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PubMed2005

Occupational exposures and reproductive health: 2003 Teratology Society Meeting Symposium summary.

Assuring reproductive health in the workplace challenges researchers, occupational safety and health practitioners, and clinicians. Most chemicals in the workplace have not been evaluated for reproductive toxicity. Although occupational exposure limits are established to protect 'nearly all' workers, there is little research that characterizes reproductive hazards. For researchers, improvements in epidemiologic design and exposure assessment methods are needed to conduct adequate reproductive studies. Occupational safety and health programs' qualitative and quantitative evaluations of the workplace for reproductive hazards may differ from standardized approaches used for other occupational hazards in that estimates of exposure intensity must be considered in the context of the time-dependent windows of reproductive susceptibility. Clinicians and counselors should place the risk estimate into context by emphasizing the limitations of the available knowledge and the qualitative nature of the exposure estimates, as well as what is known about other non-occupational risk factors for adverse outcomes. This will allow informed decision-making about the need for added protections or alternative duty assignment when a hazard cannot be eliminated. These policies should preserve a worker's income, benefits, and seniority. Applying hazard control technologies and hazard communication training can minimize a worker's risk. Chemical reproductive hazard training is required for workers by the Occupational Safety and Health Administration's Hazard Communication Standard. The National Institute for Occupational Safety and Health (NIOSH) has formed a National Occupational Research Agenda Team to promote communication and partnering among reproductive toxicologists, clinicians and epidemiologists, to improve reproductive hazard exposure assessment and management, and to encourage needed research.

Female↗
PubMed2001

Post-marketing surveillance of Norplant contraceptive implants: I. Contraceptive efficacy and reproductive health.

The subject of this study to examine the safety and contraceptive efficacy of Norplant, we undertook a 5-year study of follow-up of women initiating use of Norplant, intrauterine device (IUD) or sterilization in eight developing countries. Women attending family clinics were enrolled if they consented and were medically eligible to use Norplant, IUD, or female sterilization. Women who chose to initiate use of IUDs or surgical sterilization served as controls and were frequency matched in 5-year age-bands with women who chose to use Norplant. At admission women had a physical examination, and their medical histories, demographic, and socio-economic characteristics were recorded. Follow-up visits were scheduled in the first 6 weeks after admission and semi-annually thereafter for 5 years irrespective of change of contraceptive method. Incidence rate ratios of health events were estimated for initial and current contraceptive method use. This paper reports reproductive health events and contraceptive efficacy. Altogether, 7,977 women initiating use of Norplant, 6,625 of IUD, and 1,419 of surgical sterilization were admitted. Their mean ages at initiation were 28.5, 28.5, and 29.6 years, respectively. More than 99% were married or cohabiting, and parous. Five-year follow-up was completed by 94.6% of the women. By the end of 5 years, the mean duration of first segment use per initiator was 4.16 years for Norplant, 4.10 years for IUDs, and 4.96 years for sterilization accounting for 39,337 woman-years for Norplant, 31,915 for IUDs, and 7,071 for sterilization. The study accumulated 78,323 woman-years of observation. Pearl pregnancy rates for Norplant, copper IUDs and female sterilization were 0.27, 0.88, and 0.17 per 100 woman-years, respectively. Users of Norplant, copper IUDs, and sterilization had rates of ectopic pregnancy of 0.30, 0.68, and 0.13 per 1,000 woman-years, respectively. Major health events related to the reproductive system were rare. Rates of acute PID were significantly lower among Norplant users than IUD users (p = 0.004). The rate of ovarian enlargement was significantly higher in Norplant users than controls (p <0.001), but not rates of hospitalization for this condition. Vaginitis and vaginal discharge, and low abdominal pain were significantly less frequent in Norplant users than in the other groups. Bleeding disturbances were more frequent among Norplant users than controls but not anemia. The study confirms the high contraceptive efficacy of Norplant, copper IUDs, and female sterilization. The incidence rates of major reproductive health problems were low. There was no significant excess of serious reproductive morbidity among users of Norplant compared to users of IUDs and sterilization.

Abdominal Pain↗
PubMed1996

Utilization of reproductive health services in a mountainous area in Vietnam.

This study uses data from two surveys performed in 1991 and 1994 in a mountainous district of northern Vietnam. The aim was to describe the utilization of family planning, antenatal care, delivery and immunization services during a period of rapid structural change in the health services in general and implementation of a primary health care project in the study area. This project was aimed at increasing access to health services and improving the quality of primary health care services. Factors influencing the utilization of reproductive health services were analyzed. The contraceptive prevalence among women aged 15-49 increased significantly from 48% in 1991 to 60% in 1994. The most commonly used contraceptive method was intra-uterine devices. The BCG coverage among children under five years of age increased from 36 to 70%. The proportion of pregnant women receiving three antenatal check-ups, as recommended by the health authorities was low and increased slightly from 15% in 1991 to 20% in 1994. About one third of the pregnant women were delivered in health care institutions during this period. The utilization of family planning, antenatal care and delivery services varied with ethnicity and was positively related to the mother's educational level both in 1991 and 1994. There is a need to strengthen the reproductive health services, especially antenatal care and delivery services, in terms of improving the quality of care and accessibility to women. Efforts should be made to reach women with a low education level as well as those belonging to ethnic minorities.

