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Maturitas. 2004 May 28; 48(1):39-49.The aims were to compare menopausal age and the use of oral contraceptives (OC) and hormonal replacement therapy (HRT) between the 32 populations of the WHO MONICA Project, representing 20 different countries. Using a uniform protocol, age at menopause and the use of OC and HRT was recorded in a random sample of 25-64 year-old women attending the final MONICA population cardiovascular risk factor survey between 1989 and 1997. A total of 39,120 women were included. There were wide variations between the populations in the use of OC and HRT. The use of OC varied between 0 and 52% in pre-menopausal women aged 35-44 years, Central and East Europe and North America having the lowest and West Europe and Australasia the highest prevalence rates. Among post-menopausal women between 45 and 64 years, the prevalence of HRT use varied from 0 to 42%. In general, the use of HRT was high in Western and Northern Europe, North America and Australasia and low in Central, Eastern and Southern Europe and China. With the exception of Canada (45 years), the mean age at menopause differed only little (ranging from 48 to 50 years) between the populations. The use of OC and HRT varies markedly between populations, in general following a regional pattern. Whereas, the prevalence rates are mostly similar within a country, there are remarkable differences even between neighbouring countries, reflecting nation-specific medical practice and public attitudes that are not necessarily based on scientific evidence. (author's)
Chapel Hill, North Carolina, Ipas, 2003.  p.This document compiles facts and recommendations for action to prevent maternal mortality from unsafe abortion, ensure legal abortion is safe and accessible to all women, put legal abortion and postabortion care within reach of all women throughout health systems, and review laws and policies that place women’s lives in danger or contain punitive measures against women who have undergone illegal abortion. These essential steps to protect women’s health and guarantee their human rights — endorsed by the world community over the past decade — require concerted action from health systems, professional associations, parliamentarians, women’s organizations and all relevant stakeholders. Implementing safe, legal abortion services, removing barriers to existing services, and informing the public about where they can obtain abortion care are key measures to ensure safety and access to abortion in order to safeguard women’s health. The material included here is drawn from the International Conference on Population and Development (ICPD), the Fourth World Conference on Women, the corresponding 5-year reports on progress, and the UN Millennium Goals. The most recent estimates of public health impact of abortion in the region are also included. (excerpt)
Geneva, Switzerland, WHO, 1994. viii, 143 p.This World Health Organization publication provides an analysis of the importance of providing a mix of contraceptive methods to the achievement of family planning (FP) program goals. The first chapter defines contraceptive method mix as a component of reproductive health care for women. Chapter 2 looks at the impact of method mix on contraceptive prevalence. Chapter 3 provides detailed information on all of the currently available methods. The fourth chapter considers the factors that play a role in the successful matching of methods to clients. Chapter 5 describes the program factors that influence method mix. The sixth chapter deals with information, education, and communication (IEC) to promote method mix and includes a discussion of the importance of IEC to client choice as well as guidelines covering the role of providers, administrators, and policymakers in IEC. Chapter 7 provides guidelines for the training and supervision of contraceptive providers including supporting and coordinating training and supervision activities, determining training needs, and the relationship among training, supervision, and quality of care. The eighth chapter covers such issues as the introduction of new methods as research and development and introduction procedures. Chapter 9 discusses the essential role of evaluation in determining whether method mix and client choice objectives are being met. Guidelines are proposed for defining the scope of the evaluation, formulating the questions to be addressed, identifying the measurable indicators of achievement, determining acceptable levels of achievement, choosing a methodology and collecting data, and analyzing information and recommending changes. The concluding chapter provides the following steps program managers, administrators, and policymakers can take in insuring provision of an appropriate method mix and, thereby, improving contraceptive prevalence rates and accelerating fertility decline: 1) assessing client needs; 2) reviewing and changing existing policy; 3) considering costs; 4) paying attention to logistics; 5) developing IEC, training, and supervisory capabilities; 6) including indicators of client choice in monitoring and evaluation; and 7) evaluating method mix based on client choice and satisfaction and on overall contraceptive use.
