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PubMed2003

[Effects of male reproductive health information education communication on mastering STDs knowledge among young couples].

OBJECTIVES: To increase the knowledge of STDs control and prevention among young couples by intervention, and to improve their reproductive health. METHODS: The intervention plan was made and carried out on the basis of the information from baseline interview and Focus Group Discussions. The activities of the intervention included lectures given by experts, counseling service, delivering knowledge foldouts and knowledge competition. The final survey was conducted. The data of baseline and final survey were analyzed with SAS software. RESULTS: Before intervention, young couples knowledge of STDs was similar between the experimental and the control group. After intervention, proportion of knowing numbers of STDs kinds in experiment group significantly was higher than that in control group(P < 0.01); The proportion of knowing harm of STDs and knowing to use consom to prevent STDs couples were significantly higher in experiment group than that in control group(P < 0.01). CONCLUSIONS: The intervention activities including lectures and counseling services were positive and great sociological affects on family planning and reproductive health improvement for young couples which has one child.

Adolescent↗
PubMed1999

Touch-pad technology: immediate feedback for resident educators in teenage reproductive health.

OBJECTIVE: To describe a program for residents in obstetrics and gynecology to design, research, and present an innovative teaching activity to secondary-school students in reproductive health. METHODS: An interactive 3-hour assembly was held for 285 grade-9 and -10 students. Six residents chose topics that encompassed key areas in adolescent health (menstruation, contraception, risk-taking behaviors, sexuality, and sexually transmitted diseases [STDs]). Each gave an interactive presentation designed to address issues identified through anonymous questions submitted by the students in advance. Touch-pad technology was used throughout the presentations to ascertain the students' knowledge about, and attitudes toward, a range of reproductive health issues. Each resident participant completed a follow-up questionnaire. RESULTS: Touch-pads provided a unique format, allowing teens to respond candidly to sensitive topics anonymously while providing important feedback to resident educators to help them focus their presentations and address areas of greatest need. Resident participants reported that by preparing these presentations, they honed their knowledge about contraception, STDs, and teen sexuality; identified important community resources for teens; and were sensitized to issues unique to teen sexual-health counseling. CONCLUSION: This project provided an opportunity for residents to improve their knowledge of teenage sexuality and to develop skills as teachers, while forging a valuable link between the community and the university.

Computer-Assisted Instruction↗
PubMed1997

Family practice residents aren't getting enough training in reproductive health care.

Most doctors who graduate from family practice programs in the US receive little or no clinical training in reproductive health care, according to a study published in the September/October issue of Family Planning Perspectives. Researchers report that the majority of respondents to a 1995 survey of program directors and chief residents at 244 family medicine residency programs in the US reported they had no clinical experience in cervical cap fitting, diaphragm fitting, or IUD insertion and removal. What's more, only 15% of chief residents had gained clinical experience providing first-trimester abortions before graduating, despite the fact that 29% of programs included the training as either optional or routine. Only 5% of residents surveyed answered "yes" when asked whether they would "certainly" or "probably" provide abortions in their future practices. 65% responded that they "certainly would not" provide abortions. The study also found that residents who attended a program in which abortion training was offered were more likely to have a favorable attitude toward abortion training and services.

Abortion, Induced↗
PubMed2001

Unmet need for reproductive health in India.

Using data from the National Family Health Survey of 1992-93 and the individual reproductive histories of a cross-section of 70 women from rural Tamil Nadu, this paper exposes the limited extent to which women in India have been able to achieve their reproductive intentions and the failure of health services to meet their considerable reproductive health needs. Of the 70 women, 69 had been unable to achieve their reproductive intentions, not only non-users of contraception but also ever-users, and all 69 had an unmet need for reproductive health services. Sterilisation is often the first and only method of contraception taken up and only after a series of wanted, mistimed and unwanted pregnancies, miscarriages, induced abortions and neonatal and infant deaths. Women who wanted to have more children than they were able to were also found. Given the paradigm policy shift in India from promoting fertility reduction only to meeting women's reproductive and sexual health needs, a more useful concept for measuring 'unmet need' for services in programme planning is required, one such as the HARI index, that would capture the extent to which individual women are achieving their reproductive intentions in good health. Without this, the same problems will only recur in younger women.