Adolescent↗
PubMed1998

[Indications for the evaluation of reproductive health and pertinent programs].

This report presents a set of indicators to aid in the assessment of reproductive health and its associated programs in developing countries. The indicators basically stem from the accords ratified at the International Conference on Population and Development (ICPD), which was held in 1994 for the purpose of improving the reproductive health status of women, men, and adolescents throughout the world. However, working drafts and ways of approaching the subject were developed in 1996 at several meetings of representatives of the United Nations Population Fund (UNFPA), bilateral agencies, and nongovernmental organizations. The indicators are not in their definitive and final form, and it is expected that comments received from users will allow them to be improved. The indicators deal with the monitoring of progress toward the goals of the ICPD, managerial policies and procedures, family planning, maternal health, infections of the reproductive system and sexually transmitted diseases, abortion and infertility, and other demographic, social, and economic factors.

Adolescent↗
PubMedDate not supplied

Chronic drug use and reproductive health care among low-income women in Miami, Florida: a comparative study of access, need, and utilization.

Interviews of low-income women in Miami, FL, addressed reproductive health issues in a stratified, network-referred sample of chronic drug users (CDUs) and socially and ethnically similar women who were not CDUs. Women who were not CDUs were significantly more likely to report a regular source of health care than CDUs. About one third of each group reported experiencing reproductive health problems (other than pregnancy) in the 12 months preceding their interview. Chronic drug users were twice as likely to report that these problems remained untreated. Measures of use of preventive services (physical exam, breast exam, pelvic exam, family planning visit) consistently showed lower use by CDUs. A higher proportion of women who were not CDUs reported pregnancies in the 12 months preceding interview. The 32 pregnant CDUs were much less likely to have received prenatal care than the 42 pregnant women who were not CDUs. For women who reported a pregnancy in the year preceding interview, logistic regression analysis showed a strong and robust negative effect of being a CDU on receiving prenatal care even when the effects of having a usual source of care and having third-party coverage were controlled.

Adolescent↗
PubMed1997

Reproductive health in humans and wildlife: are adverse trends associated with environmental chemical exposure?

In recent years, evidence from disparate observations has indicated adverse changes in the reproductive health and fecundity of animals and humans. In humans, there is strong evidence for such trends in the incidences of testicular and female breast cancer, and concern has also been expressed regarding semen quality, cryptorchidism, hypospadias and polycystic ovaries. Laboratory studies have indicated that some chemicals in the environment, both natural and synthetic, have the potential to disrupt the endocrine system and that these could, at least theoretically, be partly responsible for the observed changes. Chemicals thus identified include the naturally occurring steroid hormones, phyto- and myco-estrogens, and anthropogenic chemicals such as synthetic hormones, organotins, organochlorine pesticides, polychlorinated biphenyls, dioxins, alkylphenol polyethoxylates, phthalates and bisphenol-A. While there is no direct evidence from human studies to confirm a causal link between exposure and effect, concern exists and is strengthened by reports of adverse reproductive and developmental effects in wildlife, possibly mediated via endocrine disruptive pathways. The development of imposex in neogastropod molluscs exposed to tributyltin has been attributed to such a mechanism and in wild populations of fish, alligators and birds, instances of masculinisation or feminisation in polluted areas have been noted. Among mammals, disturbed fertility of Florida panthers and some marine species has also been reported. A concentrated research and monitoring programme is required to clarify the nature and extent of effects on reproductive health in humans and wildlife, and to assess human and wildlife exposure to relevant naturally occurring or anthropogenic endocrine disrupting substances. This will enable a more robust evaluation of the contribution that environmental chemical exposure may have on adverse trends in the reproductive health of humans and wildlife.

Animals↗
PubMed2004

The social context of reproductive health in an Egyptian hamlet: a pilot study to identify female genital schistosomiasis.

