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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.
International Family Planning Perspectives. 2008 Jun; 34(2):98.Physical and sexual intimate partner violence may have lasting effects on a woman's health, according to a recent multicountry study by the World Health Organization. Compared with women who had never been abused, those who had suffered intimate partner violence had 60% greater odds of being in poor or very poor health, and about twice the odds of having had various health problems, such as memory loss and difficulty walking, in the past four weeks. (excerpt)
Development of a scale to assess maternal and child health and family planning knowledge level among rural women.
Health and Population: Perspectives and Issues. 2000; 23(1):37-52.This paper presents a tool specifically developed for assessing the knowledge of rural women in Rohtak district of Haryana regarding maternal and child health. This tool can also be used for (i) identification of high risk women groups in the community by the programme managers as well as by the researchers; (ii) quantitative analysis of the relationship between various decisions making variables and the knowledge level of women regarding MCH and FP and (iii) impact evaluation of the IEC programme on the knowledge of women regarding maternal and child health. (author's)
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.
INTEGRATION. 1989 Mar; (19):10-23.The Integrated Project (IP) was started in Zambia in 1984 by the International Planned Parenthood Federation (IPPF) Africa Bureau in connection with the Zambia Flying Doctor Service (ZFDS) and the Planned Parenthood Association of ZAMBIA (PPAZ). The project was begun in 3 areas, Kabushi, Fiwale, and Kapata. Its 1st major task was a survey of parasite infestation, nutritional status, and family planning knowledge and practice. This was done between 1985 and 1987. Also at this time field educators carried out many activities. A PPAZ evaluation of the Kabushi project in 1987 found that although family planning knowledge was fairly widespread, there was no accompanying increase in practice. There is a downward trend in parasitosis in Fiwale and Kapata but no reduction in Kabushi. However, there were variations in sampling, so these results are questionable. Environmental sanitation measures are being taken. The prevalence of malnutrition is around 26% in each. Community participation is essential. Women's clubs have been formed in all 3 areas where family planning and other matters can be discussed. In 1987 the ZFDS trained traditional birth attendants (TBAs). 23 TBAs have also been trained in family planning. The Japanese Organization for International Cooperation in Family Planning (JOICFP) provided project guidelines. Numerous problems have been experienced in the 1st 3 years of the project. The IP National Steering Committee (NSC) has had to deal with 3 separate agencies (IPPF, PPAZ, and ZDFS). The project has worked well with ZFDS. 1 of the problems is personnel. Some of the personnel need specific training and orientation. Parasite control activities could be improved. A more active family planning program is being planned. It is recommended that during the remaining 3-year pilot period PPAZ should take on financial monitoring, and the staff should have an overall plan and more detailed annual plans.
Intercom. 1980 Jan; 8(1):14.Guyana, a former British colony of about 830,000 population, in the 1970 Census had a composition of 52% East Indian, 31% African, and the balance Amerindian, Portuguese, Chinese, and mixed descent. The crude birth rate is believed to have peaked in 1957-59 at 44.5/1000; by 1978 the birth rate had dropped to about 28.3/1000. The World Fertility Survey of 1975 found that a total fertility rate of 7.1 children/woman in 1961 dropped to 4.4 in 1974. The largest decline in childbearing was in the over 30 age group and the under 20's. Knowledge of contraceptive methods is high; over 95% of a sample of ever-married women had heard of some method. Contraceptive usage is not as high as knowledge; of women exposed and with a partner, 38% said they were contracepting. The pill (11%) and female sterilization (10%) were the 2 most popular effective methods. Usage was lowest among women in common law marriages and visiting unions. Guyanese women overall preferred 4.6 children. Women age 20 thought 3.4 ideal; those over 40 reported 5.8 children as their choice. African women, who marry later than Indian women, preferred more children, 4.8, compared to 4.6 for Indian women. Rural women wanted 4.9 children while urban women wanted 4.3. The crude birth and death rates combine to give a rate of natural increase of 2.1% per year.
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.
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.