Birth Intervals↗
PubMed2002

The impact of price changes on demand for family planning and reproductive health services in Ecuador.

Donor funding for family planning and reproductive health (FP/RH) has declined in Latin America over the past decade, obliging providers to consider other financing mechanisms, including cost recovery through user fees. Pricing decisions are often difficult for providers, who fear that increased fees will cripple demand and create barriers to access for poor clients. Providers need information on how changes in price can affect utilization of services, and how to resolve trade-offs between generating income and serving poor clients. This paper reports on an experiment that measured the impact of higher client fees on utilization, revenue and client socioeconomic characteristics at 15 clinics operated by CEMOPLAF, an Ecuadoran not-for-profit FP/RH agency. The study improves on previous research by comparing effects of different price levels on demand for services. We conclude that demand was inelastic for three of CEMOPLAF's four main FP/RH services, and we found no evidence that the price increases had a disproportionate impact on utilization by poorer clients. The study therefore provided CEMOPLAF managers with knowledge that price increases at the levels tested would help to achieve sustainability goals (by increasing locally generated income) without undermining CEMOPLAF's social mission.

Adult↗
PubMed2000

Environmental influence on reproductive health.

A rise in industrialization and the consequent environmental pollution, an increase in the use of synthetic chemicals and repeated exposure to hazardous compounds at the workplace and at home adversely affects reproductive health. Biohazardous compounds, some of which act as endocrine disrupters, are being increasingly implicated in infertility, menstrual irregularities, spontaneous abortions, birth defects, endometriosis and breast cancer. In some cases, women are at a greater risk than men, especially with the rise in environmental estrogens. Only a fraction of these chemicals have been adequately examined for toxicity and for synergistic effects due to multiple exposures. There is a need for a greater awareness and vigilance of the effects of environmental pollution on reproductive health.

Abortion, Spontaneous↗
PubMed1998

AIDS and reproductive health.

Over 24 million adults worldwide have been infected with HIV. Primarily a sexually transmitted disease, AIDS is inexorably linked to reproductive health and care. Because HIV tends to infect those who are in their reproductive years, the impact of this disease on population growth and life expectancy is projected to be immense in some parts of the world, especially in sub-Saharan Africa. Not least is the challenge to individual families and infant care programs to care for AIDS babies. Estimates of the rate of vertical transmission of HIV range from < 10 to 46%. Transmission through sexual contact accounts for 75-85% of HIV infection worldwide, and today, nearly 20 years into the epidemic, the main tool to stall the spread is advocating change in sexual conduct. Numerous studies leave no doubt that the attributable risk of co-infection with other STDs--both ulcerative and non-ulcerative--in heterosexual transmission is substantial. The only known contraceptive method proven to reduce both infectiousness and susceptibility to HIV is barrier contraception. Spermicidal agents currently available have not been shown to reduce HIV concentrations in genital secretions, or to reduce transmission of the virus. The challenges that lie ahead are tremendous: we must continue to focus on development of affordable preventive measures; urge policy-makers to back further research in prevention to complement condom use; and advocate for continued support of basic research to learn more about fundamental mechanisms of HIV transmission.

AIDS-Related Opportunistic Infections↗
PubMed2001

Ukrainian medical students' experiences, attitudes, and knowledge about reproductive health.

In a 1999 classroom survey of sexual behavior among 689 1st-year medical students at Donetsk State Medical University, Ukraine, 59% of the women and 83% of the men revealed they had "ever" had sexual intercourse. The mean age of first intercourse was 15.7 years for the men and 16.6 years for the women. Thirty-two percent of the students reported they did not use contraceptives at their first intercourse, and 19% said they used no contraceptives at their most recent coitus. Condoms were the most frequent means of contraception, followed by coitus interruptus. Less than 5% used oral contraceptives, and 73% of students reported being afraid to use them. About 6% of the students reported they had had sexually transmitted infections (STI) and 10% had had an abortion. Improving knowledge concerning unwanted pregnancies and STI among Ukraine's future health providers may contribute to improving reproductive health issues in general in Ukraine.

