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PubMed2000

[Reproductive health in women in the Czech Republic 1993-97. II. Contraception].

THE AIM OF THE STUDY: To identify changes in reproductive health status as consequence of changes in the system of health care and social affairs. THE AIM OF THIS PART OF STUDY: To identify changes in use of different contraceptive methods among women of reproductive age in the Czech Republic. TYPE OF THE STUDY: Retrospective comparative epidemiological study. NAME AND ADDRESS OF THE INSTITUTION: Institute for the Care of Mother and Child Praha 4--Podolí. METHODS: Comparison of data on contraceptive use among women of reproductive age from two representative national surveys (see the first part of the study). Analysis was done by demographic characteristics using programs developed by the Centers for Disease Control, Atlanta, Georgia, U.S.A. RESULTS: There was no difference in proportion of women using one of four methods of contraception in 1993 sample and in 1997 sample (60%), however, there was change in their order. While the most frequently used method in 1993 sample was withdrawal (18.6% out of 60% of contraceptive users) and the pills were the last used method (7.7%), the order in 1997 sample was just opposite (pills 23.9%, withdrawal 6.7%). The proportion of condom and IUD users remained practically unchanged. With decline of withdrawal users, the proportion of other three methods increased from 37% to 52% (out of 60% of contraceptive users). The hormonal contraception was preferred method among women with higher education, while condom was the most popular among women with occasional intercourse or women with different partners (single women, women without children, divorced women). CONCLUSION: The withdrawal and condom users were the more frequent methods of contraception in 1993 sample versus two other methods (ratio 2:1), while this has changed in 1997 sample in favor of IUD and hormonal contraception users (ratio 3:2). We could conclude that the responsibility for contraception has been transferred from men to women.

Adolescent↗
PubMed1999

Legal issues in reproductive health care for adolescents.

Adolescents need reproductive and sexuality-related health care. State and federal laws affect consent, confidentiality, and payment for services. State minor consent laws allow minors to consent based on the minor's status or the services sought. State and federal laws affect confidentiality of health information generally as well as programs for specific services, such as family planning or drug and alcohol abuse treatment. Medicaid, the new State Children's Health Insurance Program, and categorical funding programs are important funding sources. Adolescents' ability to use these sources for confidential reproductive and sexuality-related services is evolving. However, possible changes in federal law and the transition to managed care in both public and private insurance present significant challenges they may face in the future.

Abortion, Legal↗
PubMed2005

Sexual abuse and reproductive health among unmarried young women seeking abortion in China.

OBJECTIVE: To investigate sexual violence and its impact on reproductive health in unmarried young women seeking abortion in China. METHODS: A total of 2002 participants were surveyed by questionnaire, gynecologic examination, and laboratory tests for sexually transmitted disease (STD). RESULTS: Overall, 14% of participants had experienced sexual violence and 43.4% were diagnosed with STD. Among victims of sexual abuse, 8.6% had their first sexual encounter when they were younger than 18 years; 42.7% had had 2 or more sexual partners; and 21.6% never used contraception. Multivariate analysis revealed that sexual abuse, multiple sexual partners, sexual activity before the age of 18 years, and not using contraception were important indicators of the presence of STD. CONCLUSION: The prevalence of sexual abuse is high in China; and among unmarried young women seeking abortion, those who experience sexual abuse are at significantly increased risk for STD.

Abortion, Induced↗
PubMedDate not supplied

Micronutrients in women's reproductive health: I. Vitamins.

