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PubMed2005

The sexual and reproductive health of young people in the Arab countries and Iran.

This article reviews the sexual and reproductive health situation of young people aged 10-24 in the Arab states and Iran, based on published and unpublished literature and interviews with 51 key informants working mostly in NGOs and international agencies in the region. There are few national government programmes addressing young people's sexual and reproductive health, with the exceptions of Tunisia and Iran, and a lack of population-based data to guide such programmes. Although the strong emphasis on the integrity and strength of the family unit has a protective effect, young people lack access to information. Education curricula that include these topics are rare and where they do exist, relevant sections are frequently skipped over by teachers, who are unprepared. Health service providers neither recognise the needs of this age group nor make young people welcome, particularly those who are unmarried. Increased education and employment mean the age at marriage is rising, but unprotected forms of marriage are also reported. Taboos surrounding discussion of sexuality remain a key constraint, and data on unwanted pregnancy and abortion, violence against women, and STIs/HIV/AIDS are limited. Building on NGO models and existing efforts, there is a need for the development of national programmes to support the well-being of young people in this region.

Adolescent↗

PubMed1998

Reproductive health. New perspectives on men's participation.

New information, new understanding, and new approaches promise to help men become full partners in better reproductive health. Men, as well as women, play key roles in reproductive health, including family planning, but increasing men's participation has been difficult. Adopting new perspectives can help.

Family Planning Services↗

PubMedDate not supplied

Reproductive health in women with eating disorders.

Medical complications are often the precipitants that lead women with eating disorders to seek health care. Complications can be wide ranging but frequently include symptoms associated with reproductive health. Unfortunately, because of the denial, embarrassment, shame, and secrecy associated with these psychiatric illnesses, the underlying cause of these complications can often go unacknowledged, delaying assessment and intervention. This article provides an overview of anorexia nervosa and bulimia nervosa, identifies the reproductive health issues that may occur in women with these disorders, and discusses the associated clinical implications for nursing practice.

Feeding and Eating Disorders↗

PubMed2003

A case/comparison study in the Eastern Region of Ghana on the effects of incorporating selected reproductive health services on family planning services.

OBJECTIVE: to assess the impact on the provision of family planning (FP) services when FP providers were also trained to provide additional, selected, reproductive health services. DESIGN: case/comparison study. PARTICIPANTS AND SETTINGS: twenty-four FP service delivery points in which training in sexually transmitted infection prevention and control services or post-abortion care services had been initiated (case facilities), were compared to 19 control facilities in which similar provider training had not yet been targeted. All settings were located in the Eastern Region of Ghana. MEASUREMENTS: service statistics for three study years (1996-1998) were reviewed. Structured interviews with providers, managers and clients provided qualitative data concerning impact and satisfaction. FINDINGS: case facilities which had integrated these additional reproductive health (RH) services experienced consistently higher numbers of clients and the total number of clients receiving FP services increased over time. There was also a statistically significant increase in continuing FP clients within case facilities. In contrast, the number of FP clients serviced in the comparison area remained basically unchanged over time. KEY CONCLUSIONS: interviews conducted with providers and managers in both types of settings indicated strong support for receipt of training to provide these integrated services and a request for additional training in an even broader array of RH and adult/child services. Clients also perceived the benefit of additional RH services and perceived these services to be of high quality. IMPLICATIONS FOR PRACTICE: expanding the repertoire of clinical skills of FP providers, enabling these practitioners to render RH services that augment basic FP services, has the potential to increase the number of new and continuing FP clients, and increases the satisfaction of both providers and consumers with respect to these services.

Abortion, Induced↗

PubMed2006

[Prospective analysis of teaching on alcohol use prevention and reproductive health at educational institutions in Lima-Peru. 2003-2004].

This study deals with the teaching of contents related to alcohol use prevention and reproductive health at 4 Education Schools/Colleges in Lima-Peru. 123 persons participated: teaching authorities, faculty, students and ex-students. The instrument for data collection and prospective analysis was elaborated and validated by the Pan-American Health Organization and adapted to this study. 40 indicators were selected for reproductive health and 32 for alcohol use prevention, which were distributed into 4 basic elements: context, structure, function and comprehensiveness, each of which were submitted to three scenarios, whose situations were defined in a continuum from stability to transformation. In view of these scenario, the results indicate moderate changes to different extents in the indicators (and consequently in the two subject areas), which were present across the 4 elements, in spite of a tendency towards stability that represents the maintenance of traditional perspectives and actions.

Alcohol Drinking↗

PubMed2000

[Development of reproductive health in women in the Czech Republic 1993-1997. III. Induced abortion].