Abortion, Induced↗
PubMed1986

World Health Organization multicenter study on menstrual and ovulatory patterns in adolescent girls. II. Longitudinal study of menstrual patterns in the early postmenarcheal period, duration of bleeding episodes and menstrual cycles. World Health Organization Task Force on Adolescent Reproductive Health.

During a two-year study, 670 girls (aged 11-15 years) submitted menstrual diaries that started at the onset of their first menstrual bleeding (Group I), and 802 girls (aged 11-15 years) who had already experienced menarche prior to the study (Group II) kept similar diaries. The two groups were recruited in three centers: Colombo (urban), Peradeniya (rural), both in Sri Lanka, and Hong Kong. The mean duration of bleeding episodes was 4.7 days (SD 1.8) in Group I and 4.9 days (SD 1.4) in Group II. The median length of the first cycle after menarche was 34 days, with 38.3% of the cycles being longer than 40 days. By the 5th cycle the median length was 31 days, similar to that of Group II. The establishment of cycle regularity was defined by three successive cycles within the range of 10 days with none of the three cycles shorter than 20 or longer than 40 days. This regularity was achieved by 19% of the Group I girls in the first three cycles and by 67% of these girls during the entire study period, compared to 89% in Group II.

Adolescent↗
PubMed2006

Can a comprehensive voucher programme prompt changes in doctors' knowledge, attitudes and practices related to sexual and reproductive health care for adolescents? A case study from Latin America.

OBJECTIVES: To evaluate whether participation in a competitive voucher programme designed to improve access to and quality of sexual and reproductive health care (SRH-care), prompted changes in doctors' knowledge, attitudes and practices. METHODS: The voucher programme provided free access to SRH-care for adolescents. Doctors received training and guidelines on how to deal with adolescents, a treatment protocol, and financial incentives for each adolescent attended. To evaluate the impact of the intervention on doctors, nearly all participating doctors (n = 37) were interviewed before the intervention and 23 were interviewed after the intervention. Answers were grouped in subthemes and scores compared using nonparametric methods. RESULTS: The initial interviews disclosed deficiencies in doctors' knowledge, attitudes and practices relating to adolescent SRH-issues. Gender and age of the doctor were not associated with the initial scores. Comparing scores from before and after the intervention revealed significant increases in doctors' knowledge of contraceptives (P = 0.003) and sexually transmittable infections (P < 0.001); barriers to contraceptive use significantly diminished (P < 0.001 and P = 0.003); and some attitudinal changes were observed (0 = 0.046 and P = 0.11). Doctors became more aware of the need to improve their communication skills and were positive about the programme. CONCLUSIONS: This study confirmed provider related barriers that adolescents in Nicaragua may face and reinforces the importance of focusing on the quality of care and strengthening doctors' training. Participation in the voucher programme resulted in increased knowledge, improved practices and, to a lesser extent, in changed attitudes. A competitive voucher programme with technical support for the participating doctors can be a promising strategy to prompt change.

Adolescent↗
PubMed1997

Women's reproductive health: the role of body mass index in early and adult life.

