PubMed · 12332182
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A S Majury. 1965. Conception control.. https://pubmed.ncbi.nlm.nih.gov/12332182/
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Since the 1994 ICPD, relatively little attention has been given to constraints in improving reproductive health programmes in industrialised countries. The Netherlands is known for its low rates of unwanted pregnancy, safe and accessible abortion services, low perinatal and maternal mortality and well-developed programmes for adolescent sexual health, but recent studies show a rising incidence of abortions and STDs, particularly among young people and immigrants. This article describes reproductive health services in the Netherlands, their historical roots and current constellation, including services for family planning, abortion, STDs, infertility, information, education and counselling on sexuality, and antenatal and delivery care, in the context of cost containment and other recent reforms. It shows that although these core components are well covered and the system of reimbursement for costs has greatly helped to increase accessibility, they are not all well integrated into the primary health care system. In some cases, they are well covered by other providers, such as midwives. Prevention and management of STDs and infertility, however, are particularly split between different providers and in some cases the extent and quality of service provision is lacking. What emerges is a still fragmented landscape--with many successes but also some significant shortcomings.
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Most women in the United States with human immunodeficiency virus (HIV) become infected through sexual transmission, and a woman's choice of contraception can affect her risk for HIV transmission during sexual contact with an infected partner. Most contraceptives do not protect against transmission of HIV and other sexually transmitted diseases (STDs), and the use of some contraceptives containing nonoxynol-9 (N-9) might increase the risk for HIV sexual transmission. Three randomized, controlled trials of the use of N-9 contraceptives by commercial sex workers (CSWs) in Africa failed to demonstrate any protection against HIV infection; one trial showed an increased risk. N-9 contraceptives also failed to protect against infection with Neisseria gonorrhoeae and Chlamydia trachomatis in two randomized trials, one among African CSWs and one among U.S. women recruited from an STD clinic. Because most women in the African studies had frequent sexual activity, had high-level exposure to N-9, and probably were exposed to a population of men with a high prevalence of HIV/STDs, the implications of these studies for U.S. women are uncertain. To determine the extent of N-9 contraceptive use among U.S. women, CDC assessed data provided by U.S. family planning clinics for 1999. This report summarizes the results of that assessment, which indicate that some U.S. women are using N-9 contraceptives. Sexually active women should consider their individual HIV/STD infection risk when choosing a method of contraception. Providers of family planning services should inform women at risk for HIV/STDs that N-9 contraceptives do not protect against these infections.