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PubMedDate not supplied

Issues in regulatory protection of reproductive health in the workplace.

Provisions of federal laws that protect reproductive health in the workplace and information on recent federal actions that seek to enhance such protection are reviewed. California's Birth Defects Prevention Act and its Proposition 65, regulatory programs that specifically address reproductive toxicity, also are described.

Abnormalities, Drug-Induced↗
PubMed2004

Evaluating men's involvement as a strategy in sexual and reproductive health promotion.

Nearly 10 years has passed since the 1994 International Conference on Population and Development recognized men as legitimate targets for sexual and reproductive health promotion. This recognition was born of the experience of many health promoting agencies in the 1980s and 1990s who realized that without working with men, change would be very difficult or impossible. It was proposed that men should be involved because their active participation was crucial to the success of programs and to the empowerment of women. However, the idea that men should play an active role in health promotion has not been without its critics, who have posed serious questions about the efficacy of involving men and the effects their involvement would have on women and children. In an effort to examine the lessons learned from men's involvement, this paper reviews published evaluations of interventions that have targeted heterosexual men. Twenty-four studies that met the criteria for inclusion (reported on interventions in areas of sexual and reproductive health that targeted heterosexual men and contained evaluation data) were found. From their review of these studies, the authors suggest that there is some evidence that the use of media approaches may be a successful strategy and that there may be some problems with the application of some cognitive behavior change approaches. However, the fact that few interventions have targeted heterosexual men and have been the subject for detailed evaluation suggests that there is a need for more interventions and better evaluations, which would examine not only the process of men's involvement, but also their impact on the lives of both the men themselves and their families. The reality is that although perhaps no longer regarded as part of the problem, men have yet to be seen as part of the solution.

Family Planning Services↗
PubMed2004

'You are a man because you have children': experiences, reproductive health knowledge and treatment-seeking behaviour among men suffering from couple infertility in South Africa.

BACKGROUND: In Africa, infertility traditionally has been viewed as a female problem. This study explores reproductive health knowledge, health-seeking behaviour and experiences related to involuntary childlessness in men suffering from couple infertility. METHODS: Twenty-seven men from a diverse cultural urban community in South Africa participated in in-depth interviews at the time of their first visit to an infertility clinic in a tertiary referral centre. RESULTS: Men had little knowledge about the physiology of human fertility, causes of infertility and modern treatment options. Awareness of male factor infertility was, however, high. Most men appeared involved in the health-seeking process. Men described their emotional reactions to childlessness and the impact of infertility on marital stability, and many reported that infertile men suffered from stigmatization, verbal abuse and loss of social status. CONCLUSIONS: These findings improve our understanding of the reproductive health needs of men suffering from couple infertility in Africa. This understanding is essential for the effective integration of male partners into modern infertility management. The need for appropriate counselling of men and, most particularly, for education of the community is recognized.

Community-Institutional Relations↗
PubMedDate not supplied

History of nurse-midwifery in reproductive health care.

From the maternity cycle to the primary health care of women, this article traces the expansion of the role of midwives in reproductive health care over the past 3 decades. Included are the recollections of Shirley Okrent about the early development of this role expansion and a few of the author's personal memories.

Female↗
PubMed2003

Using accountability to improve reproductive health care.

Accountability is best understood as a referee of the dynamics in two-way relationships, often between unequal partners. The literature on accountability distinguishes between political, fiscal, administrative, legal and constitutional accountability. This paper focuses on accountability mechanisms in health care and how they mediate between service providers and communities and between different kinds of health personnel at the primary health care level. It refers to case studies of participatory processes for improving sexual and reproductive health service delivery. Information, dialogue and negotiation are important elements that enable accountability mechanisms to address problems by supporting change and engagement between participants. In order to succeed, however, efforts towards better accountability that broaden the participation of users must take into account the social contexts and the policy and service delivery systems in which they are applied, address power relations and improve the representation of marginalised groups within communities and service delivery systems.

Attitude of Health Personnel↗
PubMed2001

Endocrine disrupting chemicals: effects on human male reproductive health.

