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PubMed1994

Important conclusions from abortion studies.

In general, it can be concluded that the initiative on the determinants and consequences of induced abortion has shown some important patterns. For example, induced abortion is not restricted to adolescents but occurs also within marriage to limit family size. Induced abortion is prevalent both where family planning services are available and contraceptive prevalence is high as well as where family planning is not common, but for different reasons. In the former, motivation to limit family size is high and women would use any option if contraception fails or an unwanted pregnancy occurs. In the latter case, induced abortion forms part of a mix of incipient fertility regulation alternatives, most of which are traditional and of little effectiveness but including some use or improper use of modern methods. Few abortion seekers, and among them even fewer adolescents, were using a modern contraceptive at the time the pregnancy started. High use of traditional methods in some countries leads to abortion as women/couples fail to follow proper instructions with regards to the safe period. Unsafe clandestine abortions are more likely to be sought by poorer women and by adolescents. The findings of this research are increasingly being used to question the legal status of abortion in countries where the law is restrictive, or to strengthen family planning efforts in order to reduce abortion incidence.

Abortion, Induced↗
PubMed1976

[Use of contraceptives among adolescents (author's transl)].

Adolescents consulting the family planning clinic in Vienna seldom use contraceptives before the age of seventeen or use a method with a high risk of pregnancy. Thereafter a marked increase in the number of pill-users is observed. All other methods of contraception, including the rhythm method, condom, diaphragm and chemical methods are employed only to a negligible extent. These results are compared with the figures of other countries, where, in general, a higher number of pill-users is reported. It is concluded that the recommendation of traditional methods of contraception by doctors does not seem practicable on account of the positive trend towards the pill among adolescents. The basis for prescription of oral contraceptives to adolescents is critically reviewed and revised.

Adolescent↗
PubMed1979

Attitudes towards family planning among the women of a Northern Australian Aboriginal community.

The results of a survey of the attitudes of 92 women from an Aboriginal community towards childbearing and family planning are presented. The majority of the women stated a preference for well-spaced families of a size which enabled a mother to care adequately for her children. The respondents were almost unanimously in favour of the use, when desired, of Western contraceptive methods. One of the authors (JR) suggests that these attitudes reflect traditional norms of family structure, and that they are also based on a critical appraisal by the women of the community of the demands of caring for young children. These demands are exacerbated by a depressed socioeconomic environment.

Anthropology, Cultural↗
PubMed2004

Integrated reproductive health services: the perspectives of providers.

With the advent of the AIDS epidemic the focus of family planning programmes has shifted from an emphasis on pregnancy prevention to include disease prevention. The move towards integration has meant a major re-orientation in the role of health providers. This article seeks to expand knowledge about the implementation of integrated services from the perspective of providers. It focuses more specifically on the provider's perceptions and experiences of integrated services. A range of methods is used to obtain information from providers, including an inventory of health facilities, in-depth interviews and focus group discussions. The results suggest that the majority of providers expressed favourable attitudes to integrated services. Integrated services are seen as a more client centred approach. However, there is a lack of clarity about the precise from that integration should take. As a result, providers seem more comfortable with the traditional focus on family planning and maternal and child health than sexually transmitted infections.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Contraceptive use in the United States, 1973--1976.

The pill and sterilization were the main methods used by U.S. married couples in 1976 to prevent pregnancy. In 1973 the poor were more likely than the more affluent, and blacks as likely as whites, to use the most effective methods. By 1976 this was no longer true, because more blacks turned to traditional and folk methods and the sterilization increase was largely limited to more affluent whites.

Adolescent↗
PubMed2004

A closer look at traditional contraceptive use in Turkey.

Withdrawal is the main method used amongst couples in Turkey to prevent pregnancy. Discontinuation of use is most likely to be due to the desire to become pregnant or failure of the method. Withdrawal users are less likely to switch to another contraceptive method; however, among users who do switch, they will most likely switch to a modem method. The strongest three determinants that predict withdrawal use are using withdrawal as one's first method, the woman's age, and the husband's education. The woman's work status and the couple's ethnicity are also important predictors of withdrawal use. Family planning programs should target different segments of the population and focus on correct knowledge of all methods. Results indicate that men and women need to learn about family planning options earlier in their lives or prior to marriage.

Adolescent↗
PubMed1995

Fertility and family planning in African cites: the impact of female migration.