Proper nutritional status of women before, during, and after pregnancy is an important element of reproductive health. It maintains maternal health and reduces the risk of adverse pregnancy outcome, birth defects and chronic disease in children later in postnatal life. Pregnancy creates a special metabolic demand for high-quality nutrients. With careful food selection, it is possible to obtain most of the recommended levels of nutrients. Apart from the dietary intake, nutrition is highly dependant on economic status, social and cultural environment, and personal habits of the mother. Nutritional imbalance could cause detrimental effects to the pregnant woman, influence pregnancy outcome, and impair breast milk composition. Despite the extensive research, we still do not have a complete understanding how nutritional status of the mother influences her health as well as fetal growth and development. It is well known that fetal growth and development is strongly linked with maternal supply of essential nutrients, e.g. vitamins. The exact role of the variety of micronutrients in fetal growth and development has yet to be explored in detail. It is estimated that up to 30% of pregnant women suffer from a vitamin deficiency. Without supplementation, about 75% would show a deficit of at least one vitamin. Moreover, multivitamin deficit combinations often co-exist, and subclinical depletations are probably common; consequences could be severe. Studies carried on in developing countries have shown that improving micronutrient intake in deficient women can reduce maternal morbidity and mortality. Also, proper maternal intake of important micronutrients directly enhances the quality of breast milk. To meet the increasing demands during pregnancy and the breastfeeding period women should not be dependent only upon the dietary intake: adequate reserve is essential for the successful pregnancy outcome.

Adult↗
PubMed1995

Experiences in developing legislation protecting reproductive health.

The law regarding special maternity leave for pregnant women in hazardous work situations has been in effect since 1981 in Denmark. In Finland, legislation regarding the protection of the reproductive health of working men and women and of pregnant women has been in effect since 1991. According to the special maternity leave law, women who are exposed to certain chemical, physical, or biological agents that are considered to be harmful to the fetus may be entitled to special maternity leave and benefits. In Denmark and in Finland, approximately 1% and 0.1%, respectively, of pregnant women have used the special maternity leave due to a risky work situation. In Finland, the yearly costs of the leave have been US $200,000 to $250,000. Trained occupational physicians can facilitate changes at the workplace that will decrease the need for special maternity leave.

Denmark↗
PubMedDate not supplied

Reproductive health promotion in Kosovo.

Relief agencies that specialize in postwar emergency relief and then work to contribute to sustainable development as the crisis ends are increasingly recognizing the positive impact of midwifery care and training on reproductive health outcomes. Midwives are finding work and developing new roles in postwar reconstruction and refugee health care. This article describes the experiences of a nurse-midwife who worked for Mercy Corps International in Kosovo and launched the Kosovo Women's Health Promotion Project. A short history of the conflict in Kosovo, the effects of the war on its people and the health care system, a description of women's health care, and the status of women in Kosovo are included.

Female↗
PubMed2002

Contextual influences on reproductive health service use in Uttar Pradesh, India.

This study examines the determinants of the use of four types of reproductive health-care services in Uttar Pradesh, India: contraceptive services, antenatal care, delivery in a medical institution, and services dealing with reproductive tract and sexually transmitted infections. The analysis uses a multilevel modeling strategy to assess the presence of household- and community-level variation in service use. The influence of community-level characteristics and reproductive health-care service attributes on service use is examined. The results highlight strong community-level influences on service use, although the type of community effect varies by service type. The role of some individual and household factors in determining a person's use of services is mediated by the characteristics of the community in which the individual lives. The results demonstrate the need to look beyond individual factors when examining health-care-seeking behavior, and illustrate that there is no singular "community" effect on service use.

Adolescent↗
PubMed2002

Clinical performance of the Nova T380 intrauterine device in routine use by the UK Family Planning and Reproductive Health Research Network: 5-year report.

OBJECTIVES: The purpose of the study was to evaluate the pregnancy and complication rates of this new device, with its increased area of copper, in comparison with other published results, in the clinical setting of British general practice and family planning clinics. DESIGN: Doctors working in general practice and at family planning clinics throughout the UK who collaborate in the UK Family Planning and Reproductive Health Research Network were responsible for the fitting of 574 Nova T380 intrauterine contraceptive devices (IUDs). The Nova T (and formerly the identical Novagard IUDs have copper with a surface area of 200 mm(2). The Nova T380 has copper with a surface area of 380 mm(2). RESULTS: This is the first 5-year report on this device. The 5-year cumulative life-table event rates per 100 women were pregnancy 2.0, expulsion 13.0, and removal for bleeding problems and bleeding with pain 29.6. CONCLUSIONS: The increased surface area of copper was associated with a reduced pregnancy rate as compared to the Nova T though no statistical comparison is possible. Although the present study was not a direct comparative study with the Nova T, the result lends weight to the notion that increasing the copper reduces the pregnancy rate. The discontinuation rate for bleeding problems and bleeding with pain and the expulsion rates were higher than in published Nova T studies.

