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PubMed2001

Prospects for research in reproductive health and birth outcomes.

In the last several decades there have been major improvements in the ability to control fertility, treat infertility, and reduce maternal, fetal, and infant mortality. However, neither the preterm birth rate nor the rate of long-term neurologic disabilities associated with preterm birth has declined. Increasing knowledge of the events leading to preterm birth and the pathophysiology of neonatal brain and lung injury suggests that the mortality and long-term impairments associated with these conditions will decrease. The large disparities in reproductive health and birth outcomes between industrialized and developing countries and between most other ethnic groups and blacks in the United States could be reduced by better access to already existing effective interventions.

Adult↗
PubMed2006

Menstrual irregularity from hormonal contraception: a cause of reproductive health concerns in minority adolescent young women.

CONTEXT: Adolescents are frequent users of hormonal contraception (HC), yet their adherence to these methods is often poor. Concerns about side effects, especially those affecting the menstrual system, are often given as reasons for contraceptive nonadherence or discontinuation. We sought to identify teens' concerns and misperceptions about the menstrual-related side effects of HC. METHODS: Open focus groups were conducted with both sexually active and virgin adolescent women aged 12-18 years who were recruited from the Philadelphia area. The adolescents did not have to be contraceptive users in order to participate. The question put to each group was, "What are the things you have heard about the birth control pill, Depo-Provera and Norplant?" Groups were audio-recorded, transcribed and analyzed using qualitative software. RESULTS: We conducted 13 female-only groups. Participants raised frequent concerns about menstrual-related side effects, believing that these side effects were evidence of possible negative effects of HC on their reproductive health. Four themes related to hormonal contraceptive-induced menstrual irregularity emerged from the groups. Theme 1: Menstruation is natural and should not be altered in any way. Theme 2: The menstrual period is necessary for cleansing of the body. Theme 3: "Spotting," intermenstrual bleeding and amenorrhea cause doubts about the method's effectiveness and worries about pregnancy. Theme 4: All menstrual irregularity, from intermenstrual bleeding to amenorrhea, causes worry about the effects on fertility and on physical health. CONCLUSIONS: Teens have concerns about the menstrual irregularity caused by HC. Providers understand that these side effects are minor and of little medical consequence. Yet, adolescent patients may be ascribing great significance to these effects and may be declining these methods because of fear and misperceptions.

Adolescent↗
PubMed2000

Reproductive health in selected villages in Lao PDR.

The aim of the project was to improve the knowledge and attitude towards birth spacing by training the villagers in the selected villages of Vientiane Province in Lao PDR in family planning, providing them with the various family planning methods, and improving antenatal (ANC) and postnatal (PNC) care in the villages. Throughout the province, traditional birth attendants (TBA) were trained on several occasions during the project period. There were clear indications that reproductive health improved between 1995 and 1997. Considerable improvements were observed in the percentage of women making use of ANC and practising birth spacing by using some form of contraception or other. The most common methods used were contraceptive pills and injectables. In the case of child mortality a slight decrease was found in the percentage of women having their first pregnancy below the age of 18 years. A still unsolved problem is the high number of abortions.

Adolescent↗
PubMedDate not supplied

Innovations in reproductive health care: menstrual regulation policies and programs in Bangladesh.

Although abortion is legally restricted in Bangladesh, early menstrual regulation (MR) as a means of reducing female morbidity and mortality associated with indigenous abortion has been part of the government's health and family planning efforts since 1975. Approximately 3,000 doctors and 2,600 female family planning workers (Family Welfare Visitors) have been trained in techniques of MR in a program intended ultimately to serve rural populations in all areas of the country. This paper assesses MR training and service programs in Bangladesh for their capacity to provide high quality reproductive health care for very poor women who are trying to control their fertility. Among other advantages, MR programs serve as an entry point for many women to contraceptive services and to maternal health care.

Abortion, Induced↗
PubMed2002

Participatory evaluation of reproductive health care quality in developing countries.

Participatory approaches are becoming increasingly important in the field of health, and many organizations, governments and donors have recognized the need to increase stakeholder involvement to ensure sustainable and real change. However, commitment to participation is often lacking and participatory processes, if applied, tend to be short-term and discrete, especially in institutional settings. Rarely, for example, are stakeholders involved in long-term monitoring and evaluation activities, due the time-consuming nature of participation, and to perceptions on the part of donors and other decision-makers that participation lacks the rigor and objectivity of external evaluation. This paper describes the strategies used by an international reproductive health organization to collaborate with local stakeholders in a long-term participatory approach to quality improvement, focusing on defining quality of care, identifying problems in health facilities, setting goals and seeking solutions to those problems, tracking changes in quality over time, and feeding this monitoring and evaluation information back into the quality improvement process. The paper also illustrates how greater participation was achieved over time as local stakeholders moved away from traditional models and relationships and started working together to meet their quality improvement goals. The paper argues that participatory techniques are essential if the real needs of clients are to be met through sustained change and continuous quality improvement at the site level.