This pilot study is the first to identify female genital schistosomiasis (FGS) in an Egyptian community setting. The year-long interdisciplinary study, in a small hamlet (ezba), combined clinical assessment with an in-depth study of the social context of reproductive health. Schistosoma haematobium ova were found in 16.7% of women in the study (21/126). Half of the women who agreed to a full gynecological examination (43 of 86) had evidence of reproductive morbidity due to schistosomiasis, either schistosome eggs in the cervix or sandy patches, tissue changes in the reproductive tract. Other reproductive tract morbidities included infections (vaginitis 40%, chronic cervicitis 75%, pelvic inflammation 9%) and prolapse (54%). FGS was associated with dysparunia, abnormal vaginal discharge, vaginal or cervical polyps, contact bleeding, vulval itching and chronic cervicitis. Community members recognized S. haematobium as a health problem, but did not believe that it affected reproductive health. Indeed, they had little awareness of reproductive health and the possible impact of reproductive morbity on women's arduous daily tasks. There was no discussion of any reproductive health issues (except infertility) between women or between spouses. The study identified a number of factors that would affect the identification and treatment of FGS, and reproductive health care in general; (1) the neglect of women's health: (2) misconceptions about reproductive health and family planning; and (3) limited access to, and use of formal health care. The paper ends with a brief discussion of the significance of our findings about FGS, strategies to increase awareness of FGS, and the need for future research.

Egypt↗
PubMed1997

The teaching of evidence-based reproductive health in developing countries.

Evidence-based medicine is gaining increased importance in clinical practice. Unfortunately, prevailing circumstances have prevented this application of the best available evidence to clinical decision-making for reproductive health in developing countries. Poor infrastructure, inadequate personnel, gross underfunding of services for health and education as well as a conservative education system are obstacles in effecting change. By examining these impediments, we suggest strategies for clinical education and research with the aim of improving reproductive health care in developing countries. Evidence-based reproductive health will be promoted through access to appropriate information, interest from government and consumers, curriculum changes, application of research findings and finally, the judicious use of its principles in clinical practice.

Developing Countries↗
PubMed2001

Priorities for reproductive health: assessing need in the older population in the Asia-Pacific region.

Best practice in healthcare entails the identification of priority health needs so that scarce resources can be most appropriately deployed in the development of services. In this light, the priorities for health of older women and men in the Asia-Pacific region are considered in terms of reproductive health. A broader definition of "reproductive health" is used here, which considers conditions that affect the reproductive systems of older women and men. Although previous fertility history may influence some of these conditions, such as breast or cervical cancer or uterine prolapse, others -- including sexually transmitted diseases and impotence -- emerge as independent factors; that is, they relate directly to past and/or current sexual activity. Regional and country-specific survey data and the estimates of deaths and disease burden provided by the Global Burden of Disease Inquiry Project show that a component of the overall health problems of older women relate directly to pregnancy and the practice of unsafe sex. The lack of data for other conditions that affect the reproductive systems of older women and men is noted, as is the importance of further research if an individual's health needs are to be fully met. It is argued that healthcare and health services alone cannot meet some of the health needs of the older population; broader political and social change are required.

Adult↗
PubMed2006

Reproductive health and domestic violence: are the poorest women uniquely disadvantaged?

We use Demographic and Health Survey data from Cambodia, the Dominican Republic, and Haiti to compare women in different poverty and violence categories in terms of their experience of selected reproductive health outcomes. "Poor" women are those who belong to the bottom quintile of households arrayed according to a widely accepted asset-based wealth index. The results suggest that women who are both poor and have experienced violence are not unique in their reproductive health disadvantage. In particular, for all three reproductive health outcomes we consider the negative association with having experienced violence cuts across all women, poor and wealthy.

Adolescent↗
PubMed1998

Gender violence and reproductive health.

The available literature reflects the growing interest in gender violence and reproductive health. Violence is generally studied by identifying pathologies, measuring their demands on services and evaluating their repercussions on fetal outcome. Institutional violence, however, has received little attention and is mainly concerned with the consequences of inappropriate use of technologies. Data from the Sexuality and Health Feminist Collective shows that among patients, 20.5% stated that they have never talked about their sexual life with their partners; 38.3% stated that they have had sexual intercourse against their will, including situations ranging from sexual harassment to rape which was referred by 12.3% of them. One of the most relevant issues arising from the anamnesis and interviews of these women was the violence to which they were submitted by health services. The high prevalence of violent situations indicates the urgency of incorporating an approach which deals with gender violence and promotes the empowerment of women into the routine of reproductive health services.

Battered Women↗
PubMedDate not supplied

Women's reproductive health--challenges for the 1990s.