There is now considerable evidence that male reproductive function is declining in human and wildlife populations. This is coincident with the increasing use and prevalence of man-made chemicals in the environment over the last fifty years. Certain chemicals have subsequently been shown to disturb the developing fetal endocrine system of laboratory animals in utero. In these experiments, treatment caused similar male reproductive problems in offspring as those already observed in wildlife and human populations. In addition, both the human DES data and rodent studies have shown that there are specific windows of gestation when the developing fetal gonad is highly sensitive to small endocrine changes. Animal in vivo and human in vitro studies have identified EDC sensitive genes. Consequently, hypotheses are being generated concerning mechanism of action e.g. disturbed testicular apoptosis and altered hepatic biotransformation of steroids. While animal studies provide us with valuable insights into the range of effects that can be attributed to in utero EDC exposure, varying maternal doses employed by different research groups make relation of the results to human observations difficult. The EDC concentration representative of fetal exposure levels is uncertain. Confounding factors include: (a) the vast number of chemicals termed EDCs, (b) the ability of chemicals to bioaccumulate in body lipid, (c) the metabolism of body lipid during pregnancy releasing the mothers lifetime EDC legacy into circulation and (d) the poorly understood kinetics of EDC transfer across the placenta. Thus, the level of fetal exposure can only be crudely estimated at present. This highlights the need for large animal models of EDC in utero exposure where the partitioning of EDCs between the mother and fetus and transfer across the placenta can be studied in detail. Despite considerable effort the mechanisms by which these endocrine disrupting chemicals exert their effects are still largely unknown. Further studies of the mechanism of action, and consequences, of EDCs in fetal development must be done in order to elucidate how EDCs exert their effects. This can only be achieved using a combined approach whereby animal models are used in combination with in vitro human studies. In conclusion however, there are now sufficient animal model data to prove that EDCs can adversely affect reproductive development and function in the male. Our further understanding of the mechanisms involved may allow intervention strategies whereby we can at least prevent a further decline in male as well as female reproductive health.

Animals↗
PubMedDate not supplied

[Care of reproductive health in adolescents].

Sexual behaviour in adolescent period is an important factor of reproductive health in later life. The scope of the study is to assess features of sexual behaviour in boys and girls aged 15-19 in Croatia. The study included 2466 schoolboys and 2858 schoolgirls in six towns in Croatia. According to obtained data sexual experience has been present in 49% of boys and 22% of girls. 60% of sexually active adolescents don't use any contraceptive means. Basic knowledge in human reproduction as well as in contraception is very poor in almost all examinees. Rate of induced abortion is much lower than in their peers in Western Europe as well as in the United States. The needs for an intensive health education programme of children and adolescents as well as the administration of an effective programme for the protection of their reproductive health have been stressed.

Adolescent↗
PubMed2006

Randomized trial of peer counseling on reproductive health in African American breast cancer survivors.

PURPOSE: We designed a peer counseling program to improve sexual function, increase knowledge about reproductive health, and decrease menopausal symptoms and infertility-related distress for African American breast cancer survivors. PATIENTS AND METHODS: Women were randomly assigned to immediate counseling or a 3-month waitlist. Three peer counselors conducted a 3-session intervention using a detailed workbook. Questionnaires at baseline, after the waitlist period, at posttreatment, and at 3-month follow-up assessed spirituality, sexual function, menopause symptoms, emotional distress, relationship satisfaction, fertility concerns, and knowledge about reproductive health and breast cancer. At the postcounseling assessment, women rated the workbook, their counselor, and the program. RESULTS: Of 93 women screened, 60 women (65%) enrolled in the study. Women who completed counseling (80%; N = 48) had a mean age of 49 years (standard deviation [SD], 8 years) and a mean follow-up of 4.5 years (SD, 3.8 years) since cancer diagnosis. Almost all rated the workbook as very easy to understand (94%) and their counselor as very knowledgeable (96%) and very skillful (98%). Eighty-one percent rated the program as "very useful to me." Immediate counseling and waitlist groups did not differ at baseline in psychologic adjustment, nor did scores change during the waitlist period. Therefore, the groups were combined in analyzing outcomes. Knowledge of reproductive issues improved significantly from baseline to 3-month follow-up (P < .0001), as did emotional distress (P = .0047) and menopause symptoms (P = .0128). Sexually dysfunctional women became less distressed (P = .0167). CONCLUSION: Women valued the Sisters Peer Intervention in Reproductive Issues After Treatment program highly and found it relevant. The program had positive effects on knowledge and target symptoms.

