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Geneva, WHO, 1982 Nov. 159 p.The World Health Organization's (WHO) 7th General Program of Work, covering the period 1984-89, includes the WHO Special Programme of Research, Development, and Research Training in Human Reproduction. Objectives of the latter include improving the health status of populations in developing countries by: 1) devising improved approaches to the delivery of family planning care in the primary health care context, 2) assessing the safety of existing methods of fertility regulation, 3) developing new contraceptive technology, and 4) generating the knowledge and technology required for the prevention and treatment of infertility. By 1989 the program aims to have devised the means of integrating family planning into primary health care, assessed the safety and efficacy of contraceptive methods used between 1970-77, and those introduced between 1977-85, developed at least 6 new methods of contraception, clarified the etiology of certain reproductive diseases, and strengthened at least 1 research facility in each of those developing countries that will have national policies on and services for family planning. Some findings of research included: 1) copper bearing IUDs with a minimum surface area of 200 mm are safe and effective for at least 4 years of use, 2) depot-medroxyprogesterone acetate (DMPA) has been shown to have no apparent adverse effect on the quantity of breast milk, and 3) mean delay of conception after DMPA use was 6 months for women 20-24 years, 6.2 months for women 25-29, and 8 months for women age 30 and over. Work has centered on developing new injectable contraceptives of 3 or more months' duration, biodegradable implants, and vaginal rings that release 20 mcg levonorgestrel/day for 3 months. Several non-isotopic techniques have been developed for predicting and detecting ovulation as well. Research on infertility has studied standardized investigation of infertile couples, prevalence in different populations, and etiology. Other areas of work have been in institution strengthening, dissemination of information, and relations with industry.
Sterilizations by sex and percentages of: male to female sterilizations and total number of sterilizations as percentage of total new acceptors. IPPF/WHR, 1978-82.
[Unpublished] . 3 p.This paper presents data from 23 International Planned Parenthood Federation (IPPF) associations on the numbers of male and female sterilizations performed in 1978-82, the percentage of male to female procedures, and the number of sterilizations as a percentage of the total number of new acceptors. Countries covered include Antigua, Aruba, Barbados, Bermuda, Brazil, Colombia, Dominica, Dominican Republic, Ecuador, El Salvador, Grenada, Guatemala, Guyana, Honduras, Jamaica, Mexico, Montserrat, Nicaragua, Panama, St. Kitts-Nevis, St. Lucia, Trinidad and Tobago, and the US. In the 22 developing countries, sterilizations numbered 58,147 in 1978, 72,167 in 1979, 57,137 in 1980, 65,827 in 1981, and 90,087 in 1982. Male sterilizations represented only 3 or 4% of female procedures throughout this period, and sterilizations accounted for 10-13% of new acceptors. In the US, there were 9333 sterilizations performed in 1978, 7642 in 1979, 6479 in 1980, and 6637 in 1981. The corresponding percentages of male to female procedures were 945%, 702%, 527%, and 386%, respectively. The percentages of sterilizations to new acceptors was 2% in 1978 and 1% in 1979-81.
[Unpublished] 1983. Paper presented at International Conference on Voluntary Sterilization, 5th, Santo Domingo, Dominican Republic, December 5-8, 1983. 5 p.This paper discusses the needs in surgical contraception for the 80's. Specifically, in order to meet the population increase in 1990, 163,150,000 sterilizations will have to be done in the developing countries, nearly 5 times the number of sterilized women by 1980. A total of 10.8 billion dollars will be needed to carry out this enormous task. Of this total sum, 58% of this amount will be to pay salaries and social benefits, the rest will be for expendable materials, equipment, remodelling of operating rooms, training, supervision, communications, repair, and maintenance. Also discussed is the building of international commitments regarding surgical contraception. The role of Planned Parenthood, World Federation, UNFPA, and WHO are emphasized in recommending influencial strategies for governments in order to favor family planning, maternal and child health, and promotion of contraceptive research.