BACKGROUND: Higher risks of menstrual problems and infertility have been found in underweight and overweight women but evidence is inconsistent especially in relation to the effect of age of onset of obesity. OBJECTIVE: To determine whether body mass index (BMI) in adulthood or childhood affects the reproductive health of women. METHODS: Heights, weights (at 7, 11, 16, 23 and 33y) and reproductive data were available for 5799 females in the 1958 British birth cohort study. Body mass index (BMI) was calculated as weight/height2. Age-specific cut-offs were used to define overweight and obesity. Reproductive outcomes reported at age 33 included: menstrual problems (also reported at 16y), hypertension in pregnancy and subfertility. RESULTS: Early menarcheal age was associated with higher risks of menstrual problems by 16y but this relationship did not persist to 33y. Obesity at 23y and obesity at 7y both independently increased the risk of menstrual problems by age 33 (OR = 1.75, OR = 1.59 respectively) after adjusting for other confounding factors. Obesity at 23y increased the risk of hypertension in pregnancy (OR = 2.37), after adjusting for confounders. Consistent with these findings, obese women at 23y were less likely to conceive within 12 months of unprotected intercourse after adjustment for confounders (RR = 0.69). CONCLUSIONS: Overweight and obesity in early adulthood appears to increase the risk of menstrual problems, hypertension in pregnancy and subfertility. Other than menstrual problems, childhood body mass index had little impact on the reproductive health of women.

Adolescent↗
PubMed2000

What husbands in northern India know about reproductive health: correlates of knowledge about pregnancy and maternal and sexual health.

Women in India suffer from a high incidence of reproductive disease, disability and death. Very little work has been done on men, but a much higher incidence of sexual experience outside marriage and sexually transmitted diseases (STDs) among males than previously expected for this population is now being documented. In north India, women are dependent on their husbands and other family members for health-related decisions. Therefore, the behaviour, knowledge and attitudes of men are integral to the reproductive health status of couples there. This study explores knowledge about three distinct areas of reproductive health among 6549 married men in five districts of the northern state of Uttar Pradesh, India. Factors contributing to men's knowledge in the areas of fertility, maternal health and STDs were investigated. Results showed that very few men had basic knowledge in any of these areas. The likelihood of reporting knowledge was associated with a set of determinants that differed in their magnitude and effect across the areas of reproductive health explored. In particular, men's belief about the ability of an individual to prevent pregnancy demonstrated an independent association with men's knowledge. After controlling for factors such as age, parity and educational and economic status, men who believed it not possible to prevent a pregnancy were less likely to know when during the menstrual cycle women would become pregnant and certain facts about STDs, but they were more likely to be able to name two or more symptoms of serious maternal health conditions. Possible explanations for this trend are discussed.

Adolescent↗
PubMed2002

Age-related changes in ovarian volume, antral follicle counts and basal FSH in women with normal reproductive health.

OBJECTIVE: To investigate the relation between ultrasound-based ovarian volume and antral follicle counts and hormonal parameters of ovarian reserve in a group of women with normal reproductive health. STUDY DESIGN: Prospective study. One hundred eight women with at least one previous pregnancy reaching term were divided into three age groups (group 1 = 35-39 years, group 2 = 40-44 years, and group 3 = 45-50 years). Basal hormone measurements and transvaginal ultrasonography estimation of ovarian volume and follicle counts were performed in the early follicular phase (day 3) of the menstrual cycle. RESULTS: There were significant differences in FSH (P < .0001) and E2 (P < .002) levels when group I was compared to groups II and III. There was a significant decrease in mean follicle counts (MFC) between groups I and III (P < .05). The decrease in mean ovarian volume (MOV) with age was not statistically significant. Age strongly correlated with MFC (r = -.38, P < .001) and weakly with MOV (r = -.29, P < .05). However, basal FSH correlated positively with age (r = .50, P < .001) and negatively with MOV (r = -.590, P < .001) and MFC (r = -.658, P < .001). Basal E2 correlated with MOV (r = .50, P < .001) and MFC (r = .50, P < .001). There was also a strong positive correlation between MFC and MOV (r = .777, P < .001). CONCLUSION: There was a decrease in MOV and MFC with aging coincident with increasing basal FSH levels after age 35 in women with normal reproductive health.

Adult↗
PubMedDate not supplied

[State of reproductive health of boys in St. Petersburg].

