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[IUD use at the Sidi Fateh urban community clinic: qualitative study] Utilisation du DIU au niveau du dispensaire urbain Sidi Fateh (etude qualitative).
Rabat, Morocco, Institut de Formation aux Carrieres de Sante, 2000. , 61,  p.Contraceptive prevalence across Morocco increased from 20% in 1980 to 60% in 1997, with a corresponding decline in total fertility from 6 children per woman in 1975 to 3 per woman in 1997. Morocco's National Family Planning Program has achieved great success in reducing prevailing levels of fertility, but the program's particular promotion of the oral contraceptive pill has led to the disproportionate use of the latter at the expense of longer-acting hormonal and barrier methods. Findings are presented upon IUD use at Sidi Fateh urban dispensary, based upon questionnaires, personnel observation, and interviews with consultants on the relevant attitudes and behaviors of clients and service providers. Although 48.12% of the 133 married women surveyed know a range of modern contraceptive methods, their knowledge is superficial and very general beyond what they know about the particular method they employ. 66.3% use oral contraception, although most are unsatisfied due to the pill's side effects, but believe that they have no other contraceptive option. 63.9% of women oppose IUDs because of the method's side effects and negative rumors about its use. Likewise, 30.7% of husbands have negative attitudes about the IUD. Women's opinions of the IUD improve with rising educational status. The general population of IUD users is satisfied with its method choice, finding the IUD to be reliable, reversible, and of long-term effect without the need for daily administration. However, the adverse experiences of a few women with the method creates concerns and fear of the IUD among users and potential users. Obstacles and constraints to IUD use, personnel competence, and client satisfaction on family planning consultations are discussed.
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)
[Qualitative study on the intrauterine device (IUD) in Morocco] Etude qualitative sur le dispositif intra uterin au Maroc.
Rabat, Morocco, Ministere de la Sante Publique, Direction de la Population, Programme de Planification Familiale, 1996 Nov. 80 p.Morocco s National Family Planning Program (PNPF) offers a range of contraceptive methods to its population and the Ministry of Public Health encourages the informed, voluntary choice of couples in contraceptive matters. However, the success of this approach depends upon the involvement of service providers to help people decide which contraceptive option is best for them. While the overall level of contraceptive prevalence rose from 20% in 1980 to 50% in 1995, a larger proportion of urban women compared to rural women use contraception, women use especially short-term methods, and there remains unmet need for family planning. Moreover, there exists a large gap between the level of contraceptive knowledge and method use. The IUD, introduced in Morocco in 1965, remains the second most widely used contraceptive method in the country behind the oral pill, at 4.3% and 32.2%, respectively. The PNPF plans to promote the IUD to both health professionals and the general population. This study examines the attitudes, behaviors, and perceptions of family planning service providers and the population with regard to the IUD. The goal was to identify rumors about the IUD, the population s expectations, the competence levels of service providers, and the quality of services. Relations between service providers and the population were also evaluated.
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.
[Unpublished] 1989. Presented at the IIDSS Conference, August 18-20, 1989.  p.The author explains the operations of and rationale behind the Social Marketing for Change (SOMARC) project of the Futures Group. Using indigenous private sector company commercial channels in developing countries, SOMARC helps develop advertising campaigns and other marketing approaches to sell branded condoms, oral contraceptives, vaginal foaming tablets, and sometimes IUDs. Commercial marketing research techniques are employed in these exercises, and include developing and evaluating advertising and marketing strategies, designing and testing advertising messages, and selecting and improving product names and packaging for their contraceptive products. Although technical assistance is generally required in most countries, local companies are nonetheless depended upon to develop and manage the projects overall. The importance of brand image research in reaching target markets is discussed, followed by examples of testing and evaluating marketing strategies, product names, package testing, and advertising messages.
MARHIA. 1990 Jan-Jun; 3(1-2):27-8.The Institute for Social Studies and Action of the Philippines is endeavoring to encourage the public and the Catholic Church to Recognize the differences between contraception (which prevents the union of the sperm and ovum) and abortion (which terminates pregnancy long before the fetus is viable). Nonetheless, widespread opposition to contraceptives, especially the IUD, persists because they are considered abortifacients. In terms of the IUD, there is accumulating research evidence that the device works primarily by preventing fertilization and, less frequently, by interfering with implantation. The injectable contraceptive, Depo-Provera, which is banned in the Philippines, suppresses ovulation, as does the pill. Despite the evidence that the most widely available contraceptives are not abortifacients, debate over this issue obscures a far more central issue--the right of each woman to plan her family size and the interval between births. Screening and counseling provided by well-trained health personnel can enable women to choose the contraceptive method that best suits their needs and protects their health. A lack of access to contraception is in part responsible for the 2000 maternal deaths that occur in the Philippines each year during pregnancy or delivery.
A study of contraceptive drop-outs in Lesotho: using focus groups to determine causes of discontinuation.
[Unpublished] . , 36,  p.Focus groups of married women aged 25-40 from Lesotho who has used contraception for at least 3 months, but discontinued within the last 12 months, were conducted in 1989 to learn reasons for discontinuation. Groups had 3, 5, 6, and 9 participants, and other groups of staff were also held. In warm-up discussion topics it was learned that Basotho families desired families of 2-6 children; that men wanted the maximum number of children and believed that family planning promoted promiscuity in wives; that most people believed in spacing births and practiced traditional methods to do so, primarily breastfeeding and abstinence. Women liked injection because they can be used without husband's knowledge, and do not require daily medication or constant resupply. Misinformation was common on all methods, and lists of examples are included for each method. Some of the many reasons for discontinuing were real or impugned side effects. Many women complained of vaginal wetness (which was also a reason for accepting contraception). Many also accepted and others stopped to keep husbands at home. High cost of pills and exams was a reason cited. Program-related reasons were long lines at clinics and unavailability and brand-switching by the clinics. Staff focus groups identified several characteristics among drop-outs: husbands disapproved of contraception; negative rumors used to pressure women; inadequate counseling on side effects; pressures from in-laws and husbands to have more children. Screening out of potential drop-outs was not considered a viable policy. Staff groups suggested that the government emphasize IEC campaigns for men, the public and private doctors, and maintain supplies of the same brands of contraceptives at its clinics.
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)