Adult↗
PubMedDate not supplied

Knowledge and attitudes of rural adolescent girls regarding reproductive health issues.

BACKGROUND: Adolescent girls (10-19 years old) comprise about 22% of women in India. They are the mothers of tomorrow and the burden of planned reproduction rests on them. Yet very little is known about their knowledge and attitudes towards reproductive health issues--a crucial aspect if India is to achieve the net reproduction rate of 1 by AD 2016. This study aimed to gather information on areas required for the planning of family life education strategies. METHODS: This cross-sectional study was conducted in the government schools and anganwadi premises of three villages of the primary health centre, Chhainsa, under the Comprehensive Rural Health Services Project Area (CRHSP), Ballabgarh, Haryana. The participants were 254 girls aged 13 to 17 years, who had attained menarche. A pre-tested interview schedule was administered to each girl after taking permission from the principals and parents and with the consent of the participants. The knowledge and attitudes regarding age at marriage, concept of small family norm, family size and preference for a son were assessed. RESULTS: All the girls were aware that there is a law regarding legal age of marriage but only 165 (65%) of them knew the correct legal age. Early marriage was preferred by 19 (7.6%). Though 214 (84.3%) girls were aware of the small family norm, only 19 (8.8%) knew the exact norm. A preferred family size of two or less was reported by 151 (59.2%). Preference for a son was reported by 233 (91.7%). CONCLUSION: All the girls were aware of the small family norm, but few could correctly define it. Though most girls preferred a two-child family, almost all of them had a preference for at least one son. This preference for a son could dominate their future decision-making. As attitude development is a long-term process, there is indeed a long way to go.

Adolescent↗
PubMed2002

[Cervical cancer screening by Pap smear: experience of the National Research Center in Reproductive Health. ONFP].

We have analysed the result of 17,173 pap smears screened in the national research center in reproductive health of Ariana from 1 may 1993 to 30 april 1997. Among these pap smears, 613 colposcopy and 380 biopsy have been performed. The results show that: 1.9% of pap smears present cytological anomalies with 0.79% of low Squamous Intraepithelial lesions and 0.66% high Squamous Intraepithelial lesions. The incidence of CIN III is 1.8% and 0.9% for invasive cancer. The age interval 35-44 years is at high risk of CIN III and invasive cancer of the cervix. evaluation of our diagnostic approach shows that: positive predictive value of pap smears with low SLI is 43.2% positive predictive value of pap smears with high SLI is 37.3%.

Adult↗
PubMed1994

Reproductive health: towards a brighter future.

In 1972 the World Health Organization initiated the Special Programme of Research, Development and Research Training in Human Reproduction. Now cosponsored by the United Nations Development Programme, the United Nations Population Fund, the World Bank and WHO, the Programme has become the main instrument of research in reproductive health in the United Nations system. The progress that has been made, and the prospects for the future, are reviewed below.

Contraception↗
PubMed1995

[Reproductive health at the threshold of the third millennium].

Attention is called to the extent and consequences of uncontrolled population growth. The concept of reproductive health is defined and the most important pillars are presented. These are the status of women, family planning, antenatal care, decreasing maternal mortality, termination of pregnancy, sexually transmitted diseases (AIDS), infertility, malignancies of the reproductive tract, nutrition, care of the newborn and children, adolescent sex, dangerous sexual practices, way of life and environment. The contradiction of increasing health costs and increasing poverty is exposed.

Abortion, Induced↗
PubMed1999

Medical students' attitudes toward abortion and other reproductive health services.

