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PubMedDate not supplied

[Education in reproductive health: proposal or reality in the Family Health Program?].

As supervisors of primary health care units in the State of Ceará, Brazil, we have observed a low supply of health education services. As part of the activities under the Family Health Program (FHP), we attempted to investigate the causes of this short supply and identify flaws in the development of such activities. Interviews and participatory observation were adopted as the research method. The following causes were defined in the lack of health education practices: disorganization of demand, insufficient coverage of the population by FHP teams, resistance by both health professionals and the population to educational activities, absence of adequate floor space for conducting such activities, and lack of support materials. The following flaws were identified in the implementation of activities: limited exchange of experiences among participants; limited focus on the group's needs; frequent use of scientific language; transfer of outdated information; and inadequate utilization of teaching materials. The conclusion is that there is a need to retrain health professionals and to improve the availability of physical resources and teaching materials in order for education in reproductive health to become a reality in the FHP.

Brazil↗
PubMed2000

Reproductive health consequences of intimate partner violence. A nursing research review.

Intimate partner violence is widespread and results in significant negative mental and physical health outcomes for women. This article is a review of nursing research on intimate partner violence and women's reproductive health and focuses on studies published since 1995, building on prior reviews. We begin with research on forced sex and the resulting physical and emotional trauma as well as implications for contraception, STD/HIV prevention, and condom use negotiation. We then discuss several approaches to the study of abuse during pregnancy, including several studies of nursing interventions. We conclude with the clinical implications of these studies.

Battered Women↗
PubMed2000

Clinical performance of the levonorgestrel intra-uterine system in routine use by the UK Family Planning and Reproductive Health Research Network: 12-month report.

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 692 Levonorgestrel Intra-uterine Systems (LNG IUS). This study was undertaken to determine the performance of the LNG IUS in British women in routine clinical use. The 12 months cumulative life-table event rates were: pregnancy 0.6, expulsion 4.5. The continuation rate was 70.6. Removals were also required for side effects, which may be due to absorbed levonorgestrel, the removal rate being 7.4. Positive effects include effective contraception and considerably reduced quantity of bleeding for most participants. A need was identified to counsel women about the early bleeding problems, including the possibility of oligomenorrhoea or amenorrhoea. This is considered to be very important as it will help women to persevere so that they can enjoy the longer-term benefits.

Abortion, Spontaneous↗
PubMed2000

Clinical performance of the Nova-T380 IUD in routine use by the UK Family Planning and Reproductive Health Research Network: 12-month report.

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 572 Nova-T380 intra-uterine contraceptive devices (IUDs). The Nova-T (and formerly the identical Novagard) IUDs have copper with a surface area of 200 mm(2). The device used in this study, the Nova-T380, has copper with a surface area of 380 mm(2). 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. The 12-month cumulative life-table event rates were: pregnancy 0.8, expulsion 5.6, removal for bleeding or bleeding and pain 11.0. The continuation rate was 73.4. The pregnancy rate at 12 months showed good contraceptive performance. The increased surface area of copper was not associated with a reduced pregnancy rate, but as this was not a direct comparative study with the Nova-T, the influence of the increased area of copper must remain somewhat uncertain. This study found the discontinuation rate for bleeding problems and pain with bleeding to be higher than in other published studies. Other event rates were consistent with other published studies.

Adolescent↗
PubMedDate not supplied

[Talking about sex: the social and familial net as a base for sexual and reproductive health promotion among adolescents].

This study aimed to assess whom adolescents shared information and dialogues about sexuality with. Therefore, 383 fifteen to nineteen year-old adolescents enrolled in a family health unit in the city of São Paulo (Brazil) were interviewed in 2002. Adolescents most frequently seemed to talk about sex with peers, although they lost priority according to the complexity of the theme. Thus, teachers and health professionals were mainly indicated as a reference when talking about std/aids. For 20% of the adolescents, parents were the main persons to get information from, no matter the subject. The results indicated that this entire social and family network should be incorporated as partners in sexual and reproductive health promotion among adolescents.

Adolescent↗
PubMed1993

Methods to evaluate reproductive health of the human male.

The proportion of men suffering from subfertility has increased and sperm quality of the general population has decreased rather dramatically during the last decades. Conventional methods to measure sperm concentration, motility, and morphology give a rough estimate of the fertilizing capacity of semen. Objective assessment of motility characteristics and morphometric image analysis may give more precise information, but technology still needs to be refined. Some aspects of the functional capacity of spermatozoa may be impaired before measurable changes occur in their number or morphology. A battery of tests is described to evaluate sperm migration and capacitation, acrosome reaction and acrosin activity, zona adhesion and binding, sperm oolemma fusion, sperm head decondensation, and chromatin make-up. Also methods are described to localize the possible site of impairment of the genital tract. Implementation of these methods may enhance our capability to detect minor effects of environmental hazards on male reproductive health.