Attitude to Health↗
PubMed2000

Monitoring std prevalence and reproductive health care among high-risk adolescent women

Background: Urban adolescent women, particularly those in socially disadvantaged situations are at high risk for infections with Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (GC) and their sequelae. Non-invasive screening technologies, including ligase chain reaction (LCR) and polymerase chain reaction (PCR) urine tests for CT and GC allow for provision of screening services in settings frequented by high-risk adolescents where such services have not been traditionally provided. In 1999, the CDC lead a multi-site project monitoring STD prevalence and reproductive health service, collecting a standard set of variables in women <20 yrs in juvenile justice system, drug treatment centers, and school-based clinics. This report provides preliminary data from Alabama and Colorado. Methods: Adolescent women who present for intake/services at selected facilities are enrolled in the project. In collaboration with CDC, sites developed a set of standard variables to be collected, including demographics, risk behaviors, symptoms, test performed, and test results. Dependent on services already performed, sites added CT and/or GC urine PCR/LCR and pregnancy testing to existing screening protocols.Results: In first 3-months, 533 adolescent women were enrolled in this on-going study; 379 in juvenile institutions, 38 in drug treatment centers, and 116 in school-based clinics. Mean age was 16 yrs, over 90% were sexually experienced, nearly 50% did not use condom with the last sex, less than 40% reported "current" birth control use, over 2/3 had sexual intercourse in past 3 months, many with multiple partners. Prevalence rates for CT and GC are summarized in the table. Conclusions: Non-invasive (urine) LCR/PCR tests allow for easy monitoring of selected STDs among adolescent women in high-risk settings. These findings may contribute to a sentinel surveillance system among high-risk populations and, in turn, may provide the rationale for the development of health care/intervention priorities at policy level.

Journal Article↗
PubMedDate not supplied

[Effects of dioxins in the development of malignant tumors and disorders of reproductive health of the population].

The mortality caused by malignant tumors in the town of Chapaevsk, characterized by increased level of dioxins in the environment, is statistically higher than the expected values. For men the relative risk of general morbidity is 1.9 and mortality, 1.8; for lung cancer: morbidity, 3.3 and mortality 3.1; for urogenital cancer: morbidity, 3.6 and mortality, 2.6; for gastric cancer: morbidity 1.9 and mortality, 1.7. In women the morbidity and mortality due to breast cancer (relative risks 1.9 and 2.1, respectively) and cancer of the cervix uteri (relative risks 2.1 and 1.8, respectively) are increased. Changes in the reproductive health of residents of this town are as follows: high incidence of spontaneous abortions, appearance of small-for-date babies, and genital disorders in body (cryptorchidism, phimosis, hypospadia, delayed sexual development).

Adolescent↗
PubMed2006

[Work, schooling, and reproductive health: an ethno-epidemiological study of adolescent women belonging to a birth cohort].

An ethno-epidemiological study was carried out with adolescent women who have been studied since birth. In 2001, all female adolescents from the 1982 Pelotas Birth Cohort were identified in 27% of all census tracts in Pelotas, Rio Grande do Sul State. Risk factors for childbearing during adolescence were investigated using a case-control approach. Cases (n = 420) were identified through the local live birth information system, and controls included 408 women who had not given birth by 2001. To understand social and cultural factors related to childbearing during adolescence, an ethnographic study focused on 23 young women from the case group. Work, schooling, sexuality, and reproductive health were analyzed using an ethno-epidemiological approach. Socioeconomic variables like work and schooling were strongly associated with childbearing in adolescence. An inverse linear association was observed between age at first dating and childbearing during adolescence (p < 0.001). Focusing on the contexts and social values (traditional and/or modern), pregnancy was: a positive consequence of an affective relationship with the partner; a way of exposing adolescent sexuality; and a means to achieve a certain social autonomy and other forms of social status within the age group.

Adolescent↗
PubMed2004

Intrauterine devices and reproductive health: American women in feast and famine.

Intrauterine contraception has been available in the United States since the early 1960s. During the past 4 decades, American women have mainly used nine different devices and accumulated approximately 47 million person-years of use. Interest in IUDs, as expressed by both use patterns and market forces that created and retired products, varied tremendously over this period. In the peak years, women had unfettered access to, and choice of, IUDs, over time availability has declined. The American experience with IUDs involved a unique combination of factors: invention, expansion of publicly funded services, mass media, medical missteps, conflicting research, medical opinion and tort law. The IUD generated a controversial balance sheet of risks, benefits and reputation that still impacts reproductive health today.

Humans↗
PubMedDate not supplied

Onchocerciasis and reproductive health in Ecuador.

A retrospective study was performed comparing the number of spontaneous abortions in a hyperendemic area for onchocerciasis in Ecuador before and after invermectin treatment with that of a comparable non-endemic area. The frequency of spontaneous abortions was associated with a change in the community microfilarial load, suggesting that there may be a relationship between spontaneous abortions and infection with Onchocerca volvulus. In the endemic area, a significantly greater rate of spontaneous abortions was seen in the period before ivermectin distribution compared to that after the start of ivermectin treatments every 6 months. In the non-endemic area, no change in the rate of spontaneous abortions was seen over the same time period. In addition to the well-documented improvements in skin and ocular disease, ivermectin may also improve the reproductive health of endemic populations.