[Unpublished] . 12 p.In 1972 the US Agency for International Development (USAID) began to provide funds to Johns Hopkins and other universities to train developing country personnel in laparoscopic sterilization technique. The demand for this training and AID's perceived need for a mechanism to provide developing country doctors with current training in family planning and other aspects of reproductive health led, in 1974, to the creation of the Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHPIEGO). One of its purposes was to provide short-term training in laparoscopy for overseas physicians and to arrange for distribution and maintenance of laparoscopic equipment. JHPIEGO was also conceived of as a broad based program for training in reproductive health emphasizing the important role that family planning plays in reproductive health. Most of this USAID supported training now takes place in medical centers in the developing countries. The training usually consists of 2-4 weeks of didactic and clinical work in many aspects of reproductive health of which training in laparoscopy is often an important part. After the laparoscopic training, each qualifying trainee is visited at his/her own hospital by a consultant who helps set up the laparoscopic equipment for use. A significant number of supervised laparoscopic procedures are then performed by the trainee over a period of several days. When the consultant trainer is satisfied with the skill of the particular trainee, a laparoscopic unit is given to the trainee's institution. By September 1983, 2500 physicians from approximately 100 countries had received this type of JHPIEGO training, and more than 1600 of them have since been provided with laparoscopies at their home institutions. USAID funded laparoscopic training and equipment and other types of training and equipment also have been provided to the developing countries by the Association for Voluntary Sterilization (AVS). These 2 groups have now cumulatively provided laparoscopic training for at least 3800 physicians from developing countries. The Falope Ring applicator is now in use throughout the world, and JHPIEGO and AVS have converted their overseas laparoscopes to include this capability and for the past 5 years all laparoscopes supplied by USAID have had this Falope Ring capability. The laprocator, a simplified laparoscope which is designed for use of the Falope Ring, was developed in response to USAID's interest in lowering costs and maintenance requirements. USAID has provided over 1000 of these simplified systems to more than 75 developing countries. The use of laparoscopy in the voluntary sterilization programs of the Philippines, in India, and in Africa are reviewed. Voluntary sterilization has grown each year in popularity and is now the method of birth control in most widespread use around the world.
In: Proceedings of the Fourth Annual Scientific Meeting of the Sudan Fertility Control Association held at Friendship Hall, Khartoum, 23 February 1983, edited by Dr. A/Salam Gerais. [Khartoum], Sudan, Sudan Fertility Control Association, 1983. 47-8.This paper consists of narrations to accompany a slide show. The slide illustrating the I.F.F.H. concept of data collection presents an integrated approach. Another slide shows the FIGO recommended case record, which is accepted by the WHO. A family planning question arises before birth and after birth of the child, female sterilization, number of additional children wanted. The slide on birth interval behavior enables the study of current birth outcome as a function of breastfeeding, family planning and prenatal visits. The last birth interval can be studied with maternity care monitoring, breastfeeding, and the status of the last surviving infant, a key variable. Once you know how many children you have reached, you can go forward and study the next birth interval. The slide showing the model approach enables determination of the current perinatal death from knowledge of the last birth interval and loss of the last live birth. With the increase of education, breastfeeding is reduced; family planning before current conception increases, with education it doubles; prenatal care increases with education. The birth interval is prolonged in cases of breastfeeding without family planning. If family planning is used, there is a marked prolongation of the birth interval. 63% of women attending the 11 centers surveyed in Indonesia wanted additional children among those who had 3 living children postpartum. Only 38% of those with 4 children wanted additional ones. This 50% cut is known as the 50% LDC and varies according to geographic location. Using the LDC (developing countries), one can determine the proportion of women who do not want to protect themselves postpartum, and the relation of having more living children to seeking contraceptive protection.
Assessment of WHO Special Programme of Research, Development and Research Training in Human Reproduction (HRP) in India.
