Family planning and PHC programme.
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Chronically and variably impaired autonomy makes women with chronic mental illness particularly vulnerable to contracting sexually transmitted diseases (STDs) including AIDS. A lack of female controlled protective devices also adds to the vulnerability of these patients. In this context, the authors make recommendations for the design of clinically comprehensive and ethically justified programs to minimize the risk of mentally ill women for STDs. When female chronically mentally ill patients are at risk of STDs, barriers to the exercise of their autonomy must be identified and clinically treated. Preventive clinical interventions can also be usefully augmented by educational strategies and facilitate patients' communication and behavioral skills, particularly in order to enable them to abstain from unwanted sex or to make prospective male partners wear a condom. Outreach efforts to the male partners of female patients and to the homeless mentally ill may also be required. Preventive services could be integrated and coordinated with STD clinics, substance abuse treatment programs and family planning programs.
OBJECTIVES: This review summarizes abortion statistics, mainly in Europe and primarily in Eastern Europe. The reasons for unwanted pregnancies and consequent abortions are analyzed. Recommendations are proposed to achieve a shift from abortion to contraception in fertility regulation. METHODS: The relevant literature and the results of the data collected by the author in 16 Eastern European countries by means of a questionnaire are reviewed. CONCLUSIONS: The need and the possibilities for better future perspectives are outlined in the conclusions of The Szeged Declaration. The major problems identified were the low level or lack of training of professionals, deficiencies in the knowledge of current family planning methods among professionals, consumers, policy makers and media representatives, the lack of supplies of modern contraceptives to meet the needs of the population, the lack of sex education in schools and the high level of induced abortions. In the majority of the countries in the Eastern European region, there is a need for the establishment of a system for the delivery of high-quality family planning services. This imposes a requirement for the establishment of a system for the continuous supply of contraceptives, through national family planning programs, by governmental and/or nongovernmental organizations. To increase contraceptive use, countries in this region should consider the establishment of extensive educational programs on current family planning methods and other aspects of reproductive health for their health professionals, consumers and representatives of the media. Sex education in schools should be promoted. Governments should be encouraged to invest more in setting up and running family planning services and programs.
This study was conducted to heighten awareness of quality of care as a programmatic issue in the Moroccan governmental family planning program and to test modified Situation Analysis instruments for measuring quality of care. Data were collected from 50 service-delivery points in five provinces to measure six elements of quality in accordance with the Bruce/Jain framework. A procedure for calculating quality-indicator scores is presented. Although facilities varied by province and within provinces, most had the equipment and supplies needed to deliver services; service personnel were trained and regularly supervised; the service-delivery points scored well on mechanisms to ensure continuity of use. Notable shortcomings included a dearth of materials for counseling and a widespread unavailability of the Ovrette pill. This study raises issues regarding the complexity of measuring quality, the ownership of results, and the appropriateness of a centralized study of quality in a decentralized program.
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This study traces the diffusion of family planning behavior-the use of abortion, contraception, and/or sterilization-in Korea between 1935 and 1976. Within- and cross-cohort examinations were made of the levels of ever-use of family planning, method of initiation of family planning, and patterns of family planning behavior. Ever-use of any of the three modes was very low for all cohorts prior to the introduction of the National Family Planning Program in 1962; afterwards, family planning diffused at a rapid rate. A major determinant of ever-use levels attained by cohorts married before 1962 was the length of time between the introduction of the program and menopause.
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Five programs of instruction in the ovulation method (OM) in diverse geographic and cultural settings are described, and characteristics of approximately 200 consecutive OM acceptors in each program are examined. Major findings include: the religious background and family size of acceptors are variable, as is the level of previous contraceptive use. Acceptors are drawn from a wide range of socioeconomic and religious backgrounds; however, family planning intention was similarly distributed in all five countries. In sum, the ovulation method is accepted by persons from a variety of backgrounds within and between cultural setting.
The lactational amenorrhea method is a natural method of family planning for women who breastfeed their infants. The underlying physiology results in a natural suppression of ovulation, and the concomitant amenorrhea, induced by exclusive (or almost exclusive) breastfeeding. This in addition to the infant's age of 6 months or less and specific feeding pattern are the parameters used to identify the possible return of fertility. The lactational amenorrhea method provides at least 98% protection against pregnancy. Data from a recent multicenter study of breastfeeding support the use of the lactational amenorrhea method as a natural family planning method. The lactational amenorrhea method can be incorporated into natural family planning programs and teaching.
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AIM: To evaluate the acceptance and efficacy of the lactational amenorrhoea method of family planning in breastfeeding clients attending clinics of the NZ Association of Natural Family Planning. METHODS: Mothers who were fully breastfeeding their babies, were amenorrhoeic and were early postpartum were offered for the purpose of family planning either lactational amenorrhoea method or the usual fertility awareness charting method. The clients who chose lactational amenorrhoea method were contacted at monthly intervals to check if they continued to meet the lactational amenorrhoea method criteria of fully breastfeeding and amenorrhoea. The fertility awareness group followed the normal practice of clinic visits for instruction until they became autonomous users. The status of both groups were assessed at 6 months postpartum when lactational amenorrhoea method users were advised to adopt another family planning method. RESULTS: Of 149 breastfeeding clients, 110 met the lactational amenorrhoea method criteria. Seventy chose lactational amenorrhoea method, the majority (56.7%) because of its simplicity. Thirty (48.6%) of initial lactational amenorrhoea method users were able to use the method for the full 6 months postpartum period. None of the women conceived while using lactational amenorrhoea method. CONCLUSION: For mothers who choose to fully breastfeed and who maintain a state of amenorrhoea lactational amenorrhoea method is an effective means of avoiding pregnancy during the first 6 months postpartum.
In Sri Lanka in 1975, the majority Sinhalese had a much higher use of contraception than either the Sri Lanka Tamils or the Moors. This study uses a national sample of women of childbearing age gathered by the Sri Lanka World Fertility Survey in 1975 to assess four possible reasons for differential contraceptive use: (1) differences in socioeconomic position; (2) cultural differences; (3) minority status; and (4) differential access to family planning services. The first three explanations focus on differences in the demand for contraception while the fourth explanation focuses on differences in the availability of contraceptives. The socioeconomic, cultural, and minority status hypotheses fail to explain the higher contraceptive use among the Sinhalese. The evidence is consistent with the idea that ethnic differences in contraceptive use were largely caused by differential access to family planning services.
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