OBJECTIVE: To analyze the effect of changes in system of health and social care on reproductive health of women. In particular to analyze the changes in frequency of induced abortions as a basis for evaluation of changes in contraceptive use. DESIGN: Retrospective comparative epidemiological study. SETTING: Institute for the Care of Mother and Child, Praha 4--Podolí. METHODS: The database of the Czech Office of Health Statistics and Information was used. Besides comparison of absolute numbers of induced abortions we used international criteria "Abortion rate" and "Abortion ratio". These parameters were compared with maternal age, marital status, level of education, and number of children. RESULTS: Since the legislature on induced abortions came into effect till 1991 the annual variations of the number of induced abortions in the Czech Republic were inverse to changes in number of births due to current fertility. However, since then the number of abortions has been decreasing while the number of births was also decreasing. Using the abortion ratio as a measure, we were able to observe the decrease from 34.3 to 29.1% during 1993-1997, however the later value is still higher than in developed world. According to the selected social-demographic parameters of women we have seen the highest decrease of absolute number of abortions among married women, women with two children, and women with secondary education. According to the number of abortions per 1000 women of reproductive age there has also been decrease among married women, however also among women 15-19 year and among women with university education. The smallest decrease of abortion rate has been observed among single women. CONCLUSIONS: In this part of the study we analyzed the decrease of induced abortions during 1993-1997 related to four selected social-demographic characteristics of women of reproductive age. Our results will be used for further analyses of relationship of contraception and induced abortions during the specified period. Such analysis is a subject of separate study.

Abortion, Induced↗

PubMed1996

Age of sexual debut related to life-style and reproductive health factors in a group of Swedish teenage girls.

AIM: To compare life-style and reproductive health care factors in girls with a coitus debut < 15 years of age and girls with a later debut. METHODS: Girls resident in the municipality of Karlstad, Sweden, starting their upper secondary school education were invited to attend the teenage clinic during two years (five visits). Gynecological examinations were performed and questions were asked about possible symptoms, sexual activity, contraception and sexually transmitted diseases. RESULTS: Ninety-eight girls accepted the invitation to participate and 88 girls completed all visits (mean age on admission 16 years). Median age for coitarche was 16 years. A sexual debut < 15 years was reported by 17 girls (19.3%), 54 (61.4%) had their debut > or = 15 years and 17 girls (19.3%) had not had their sexual debut on completion of this study. Girls with an early sexual debut had a greater number of sexually transmitted diseases (p < 0.05) and more cervical atypias (p < 0.05), and more often had a menarcheal age < 13 years (p < 0.05), > two brothers and/or sisters (p < 0.01), were more often not living with their parents (p < 0.01) and reported a greater number of life-time partners (p < 0.06) than the remainder, Girls with a sexual debut < 15 years started drinking alcohol earlier than others (p < 0.01). There was a greater proportion of smokers among girls with an early sex debut compared to the remainder (p < 0.05). CONCLUSIONS: Early sexual debut is associated with an earlier menarche and a more premature adult life-style and is an important indicator for continued risk behavior regarding reproductive health.

Abortion, Legal↗

PubMed1995

[Reproductive health of the family as a goal of industrial medicine].

Modern demographic situation stressed the problems of human reproductive health associated with industrial medical topics. The article suggests to regard a family (child and two parents) as a unit under study in industrial medicine. This methodic approach should work in scientific programs reviewing influence of industrial ecology and environmental factors on reproductivity. The authors suggest elaboration of universal strategy for ecologic and epidemiologic studies to form a scientific branch "Epidemiology of reproductive health" and to elaborate methods for better health management during the present demographic crisis.

Family↗

PubMed1995

Compliance with return appointments for reproductive health care among adolescent Norplant users.

PURPOSE: Norplant's long duration of action may result in users being less motivated than non-users to return for reproductive health care appointments. This study determined compliance with scheduled return appointments among adolescents using Norplant and those using other methods of contraception. METHODS: We retrospectively reviewed the records of all teenagers (age < or = 18 years) who received Norplant between June 1991 and August 1993, as well as those of a comparison group of adolescents, matched for age and race, using other methods of contraception. Subjects receiving Norplant were given appointments for a two-week and an annual examination. Comparison subjects were given only an appointment for an annual examination. Norplant users not returning within 5 weeks or any subject not presenting within 12 months for an annual examination, were considered non-compliant. RESULTS: Eighty-eight adolescents received Norplant during the study period and the records of 85 were available for review. Only 48 of the 85 Norplant users returned for scheduled two-week check-up, while 18 of 43 subjects who had Norplant at least 12 months were compliant with annual examinations. The compliance rate with annual examinations among the 89 subjects not using Norplant was 38%, not dissimilar from that of the Norplant group. CONCLUSIONS: These data demonstrate that compliance with return appointments for reproductive health care among adolescent Norplant users is poor but not significantly worse than that of non-users of Norplant. Strategies promoting the benefits of return visits need to be improved for adolescents receiving contraception.

