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REPRODUCTIVE HEALTH MATTERS. 2000 Nov; 8(16):185.A new reproductive health law was passed in the city of Buenos Aires in June 2000, marking an important turning point in the history of reproductive health and rights in Argentina. The law is based on the City's Constitution of 1996 which "recognizes sexual and reproductive rights free of violence and coercion as basic human rights". The law: 1) guarantees women's and men's access to contraceptive information, methods and services needed for the responsible exercise of their sexual and reproductive rights; 2) guarantees holistic care for women during pregnancy, delivery and puerperium; and 3) establishes actions to reduce maternal/child mortality and morbidity. The law generated heated debate and street demonstrations, particularly regarding whether adolescents should have access to contraceptives without parental authorization, whether the IUD should be included among the methods provided at public facilities (as many opponents claimed the IUD is an abortifacient), and the duty of public health care workers to provide family planning services even if this is against their principles or religious beliefs. When the law was passed, the provision of IUDs was included along with other reversible and temporary methods; sterilization, therefore, appears to have been excluded. Parental authorization for adolescents requesting contraception was not required, but instead the law encouraged the participation of parents in everything to do with the reproductive health of their children, where possible. Finally, the law encouraged the use of condoms for dual protection. There was no reference to conscientious objection. (full text)
FAMILY PLANNING WORLD. 1993 Jul-Aug; 3(4):19.Although the Chinese find the IUD quite suitable as a contraceptive (83% of IUD use worldwide), women and doctors in the US are not convinced of its safety. The US fiasco of the Dalkon shield during the 1980s has not been forgotten. An Ortho Pharmaceutical study in 1991 found that 55% of US women would never use an IUD. Many types of IUDs are now available, and the single coil stainless steel ring is the most widely used in China. A Family Health International (FHI) IUD researcher, Dr. I-Cheng Chi, reports that research over the past ten years on IUDs has been "unequivocally positive" and predicts the IUD's comeback. The four IUDs which are popular are the Copper T, the MLCu375 or Multiload made of polyethylene, the Nova T (copper with a silver core), and the LNG-20, which has a T-shape and a sustained source of levonorgestrel. Only the Multiload is not available in the US. The Nova T and the LNG-20 are relatively new devices. All devices are found in Dr. Chi's study to be safe and efficient, but each has some flaws. The LNG-20 has the longest efficacy, with 40% of the hormone intact at five-year removal. The LNG-20 may be effective for 10 years. The disadvantage is amenorrhea. The life span ranges from six to eight years for the Copper T, which may be effective for 10-15 years. Only the Nova T is rated appropriately at only five years use and may have reduced effectiveness after three years. Pelvic inflammatory disease (PID) rates are low for all models. The PID rate for the Copper T is 0.59%, 0% for the Multiload, 1.06% for the Nova T, and 0% for the LNG-20. IUDs are generally prescribed for women in monogamous relationships and with children, but the Nova T may be used by young, nulliparous women because of the elasticity of the device. Population Action International reports that companies will research devices with sales over $50 million. IUD sales only total about $12 million. Norplant is considered in the US to have greater sales potential and fewer public relations problems.
FAMILY PLANNING WORLD. 1993 Jul-Aug; 3(4):5, 26.IUD use among American women has been and will continue to be in a decline as long as the new IUDs are linked with the adverse publicity on the Dalkon Shield, there is a fear of litigation, and there are misconceptions among client and physician about its safety. The evidence from studies published in the last 10 years has confirmed that IUDs are the most effective and safest forms of contraception available to women. But most American women who would be eligible for the IUD are unaware of its safety. Current IUD users generally are satisfied, but many physicians will not prescribe the IUD and medical schools offer little in the way of training in proper insertion techniques. Potential side effects are increased menstrual bleeding, pain, intermenstrual spotting, and lack of protection from sexually transmitted diseases or pelvic inflammatory disease. Potential complications for the new copper releasing IUDs are lower than for the old ones and their use has not been shown to have long lasting systemic effects. Breast feeding mothers may safely use the IUD without effects on quality or quantity of breast milk. The copper releasing IUDs also have the lowest failure rates. The TCu 380A has a US Food and Drug Administration approval rating of 8 years, which makes it the most cost-effective, long-lasting contraceptive option. Expanding IUD use will depend on how well IUD companies are able to increase awareness of the results of recent research and whether IUD insertion will be approved for nurse, nurse practitioners, and physician assistants as IUD service providers. A disincentive for women wanting IUDs is the lengthy information booklet (11 pages for the Paragard T 380A), which must be initialed on every page. Other competitive contraceptives, such as the diaphragm or sponge do not require informed consent. Potential IUD users are now screened carefully for those who might be at risk for pelvic diseases; nonparous women are still discouraged from using IUDs because of the risk of perforation.
Ottawa, Canada, International Development Research Centre, 1973. 30 p. (IDRC-009e)This paper evaluates the progress of a Latin American population through stages in family planning adoption. The focus is on changes in knowledge of contraception, attitudes, and practices which occurred over 5 years (1964-69) of widespread public discussion concerning family planning and of program activity in Bogota, Colombia. Data from 2 surveys, 1 in 1964 and the other in 1969, permit the 1st temporal analysis of family planning adoption for a major metropolitan city in Latin America. Additional data on rural and small urban areas of Colombia from the 2nd survey permit a limited assessment of diffusion of family planning from the city to the nation as a whole. The 1st survey in Bogota revealed moderate to high levels of knowledge of contraceptive methods and generally favorable attitudes to birth limitation. However, at this time many women had never spoken to their husbands about the number of children they wanted, nor tried a contraceptive method at any time. The 2nd survey showed substantial changes in this picture. The proportion of currently mated women who had spoken to their husbands about family size preference changed from 43 to 62% for an increase of 71%. Fertility fell appreciably over this period, especially among younger women. Family planning program services had a significant direct contribution to the adoption process, since 36% of mated women had been to a clinic by 1969. The most modern methods of birth control -- the anovulatory pill and the intrauterine device -- which were scarcely known in 1964 were widely known in 1969, and contributed most to the observed increase in current contraceptive practice. However, among the previously known methods, the simplest method of all, withdrawal (coitus interruptus), showed the greatest increase in current practice and remained the most commonly used method. These findings suggest that favorable attitudes and knowledge tend to become rather widespread before levels of husband-wife discussion of family size preferences and levels of contraceptive trial increase appreciably. The results also indicate that contraceptive knowledge and favorable family planning attitudes are spreading rapidly outward from the cities into the rural areas, but that contraceptive practice is still predominantly restricted to urban populations. (author's)