.
NETWORK. 1991 Sep; 12(2):14-7, 27.Many unwanted births and pregnancies could be avoided by improving instructions for and comprehension of the use of oral contraceptives. Employed less than only the IUD, the oral contraceptive pill is the 2nd- most widely used reversible form of contraception, used by 8% of all married women of reproductive age. 6-20% of pill users, however, fall pregnant due to improper pill use. Improving instructions in the pill pack, ensuring that instructions are correct, and working to facilitate user understanding and motivation have been identified as priorities in maximizing the overall potential effectiveness of the pill against pregnancy. Since packets in developing countries may consist of pills in cycles of 21, 22, 28, or 35 days, providers must also be trained to instruct users in a manner consistent with the written instructions. Pictorial information should be available especially for semi-literate and illiterate audiences. The essay describes recommendation for instruction standardization and simplification put forth by Family Health International, and endorsed by the U.S. Food and Drug Administration. International Planned Parenthood Federation efforts to increase awareness of this issues are discussed.