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[New recommendations from the World Health Organization (WHO) for the use of contraceptive methods] Nuevas recomendaciones de la Organizacion Mundial de la Salud (OMS) para el uso de los metodos anticonceptivos.
Gaceta Medica De Mexico. 2016 Sep - Oct; 152(5):601-603.The Medical Eligibility Criteria for Contraceptive Use of the World Health Organization have been updated recently. These criteria constitute a guideline for the selection of family planning methods appropriated for women and men with known medical conditions or personal characteristics of medical relevance. The guidelines last updating incorporates recommendations for the use of a new emergency contraceptive pill and three long-acting hormonal methods, and revises some previously established recommendations. This article provides information on the last edition of such document and aims to contribute to its dissemination.
[WHO updates medical eligibility criteria for contraceptives] OMS reactualizeaza criteriile medicale de eligibilitate pentru utilizarea contraceptivelor.
Targu-Mures, Romania, Institutul Est European de Sanatate a Reproducerii, 2006. 15 p. (Actualitati in planificarea familiala No. 1)The World Health Organization (WHO) has issued new family planning guidance, including the following: Most women with HIV infection generally can use IUDs. Women generally can take hormonal contraceptives while on antiretroviral (ARV) therapy for HIV infection, although there are interactions between contraceptive hormones and certain ARV drugs. Women with clinical depression usually can take hormonal contraceptives. More than 35 experts met at WHO headquarters in Geneva, Switzerland, in October 2003 and developed this and other new guidance. The new guidance updates the 2000 Medical Eligibility Criteria (MEC) for Contraceptive Use. (excerpt)
Geneva, Switzerland, WHO, .  p.This document is one important step in a process for improving access to quality of care in family planning by reviewing the medical eligibility criteria for selecting methods of contraception. It updates the second edition of Improving access to quality care in family planning: medical eligibility criteria for contraceptive use, published in 2000, and summarizes the main recommendations of an expert Working Group meeting held at the World Health Organization, Geneva, 21-24 October 2003. The Working Group brought together 36 participants from 18 countries, including representatives of many agencies and organizations. The document provides recommendations for appropriate medical eligibility criteria based on the latest clinical and epidemiological data and is intended to be used by policy-makers, family planning programme managers and the scientific community. It aims to provide guidance to national family planning/reproductive health programmes in the preparation of guidelines for service deliveryof contraceptives. It should not be seen or used as the actual guidelines but rather as a reference. (excerpt)
Best Practice and Research Clinical Obstetrics and Gynaecology. 2006; 20(3):323-338.Access to modern contraception has become a recognized human right, improving the health and well-being of women, families and societies worldwide. However, contraceptive access remains uneven. Irregular contraceptive supply, limited numbers of service delivery points and specific geographic, economic, informational, psychosocial and administrative barriers (including medical barriers) undermine access in many settings. Widening the range of providers enabled to offer contraception can improve contraceptive access, particularly where resources are most scarce. International efforts to remove medical barriers include the World Health Organization's Medical Eligibility Criteria. Based on the best available evidence, these criteria provide guidance for weighing the risks and benefits of contraceptive choice among women with specific clinical conditions. Clinical job aids can also improve access. More research is needed to further elucidate the pathways for expanding contraceptive access. Further progress in removing medical barriers will depend on systems for improving provider education and promoting evidence-based contraceptive service delivery. (author's)