In: Assessment of the WHO Special Programme of Research, Development and Research Training in Human Reproduction [HRP]. II. Task Force reports. Country reports, [compiled by] Sweden. Swedish Agency for Research Cooperation with Developing Countries [SAREC]. Stockholm, Sweden, SAREC, 1983 Apr. 34 p.The Human Reproduction Program (HRP) presence in India since 1972 included 1 Research and Trailing Center (RTC), 2 Collaborating Center for Clinical Research (CCCR), the Indian Council of Medical Research, as well as other nondesignated centers. The All India Institute of Medical Sciences was designated a RTC and a PhD program in reproductive biology. Its curriculum research and training in teaching during 1975-78 involved 39 medical colleges and 300 persons in 8 workshops. Expertise was developed in intranasal approached to fertility regulation, long-acting hormonal contraception (silastic implants), and male methods of fertility control. The anti-HCG (human chorionic gonadotropin) vaccine and male methods research were gradually terminated in 1978-79 and 1980. Expertise was acquired in measuring physiological parameters in reproduction and in producing vaginal rings. The Institute of Research in Reproduction houses the National Pituitary Agency with a staff of 300 including of 30 PhDs, 20 MDs, and 40-50 students and technicians as well as 200 supporting staff. Fields of interest are immunoassay, male reproduction, and vasectomy. The CCCR was the site of the WHO trial on contraceptive efficacy of the NETA injectable. The Post Graduate Institute of Medical Education and Research, Chandigarh, also participated in WHO trials on infertility, evaluation of male drugs, and injectables and low-dose pills. The Central Drug Research Institute, Lucknow, engaged in research and development on nonsurgical methods of female sterilization, a postcoital once-a-week pill (Centchroman), a spermicidal cream (Consap), and cervical dilators. The Indian Institute of Science, Bangalore, deals with lactational amenorrhea, infertility, and passive immunization. Multicenter WHO trials are carried out at these centers, however, HRP heavily favors clinical trials at the expense of basic research. The central role of WHO in India could help stop the brain drain by funding career development grants.
HRP Task Force evaluation. Summary of conclusions regarding intrauterine devices and female sterilization.
In: Assessment of the WHO Special Programme of Research, Development and Research Training in Human Reproduction [HRP]. II. Task Force reports. Country reports, [compiled by] Sweden. Swedish Agency for Research Cooperation with Developing Countries [SAREC]. Stockholm, Sweden, SAREC, 1983 Apr. 4 p.The promotion of contraceptive methods is a high priority in developing countries. IUDs are effective, but the misfortune with the Lippes Loop in the 1960s has detrimentally impacted the use of IUDs in South East Asian countries. Complications can include bleeding, uterine cramps, perforations, expulsions, infections, and the risk of intrauterine and ectopic pregnancy. These can be alleviated by modifying the shape of the devices, by professional evaluation and fitting of IUDs on the part of maternal-child health (MCH) services, and by an assessment of psycho- social implications of IUD use. Unipurpose crash family planning programs have failed. The WHO's IUD research program is concerned with the reduction of side effects and contraceptive safety. Research on female sterilization has the objective of reducing maternal and child morbidity and mortality in grand multiparity. On the other hand, sterilization has been misused in several developing countries. It is imperative to ensure informed and voluntary consent to minimize misuse and to secure adequate health care for the living children of the sterilized client (immunization and infectious disease control). Economic reasons for promoting sterilization are unacceptable. Sterilization infrastructure development is indispensable (trained staff, equipment, and anesthesia). Simple but safe sterilization procedures need further development, and adverse psychological effects require further research. Attitudinal studies are needed on providers and acceptors, targets, incentives, and disincentives. Sterilized couples have to have access to MCH services, and the WHO research program on human reproduction should incorporate sterilization and its ramifications.