Evaluation Studies as Topic↗
PubMed2000

Male reproductive health: cause for concern?

A substantial body of evidence has accumulated in recent years that human semen quality may be deteriorating. This has been associated with evidence of other changes in male reproductive health, including increases in congenital malformations and testicular cancer in humans, and similar problems in wildlife. Unfortunately, the evidence remains inconclusive. It has been suggested that these changes may be due to environmental xeno-oestrogens acting during development. Although there is now a large quantity of data indicating that this is a plausible hypothesis, evidence of causality, rather than association, remains to be provided. The potential importance of these changes for human health is considerable and urgent research is required to clarify the situation.

Animals↗
PubMed2001

Reproductive health needs and care seeking behaviour of pavement dwellers of Calcutta.

An unabated growth of street dwellers in the city of Calcutta is reported to be due to twin reasons like, migration of rural poor people as well as uncontrolled fertility among these poor settlers of the city. A community-based study on reproductive health, fertility and related care seeking behaviour was studied among a sample of women of child bearing age living on streets of Calcutta. Besides, the quite common conditions like leucorrhoea (28.5%), menstrual irregularities (12.3%), infertility (2.5%) and STDs (1.3%) were also reported. But most of these illnesses (three-fourth) were uncared for, and the remaining one-fourth sought treatment from govemment institutions, private agencies or even from untrained practitioners (quacks). The reproductive behaviour of street dwelling women was characterised by early marriage, teenage pregnancies, and scarce use of contraceptives (32%) as well as frequent abortions (2.8%). Very few pregnant women received adequate antenatal care (3.8%). Coverage of tetanus toxoid immunisation (68.5%) and proper iron and folic acid supplementation (16.7%) were also poor. Whereas, antenatal care was received mostly from government health institutions (71%), home delivery (ie, on street) was a common practice and conducted mostly by untrained birth attendants (51.8%).

Adolescent↗
PubMedDate not supplied

[Legal protection of population's reproductive health].

The topicality of decision-making of the legal and organizational nature, passed mainly at the state level, and ensuring the normal performance of the reproductive function as a component of public health is demonstrated. Statistic data on the specificity of reproductive health and its shaping-up in the growing generation as well as on the aftermaths of an early sexual activity and on an influence of the so-called "deviational" behavioral forms as observed in contemporary teenagers are presented. Appropriate international documents are analyzed; the role of international organizations in designing the reproductive rights of citizens and the related recommendations of how to implement such rights are demonstrated. National legislation acts pertaining to the discussed sphere and, in particular, the efforts undertaken to eliminate, in Russia, all forms of discrimination in respect to women, as well as efforts targeted at securing the rights to a free reproductive choice, at reproductive health protection and at family planning are in focus of attention.

Adolescent↗
PubMed2004

[Integrated traditional Chinese and western medicine should make new contribution to the reproductive health of women].

The Obstectrics and Gynecology Hospital attached to Fudan University has made great achievements in the clinical and experimental study of integrated traditional Chinese and western medicine in the past 45 years. Study on induction of ovulation with acupuncture revealed the relationship between circulating estrogen and central beta-endorphin, and suggested that the depletion of central beta-endorphin resulted in the release of GnRH and ovulation, and the main indication for acupuncture treatment was pubertal dysfunctional uterine bleeding. Acupuncture was also successfully used to treat anorexia nervosa. The successful treatment of polycystic ovary syndrome (PCOS) with Yu's Tonifying Recipe for tonifying the kidney and resolving phlegm was found to be related to the elevation of serum FSH which resulted in ovulation. Good result was obtained in hyperinsulinemia pattern of PCOS treated with Tiangui Recipe for replenishing the kidney and activating blood. In studies on patients and animal model, Tiangui Recipe was found to decrease peripheral androgen and insulin levels and lead to central regulation of proopiomelanocortin, neuropeptide Y and leptin receptor, as well as regulation of neuro-endocrine-metabolic network. Thus it can promote ovulation and reduce body weight. In the studies, a new way to classify PCOS was suggested. Gengnianchun Recipe for women with postmenopausal syndrome was found to be effective in increasing estrogen receptors (ERs) and ER mRNA in hypothalamus and peripheral organs and regulating neuro-endocrine-immune-metabolic network in patients and aging rats. Gongtai was effective for controlling menorrhagia under the mechanism of regulating endometrial prostaglandins. The researches mentioned above indicate that illness is the disorder of some key-links in the life network of the patient which may be affected by factors from the environment. And this idea is different from the ideas in traditional Chinese medicine and biomedicine. It indicates that woman in subclinical health state has already got something incontrollable in her life network, and it also gives a new impact on the treatment and prevention of women's diseases as well as the prevention and treatment of women's reproductive health.