Population 2005. 2002 Jun-Jul; 4(2):13.About two-thirds of all couples around the world – or some 650 million people – use some form of contraception, according to new statistics released by the United Nations. Worldwide, 62 percent of the more than 1 billion married or “in-union” women of reproductive age are using contraception, but there are great variations among regions. In Africa, only 25 percent of married women use contraception, while in Asia and Latin America and the Caribbean that figure is between 66 and 69 percent. These statistics are featured on a new wall chart entitled “World Contraceptive Use 2001,” issued by the UN Population Division as part of its ongoing monitoring of world use of family planning. “These data continue to show good news in terms of couples being able to choose the number and spacing of their children,” according to Joseph Chamie, director of the Population Division. “We’ve seen dramatic increases and our best projections for the future indicate that these trends will continue,” he said. (excerpt)
Baltimore, Maryland, Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Information and Knowledge for Optimal Health Project [INFO], 2004 Aug. 8 p. (INFO Reports No. 1; USAID Grant No. GPH-A-00-02-00003-00)The World Health Organization (WHO) has issued new family planning guidance, including the following: Most women with HIV infection generally can use IUDs. Women generally can take hormonal contraceptives while on antiretroviral (ARV) therapy for HIV infection, although there are interactions between contraceptive hormones and certain ARV drugs. Women with clinical depression usually can take hormonal contraceptives. More than 35 experts met at WHO headquarters in Geneva, Switzerland, in October 2003 and developed this and other new guidance. The new guidance updates the 2000 Medical Eligibility Criteria (MEC) for Contraceptive Use. (excerpt)
In: WHO updates medical eligibility criteria for contraceptives, by Ward Rinehart. Baltimore, Maryland, Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Information and Knowledge for Optimal Health Project [INFO], 2004 Aug. 1. (INFO Reports No. 1; USAID Grant No. GPH-A-00-02-00003-00)The World Health Organization (WHO) has issued new family planning guidance, including the following: Most women with HIV infection generally can use IUDs; Women generally can take hormonal contraceptives while on antiretroviral (ARV) therapy for HIV infection, although there are interactions between contraceptive hormones and certain ARV drugs; Women with clinical depression usually can take hormonal contraceptives. More than 35 experts met at WHO headquarters in Geneva, Switzerland, in October 2003 and developed this and other new guidance. The new guidance updates the Medical Eligibility Criteria (MEC) for Contraceptive Use. This was the third expert meeting to consider medical eligibility criteria. WHO first issued the MEC in 1996; they were first updated in 2000. (excerpt)
Contraception. 2004 May; 69(5):347-351.A recent review article by Smith et al. in The Lancet purports to find a causal relationship between long-term use of oral contraceptives (OCs) and cervical cancer. While we endorse the search for such a relationship, we felt it important to critically examine Smith et al.’s review process and, as a result, we have questions about the validity of their conclusions. In our view, the findings of published articles as presented by Smith et al. do not confirm a causal connection between long-term use of OCs and cervical cancer. Our goal is not to conduct another formal review of the evidence, but to evaluate whether Smith et al. have met the burden of proof for establishing a causal relationship. Given the importance of OCs to women the world over, we urge reproductive health professionals to consider this issue carefully before accepting that a causal relationship exists. (author's)
Network. 2003; 22(4):11.For female condom users, use of a new female condom for every act of sexual intercourse continues to be recommended by the World Health Organization (WHO). Likewise, the female condom (a potential alternative for the male condom) is approved only for one-time use by the U.S. Food and Drug Administration. Such positions by public health experts reflect, in part, concerns that women may be unable to clean the device adequately to make its reuse safe. However, female condom reuse has been reported in a number of settings, likely because many women cannot afford to buy multiple female condoms. Recognition that reuse is occurring -- and may be acceptable, feasible, and safe in some circumstances -- led WHO to declare in July 2002 that "the final decision on whether or not to support reuse of the female condom must ultimately be taken locally." (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.