TIDSSKRIFT FOR DEN NORSKE LAEGEFORENING. 1991 May 30; 111(14):1729-33.The 4 cornerstones of reproductive health according to the WHO are family maternal care neonatal and infant care, and the control of sexually transmitted diseases. In recent years, the AIDS epidemic has caused concern in the world. The world's population doubled to 4 billion from 1927 to 1974, and it will reach 6 billion by the year 2000. The rate of growth is 1.4% in China and 2% in India vs. .3% in Europe. Contraceptive prevalence is 15-20% in Africa, 30% in South Asia, and 75% in East Asia. Shortage of contraceptives leads to abortion in eastern Europe. In 1985 in the USSR, there were 115.7 abortions/1000 women (mostly married) aged 15-44; and 6.4 million abortions for 5.5 million births in 1989. RU-486 or mifepristone combined with prostaglandin has produced abortion in 90% of first trimester pregnancies. After approval in France in 1987, it was used in 40,000 abortions in the following year. 90% of the estimated annual 500,000 maternal deaths occur in developing countries. In Norway, the rate is fewer than 10/100,000 births vs. 100/100,000 in Jamaica. In the mid-1980s, 26% of rural women in Thailand, 49% in Brazil, 54% in Senegal, and 87% in Morocco went without maternal care. In Norway, infant mortality is 6-8/1000 live births vs. 75-150/1000 in developing countries. A WHO investigation on causes of infertility in 25 countries found a 31% rate of tubal pathology in 5800 couples. In Africa, over 85% f infertility in women was infection related. Venereal diseases and infertility are associated with premarital sexual activity in young people. Various donor agencies and the WHO Special Program of Research, Development, and Research Training in Human Reproduction are providing help and resources including AIDS research.
AFRICA HEALTH. 1993 Mar; 15(3):18-9.Until recently, Africa's fertility rates showed no sign of change in spite of the vast resources committed to decreasing population growth. Now there are early indications of success in parts of Nigeria, Botswana, Zimbabwe, and Kenya. In Kenya, between 1984 and 1989, total fertility fell from 7.7 to 6.7, the crude birth rate fell from 52/1000 to 46/1000, and the contraceptive prevalence rate rose from 17% to 27%. Public awareness of modern contraceptive techniques is above 70% in much of Africa, and in Kenya it is up to 90%. Injectable contraceptives are very popular. In October 1992, they were finally licensed by the United States Food and Drug Administration. Injectable contraceptives were first used in Africa in the late 1960s. They were withdrawn from the Bangladesh family planning program, and they were banned in Zimbabwe in 1981. 2 injectable contraceptives administered by deep intra-muscular injection are widely available. Depo medroxyprogesterone acetate (DMPA) or Depo-Provera is normally given in a dose of 150 mg every 12 weeks. Norethindrone enanthate (NETEN) is given in a dose of 200 mg every 8 weeks. DMPA has been used by more than 10 million women. It is repeatedly endorsed by the WHO and the IPPF and has the lowest failure rate of any method of reversible contraception. Side effects include spotting or amenorrhoea, and rarely, menorrhagia. Injectables are suitable for women who are breast feeding, as they may even increase the quantity of breast milk. Norplant, an implanted device developed by the Population Council, releases progestogen at a low, steady rate for 5 years. There is less progestogen in a 5-year Norplant than in the 3-month dose of DMPA. The implant can be removed at any time and fertility is quickly restored. Norplant is becoming increasingly available throughout Africa.
[Unpublished] 1991. Presented at the Demographic and Health Surveys World Conference, Washington, D.C., August 5-7, 1991. 22 p.A supply-demand approach is used to estimate total and unmet demand for family planning in Indonesia over the last decade. The 1976 Indonesia Fertility Survey, the 1983 Contraceptive Prevalence Survey, and the 1987 National Contraceptive Prevalence Survey form the database used in the study. Women under consideration have been married once, are aged 35-44, have husbands who are still alive, have had at least 2 live births, and had no births before marrying. High demand was found for family planning services, with the proportion of current users and women with unmet demand accounting for over 85% of the population. Marked improvement in contraceptive practice may be achieved by targeting programs to these 2 groups. Attention to unmotivated women is not of immediate concern. Women in need of these services are largely rural and uneducated. Programs will, therefore, require subsidization. The government should gradually and selectively further introduce self-sufficient family planning programs. User fees and private employer service provision to employees are program options to consider. Reducing the contraceptive use drop-out rate from its level of 47% is yet another approach to increase contraceptive prevalence in Indonesia. 33% drop out due to pregnancy, 26% from health problems, 10% because of method failure, 10% from inconveniences and access, and 21% from other causes. Improving service quality could dramatically reduce the degree of drop-outs.