Adolescent↗

PubMedDate not supplied

Crossing the public-private sector divide with reproductive health in Cambodia: out-patient services in a local NGO and the national MCH clinic.

Set within the context of recent literature on the private-public divide in the health sector of developing countries generally and Asia specifically, this study considers the major government and the major indigenous non-government clinics offering out-patient reproductive health services in Phnom Penh, Cambodia. Reproductive health is of critical importance in Cambodia, which has one of the highest levels of unmet need for family planning in the developing world and suffers from what is arguably the most severe STD and HIV/AIDS problem in Asia. The study is unusual in that it examines and compares aspects of service delivery and pricing along with the socio-economic profile and health-seeking behaviour of clients self-selecting services in the two settings. The socio-economic status of clients was much higher than the norm in Cambodia but did not differ significantly between the two clinics. A few service indicators suggested that the quality of care was better in the NGO clinic. Underlying variables--such as the broader mandate of the public sector institution and the significant discrepancy between public and private sector salaries--offer an obvious explanation for these differences. The Ministry of Health in Cambodia has been developing policies related to the NGO sector, which has expanded rapidly in Cambodia during the 1990s, and it is struggling to increase staff remuneration within the public sector.

Adult↗

PubMedDate not supplied

[Trends in female reproductive health and health of newborns in an industrial city].

The reproductive health of women and health status of newborns is assessed for the period of 1979-1995. The incidence of diseases of pregnancy, abnormal labors, and chronic diseases concomitant with pregnancy has increased. The social structure of women has changed. The share of healthy women decreased and that of women with combined diseases during gestation, labor, and with concomitant diseases increased. The incidence of diseases in the newborns increased over the studied period. The process of newborn acceleration is over; we can now speak about relative delay of physical development.

Adolescent↗

PubMed2002

Effects of exposure to environmental tobacco smoke on reproductive health.

The scientific evidence on the effects of preconceptional and prenatal exposure to environmental tobacco smoke on reproductive health is reviewed in this article. The evidence is the most convincing for the adverse effects of environmental tobacco smoke on birthweight. In meta-analyses, exposure to environmental tobacco smoke has been estimated to reduce mean birthweight by about 25-40 grams. The majority of the studies on low birthweight also show a moderately or slightly increased risk among infants of exposed women. There is also some support for an association between high exposure to environmental tobacco smoke and preterm birth. The evidence on the effects of environmental tobacco smoke on spontaneous abortion and birth defects is weak and inconsistent. Very little is known about the impact of exposure on fertility, menstrual function, reproductive health of men, and childhood cancer. Further studies, paying attention to study design and careful exposure assessment, are therefore needed on these associations.

Abortion, Spontaneous↗

PubMed2005

The importance of socio-economic context for social marketing models for improving reproductive health: evidence from 555 years of program experience.

BACKGROUND: Over the past two decades, social marketing programs have become an important element of the national family planning and HIV prevention strategy in several developing countries. As yet, there has not been any comprehensive empirical assessment to determine which of several social marketing models is most effective for a given socio-economic context. Such an assessment is urgently needed to inform the design of future social marketing programs, and to avoid that programs are designed using an ineffective model. METHODS: This study addresses this issue using a database of annual statistics about reproductive health oriented social marketing programs in over 70 countries. In total, the database covers 555 years of program experience with social marketing programs that distribute and promote the use of oral contraceptives and condoms. Specifically, our analysis assesses to what extent the model used by different reproductive health social marketing programs has varied across different socio-economic contexts. We then use random effects regression to test in which socio-economic context each of the models is most successful at increasing use of socially marketed oral contraceptives and condoms. RESULTS: The results show that there has been a tendency to design reproductive health social marketing program with a management structure that matches the local context. However, the evidence also shows that this has not always been the case. While socio-economic context clearly influences the effectiveness of some of the social marketing models, program maturity and the size of the target population appear equally important. CONCLUSIONS: To maximize the effectiveness of future social marketing programs, it is essential that more effort is devoted to ensuring that such programs are designed using the model or approach that is most suitable for the local context.

Condoms↗

PubMed2001

Male involvement in reproductive health care.

The programme of action globally endorsed at the International Conference on Population and Development (ICPD) emphasised the need for equity in gender relations with a special focus on men's shared responsibility and active involvement to promote reproductive and sexual health. If men are brought into a wide range of reproductive health services in such a way that they are supported as equal partners and responsible parents, as well as clients in their own right, better outcomes are expected in reproductive health indicators such as contraception acceptance and continuation, safer sexual behaviours, use of reproductive health services, and reduction in reproductive morbidity and mortality. This paper focuses on these key questions. What does men's involvement mean and how should it be operationalised? What does shared responsibility mean for various reproductive health problems subsumed within the reproductive health framework? Programmes to involve men should be designed to address three major goals: (1) Improve sexual and reproductive health of men and women, (2) generate men's support for women's actions related to reproduction and respect for women's reproductive and sexual rights, and (3) promote responsible and healthy reproductive and sexual behaviour in young men and boys. Gender inequality is a major barrier that must be overcome if these goals are to be met. Improving the reproductive well-being of women and men requires freeing them both from restricted gender roles.