Obstetrics and Gynecology. 2002 Jun; 99(6):1100-1112.The objective of this study is to review new evidence regarding 10 controversial issues in the use of contraceptive methods among women with special conditions and to present WHO recommendations derived in part from this evidence. The authors searched MEDLINE and PREMEDLINE databases for English-language articles, published between January 1995 and December 2001, for evidence relevant to 10 key contraceptive method and condition combinations: combined oral contraceptive (OC) use among women with hypertension or headaches, combined OC use for emergency contraception and adverse events, progestogen-only contraception use among young women and among breastfeeding women, tubal sterilization among young women, hormonal contraception and IUD use among women who are HIV positive, have AIDS, or are at high risk of HIV infection. Search terms included: "contraception," "contraceptives, oral," "progestational hormones," "medroxyprogesterone-17" acetate," "norenthindrone," "levonorgestrel," "Norplant," "contraceptives, postcoital," "sterilization, tubal," "IUDs," "hypertension," "stroke," "myocardial infarction," "thrombosis," "headache," "migraine," "adverse effects," "bone mineral density," "breastfeeding," "lactation," "age factors," "regret," and "HIV". From 205 articles, the authors identified 33 studies published in peer-reviewed journals that specifically examined risks of contraceptive use among women with pre-existing conditions. Combined OC users with hypertension appear to be at increased risk of myocardial infarction and stroke relative to users without hypertension. Combined OC users with migraine appear to be at increased risk of stroke relative to non-users with migraine. The evidence for the other eight method and condition combinations was either insufficient to draw conclusions or identified no excess risk. Of the 10 contraceptive method and condition combinations assessed, the evidence supported an increased risk of cardiovascular complications with combined OC use by women with hypertension or migraine. As a new evidence becomes available, assessment of risk and recommendations for use of contraceptive methods can be revised accordingly. (author's)
[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. 38 p. (ESD/P/ICPD.1994/EG.III/13)The role of women's education in fertility and its proximate determinants was approached by first discussing the trends in literacy and school enrollment by gender. The subsequent discussion revealed the trends in direct relationships between education and fertility and education's influence on women's situation. The intervening mechanisms of supply of children, demand for children, unmet need for contraception, and fertility regulation were each discussed. Developing countries have a diversity of cultures, development, and fertility levels, but consistently strong patriarchal systems. Women have the least control over their lives in South Asia and among Muslims. Female literacy and school enrollment also show wide variation worldwide. Analysis of over 100 developing countries found strong inverse correlations between education and fertility, in general, but some variation in specific settings. The dynamic followed an initial fertility increase with increased education (curvilinear relationship), and then, at higher national development levels, an inverse relationship. Threshold levels were needed before fertility declined. Differences narrowed as development level increased. Female education had a stronger impact on fertility than male education or other household socioeconomic characteristics. Education affects women's situation through 1) decision making autonomy, 2) control over resources, 3) knowledge and exposure to the modern world, and 4) husband-wife closeness. Education indirectly affected fertility by delaying entry into marriage, by reducing breast feeding duration and intensity, by lack of observance of traditional postpartum taboos, and by lower infant and child mortality. Better educated women had later marriage, shorter periods of postpartum abstinence, shorter breast feeding periods, and greater use of health care. Societies which maintained female seclusion and strong son preference had reduced returns from improved female education. Education affected deliberate changes in behavior and adoption of smaller family size preferences. Son preference was only weakly eroded by increased education. Better educated women were not as reliant on children for labor or support in old age, although better educated women continued to desire old age economic security. Usually unmet need for contraception was inversely related to maternal education.
The promotion of the lactational amenorrhea method and child spacing through breastfeeding advocates, Contract No. OR-HO-001.