Studies in Family Planning. 1972; 3(7):151-156.In Thailand the family planning program is integrated into health services. During 1971 there were 404,187 new acceptors, the majority of which chose the pill since they are prescribed by midwives and are available in more than 3500 centers. The number of pill acceptors increased from approximately 8800 per month to more than 30,000 after auxiliary midwives were officially authorized to prescribe oral contraceptives. In 1972 a pilot program was started to train paramedical personnel to insert IUDs. In 1971 12-month continuation rates were 75% for the IUD (with the majority of women expelling them having reinsertions), 65% for the pill, with more than 20,000 sterilizations. A major effort will be made during 1972 to introduce vasectomy more widely. More than 80% of acceptors are from rural areas, with 90% having less than 4 years of education. Postpartum acceptors accounted for 16% of the national program. Since 85% of all deliveries occur at home, the postpartum concept should be adapted to these women. In a 1970 followup survey of 2597 acceptors in the 3 largest cities, among IUD users, expulsions were negatively correlated and removals positively correlated with age; pregnancies were 3%. Pills were more widely accepted than IUDs in all age groups, and younger women definitely preferred them. The source of family planning information was: husband, 47%; health personnel, 38%. It is estimated that 144,000 couple years of protection were provided in 1971, and 393,000 in 1972 -- 3% and 8% respectively of married women of reproductive age. Cost of the program is estimated to be US$.08 per capita or US$7.00 or $8.00 per acceptor. The greatest problem has been lack of effective supervision at the field level. The usefulness of family planning field workers is being studied.
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: Inter-governmental Coordinating Committee and International Fertilit y Research Programme, Proceedings of the expert meeting on comparative fertility research, sterilization and post-conceptive regulation. Singapore, July 29-31, 1974. Kuala Lumpur, I.G.C.C., 1974. p. 8-16Organization of the International Fertility Research Program is desc ribed and study options in female sterilization are detailed. All 3 divisions of IFRP (field studies, data processing, and design and analysis) are involved in evaluation of all new and on-going studies. To date data collection instruments have been developed for studies of pregnancy termination, menstrual regulation, female sterilization, IUDs, systemic contraceptives, and conventional contraceptives. These instruments record patient identification, patient characteristics, method of fertility regulation used, and follow-up. Instruction manuals are available for each instrument. Help is also available for those wishing to set up surveillance studies, straight studies, and comparative studies. Plans call for more regional programs with IFRP merely acting as a consultant. Such studies are especially needed in the field of female sterilization. Information needs to be gathered to compare operative methods, patient categories, and type of occlusive method used. A disciplined network of Trial Centers using standard research tools could significantly advance the usefulness of female sterilization in Southeast Asia.
IPPF Medical Bulletin. April 1973; 7(2):3-4.A 2nd international conference on sterilization was held by the International Project of the Association for Voluntary Sterilization in Geneva from February 26 to March 1, 1973. Both male and female sterilization were discussed. Techniques, side effects, and equipment for sterilization procedures were discussed. It was agreed that arbitrary parity and age requirements for sterilization are no longer necessary. Psychological aspects of the procedure were mentioned. It was pointed out that governments have an obligation to make available sterilization procedures as part of a total contraceptive program. Voluntary organization, particularly the International Planned Parenthood Federation, have an important place in sterilization work also.
IPPF Situation Report, January 1974. 4 p.The New Zealand Family Planning Association, Inc. (FPA) was founded in 1935 and became a member of IPPF in 1955. In 1975 the government recognized the group's work, for the 1st time made space available for clinic activities, and is permitting Health Dept. doctors to devote sessions to family planning. In 1973 the government donated NZ$18,000 to purchase equipment for new clinics and has provided financial assistance for work in lower income areas. It is estimated that 40% of eligible women are using effective contraception, particularly orals. Prescriptions for orals are generally obtained from private doctors, particularly in rural areas with no family planning clinics. In 1972 the FPA ran 19 clinics, ran an active program of group meetings and press information, and distributed 104,320 copies of leaflets, posters, and pamphlets. 42 doctors were given special family planning training. Trials were undertaken on Copper 7 IUD, Noriday, Depo-Provera, and chlormadnone. In 1973 the number of clinics was increased to 25. Most of the new clinics were in lower socioeconomic areas with equipment purchases subsidized by the government.