Complex medical social analysis of reproductive health of modern boys was carried out. Approaches to specialized care of boys and youths in St. Petersburg are presented. Measures aimed at creation of a universal staged specialized service including outpatient and inpatient care are offered. Standards were determined as regards care of boys with reproductive system disorders for primary health care centers and for the second component of specialized service, responsible for the major part of outpatient care. A comprehensive departmental system of medical care quality control is suggested, including public health administrative organs and clinical expert committees of treatment and prophylactic institutions.

Adolescent↗
PubMed2006

Sexual violence and reproductive health among young people in three communities in Jamaica.

A secondary analysis of data collected from 1,130 young people ages 15 to 24 in a population-based household survey to assess the reproductive health needs of young people in three communities in Jamaica was conducted to determine the relationships among three measures of sexual violence, background variables, three measures of sexual risk taking (early sexual debut, multiple partners, and no condom at last sex), and two reproductive health outcomes (genital discharge within the past 12 months and pregnancy). In the multivariate analyses, forced first sex increased the likelihood of genital discharge among males (odds ratio, OR = 5.33) and females (OR = 2.02) and pregnancy among females (OR = 2.05), controlling for background characteristics and sexual risk taking. Associations between sexual violence and reported genital discharge and pregnancy that were not mediated by our measures of sexual risk taking were found. More research into the causal mechanisms for this association is needed.

Adolescent↗
PubMedDate not supplied

[Mexico: reproductive behavior and social margination, 1970-1990. Elements of geographic diagnosis in reproductive health].

The lack of a definite knowledge on regional reproductive behavior characteristics hinders the evaluation of the goals stated in the General Population Law (Ley General de Población) and counteracts any efforts towards equating population growth with regional development. The present work aims at overcoming this problem. Indirect specific fertility rates and global fertility rates (GFR) were obtained by state, using census and vital statistics data for the states of Mexico during the 1970-1990 period. Reproductive behavior was related to social deprivation indexes used by PRONASOL and CONAPO for those years. A high statistically significant correlation (p < 0.01) between state social deprivation levels and the downward trends of GFR for the same decades was found. Findings evidence a general downward trend of GFR during the period of study. However, this trend was not uniform across the country. Further studies are needed to determine whether these differences are due to the various social deprivation levels rather than to the effectiveness and extension of family planning programs. Mapping these results could be useful as diagnostic elements of the reproductive behavior of the population and also generates information necessary to support social organized responses in reproductive health.

Adult↗
PubMed1996

The new antiepileptic drugs and women: efficacy, reproductive health, pregnancy, and fetal outcome.

As new antiepileptic drugs (AEDs) become available, physicians will define their appropriate use in particular patient populations. For women, the issues include gender-specific efficacy and tolerability, including the impact of the AED on reproductive health. Women with epilepsy who are treated with established AEDs appear to be at risk for compromised bone health, for disturbances in fertility, menstrual cyclicity, ovulatory function, and sexuality and, with some AEDs, for failure of hormonal contraception. Finally, pregnancy outcome may be adversely affected by the established AEDs, all of which are human teratogens. Felbamate (FBM), gabapentin (GBP), lamotrigine (LTG), oxcarbazepine (OCBZ), tiagabine (TGB), topiramate (TPM), and vigabatrin (VGB) were reviewed. The preclinical development process had not addressed all the issues of concern to women. Although gender-specific efficacy is routinely evaluated, impact on reproductive health is not. FBM, GBP, LTG, TGB, TPM, and VGB have similar efficacy in women and men. It is not known whether the new AEDs will affect bone health, fertility, the menstrual cycle, and sexuality. FBM, GBP, LTG, TGB, and probably VGB do not interfere with hormonal contraception. Whether these new AEDs are good choices for the pregnant woman with epilepsy awaits further experience in human pregnancy. However, animal reproductive toxicology studies appear promising. The limited number of human pregnancy exposures do not, thus far, signal a significant number or particular type of adverse outcomes. However, only with improved postmarketing surveillance can essential information about teratogenic effects by acquired in an acceptably short time.

Abnormalities, Drug-Induced↗