[Unpublished] . vii, 44 p. (HON-05)In Honduras, a decreasing prevalence of exclusive breast feeding, with over 50% of infants given supplemental liquids during the first 30 days, was causing health risks for the infants and pregnancy risks for the mothers (with 49% at risk within a year of giving birth). Therefore, La Leche League Honduras (LLLH) conducted an operations research study in the Las Palmas neighborhoods of San Pedro Sula to evaluate whether the combination of medical personnel and mother support groups trained in lactation and the lactational amenorrhea method (LAM) for child spacing would increase prevalence and duration of exclusive breast feeding, amenorrhea, and the reported use of LAM at 6 months postpartum over that found in a community served only by trained medical personnel. This project received financing in the amount of US $20,250 from Georgetown University and technical assistance from the Population Council. Specific objectives were to train at least 50 physicians, provide updated information to at least 50 nurses through a workshop, train and certify at least 36 community mothers to serve as breastfeeding advocates (BAs) with specific information on LAM and the ability to make referrals to complementary family planning (FP) services, and initiate at least 6 mother support groups which would meet monthly throughout the year-long study period of 1991. A nonequivalent pre/post-test design was used with the experimental group receiving BA training and support groups and both the control and experimental groups receiving identical training of medical staff. A July 1990 survey of the 6,794 households in the project area revealed 1083 mothers of babies less than a year old and 630 pregnant women. 848 women from this group were interviewed at baseline and 922 at endline to determine socioeconomic status, health system affiliation, reproductive history, breastfeeding and infant feeding practices, contraceptive use, and LAM knowledge and attitudes. Focus groups were held after 3 months of service delivery for qualitative evaluation, interviews were conducted, and 4 mother support groups were observed. BAs were given record-keeping forms, and referral stubs were collected. This report described the implementation of project activities and the impact of the intervention in great detail. The results suggest that training health professionals was partially successful in improving breastfeeding practices and that use of LAs was effective in promoting exclusive breast feeding and use of compatible FP methods and increasing LAM knowledge. However, analysis of women using LAM as a FP method revealed that only 6.5% correctly met all criteria. Lessons learned from this evaluation are cited and the following suggestions are made for further research: 1) develop materials to teach LAM to low-literacy women; 2) examine the role of provider bias and influence of exclusive breast feeding prevalence on LAM acceptance; 3) discover the relative effectiveness of LAM promotion by LLLH vs. FP agencies; 4) test the effectiveness of strategies which segment a target population for LAM education; and 5) determine whether LAM leads to subsequent use of other FP methods.
Fertility trends and prospects in East and South-East Asian countries and implications for policies and programmes.
POPULATION RESEARCH LEADS. 1991; (39):1-17.Fertility trends and prospects for east and southeast Asian countries including cities in China, Taiwan, the Republic of Korea, Thailand, Indonesia, Malaysia, the Philippines, Myanmar, and Viet Nam are described. Additional discussion focuses on family planning methods, marriage patterns, fertility prospects, theories of fertility change, and policy implications for the labor supply, labor migrants, increased female participation in the labor force (LFP), human resource development, and social policy measures. Figures provide graphic descriptions of total fertility rates (TFRS) for 12 countries/areas for selected years between 1960-90, TFR for selected Chinese cities between 1955-90, the % of currently married women 15-44 years using contraception by main method for selected years and for 10 countries, actual and projected TFR and annual growth rates between 1990-2020 for Korea and Indonesia. It is noted that the 1st southeast Asian country to experience a revolution in reproductive behavior was Japan with below replacement level fertility by 1960. This was accomplished by massive postponement in age at marriage and rapid reduction in marital fertility. Fertility was controlled primarily through abortion. Thereafter every southeast Asian country experienced fertility declines. Hong Kong, Penang, Shanghai, Singapore, and Taipei and declining fertility before the major thrust of family planning (FP). Chinese fertility declines were reflected in the 1970s to the early 1980s and paralleled the longer, later, fewer campaign and policy which set ambitious targets which were strictly enforced at all levels of administration. Korea and Taiwan's declines were a result of individual decision making to restrict fertility which was encouraged by private and government programs to provide FP information and subsidized services. The context was social and economic change. Indonesia's almost replacement level fertility was achieved dramatically through the 1970s and 1980s by institutional change in ideas about families and schooling and material welfare, changes in the structure of governance, and changes in state ideology. Thailand's decline began in the 1960s and is attributed to social change, change in cultural setting, demand, and FP efforts. Modest declines characterize Malaysia and the Philippines, which have been surpassed by Myanmar and Viet Nam. The policy implications are that there are shortages in labor supply which can be remedied with labor migration, pronatalist policy, more capital intensive industries, and preparation for a changing economy.