Contraception↗

PubMed1998

Biomarkers for assessing human female reproductive health, an interdisciplinary approach.

Identification of environmental hazards to reproductive health and characterization of the adverse outcomes necessitate a multidisciplinary approach. Epidemiologic studies are required for the identification of adverse health effects in human populations and then to confirm that specific exposures are responsible. Clinical studies are required to develop assays for reproductive biomarkers and to validate these assays prior to their application in the field. Assays for field use must be formatted and streamlined for large-scale applications and, whenever possible, computer algorithms should be developed to interpret biomarker data. Appropriate animal models must be identified, biomarker assays validated for that model, and animal experiments conducted to identify the mode of action and target organ of a putative reproductive toxicant. Finally, in vitro studies at the level of the cell and cell organelle are essential for mechanisms for toxicity to be clearly identified and understood. In this article we describe the interdisciplinary approach that we have developed for study of the effects of environmental agents on female reproductive functions. This effort requires specific skills of toxicologists, epidemiologists, physicians, biochemists, and physiologists.

Adult↗

PubMed2006

Perceptions and practices of private medical practitioners to adolescent reproductive health in Lagos State, Nigeria.

INTRODUCTION AND OBJECTIVES: Adolescent sexual and reproductive ill health is a major global public health issue, contributing to high levels of morbidity and mortality in adolescents. Although adolescents are known to have low levels of doctor consultations, private medical practitioners remain the preferred health care providers. This study was carried out to document the attitudes and experiences of private medical practitioners to adolescent reproductive health issues and to assess the factors that may influence their attitudes. METHODS: Information was obtained from a random sample of 187 out of 352 (53% ) registered private medical practitioners in 5 of the 20 Local Government Areas in Lagos State using a self-administered structured questionnaire. RESULTS: Sixty-two per cent of the doctors claimed they saw adolescents regularly, mainly for the treatment of sexually transmitted infections (STIs). Many (86% ) believed that adolescents should use contraception and suggested that parents, teachers and health workers provide sexuality information to adolescents. Sixty one percent of the practitioners believed that abortion should be legalised, though with restrictions. Many of them admitted to providing post abortion care to adolescents. The religious affiliation of the private medical practitioners influenced their perception and practices. CONCLUSION AND RECOMMENDATIONS: Improving the reproductive health care of adolescents is key to improving the world's future economic and social well being. It is recommended that appropriate sexuality education be made widely available to adolescents. In addition, private medical practitioners should strengthen their skills and be more actively involved in the care of adolescents by making their facilities more adolescent friendly.

Abortion, Induced↗

PubMed2000

Menstrual dysfunction: a missed opportunity for improving reproductive health in developing countries.

The field of population has undergone a paradigm shift to a broader focus on reproductive health, which recognises women's self-perceived health needs. Investigations in various countries reveal that menstruation is a primary concern of women. Yet sparse attention has been paid to understanding or ameliorating women's menstrual complaints. We propose including the management of menstrual complaints as part of reproductive health programming. Next steps should include further quantitative and qualitative research to understand the prevalence, determinants and consequences of menstrual dysfunction; developing appropriate protocols and low-cost interventions for diagnosis and treatment of menstrual morbidity and training of health care workers in resource-scarce settings; and developing educational interventions to facilitate women's understanding of normal menstrual function and variability as well as of the types, causes and appropriate treatments for menstrual dysfunction.

Cost of Illness↗

PubMed2001

Semen quality and male reproductive health: the controversy about human sperm concentration decline.

Concern about the effect of environmental changes on male reproductive health has grown in recent years to become a major preoccupation in some developed countries. A possible decline in human sperm concentration was suggested in the early seventies following studies in the US. In 1992 a meta-analysis of 61 articles published by Carlsen et al. concluded that the mean sperm count of healthy men had declined by 1% per year over the previous 50 years. From 1995 and onwards, some retrospective, longitudinal analyses of the sperm count of fertile or infertile men contradicted this while others did not. The demonstration of a geographical variation in sperm concentration, between and within countries or regions, appears to be less controversial. The amplitude of the difference observed cannot only be explained by methodological or confounding factors, and must to some extent be attributed to ethnic, genetic or environmental factors. As many of the published studies suffer from imprecision regarding the description of population characteristics and confounding factors, and were not designed with controlled and standardised methodology, the debate remains open. Prospective studies in well-defined cohorts of men in various populations are required to evaluate the potential effect of external factors on male reproductive health. These studies should not be limited to the analysis of sperm concentration, as this may not be the best biomarker of testis function and human fertility.

Female↗