New York, International Planned Parenthood Federation, Western Hemisphere Region, Medical Division, September 1975. 49 pThis is a compilation of family planning services provided by associations operating in the Western Hemisphere Region. Separate tables are compiled for 1973 and 1974. A list of each family planning program included in the study is appended to the report. The report does not guarantee the completeness or accuracy of the data; problems with reliability of data point up the necessity for a system of standardized record-keeping. Tables cover program input in the form of clinical facilities, medical and paramedical services, and the delivery of contraceptive methods by family planning programs and community-based distribution systems. Charts on program output include information on acceptor characteristics, numbers of new and continuing acceptors, numbers of voluntary sterilizations, and percentages of other methods in use.
Journal of Reproductive Medicine. April 1976; 16(4):154-158.WHO supports programs in family planning, human reproduction, and po pulation dynamics through: 1) technical and advisory services; 2) training in specialized areas of fertility management; 3) research for diagnostic, treatment, and sterilization purposes. In the last named, the objectives are: 1) to respond to requests of governments, 2) to collect information relating to gynecologic endoscopy, 3) to coordinate existing programs, and 4) to promote research in female sterilization. Proposed research is in the area of surgical and fibroscopic methods and general coordination.
Conclusions and recommendations of the IPPF Central Medical Committee (CMC) and its panel of experts on sterilization.
In: Kleinman, R.L., ed. Male and female sterilization. A report of the meeting of the IPPF Panel of Experts on Sterilization, Bombay, January 11-14, 1973. London, International Planned Parenthood Federation, 1973. p. 8-12The conclusions and recommendations fall into 3 categories, i.e., policy, administrative and technical. Important points in the 1st category include; that sterilization be available and avilable on request, that it be voluntary, and that facilities for reversal procedures be free and avilable. Administrave recommendations include; that no arbitrary hospital stay be assinged to vasectomy patients, that no arbitrary selection criteria concerning previous training or surgical skill be used in accepting personnel for vasectomy patients, that no arbitrary selection criteria concerning previous training or surgical skill be used in accepting personnel for vasectomy training, and that endoscopic techniques should not be done without an anesthetist. Among the technical recommendations were: that postpartum sterilization under local anesthesia by laparotomy be encouraged, as that is the simplest of all female procedures; taht vaginal procedures should only be done with proper operative and anathestic facilities; that division of the uteirne tubes by the Pomeroy technique using 0 chromic catgut should be employed in mass programs of female sterilization; the removal of part of the uterine tube for biopsy and histological examination as a check on the success of the operation should not be done; general anesthesia should never be used for a simple vasectomy unless there are complications; and that tetanus toxoid should not be given to avoid infection.
In: Schima, M.E. and Lubell, I., eds. New advances in sterilization. Proceedings of the 3rd Internaitonal Conference on Voluntary Sterilization, Tunis, Tunisia, February 1-4, 1976. New York, Association for Voluntary Sterilization, 1976. p. 12-14Voluntary sterilization is 1 of the most effective, least troublesome, and least expenxive methods of contraception yet developed. Sterilization serves health, demographic, and human rights concerns in the contraceptive field. Voluntary organizations are needed to provide sterilization in areas where government family planning programs do not yet provide it. The World Federation of Associations for Voluntary Sterilization was founded to bring together all the national organizations working for the same goal. The Federation provides a framework for coordinating national organizations and for cooperating with international health organizations.
[Unpublished] 1975. 21 p.Depo-Provera has not been used on a widespread basis in the Philippines because the Federal Drug Administration has not approved it, and a large share of their family planning budget is funded by USAID. Although Governor Luiz made Depo-Provera available to 800 acceptors; it was too expensive to compete with free contraceptives. On a trip to Thailand Governor Luiz witnessed the long-term effects of a Depo-Provera program begun in 1965: fewer children and better living conditions. Laparoscopy is too expensive an operation in training and instruments required to be used in the Philippines. Mini-lap is effective and inexpensive. A Thai doctor taught a Philippine doctor the procedure in only 2 operations. The Philippine doctor can train many others quickly, and equipment can be manufactured locally.
