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[Unpublished] 1991 May 9.  p.Norplant is an effective, long-lasting, reversible contraceptive that provides protection for five years. It consists of six thin, flexible Silastic capsules filled with 36 mg of levonorgestrel, inserted just under the skin of a woman's upper arm in a minor surgical procedure. To date (1991), more than 55,000 women in 46 countries have used it in clinical trials and pharmacological evaluations. The pregnancy rate is 0.2 per 100 continuing users for the first year. The most frequently reported side effect is change in the menstrual bleeding pattern. In addition, headache, nervousness, nausea, dermatitis, acne, weight gain, and some effects on hair as hirsutism and hair loss may be associated with Norplant use. The net continuation rate is over 77% of new acceptors the first year and 35% after five years. Any specially trained physician, nurse, nurse-midwife, or trained health worker can do insertions and removals. To make sure the woman is not pregnant, Norplant should be inserted within seven days after the onset of menstrual bleeding or immediately postabortion. Norplant may be used by almost any woman who is in good health. It is particularly suited for women who want long-term birth spacing or cannot use contraceptives that contain estrogen. It can also be an appropriate method for lactating women starting at least six weeks after childbirth. At present more than half a million women have used Norplant in countries where it has been approved for widespread distribution: Finland (1983); Sweden, Ecuador, Indonesia (1985); Thailand, Dominican Republic, Colombia (1986); Peru, Venezuela, Sri Lanka (1987); Chile (1988); and Kenya, China, Czechoslovakia (1990). Among several other countries, Haiti, Nepal, and Tunisia have also authorized Norplant in their national family planning program. With approval of Norplant by the United States Food and Drug Administration in 1990, the method faces potentially greater demand in the future.
Switching back: an experimental intervention of family planning client remotivation and clinic staff retraining: impact upon reacceptance and continuity.
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. 73-82.In 1990, the Mauritius Family Planning Association presented educational sessions for former clients allowing them to meet f amily planning personnel and other women with similar experiences. It used audiovisual aids to discuss use of modern contraceptives and the advantage of scientific family planning, to dispel myths and rumors, and to explain how different methods could be used to meet their and partners' needs. At the same time, 10 service providers from the experimental clinic underwent a 6 week sensitization and retraining program emphasizing organization for efficiency, counseling skills, and skills to build client self esteem. Researchers observed both the control and experimental clinic for 9 months in 1991. 36 remotivated clients (73% return rate) and 29 mainly former clients who did not attend a session reaccepted a contraceptive method at the experimental clinic. As for the control clinic, 24 remotivated clinics (46% return rate) and 7 mainly former clients reaccepted a method. Both clinics' staff said that the extra clients returned because the 93 remotivated clients recommended or referred them directly to the clinics. The 2 interventions therefore had a spread effect. The experimental clinic did have a much better retention rate than the control clinic (46 client vs. 28 clients), however. Further it had higher continuity rates throughout the study period. At the end of the study, the continuity rate was 93.8 for the experimental clinic and 53.8 for the control clinic. The researchers concluded that the improved clinic services of the experimental clinic due to staff retraining in skills and attentiveness were responsible for the superior retention record and rates of return and continuity. Thus IEC programs that attend to former and potential clients' needs and develop skills and attentiveness of providers improve acceptor and continuity rates.
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. 54-72.Researchers arranged for interviews with 300 female discontinuing clients at 2 maternal and child health/family planning (MCH/FP) clinics in Mauritius and followed 230 of them to explain what happens to women who discontinue coming to the MCH/FP clinic. 26% of all women in the sample stopped using MCH/FP clinic services for fertility related reasons. The 2 leading reasons were desire for pregnancy (15.2% of all women) followed by husband absent or sexually inactive (5.2%). Further 30.1% switched to a competing contraceptive provider, especially a factory based provider (11.3%). They tended to switch providers because the new provider was more accessible or they were either dissatisfied with the quality of services at the MCH/FP clinic or the new clinic had an advantage over the MCH/FP clinic. 43.9% switched from scientific family planning methods to either natural or traditional family planning methods. These women tended no to wander out of the house and to be poorly educated, of an ethnic minority group, and >35 years old. In fact, 26.1% used natural family planning because of dissatisfaction with either the contraceptive methods themselves or the quality of services provided. Much attendance discontinuity was determined by misperceptions about ongoing or long term contraceptive use. This indicated that clinic counselors should become more sensitive to and fully address the problems and side effects of contraceptive method use. In conclusion, the MCH/FP clinics should focus their information, education, and communication efforts on the women who switched to unscientific or natural methods.
MEDICAL JOURNAL OF AUSTRALIA. 1991 Feb 18; 154(4):230-3.The 1st published study of efficacy of a hormonal male contraceptive, by the WHO Special Programme of Research, Development and Research Training in Human Reproduction, employed weekly deep intramuscular injections of testosterone enanthate. 271 fertile married men at 10 centers worldwide participated for 18 months. The goal of this preliminary study was to determine if azoospermia was necessary or sufficient for effective contraception. Azoospermia was produced in 157 men, who then participated in a 12-month trial. There was 1 pregnancy, for a failure rate of 0.8 per 100 person-years, highly effective in comparison with oral contraceptives, IUDs and injectables. There was a 12% annual discontinuation rate reasons cited were acne (4%), behavioral effects such as aggression or increased libido (1%), and other medical reasons (1%), e.g. weight gain, polycythemia, hyperlipidemia or hypertension. Recruitment of study subjects was difficult in developed countries until direct public appeals met with success. Future developments in the male hormonal contraceptive field will require a more acceptable administration route. To develop this, longer-acting injectables or implants utilizing testosterone cybutanate (20AET-1), or other combinations of testosterone with a progestin or a gonadotropin-releasing hormone antagonist are envisioned. The effect of incomplete azoospermia and the fertilizing capacity of remaining sperm is a serious issue for research. Each more crucial is resolution of the social, political and legal problems involved in male hormonal contraceptive research. Probably reform of the US product liability litigation procedures will do more to advance contraceptive development than any other single factor.