International Family Planning Perspectives. 1992 Jun; 18(2):75-7.The main points of a study from the WHO Special Program of Research, Development and Research and Training in Human Reproduction on menstrual bleeding patterns and contraceptive use are presented. 1875 users of oral contraceptives, 1822 users of monthly injectables, 546 users of vaginal rings, and 1109 depot-medroxyprogesterone acetate (DMPA) users kept diaries of full bleeding and days of spotting during the 1st year a method was started. This information was compared with data from the 1930s and 1960s on bleeding patterns among nonusers of contraceptive methods. Monthly data were excluded in which pregnancy occurred of following a pregnancy, and when there were menstrual disorders or gynecological surgery. Data were then limited to women aged 18-34 years which left 3893 woman years of menstrual cycles. The results revealed that women who used hormonal contraceptives such as the vaginal ring or monthly injectables tended to have shorter periods of menstrual bleeding and more regular predictable periods than women on longterm injectables. Most women have variable bleeding patterns during the year, even when not using hormonal methods. Nonusers, pill users, and vaginal ring users had a median of just more than 3 bleeding or spotting day episodes during a 90-day period vs. 3 days among injectable users and <2 days for DMPA users. However, when the average duration of bleeding or spotting episodes was examined, the median was 4 days for pill users, 5 days for vaginal ring users, and 6 days for DMPA users. Menstrual cycle average length was lowest at 26 days for vaginal ring users, 28 days for nonusers, 29 days for injectable users, and 36 days for DMPA users. The median value for difference between the longest and the shortest cycle within 12 months was around 10 days for nonusers and pill users and 24 days for injectable or vaginal ring users vs. 55 days for DMPA users. The median for the longest episode of bleeding or spotting was 5 days for pill users, 7 days among nonusers, monthly injectable users, or vaginal ring users, and 12 days among DMPA users, of which 25% bled for at least 21 days and 1 in 29 bled for 55 days or more. The shortest bleeding-free intervals was the median for vaginal ring users at 21 days, and longest for DMPA users at 27 days. Other methods were similar to the intervals for the vaginal ring. 25% of DMPA users had a minimum bleeding-free interval of only 2 days, and 25% had an interval of at least 20 days. The myth is debunked that normal women have normal and regular cycles of 25-35 days.
FAR EASTERN ECONOMIC REVIEW. 1992 Feb 20; 28-9.As the AIDS epidemic and HIV transmission in India increasingly resembles that observed in sub-Saharan Africa, Indian society's arrogant perception of invulnerability to the pandemic is proving to be considerably ill-conceived. The dimensions of the epidemic have multiplied greatly since AIDS was 1st identified among prostitutes in Madras, with the trends observed in Maharashtra and Tamil Nadu being especially ominous. AIDS has forced Indian society and research professionals to acknowledge the existence of domestic prostitution, homosexuals, and drug users. While only 103 AIDS cases and 6,400 HIV infections have been officially identified, it is clear that these cases represent only a tiny fraction of the true extent of the epidemic in India. The government will therefore spend up to US$7.75 million on an anti-AIDS program aimed at ensuring secure blood supplies, and checking heterosexual transmission through education and the promotion of condoms. The program also targets IV-drug users and truck drivers for education and behavioral change. India is the 2nd country after Zaire to accept foreign loans for such a purpose. It will receive US$85 million over 5 years from the World Bank in addition to supplemental funds from the WHO and the U.S. Weak attempts, however, have been made to test blood supplies, with only 15% being tested in Tamil Nadu. A large gap also remains between health educators and needy target groups. Finally, while some top officials realize the need for immediate action against AIDS, broad public awareness and coping will come only after AIDS mortality begins to mount in the population.
