Sexual and reproductive health: an IPPF approach.
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Caregivers↗
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Population policy forum. Beginning with individual women.
When IPPF was formed in 1952, its driving force was concern for women, for women's health and women's reproductive rights. 40 years on, those same issues are still at the heart of IPPF's policies and programs. Marge Berer has made a plea for a feminist approach within international family planning, and IPPF is in complete agreement that women's needs and choices should be paramount. All individuals and couples must have the basic human right to decide freely and responsible the number and spacing of their children. Women must also have the right to receive full information and counselling to choose their contraceptive method. Our secretary general, Dr. Halfdan Mahler, stresses that if family planning is to be effective, it must always begin with the individual, taking the whole issue of reproductive health into consideration. Men must share the responsibility for sexual behavior and family planning, and real equality will only be attained when women are empowered to regulate their own fertility. As nongovernmental health care organizations, IPPF's member associations offering services in 133 countries are able to work towards the principles of informed choice and voluntary family planning--even where governments may not be giving women the choices they deserve.
Behavior↗
Millennium hopes. Fighting taboos.
The author's first wish is for International Planned Parenthood Federation (IPPF) to be tenacious in its continuous, unstinting support of family planning in its original sense. Secondly, the author would like to see wider recognition of the urgency with which IPPF must move into the sexual and reproductive health arena, including fighting for the rights of women, men and young people in the many areas of the world still suffering from societal taboos. Thirdly, the author wants IPPF to be visionary in recognizing that young people, women and men need supportive social and economic environments to help them plan and space the children that they would like to have. Current educational and economic requirements and circumstances have become very child unfriendly, as the low birth-rate countries illustrate. Finally, the author hopes to see a much better understanding of intergenerational communication and support as IPPF steps up its efforts to support society in its sexual and reproductive needs.
Family Planning Services↗
Pacific islands for form federation.
An agreement expressing the desire to form themselves into a Federation of Planned Parenthood Associations of Pacific Islands and to become members of IPPF has been drawn up by island members present at a seminar which took place from 8 to 11 July 1974 in Apia. The seminar was conducted by Dr. Asi Faletoese, IPPF South East Asia and Oceania Regional Office resident officer in Apia with the assistance and cooperation of the Samoa Planned Parenthood Association. The Agreement was signed by representatives of Solomon Islabds Planned Parenthood Association, Gilbert and Ellice Islands Family Planning Association, American Samoa Planned Parenthood Association, Planned Parenthood Association of New Hebrides, Planned Parenthood Association of Tongo, Planned Parenthood Association of Tokelau Islands and Samoa, and the Planned Parenthood Association of Western Samoa. Brigadier Derek Sharp, the SEAO regional executive director, moved a vote of thanks to Dr. Asi for the good work he has done during the past two years in bringing us to this stage where so many of the Pacific Islands countries now have family planning associations and where such a wonderful spirit of cooperation exists between them. Outlining the guidelines set out for all regional offices by the IPPF budget and finance committee at their last meeting in London, Brigadier Sharp told would be members of the new Federation: "Because of budget limitations we will not be able to devote money to setting up an office in the Pacific area for the new Federation, but we will create an office within the existing staff of the SEAO Regional office in Kuala Laumpur to which each member association in the new Federation will correspond direct."
Developing Countries↗
Global gene expression profiling of Bovine immature B cells using serial analysis of gene expression.
The Peyer's patches of the small intestine are important sites of antigen processing. The follicles of the Peyer's patches receive the antigen transported by the M cells at the mucosal surface and then play a major role in development of both protective humoral and mucosal immune responses. Serial analysis of gene expression (SAGE) was employed to derive the global gene expression profile of B lymphocytes isolated from the IPPF. Analysis of the SAGE data revealed the identity of genes and the level to which they are expressed by IPPF B lymphocytes. This analysis indicated that they were metabolically active and that the transcripts encoding proteins necessary for a response to antigen presentation were expressed. These transcripts included the B cell receptor components CD76a and b (Ig-alpha and Ig-beta) and accessory c-Src family kinases Lyn and Blk. Furthermore, many of the positive and negative regulators, and accessory proteins that are necessary for B cell antigen receptor signaling were identified. Also present were transcripts encoding interleukins and their cognate receptors. Overall, this SAGE analysis yielded a global picture of gene expression in IPPF B lymphocytes and provides a starting point for the comparison of gene expression in further functional studies.