Adaptation, Psychological↗
PubMed2002

Reproductive health knowledge and use of services among young adults in Dakar, Senegal.

A study was conducted in Dakar, Senegal, to measure reproductive health knowledge and contraceptive use among young adults, and access to family planning services. A household survey was conducted with 1973 single and married women aged 15-24 and 936 single men aged 15-19. Two focus groups and a simulated client study were also conducted. The survey and focus groups noted gaps in knowledge of family planning methods and reproductive health. There were misconceptions about methods and only one-third of men and women aged 15-19 correctly identified the time of the menstrual cycle when a women is most likely to get pregnant. Contraceptive use at time of first premarital sexual experience was less than 30%. The simulated client study noted many barriers to services. 'Clients' felt uncomfortable in the clinics and felt that providers were reluctant to take care of them. None of the 'clients' who requested contraception received it.

Adolescent↗
PubMed1996

Utilisation of reproductive health services in rural Vietnam; are there equal opportunities to plan and protect pregnancies?

STUDY OBJECTIVES: To describe the utilisation of reproductive health services (family planning, antenatal care, and delivery services) and the socioeconomic determinants for utilisation of health services. DESIGN: This was a cross sectional survey, using a multistage sampling technique. SETTING: Tien Hai district, Thai Binh Province, Vietnam. Altogether 1132 mothers with children under 5 years of age were interviewed about antenatal, delivery, and family planning services utilisation during a five year period (1987-92). MAIN RESULTS: Seventy per cent of the women used contraceptive methods, with the intrauterine device being the most common. The use of the intrauterine device was positively associated with the number of children alive but not with other sociodemographic factors in the mothers. Thirty per cent of the women had attended an antenatal clinic for check ups during their last pregnancy. It was found that mothers with fewer deliveries, higher education, and who were Buddhist or of no religion had utilised antenatal services more frequently than the others. Seventy five per cent of the mothers in this study had been assisted by health professionals at their last delivery. Those mothers with fewer deliveries, higher education, who were Buddhist or had no religion, and had sufficient to eat were more likely to have their births attended by health professionals. CONCLUSIONS: In spite of a relatively high education level in the population and services which are generally available, there was an under utilisation of antenatal and delivery care and there was no equal opportunity for different groups of mothers to use these services. Family planning services were, however, frequently used and were used to the same extent by different groups of mothers. Except for abortion, alternatives to the intrauterine device method were rarely available. If pregnancies are to be protected in an efficient way in rural Vietnam, reproductive health care must be strengthened and efforts should be made to reach the women who are not using these services at present.

Adult↗
PubMed2003

Improving young people's access to reproductive health care in rural Zimbabwe.

The aim of this study was to explore ways to improve the accessibility of clinics for young people with reproductive health problems in rural Zimbabwe. This study, which took place in rural Masvingo, was part of a project to develop a comprehensive adolescent reproductive health intervention for Zimbabwean youth. Six focus group discussions were held with secondary school pupils aged 16-19; four focus group discussions were held with nurses. Additionally, 16 community meetings with parents of adolescents were observed. The data were analyzed using the principles of grounded theory: three main categories and several sub-categories emerged from the data. The accessibility of existing services for young people was poor, partly because nurses were reluctant to provide such services due to lack of clarity in legislation and also through fear of condoning adolescent sexual activity. Although the clinical acumen of staff was recognized as sound, service delivery was perceived to be judgemental and lacking in confidentiality and privacy. This reflects the cultural context in which services are delivered. Culturally, adolescents are deemed to be children and as such to have few rights. There is a widely held belief that teaching young people about sex will promote sexual activity. Our findings suggested that staff training should focus on attitudinal rather than medical issues.

Adolescent↗
PubMed2000

Reproductive health, infertility and sexually transmitted infections in indigenous women in a remote community in the Northern Territory.