Female↗
PubMed2001

Role of traditional birth attendants in improving reproductive health: lessons from the family health project, Sindh.

OBJECTIVE PURPOSE OF THE STUDY: Despite strenuous efforts, the maternal mortality rate in Pakistan remains high. The national figure of 340 maternal deaths per 100,000 live births tends to hide the fact that in some rural areas it is as high as 700 per 100,000 live births. Not surprisingly, in Pakistan only 20% of births are attended by a trained health professional. In most rural areas, home to almost 70% of the population, traditional birth attendants (TBAs) deliver 90% of the births. TBAs, therefore, play a crucial role in the delivery of maternal health care in Pakistan. Realizing the importance of TBAs, the Family Health Project (FHP) of the Department of Health Sindh, financed by the World Bank, tried to enhance their knowledge and skills through comprehensive training programs. FHP provided training to 650 TBAs in 10 districts. The training was provided by the Department of Community Health Sciences (CHS) of the Aga Khan University (AKU) who acted as technical consultant to the project. STUDY DESIGN: A community-based qualitative post-intervention survey. RESULTS: Post-intervention survey of this seven-year project (1992-1999) revealed that (a) the training enhanced the knowledge and skills of the TBAs, (b) the trained TBAs provide more broader health care services and (c) they enjoy greater community acceptance and provide greater consumer satisfaction. It also showed that the TBAs remain the most available and accessible health resource in most rural settings. CONCLUSION: It is imperative that TBAs and their continuing training should remain central to any reproductive health intervention along with an effective referral system linking them to well-equipped emergency obstetric care facilities. However, the assessment clearly demonstrated that an integrated referral system backed by effective emergency obstetric care is essential to the success of the TBA training program.

Humans↗
PubMed2004

Power and politics in international funding for reproductive health: the US Global Gag Rule.

Since 2001, the US government has used its power as a leading donor to family planning programmes to pursue policies in conflict with global agreements on reproductive rights. Prominent among these policies is the Mexico City Policy (or Global Gag Rule), which restricts non-governmental organisations (NGOs) in developing countries that receive USAID family planning funding from engaging in most abortion-related activities, even with their own funds. This paper reviews the history and political origins of the Gag Rule under several Republican party presidents. The Gag Rule has not achieved an overall reduction in abortions; rather, where it has disrupted family planning services, the policy is more likely to have increased the number of abortions. This paper concludes that the Gag Rule is a radical intrusion on the rights and autonomy of recipients of US funding. Regardless of whether or not it is rescinded in the future, the underlying issues in the politics of US reproductive health assistance are likely to persist. NGOs that wish to free themselves from the constraints it imposes must find the means to end their dependence on USAID funding, including turning to other donors. NGOs should also take the lead in opposing policies such as the Gag Rule that violate global agreements.

Ambulatory Care Facilities↗
PubMed2004

Cluster randomized trial of an active, multifaceted information dissemination intervention based on The WHO Reproductive health library to change obstetric practices: methods and design issues [ISRCTN14055385].

BACKGROUND: Effective strategies for implementing best practices in low and middle income countries are needed. RHL is an annually updated electronic publication containing Cochrane systematic reviews, commentaries and practical recommendations on how to implement evidence-based practices. We are conducting a trial to evaluate the improvement in obstetric practices using an active dissemination strategy to promote uptake of recommendations in The WHO Reproductive Health Library (RHL). METHODS: A cluster randomized trial to improve obstetric practices in 40 hospitals in Mexico and Thailand is conducted. The trial uses a stratified random allocation based on country, size and type of hospitals. The core intervention consists of three interactive workshops delivered over a period of six months. The main outcome measures are changes in clinical practices that are recommended in RHL measured approximately a year after the first workshop. RESULTS: The design and implementation of a complex intervention using a cluster randomized trial design are presented. CONCLUSION: Designing the intervention, choosing outcome variables and implementing the protocol in two diverse settings has been a time-consuming and challenging process. We hope that sharing this experience will help others planning similar projects and improve our ability to implement change.

Female↗