This study uses data from thirteen Demographic and Health Surveys to examine effects of female migration on fertility in African cities. Contrary to expectations, migration from villages and towns in the 1980s and 1990s reduced total fertility rates in African cities by about one birth, from an estimated average of 5.55 in the absence of migration to 4.59. New arrivals experience much lower fertility in their first few years in cities than long term residents of similar age and parity. This results from the initial unmarried status of most migrants, high levels of spousal separation among new arrivals who are married, dramatic increases in use of modern methods of contraception after 2 years in cities, and continuation of traditionally long durations of postpartum abstinence. Accommodation of additional migrants thus appears consistent with efforts to reduce fertility in cities. Moreover, prospects for increased contraceptive prevalence in Africa may depend heavily on changes in population distribution that influence the demand for children, specifically movement to cities.

Africa↗
PubMed1997

The meaning of RTI in Vietnam--a qualitative study of illness representation: collaboration or self-regulation?

In collaboration with the National Committee for Population and Family Planning, a study was conducted in a rural and urban commune of northern Vietnam to provide community-level information about women's reproductive health and behaviors. Ethnographic and structured interviews were conducted with 32 women. A psychosocial model of health behavior, the Dual Process Model, was applied to provide a theoretical framework for understanding women's interpretations of, and strategies for, coping with symptoms of reproductive tract infections (RTIs). Women were found to interpret and manage RTI symptoms collaboratively with other women. Therefore, women's approach to care seeking was influenced heavily by their peer network and not driven by their method of family planning.

Adaptation, Psychological↗
PubMedDate not supplied

Simplifying NFP: preliminary report of a pilot study of the 'collar' method in Brazil.

Natural methods of fertility regulation are acceptable in most cultures. Many couples worldwide do not wish to use contraceptives or do not have access to them but wish to limit their family size or lengthen the time between births. Barriers to expanding use of natural family planning (NFP) methods include a lack of providers who can teach NFP and a lack of time to teach and follow couples during the initial months of NFP use. If simple yet effective methods of NFP are available, then NFP could be introduced to a wider audience. Recently, calendar rules have been revised that use a set interval to identify fertile days. These new rules provide better coverage of fertile days and require less abstinence than the rules traditionally used with the calendar method. One of these new rules is being field tested in a pilot study in Brazil. Couples are asked to abstain from day 9-19 (inclusive) of the menstrual cycle, using a beaded necklace (the 'collar') as a mnemonic device. Focus groups with the teacher-monitors and in-depth interviews with female and male users were carried out to evaluate the acceptability of the 'collar' method. A preliminary analysis of these focus groups and interviews from the first site is presented.

Brazil↗
PubMed1989

Contraceptive method change among rural Sri Lankan women.

Patterns of contraceptive method change and their association with reproductive motivation and contraceptive failure are examined using data from a 1986 survey of family planning behaviour of rural Sinhalese married women aged 15-44 in seventeen districts of Sri Lanka. A notable degree of rationality in contraceptive method changes occurs with family formation. The attempt to control unwanted fertility leads to more efficacious use of contraception, including traditional methods. Some methodological improvements to the analysis of contraceptive switching are indicated. Implications of the findings for programmatic emphasis on permanent versus non-permanent modern methods are discussed.

Adolescent↗
PubMed2003

Trends and determinants of contraceptive method choice in Kenya.

This study uses data from the 1989, 1993, and 1998 Kenya Demographic and Health Surveys to examine trends and determinants of contraceptive method choice in Kenya. The analysis, based on two-level multinomial regression models, shows that, over time, the use of modern contraceptive methods, especially long-term methods, is higher in urban than in rural areas, whereas the pattern is reversed for traditional methods. Use of barrier methods among unmarried women is steadily rising, but the levels remain disappointingly low, particularly in view of the HIV/AIDS epidemic in Kenya. One striking result from this analysis is the dramatic rise in the use of injectables. Of particular program relevance is the notably higher levels of use of injectables among rural women, women whose partners disapprove of family planning, uneducated women, and those less frequently exposed to family planning media messages, compared with their counterparts who have better access to services and greater exposure to family planning information.

Adolescent↗
PubMed2006

Effect of postpartum counseling on postpartum contraceptive use.

OBJECTIVE: The aim of this study was to evaluate the effect of postpartum counseling on postpartum contraceptive use. METHODS: One hundred and forty-three women who delivered between 1 January 2004 and 31 September 2004 and counseled about postpartum contraception were included in the study. The participants were interviewed by telephone. Age, gravidity, parity, and mode of delivery of the participants were recorded. Their method of contraception before pregnancy, their decision on the contraceptive method after counseling and the method actually used were asked. RESULTS: Just after postpartum counseling, 47 women (32.9%) decided to use the intrauterine device (IUD), 23 (16.1%) condoms, 16 (11.2%) progestin injections, 7 (4.9%) oral contraceptives, and 7 (4.9%) coitus interruptus for contraception. Thirty-six women (25.2%) did not decide on any method of use. At the time of the telephone interview the actual method used was learned. Fifty-one women (35.7%) were using coitus interruptus, 45 women (31.5%) condoms, and 14 (9.8%) the IUD. Sixteen women (11.2%) were reported as not using any methods. CONCLUSION: In spite of postpartum counseling, a high majority of the women appeared to use traditional and less effective contraceptive methods.