New York, International Planned Parenthood Federation, Western Hemisphere Region, September 1975. 149 pThe primary focus in this 4th edition in the series of annual "overviews" of the contraceptive services in the Western Hemisphere Region of the International Planned Parenthood Federation is on clinical facilities, medical and paramedical services, and on the delivery of contraceptive methods by family planning programs. Family planning services link information on methods for spacing or limiting children to their availability, and they provide education on the advantages of contracepting. They seek to motivate acceptors to continue their chosen method. Counseling and information and education activities, although an integral component of family planning programs, are not included among the topics considered in the "Overview." In the Western Hemisphere Region, the most notable innovation has involved the community-based distribution of contraceptives (CBD), and for the 1st time, non-clinical distribution of contraceptives by associations in the region is a part of the "Overview." The Annual Reports submitted by IPPF affiliates and published and unpublished data from other programs are the primary sources of statistics for this report. Information for 1973 encompassed 29 associations related to IPPF and 4 other programs, and for 1974, 28 associations and 5 other programs could be covered. As for clinical input of family planning programs, the affiliates reported to the Regional Office of IPPF the number and types of clinics, weekly session hours, hours of medical and paramedical personnel. Data on the output of clinical activities of family planning programs for the calendar year were limited to 1st visits or new acceptors by methods, 1st revisits of the year or continuing (old) acceptors by method, number of revisits by old and new acceptors by method, demographic characteristics of new acceptors by method, and voluntary male and female sterilization performed or referred. Data on contraceptive services and clinical activities are summarized and presented in the form of tables.
Indonesian Association for Voluntary Sterilization. Perkumpulan Untuk Sterilisasi Sukarela Indonesia.
Presented at the World Federation of Associations for Voluntary Sterilization General Assembly Meeting, Tunis, February, 1976. 2 pIn this report by the president of the Indonesian Association for Voluntary Sterilization, Perkumpulan Untuk Sterilisasi Sukarela Indonesia (PUSSI), he notes that at present time, both male and female sterilization is in demand in an ever increasing volume in his country. In 1957, the Indonesian Planned Parenthood Association was founded; and since 1970 the country has had its own national family planning program under the guidance of the National Family Planning Coordination Board. By the end of its first 5-year development plan, 1970-1975, a total of 5 million new acceptors had been registered. The IUD and oral contraception have been accepted. The present increased demand for sterilization is perhaps due to the fact that more and more people have become family planning conscious, especially since 1974 when the government adopted the following policy: government officials shall henceforth receive allowances for a maximum of 3 children. This policy has been followed by private business. Sterilization must be on a strictly voluntary basis, with the express consent of the spouse. And though it has not yet been accepted officially as a family planning method, PUSSI was established in 1974; and various sterilization centers are located throughout Indonesia. PUSSI maintains that the propagation of the sterilization method to the Indonesians helps the prevention of their exposure to the adverse effects of oral contraceptives and IUD for too long a period of time.
Medical World News 18(15): 11. July 25, 1977.Several physicians express their views on outpatient minilaparotomy sterilization in the wake of the establishment of a $300,000 loan program by the Planned Parenthood Federation of America and the Associaiton for Voluntary Sterilization. The procedure can be performed in 15-20 minutes and costs $275-325, which is considerably less than laparoscopy. The patient is usually able to return home within a few hours. Nonetheless, safety guidelines in the U.S. require that a physician, technician, and resuscitating equipment be present. 1 doctor said the procedure could well serve those of lower income but has no place in private practice. Another felt that the procedure should only be performed in a surgical setting and not in a private office. The operative procedure is briefly described.
People. 1977; 4(3):39.The Management and Planning Committee of the International Planned Parenthood Federation has reiterated its belief in the principle of voluntary sterilization as a means of family limitation. The Committee asserts that counseling and follow-up sessions should be provided for all sterilization patients as well as information regarding risks involved and alternatives to sterilization. All incentives to sterilization should supplement basic human rights, no disincentives should tamper with such rights, and both incentives and disincentives should harmonize with prevailing social values and mores.