Animals↗
Guidelines for IUD sterilization.
At its recent meetings, the IPPF International Medical Advisory Panel formulated guidelines for sterilizing bulk packaged IUDs which are supplied by IPPF to many family planning associations. They may also be supplied in the family planning field by other organizations. These guidelines are set out below to help our readers. Any of the following solutions are acceptable for sterilizing IUDs: benzalkonium chloride (1:750); aqueous iodine solution (1:2500); isopropyl alcohol (75%). The iodine solution should be freshly prepared daily as follows: 25 ml of 2% tincture of iodine in 1 liter of water, or 7 ml of 7% tincture of iodine in 1 liter of water. The IUDs and inserters should be presterilized for 24 hours in the benzalkonium chloride solution or for 10 minutes in the aqueous iodine solution or the isopropyl alcohol solution. The IUD should not be left in the benzalkonium-chloride solution for more than 24 hours at a time as the plastic may become brittle. Metal instruments should be sterilized in an autoclave or by boiling, depending on the procedure routinely used in the clinic. Chlorhexidine gluconate (Savlon) should not be used. IUDs should be stored dry, not in a sterilizing solution. At present it is not recommended that IUDs be sterilized more than 3 times.
Clinical Laboratory Techniques↗
The provision of family planning services in the Caribbean.
This article examines the provision of family planning services in selected countries in the Caribbean. The potential impact of the funding shortfall resulting from the phasing out of funding by the International Planned Parenthood Federation (IPPF), and the strategies being adopted by the selected countries to cope with this, are considered. Stratified random sampling methods were employed to select eight Caribbean countries and a pre-designed questionnaire was administered to the agency responsible for family planning services in each country. The sample was stratified geographically to include countries from different parts of the Caribbean. The questionnaire was designed to collect information on the services provided, the name of the agency responsible for the provision of services and, where possible, the number of users of each type of service in 1998 and 1997. Vast disparities were found in the provision of family planning services in different Caribbean countries, in terms of the groups involved, the services available in each country, as well as methods of data collection and compilation. Anguilla and Bermuda were found to provide only limited family planning services, while Barbados, Jamaica and Grenada provide much more sophisticated services. A salient finding was the innovative approaches that various countries in the region have adopted to fund family planning programmes in anticipation of the phasing out of IPPF funding. The standpoint taken in the study is that countries such as Anguilla and Bermuda must strive to improve their provision of family planning services, and that they could learn from Barbados, Grenada and Jamaica, which provide much more comprehensive services. It is also concluded that, unless alternative funding sources are identified and accessed, the provision of family planning services in the Caribbean is likely to decline in the future.
Caribbean Region↗
Assessment of the nasopharyngeal area by cephalometry in cases of cleft lip and palate.
The nasopharyngeal area in 149 patients with cleft lip and palate and 157 normal individuals was evaluated by cephalometric radiography. The patients were male and female Caucasians, ranging in age from 12 to 16 years. Linear cephalometric parameters: (Ptm'-Sl; Ptm'-IPPF; IPPF-I, I-Ptm'), ANS angle and nasopharyngeal area were utilized. From comparative analysis of nasopharyngeal area in the cleft and the control groups, the following conclusions were made: 1) The nasopharyngeal area was smaller in the cleft group. 2) There was no correlation between ANS angle and nasopharyngeal area in either group.
Adolescent↗
Cash payments to encourage contraception, 1988.
The Government of Sri Lanka has established a new scheme to pay cash incentives to women who use the loop method of contraception. The payment for the first year will be Rs. 125, for the second year Rs. 250, and for the third year Rs. 375. This scheme is part of a larger strategy by government officials to reduce emphasis on sterilization and promote birth spacing and family planning methods. In 1988, the Government also approved for contraceptive use the subdermal implant, Norplant. See IPPF, People, Vol. 15, No. 3 1988, p. 27 and IPPF Open File, 20 January 1988, pp. 33-34.
Asia↗
POPs less widely used.