In: African research studies in population information, education and communication, compiled and edited by Tony Johnston, Aart de Zeeuw, and Waithira Gikonyo. Nairobi, Kenya, United Nations Population Fund [UNFPA], 1991. 83-100.Researchers studied 62 pregnant women intending to not terminate their pregnancy and to continue their studies and 27 nonpregnant women to learn about female student fertility related behavior. They were all enrolled at the University of Zambia either during the 1987-1988 or 1989-1990 academic years. Methodology consisted of interviews, questionnaires, and focus group discussions. 68% of all women were single with 40% of them having at least 1 child. 75% of the women were sexually active. 42.7% knew traditional family planning methods with friends, grandmothers, and social aunts telling 25.9% of all the women about such methods. Yet mass media provided most women (49.4%) with knowledge about modern methods. 50.6% thought the pill to be the most effective method. >65% considered the 24-26 as the ideal age at marriage. The mean ideal family size was 3.5, somewhat less than family size for urban women in Zambia. 71.9% considered children to be assets since children are a means to social security (33%), self fulfillment (8%), and companionship (7%). 94.4% approved of family planning mainly for purposes of child spacing (29.2%), limiting (23.6), and spacing and limiting (32.6%). Even though they knew about and approved of family planning and claimed modern attitudes concerning ideal age at marriage and ideal family size, 62% of single pregnant students and 59% of married pregnant students did not use or regularly use contraception. This suggested that they considered early childbearing to be an asset. The leading reasons for contraception nonuse included perception of low pregnancy risk (40%) and desire for a child (28%). Only 3.2% claimed method failure. 64% of all women said partners did not approve of contraceptive use. Access to family planning and cost were not a problem. Only 22% of pregnant students said pregnancy would reduce their chances of marriage. In conclusion, many women became pregnant surreptitiously.
[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.
Report on the evaluation of the UNFPA-supported women, population and development projects in Indonesia (INS/79/P20 and INS/83/P02) and of the role of women in three other UNFPA-supported projects in Indonesia (INS/77/P03, INS/79/P04, and INS/79/P16).
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Apr. vi, 52 p.The Evaluation Mission analyzes and assess the 2 United Nations Fund for Population Activities (UNFPA)-supported Women, Population and Development Projects and the role of women in 3 other UNFPA-assisted projects in Indonesia. The Mission concluded that the family planning and cooperative/income generation scheme as evolved in the 2 projects has contributed to increasing contraceptive acceptance and continuation and to a shift from the less reliable to the more reliable contraceptive methods. The projects have also assisted women and their families to expand their income generating activities, raise their incomes, and improve the family's standard of living. The Mission recommends that: 1) more diversified income producing activities be encouraged; 2) product outlets be identified and mapped and appropriate marketing strategies devised; 2) loan repayment schedules be carefully examined; 4) data collection, monitoring and evaluation be streamlined and strenghthened; and 5) the process of the entire rural cooperatives/income generation scheme be more comprehensively documented. In the 3 other projects, which are addressed to both men and women, the needs and concerns of women have not been adequately taken into account and/or the participation of women in all phases of the projects and their access to project benefits have not been equal to men. The Mission therefore recommends that special consideration be given to women's concerns in the design and formulation of all projects. The Mission ascertained that non-women specific projects tend to perpetuate existing discriminatory or unequal access to, and control of, resources by women unless specific consideration is accorded to them.
In: Molnos A, ed. Social sciences in family planning. (Proceedings of the Meeting of the IPPF Social Science Working Party, Colombo, Sri Lanka, June 10-13, 1977). London, International Planned Parenthood Federation, 1978 Dec. 9-14.Kenya has a fairly well developed family planning program at the official government level along with an active voluntary Association. It is estimated that over 50,000 women are visiting family planning clinics annually, but as many women drop out of the program in each given month as are recruited. This discontinuation rate presents a major problem for family planning programs, and the underlying causes need to be determined. It is believed that, with the exception of those women who are highly motivated to use contraceptives on a continuous basis, the majority of women, particularly in rural areas, will fail to use contraceptives for long periods of time if the significant others in their lives do not support the idea. It is also probable that many women drop out of family planning programs due to the lack of reliable transport, high transport costs, varying weather conditions, and the family planning program policy which, with the exception of the IUD, provides only sufficient contraceptives to last for 3 months. There are several other reasons why a woman might want to stop using contraceptives: 1) a desire to become pregnant; 2) social pressure to withdraw from the family planning program; 3) the side effects of her method and without a suitable alternative method; 4) difficulty in obtaining contraceptive supplies; and 5) reaching menopause. A family planning campaign which ignores the men is destined for failure in Africa, for the women do not make many of the important decisions. The male must be persuaded to participate in decision-making concerning the use and non-use of contraceptives. Family planning programs should deliberately reduce their drop-out rates even if that means lowering acceptor rates.