BACKGROUND AND OBJECTIVES: The continued availability of legal abortions in the United States depends on the willingness of future physicians to provide this procedure. This paper explores the attitudes toward abortion issues of first- and second-year medical students at a large regional primary care-oriented medical school. METHODS: We anonymously surveyed 286 first- and second-year medical students at the University of Washington. RESULTS: The response rate to the written survey was 76.6%. Women were slightly overrepresented among the respondents. The majority of students supported the broad provision of reproductive health services; 58.1% felt that first-trimester abortions should be available to patients under most circumstances. Of the 43.4% of students who anticipated a career in family practice, most expected to provide abortions in their future practices. Older students and women were more likely to support the provision of abortion services. CONCLUSIONS: Despite continuing pressure on abortion providers, most first- and second-year medical students at a fairly typical state-supported medical school intend to incorporate this procedure into their future practices.

Abortion, Legal↗
PubMed2005

Interface of Women's Mental and Reproductive Health.

The interface of women's reproductive and mental health is an evolving area of psychiatric practice, necessitating familiarity with psychobiological factors unique to women. The role of estrogen in particular has profound implications for the etiology and treatment of women's psychiatric illness, and has been reviewed along with the role of other hormones. Additionally, the stress of specific life events such as miscarriage, abortion, and menopause affects female mental health from a biological and psychosocial standpoint with the potential for secondary mood and anxiety disorders. Psychiatric issues during pregnancy and the postpartum period present special diagnostic and treatment challenges to the clinician. Biological and psychosocial treatments of these conditions have been reviewed. Management of psychiatric conditions during pregnancy and the postpartum period should include the obstetrician, pediatrician, and involved family members. Treatment decisions should involve careful assessment of the risks and benefits of any intervention including the risk of no treatment.

Abortion, Induced↗
PubMed2006

Family size, fertility preferences, and sex ratio in China in the era of the one child family policy: results from national family planning and reproductive health survey.

OBJECTIVES: To examine the impact of the one child family policy in China on fertility, preferred family size, and sex ratio. DESIGN: Secondary analysis of data from the Chinese cross sectional national family planning and reproductive health survey, 2001. Interviews of representative sample of women aged 15-49. RESULTS: Data were obtained from 39,585 women, with a total of 73,202 pregnancies and 56,830 live births. The average fertility rate in women over 35 (n = 17,078) was 1.94 (2.1 in rural areas and 1.4 in urban areas) and for women under 35 (n = 11,543) 1.73 (1.25 and 1.79). Smaller families were associated with younger age, higher level of education, and living in an urban area. The male to female ratio was 1.15 and rose from 1.11 in 1980-9 to 1.23 for 1996-2001. Most women wanted small families: 35% preferred one child and 57% preferred two. CONCLUSION: Since the one child family policy began, the total birth rate and preferred family size have decreased, and a gross imbalance in the sex ratio has emerged.

Adolescent↗
PubMed2005

'I never go anywhere': extricating the links between women's mobility and uptake of reproductive health services in Pakistan.

An integrated analysis of large-scale survey data and detailed ethnography is presented to examine the patterns of women's mobility and their relationships with contraceptive and antenatal care use in Pakistan. Findings confirm that women's mobility is circumscribed but also illustrate the complex and contested nature of female movement. No direct relationship between a woman's unaccompanied mobility and her use of either contraception or antenatal care is found. In contrast, accompanied mobility does appear to play a role in the uptake of antenatal care, and is found to reflect the strength of a woman's social resources. Class and gender hierarchies interact to pattern women's experience. Poor women's higher unaccompanied mobility was associated with a loss of prestige and susceptibility to sexual violence. Among richer women, such movement did not constitute a legitimate target for male exploitation, nor did it lead to a loss of status on the part of their families. The findings caution against the use of western notions of 'freedom of movement' and associated quantitative indicators. At the same time, the wider impact of mobility restrictions on women's reproductive health is acknowledged and policy implications are identified.

Adolescent↗