Progestin-only pills (POPs) are less widely used and available than combined pills. For example, the U.S. Agency for International Development (USAID) shipped only 3 million packets of POPs worldwide in 1994, compared with 62 million packets of combined pills, according to Mark Rilling, program analyst with USAID's Office of Population. While USAID considers POPs to be an acceptable contraceptive option for some women and intends to continue providing them, the worldwide market for them is small, Rilling says. The London-based International Planned Parenthood Federation (IPPF) reports a similar trend. IPPF shipped 16 times more combined pills than POPs during 1994, says Dr. Carlos Huezo, the organization's medical director. New efforts to clarify the role of progestin-only pills may make them more acceptable. For example, new studies have provided additional evidence that POPs do not harm breastfed infants whose mothers use them. A new label that reflects these findings, and clarifies other distinctions from combined pills, is being developed for POPs by the U.S. Food and Drug Administration, based on a draft developed by FHI. The pills also are being more actively promoted among some family planning organizations, and may prove useful for community-based distribution.
Contraception↗
[Detection of domestic violence against women. Survey in a primary health care clinic].
According to Pan American Health Organization nearly 50% of women suffer chronic domestic violence in Latin America. We evaluated the prevalence of gender based violence (GBV) in women assisted in a University Outpatient Clinic in Buenos Aires. We used a survey originally developed by the International Planned Parenthood Federation (IPPF) in Spanish. The survey was distributed to a consecutive sample of women more than 18 years of age who attended the clinic. Participants were randomized to fill out the questionnaire anonymously (self-administered) or during an interview with the physician in order to test the sensitivity of these two different modalities of data collection. Of 360 eligible women 270, (75%) completed the questionnaire. The respondents had a median age of 45.4 years, only 33% had more than 7 years of formal education and 48% did not live with a partner. Of the 270 respondents, 120 (44%) women reported mistreatment at least once during their lifetime. Of these, 108 (40%) reported psychological GBV, 53 physical GBV and 45 reported sexual GBV. Most of the respondents suffered more than one type of violence. 46 (17%) women reported sexual abuse during childhood, 219 (81%) of participants never had been asked by their physician about domestic violence. Women interviewed by the physician reported GBV more frequently than those completing the self-administered survey (p <0.005). The survey developed by the IPPF is considered a useful tool for screening in a clinical setting.
Adult↗
Contraception and lactation.
Lactation worldwide is estimated to prevent more births than all organized family planning programs, and thus has a definite contraceptive action. In addition, it contributes to better infant nutrition and well-being. In some societies women do not cohabit while lactating and therefore need no contraception. This situation is being eroded, and in any case does not apply generally. The risk of pregnancy increases with the length of lactation, and thus some form of added contraception needs to be adopted during lactation. Because of the nutritional value of lactation, the CMC deprecates the exploitative commercial advertising and promotion of bottlefeeding that exists in many parts of the world. It recommends that the IPPF and its member associations should actively promote breastfeeding. Since pregnancy can occur during lactation, additional contraception is desired. It should be remembered that IUDs, spermicides, mechanical methods, depot medroxyprogesterone acetate, progestagen-only oral contraceptives (OCs), and sterilization have no adverse effects on lactation. Evidence is accumulating that combined OCs have an adverse effect on the quantity and possibly the quality of breastmilk. Therefore, much greater caution should be exercised in distributing combined OCs than previously. Combined OCs should not be started until lactation is well established, and ideally not before 6 months or until the infant is weaned, whichever occurs 1st. If, however, no alternative contraception is available then OCs may be used earlier.
Breast Feeding↗
Quality of care in family planning: clients' rights and providers' needs.
Quality of care means that the needs of the clients in the context of their personal life should be the major determinant of the behavior of the providers and the goal of the programs. Since family planning has been recognized as a right of individuals and couples, quality of care can be focused as a right of the client. Ten rights of family planning clients have been outlined by the International Planned Parenthood Federation (IPPF) as follows. Rights to: information, access, choice, safety, privacy, confidentiality, dignity, comfort, continuity, and opinion. The responsibilities for quality of care, and therefore fulfilling the rights of the clients, are distributed throughout the whole family planning program, but those who are actually seen as most responsible are the ones who are in direct contact with the clients--the service providers. A strategy for quality of care cannot be realistic without recognising that service providers have their own needs which can be outlined as: training, information infrastructure, supplies, guidance, back-up, respect, encouragement, feedback, and self-expression. When fulfilling the rights of the clients and needs of the service providers, both technical and human aspects should be taken into account.