Health policy makers, program planners and donor agencies have paid little attention to issues surrounding women's reproductive health. This paper will look at reproductive health issues surrounding pregnancy and childbirth, the accessibility and safety of contraception, and reproductive tract infections. The gross social injustice caused by high maternal mortality can no longer be ignored. Nor can we ignore the much larger numbers of women who suffer life-long health impairment resulting directly from the health hazards associated with pregnancy and childbirth. The challenge is to reduce maternal mortality by at least 50% by the year 2000. If these challenges are not faced, the 1990s may very well be remembered as the decade that saw the largest numbers of women dying in childbirth and pregnancy. The 1990s will see the addition of some 300 million couples to the reproductive age group. These couples will need access to good sexual health care, including safe and effective contraception, and prevention of reproductive tract infections and sexually transmitted disease. The biomedical consequences of reproductive tract infections are, among others, fetal wastage, low birth weight, carcinoma of the cervix, infertility and ectopic pregnancy. In addition to these consequences, there are the psychological, social and economic costs of these diseases. Some suggestions for meeting these challenges are put forward. These include building on existing programs and expanding available resources to help women to attain health, dignity, and their basic human rights.

Female↗
PubMed2001

Reproductive health in eastern Europe: a collaborative training project in Romania.

Since the fall of the Berlin Wall, fundamental political changes in eastern Europe have affected the Soviet-style health care systems that formerly provided basic care for everyone. Many of these systems have collapsed, and the new systems of social insurance that have replaced them often are inadequate. Advanced Training in Reproductive Health in Romania aimed to create an authority in family planning and reproductive health in selected Romanian university centers and to improve training and research capabilities. Initially, the project had 2 main goals: to provide advanced training in reproductive health and family planning to Romanian obstetrics-gynecology specialists from the main university centers-which would allow them to train other physicians (obstetricians, gynecologists, and general practitioners) and medical students-and to develop, test, and finalize specific training materials in Romanian to be used by the new trainers.

Education, Medical, Graduate↗
PubMed2004

"Change yourself and the whole world will become kinder": Russian activists for reproductive health and the limits of claims making for women.

This article views reproductive health activism as a fruitful site for analyzing the cultural logics through which legitimate claims for women's needs become expressed and circumscribed. It begins from the observation that in the United States and Britain, reproductive health has been a key arena for feminist political claims and struggles for women's rights, bodily integrity, access to health care, and demands for authority in relations with experts. These concerns and struggles have not, however, emerged in all postsocialist contexts, and new activism in Russia reveals strikingly different agendas. Innovative groups of health providers seeking to increase women's access to birth control methods and safe sex, home birth opportunities, and improved health services work outside of feminist perspectives and reject political paths for change. By examining the ideological inspirations, cultural logics, and political-economic constraints shaping the outreach work of Russian health practitioners, the article explains how and why health activism became a site for personal "spiritual" revival and the strengthening of nuclear families. It also explores how conditions following the collapse of socialism have further legitimized activists' rejection of political agendas for change.

Female↗
PubMedDate not supplied

[Priority trends in the prevention of reproductive health disorders].

Common biomedical and sociohygienic risk factors leading to disorders of the reproductive health indicate that universal approaches to their prevention are to be developed. The author discusses primary (mainly social), secondary (sociomedical), and tertiary (mainly medical) prevention of the above conditions. Realization of these measures aimed at preservation and restoration of the reproductive health of a family is intended to solve the problem of proper reproduction of healthy generations.

Female↗
PubMed2005

Implications of bride price on domestic violence and reproductive health in Wakiso District, Uganda.

OBJECTIVE: Bride price payment is a gender issue with implications on gender relations in different socio-cultural contexts. It also impacts Sexual and Reproductive Health and Rights. In a qualitative study on the perceptions of domestic violence in Wakiso district, payment of bride price emerged as one of the key factors associated with domestic violence. The study explored experiences, motivations, meanings, consequences and reproductive health implications of bride price payment in Wakiso district Uganda. METHODS: 10 single-sex focus group discussions and 14 in-depth interviews were conducted in Wakiso and Nangabo sub-counties, Wakiso district from July 2003 through March 2004. Data was analyzed by thematic content analysis, assisted by Easy Text software for data retrieval. FINDINGS: Participants perceived bride price as indicating that a woman was 'bought' into the man's household, which reduced her household decision-making roles. It limited women's independence and perpetuated unequal gender power relations, especially regarding health-seeking behaviour. CONCLUSION: Bride price payment is a contextual factor that the community in Wakiso District, Uganda, perceived as associated with domestic violence, with serious sexual and reproductive health implications.

Adolescent↗
PubMed1998

Medicaid and managed care: meeting the reproductive health needs of low-income women.

State Medicaid programs have increasingly turned to managed care with hopes of controlling spending while improving access to care. The move to managed care has significant implications for the provision of reproductive health services--family planning, abortion, sterilization, sexually transmitted diseases, and maternity care. However, the delivery of reproductive health services in a Medicaid managed care environment is wrought with many difficulties. The complexity inherent in Medicaid policy, the changing world of managed care, and the health and social needs of the Medicaid population are compounded by the sensitive nature of reproductive health needs.

Adult↗