Abortion, Spontaneous↗
PubMed2000

Hydrocephalus and the reproductive health of women: the medical implications of maternal shunt dependency in 70 women and 138 pregnancies.

An increasing number of women with cerebrospinal fluid shunts are surviving to child-bearing age, and are making independent decisions in regard to planning their families. As a result, a broad range of interdisciplinary health care professionals will require information about the management of these patients, especially during pregnancy and delivery. The purpose of this ongoing study is to gather comprehensive data from shunted women regarding their clinical history during pregnancy and within the six-month post-partum period. As part of this study, the following questions were addressed: 1. How does maternal shunt dependency influence the course of pregnancy and pregnancy outcomes? 2. What neurosurgical complications characterize this population of patients? 3. What complications of shunt dependency influence obstetrical management including pre-natal testing and delivery? 4. What are the implications of shunt dependency with respect to general reproductive health concerns within this population? A total of 70 respondents, 18-41 years old and accounting for 138 pregnancies, completed a questionnaire providing information on maternal background, medical history, shunt performance during pregnancy, management of delivery, pregnancy outcomes, and unusual complications. One hundred three (103) pregnancies resulted in 105 live births including two surviving sets of twins; of these, 84 occurred in women with ventriculoperitoneal shunts (including both mothers who gave birth to live twins). Four women underwent therapeutic abortions, five delivered pre-term, one mother delivered a stillborn infant, and 16 experienced 32 miscarriages (including two ectopic pregnancies, and 33 fetal losses). Three women had seizures during pregnancy. Nine mothers reported an increase in headache activity during pregnancy. Twelve described abdominal pains during the course of pregnancy with anecdotal reports of increased frequency of painful episodes during the first and third trimesters. Twelve babies were diagnosed with congenital defects, including one pair of fraternal twins individually diagnosed with symmetric parietal foramina. Seven additional children were diagnosed with developmental disabilities including attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), pervasive developmental delay (PDD), and autism. Shunt malfunctions and revisions occurred seven times (four women) during pregnancy, and in 24 pregnancies (13 women) within six months of delivery. One malfunction and revision followed the miscarriage of twins at 12 gestational weeks. No acute malfunctions requiring immediate revision occurred during delivery, although two women reported severe headaches during labor. Transient signs of raised intracranial pressure occurred in 15 mothers over the course of 19 pregnancies which did not require surgical revision of the shunt following delivery or termination of pregnancy. No signs of shunt malfunction were identified in 100 of the pregnancies described in this series; 31 of these resulting in miscarriage and 69 resulting in live births. This study extends observations made previously to a larger population of shunt dependent mothers, and nearly doubles the amount of data available in our last publication. The results suggest that maternal shunt dependency carries a relatively high incidence of complications for some patients, but that proper management of these patients can lead to normal pregnancy and delivery.

Abortion, Spontaneous↗
PubMed1998

Quality of care in reproductive health programmes: education for quality improvement.

The provision of high quality maternity care will make the difference between life and death or lifelong maiming for millions of pregnant women. Barriers preventing access to affordable, appropriate, acceptable and effective services, and lack of facilities providing high quality obstetric care result in about 1600 maternal deaths every day. Education in its broadest sense is required at all levels and sectors of society to enhance policy formulation that will strengthen programme commitment, improve services with a culturally sensitive approach and ensure appropriate delegation of responsibility to health staff at peripheral levels. This paper is the second in series of three which addresses quality of care. The first (Kwast 1998) contains an overview of concepts, assessments, barriers and improvements of quality of care. The third article will describe selected aspects of monitoring and evaluation of quality of care.

Clinical Competence↗
PubMed2005

Sexual and reproductive health and rights in the United Kingdom at ICPD+10.

At the mid-point of the Programme of Action of the 1994 International Conference on Population and Development, we reviewed the situation in the UK in key areas. In recent years, greater attention has been paid to sexual health at a national policy level, including strategies on teenage pregnancy and sexual health, but there is still a long way to go. The law against female genital mutilation has been strengthened, twice as many men attend family planning clinics as ten years ago, access to abortion services funded by the National Health Service has improved substantially, up to 80% of contraceptive advice and care is accessed through general practice, a national screening programme for chlamydia is being rolled out, the age of consent has been equalised for men and women and for heterosexuals and homosexuals, and new recommended standards for sexual health and HIV services have been developed. However, many family planning services do not involve young men, waiting times for an abortion are too long, the abortion law has never been extended to Northern Ireland, and there are rising rates of STIs and HIV. Rapid improvements in sexuality education, training and improved resources for family planning and abortion providers and the re-introduction of national public information campaigns about all aspects of sexual health are all required.

Adolescent↗