Confidentiality↗
Serious intestinal complication five years after insertion of a Nova-T.
This report presents a case of sigmoid perforation five years after insertion of a Nova-T. This case illustrates that serious complications of third generation IUDs may occur even after several years of intraabdominal location. An IUD, which has perforated the uterus, cannot be left in the peritoneal cavity. Therefore, removal of a perforated IUD is still a medical indication as recommended by the World Health Organization and IPPF International Medical Advisory Panel Meetings.
Adult↗
Oral contraceptive during lactation: a global survey of physician practice.
The use of combined estrogen-progestogen oral contraceptives (EP-OC) by lactating women has been associated with suppression of lactation. To determine the extent to which physicians prescribe combined EP-OC for lactating women, the International Planned Parenthood Federation (IPPF) and the United States Centers for Disease Control (CDC) collaborated in a global mail survey of 3697 physicians affiliated with Family Planning Associations (FPA) in 72 countries. Usable responses were received from 831 physicians (22%) in 65 countries. The percent of clinicians who provide EP-OC to lactating women was higher in developing regions (63% or more) than in developed regions (40% or less). Patient preference was rated important more often than any other factor in the decision to prescribe EP-OC for lactating women. The percentage of clinicians who reported complaints of decreased milk production from women using EP-OC was higher (32% or more) in developing regions where breast milk is often essential to infant nutrition.
Contraception↗
Sterilization-associated deaths: a global survey.
Except for data from several geographically limited studies, little is known globally about the number and causes of death associated with surgical sterilization. To identify clinical characteristics and problems leading to deaths related to the procedures, the International Planned Parenthood Federation ( IPPF ) and the Centers for Disease Control (CDC) in the United States collaborated in a global mail survey of 4642 physicians. Usable responses were received from 1298 physicians (28%) in 80 countries. Fifty-five sterilization-associated deaths which occurred from January 1, 1980 to June 30, 1982 were reported. The most frequently reported causes of death were infection, anesthetic complications, and hemorrhage. There were some regional differences in the relative frequencies of these causes. Most cases did not involve surgical accident. The characteristics most frequently associated with the reported fatal procedures were: interval sterilizations, minilaparotomy incision, tubal ligation and general anesthesia. Most deaths were attributable to the surgical sterilization procedure.
Adolescent↗
Family planning in the 21st century: perspective of the International Planned Parenthood Federation.
Many women still die as a result of pregnancy or childbirth and yet there are an increasing number of women who wish to regulate their fertility and space or limit their child-bearing. This paper, outlining some success stories, elucidates the family planning challenges and identifies key messages to indicate the role that IPPF can play in the 21st century. Issues such as advocacy for sexual and reproductive health and rights, increased male participation, serving the interests of marginalized groups, appropriate technology, quality of care and cooperation between various partners, all need to be addressed to improve sexual and reproductive health including family planning in the 21st century.
Developing Countries↗
Reduction in mortality needs a bit more than the science of perinatology.
The absence or non-availability of medical centers with inaccessible distance and delay in providing treatment is an insurmountable problem in backward regions. A pregnant mother from a developing country is 30 times more likely to die than a mother from a developed country and her newborn faces the same risk of mortality. The involvement of government is a vital part of the attempt to achieve improvements. Government has the power and obstetricians have the information to lead the way. No doubt even when the two cooperate there is still room for inadequacy, but perhaps partners like the WHO, UNFPA, UNICEF, IPPF, FIGO, World Bank, World Association of Perinatal Medicine, World Pediatric Association, International Midwives Confederation, etc. can help to achieve targets. There is urgent need for the twinning of the perinatal departments of developing countries with the perinatal departments of advanced countries and/or the twinning of countries or geographical areas, or of NGOs with government and change in mindsets where required. To obtain the maximum benefits from such an approach, it would be necessary to go a little beyond perinatal science.
Developing Countries↗