OBJECTIVE: To investigate markers of reproductive health in a remote Indigenous community in Northern Australia. METHODS: A retrospective, cross-sectional analysis of case notes of 342 women between the ages of 20 and 45 years, living in one community in a remote region of the Northern Territory. RESULTS: The total rate of current infertility in the community was 26.3%; 8.2% for primary infertility and 18.1% for secondary infertility. An additional 3.3% of women had resolved infertility. Only 43% of the women had sought medical help for the problem. A history of ectopic pregnancy was recorded in 2.6%, stillbirth in 1.8%, miscarriage in 14.3% and neonatal death in 12.3%. Depot steroidal contraception or tubal ligation were used by 50% of the women but 45.9% used no contraception. A history of pelvic inflammatory disease (PID), T. vaginalis N. gonorrhoeae, genital C. trachomatis infection, syphilis or bacterial vaginosis was noted in 32%, 46%, 27%, 30%, 41% and 9% respectively. Current alcohol consumption was reported in 23% and cigarette smoking in 76%. In multivariate analysis, infertility was strongly associated with PID (adjusted OR 8.5), alcohol consumption (AOR 3.1), T. vaginalis (AOR 2.5), N. gonorrhoeae (AOR 2.2) and bacterial vaginosis (AOR 2.9). CONCLUSION: Reproductive health is poor in this community of Indigenous women, with endemic levels of STDs, PID and tobacco consumption. The absence of barrier contraception (e.g. condoms, diaphragms) has implications for HIV and STD control. Clinical and public health interventions are urgently required but the implementation of these is hindered by a number of structural, social and economic barriers.

Adult↗
PubMed1998

[Some elements for interpreting men's presence in reproductive health processes]

This study aims to identify analytical approaches to situate men in processes pertaining to reproductive health. We challenge the position that identifies them only as actors that can support improvements in the health of women and children. More recently there has been a concern over reshaping their role, as individuals who both reproduce and face risks to their reproductive organs, behaviors, and processes. One possibility for explaining men's presence in such processes is to identify their absence or presence as conditioning the consequences for women and children. The issue is to determine how they hamper or foster maternal health. A second possibility is to delve into the relational, social, and potentially conflictive nature of "sexualized" reproduction. This implies a new approach to the analysis of reproduction as a relational process, rather than as isolated events involving men and women, meanwhile recovering the respective specificities. The gender perspective is used to conceive of processes without denying the power dimension. Thus, a new approach is taken to sexuality, reproduction, and health in terms of interaction, in order to build clearer references with regard to the male population. We base our study on the approach attempting to build reflections on men as related to the dynamics of reproductive health.

Journal Article↗
PubMed2003

Meeting the reproductive health care needs of adolescents: California's Family Planning Access, Care, and Treatment Program.

PURPOSE: To examine the effect of the California Office of Family Planning's Family Access, Care, and Treatment Program (Family PACT), which was established in 1997 to provide comprehensive, reproductive health services for low-income adolescents and adults. Program evaluation was used to measure access to services, develop a profile of users, identify service utilization patterns, and assess the sensitivity of the health care system to the needs of adolescents. METHODS: Data sources include baseline data on California's previously established family planning services, enrollment, and claims data for the first 4 years of Family PACT, client exit interviews, and on-site observations. RESULTS: Adolescents represented 21% of all clients served by Family PACT in fiscal year 2000-2001 (FY 2000-2001). Adolescent clients served increased from 100,000 in FY 1995-1996 to more than 260,000 in FY 2000-2001(161% increase). The proportion of males has increased from 1% to 11%. In FY 2000-2001, Hispanics comprised 50% of adolescent clients, followed by 32% white, 9% African-American, and 6% Asian, Filipino, or Pacific Islander. Over one-half were aged 18 or 19 years, 42% were aged 15 to 17 years, and 5% were aged younger than 15 years. Contraceptive methods most often dispensed were barrier methods (55% for females, 72% for males), oral contraceptives (44%), contraceptive injections (16%), and emergency contraceptives (7%); 57% received sexually transmitted infection screening. CONCLUSIONS: By linking eligibility determination to the delivery of services, removing cost barriers, increasing the numbers and types of providers offering publicly funded services, and ensuring confidentiality, greater numbers of adolescents obtained needed reproductive health care, thus ensuring an opportunity to reduce unintended pregnancies and sexually transmitted infections.

Adolescent↗