FPOP Bulletin 9(3): 7. May-April 1977.A new statement which spells out in detail IPPF's belief in the right of the individual to make a voluntary choice has been drawn up by the Central Medical Committee and the Law and Planned Parenthood Committee and approved by the Management and Planning Committee. The 8-point resolution states that sterilization as a method of limiting family size, should be a completely voluntary choice made in full knowledge of alternative methods of contraception and the risks and benefits associated with sterilization. Both male and female methods should be regarded as irreversible; however, at time of sterilziation the method offering greatest hope of reversiblity should be used. Counseling and follow-up should be an integral part of any sterilization program. Incentives should not be discriminatory nor involve withholding of services from families. They also should not be so high as to be unduly influential on the poor. Doctors used by Family Planning Associations should use the best possible techniques and should be remunerated on the basis of quality of care, not the number of cases. In order to keep close watch on use of sterilization, full data should be collected and analyzed.
WHO Special Programme of Research, Development and Research Training in Human Reproduction: Programme on Sterilization.
WFAVS Report, No. 1, September 1978. p. 2-3.Research on female sterilization represents one of the priorities of WHO's Special Programme of Research, Development and Research Training in Human Reproduction. The strategy of its Task Force on sterilization concerns safety, simplification, and service delivery. Evaluation of short-term sequelae of tubal occlusion performed postpartum or as an interval measure involved no major clinical problems. Concern over long-term sequelae has led to testing and comparison of 3 operative techniques - laparoscopic tubal cautery, Pomeroy tubal ligation, and laparoscopic clip application - in order to determine the extent of subsequent menorrhagia. A future study will be concerned with psychological sequelae, comparing women requesting sterilization for birth control; preoperative and postoperative general complaints of a presumed psychological origin, and patterns of menstruation and sexual activity will be recorded. New methods being developed include a technique that would safely and simply occlude the tubes by the transcervical blind delivery of a chemical agent. The most successful approach to date has been the use of methylcyanacrylate delivery through the tubes by a device designed for the purpose. A study is being planned for use of the technique with volunteer hysterectomy patients.
WFAVS Report, No. 1, September 1978. p. 5.The IFRP (International Fertility Research Program) has an important research and training role in the field of female sterilization. All sterilization methods have been studied to assess their efficacy, safety, and acceptability. Standardized data collection instruments allow for the accumulation of information from many centers. IFRP clinical field trials have been important in the adoption of mechanical occlusion sterilization methods such as the Hulka-Clemens clip and the Fallope ring. The safety and ease of the minilap procedure were documented by numerous studies in a variety of settings. IFRP adapted the tubal ring to minilap and developed the double ring applicator for use in interval and postpartum sterilizations. As new techniques like the Hasson open laparoscopy and a promising "suprapubic endoscopy" method are developed, they will undergo scrutiny by IFRP. In addition, IFRP data collection techniques allow major studies on various aspects of sterilization. One such study on the pain which accompanies different methods has just been completed. Studies on sterilization failures are currently underway. These research and training efforts will continue to be the major emphasis of this program.
Guide to equipment selection for M/F sterilization procedures. Guide du materiel utilise pour les procedures de sterilisation des hommes et des femmes.
Population Reports. Series M: Special Topics. 1977 Sep; (1): p.This is a guide to aid in selecting and maintaining the proper equipment used in the following sterilization procedures: 1) minilaparotomy, 2) laparoscopy, 3) conventional laparotomy, 4) colpotomy, 5) culdoscopy, and 6) vasectomy. Prototype, experimental, or infrequently used instruments are not discussed. Colpotomy, minilaparotomy, and conventional vasectomy are low-technology procedures requiring relatively simple, locally produced instruments, e.g., retractors, forceps, and scalpels. High-technology equipment consists of specialized items, e.g., laparoscopes and culdoscopes. These are produced in a limited number of technically advanced countries. Equipment donor agencies are discussed. The following factors must be considered in selecting equipment: 1) suitability for the intended procedures, 2) quality of the instrument, 3) ease of repair, and 4) initial cost. Each type of equipment is pictured, diagrammed, described, and charted against others of its kind. Maintenance and repair guidelines are provided.