Asian-Pacific Population Programme News. 1978; 7(3):30-33, 42.Family planning was officially adopted as an instrument of national economic development policy in the Republic of Korea in 1961. While it was 1st based in the national health program, it gradually evolved into a diversified approach and today the family planning program is integrated into other fields of development activity. International attention is focussed on the Korean program of combining family planning with community development activity. In 1979, a "multipurpose health worker" will replace the 3 existing health field workers: family planning, mother and child health, and tuberculosis control. This is a continuation of the government effort to involve communities in the family planning program. Efforts of the Planned Parenthood Federation of Korea (PPFK) are summarized. PPFK provides all the instructional, educational, and communication functions for the family planning program. The Women's Associations, formed by the PPFK, were the 1st attempt to mobilize efforts of women on behalf of family planning and community development. The effort to integrate family planning and primary health care is currently under study.
Overview 1972: medical and clinical activities, family planning associations, western hemisphere region, January 1 - December 31, 1972.
New York, International Planned Parenthood Federation, Western Hemisphere Region, Medical Division, 1973. 103 pInformation submitted by governmental programs and by International Planned Parenthood Federation member associations is compiled in this study and the analyzed data is summarized in the form of graphs, tables, etc. with the aim of providing a basis for comparison of the family planning associations in the Western Hemisphere region. This study essentially focuses upon the number and classification of attended visits and contraceptive services. The following statistics are presented: 1) clinics--number and categories, 2) female population of fertile age, 3) total number of visits, first visits, and revisits by method, 4) new acceptors by method, 5) hours devoted to contraceptive service, 6) male and female sterilizations. Analytical information is offered on the following: 1) new acceptors per female population of fertile age, 2) new accumulated acceptors for the same population subgroup, 3) average new acceptors per year, 4) contraceptive service per medical hours, 5) revisits per first visits, 6) percentage by total number of visits, and 6) percentage by methods for new accumulated acceptors. The countries included in the study are Antigua, Argentina, Barbados, Bermuda, Brazil, Canada, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, El Salvador, Grenada, Guadeloupe, Guatemala, Honduras, Jamaica, Mexico, Montserrat, Netherlands Antilles; Nicaragua, Panama, Paraguay, Peru, Puerto Rico, St. Kitts-Nevis-Anguilla, St Lucia, St. Vincent, Trinidad and Tobago, United States, Uruguay, and Venezuela.
In: Diczfalusy, E. and Borel, U., eds. Control of human fertility. Proceedings of the Fifteenth Nobel Symposium, Sodergarn, Lidingo, Sweden, May 27-29, 1970. New York, Wiley, 1971. 39-51.A drug delivery system providing for a controlled release of progestogen and affecting ovulation and steroidogenesis minimally would deal effectively with some of the problems associated with contraception. 2 systems being developed which fit these criteria are the primary topics of discourse in this article. In 1 system an implant consists of a polymer membrane of polydimethylsiloxane (PDS) and contains the progestogen in crystalline form. Major problems with the PDS implants include a lack of intraindividual constance of release and interindividual variation in the slope of the decay in release. In the second system the implant consists of a lipid-steroid membrane containing a steroid. In this implant the concentration of the steroid in the membrane and the nature of the lipid phase may be important in determining the pattern of release. In vivo metabolic studies with lipid-steroid pellets are limited, but the patterns of output may be similar to those seen with PDS implants. Because of rate problems, a shorter regime slow-release implant seems more feasible than a longer lasting system. Surgical difficulties associated with the implantation and removal of the PDS implant make the choice of a lipid-steroid micropellet preparation more feasible for a short-term regimen. The discussion, following the main body of the article, focuses primarily on problems associated with implants.