Adolescent↗
PubMed2003

Families' needs in emergency departments: instrument development.

BACKGROUND: Families who accompany critically ill relatives in emergency departments (EDs) are an integral part of the care unit. However, there are few empirical data on their needs during this phase of care. In order to guide quality care, general and specific needs of families accompanying these critically ill relatives should be systematically examined. AIM: The aim of this pilot project was to test the tool, methods and analysis plan for a study to examine the perceived needs of family members accompanying critically ill patients in EDs and their perceptions of ED staff's ability to meet these needs. METHOD: Over a 6-week period in 1996, 84 relatives who met the inclusion criteria were recruited to the study. A postal questionnaire, to uncover the needs of family members, was pilot tested. The questionnaire consisted of 40 need statements reflecting five major themes: meaning, proximity, communication, comfort and support. Of the 84 relatives selected for the study, 73% returned completed questionnaires. RESULTS: The findings of this pilot study suggest that the questionnaire is a valid and reliable tool for researchers wishing to examine and rank the needs of family members who accompany critically ill people in EDs. In addition, the analysis plan was found to be appropriate. CONCLUSIONS: This pilot study provides both a method and a tool for further research into family needs. Examination of the pilot data supported the reliability and validity of the tool and produced findings that challenge nurses to move beyond traditional practice that has excluded families from being an integral part of caring for critically ill patients in EDs.

Adolescent↗
PubMedDate not supplied

Measuring compliance among oral contraceptive users.

Irregular use of the pill compromises the effectiveness of this highly reliable method. The consistency of pill-taking has traditionally been estimated through women's own reports of their patterns of pill use. In this study, self-reported data on pill-taking were compared with data from an electronic device measuring compliance among 103 women attending university health services and publicly funded family planning clinics. In three months of pill use, the electronic and self-reported data agreed on the number of days when pills were missed only 45% of the time; the level of agreement dropped from 55% in the first month to 38% in the third month. In each month, the proportion of women reporting no missed pills was much higher than the proportion recorded electronically (53-59% compared with 19-33%), and the proportion missing at least three pills according to the electronic data was triple that derived from the women's reports (30-51% vs. 10-14%). In addition, the electronic data recorded substantially more episodes in which women missed pills on two or more consecutive days (88 vs. 30).

Adult↗
PubMed1997

Investigation and management of patients at high risk of developing cancer.

Recent developments in cancer genetics have revealed genes that render individuals susceptible to cancer. These families have a unique set of new problems and benefits that must be thought through for the potential good to be accrued from these discoveries. Individual patients seek early diagnosis and prevention strategies that challenge the limits of current knowledge. Some available methods have not yet been evaluated. There is a need for the evidence to support plans of care, and consistency is required from one centre to the next in the advice given. These familial cancers are often different from the more common sporadic cases, and so traditional treatments need to be tested again in the context of the new genetic knowledge. Three groups of cancers, breast, ovary and colon, have been used to illustrate the issues surrounding these high risk families, their investigation and care. In applying new strategies to these patients, ethical issues arise that are new to the medical world, and must be considered by the lay public. It is up to the medical profession, patients and society to use this knowledge to give benefit to a vulnerable group, and not to give unaffordable hopes and unnecessary anxieties.

Adult↗
PubMed2003

The acceptability and use of contraception: a prospective study of Somalian women's attitude.

This study combined quantitative and qualitative data in order to understand more fully the Somalian perspective of family planning services. Quantitative data alone were insufficient to provide a plausible explanation for the poor uptake of contraceptive services and methods for spacing pregnancies among Somalian women attending the African Well Women Clinic at the Central Middlesex Hospital. The qualitative data elicited deeper issues, provided insights and explained the causal factor of low uptake of family planning services. Religious teaching, status of men and women and an oral tradition were identified as fundamental to Somalian conceptualisation of family planning services. This study suggests that there is a need to provide not only family planning, but health-care services as a whole within a broader social and cultural dimension that meets the need of this clientele. This would entail viewing care within their social and religious context.

Animals↗
PubMed1997

Method of Medicare reimbursement and the rate of potentially ineffective care of critically ill patients.

CONTEXT: The worst outcome of critical care may not be death itself; rather, the worst may be an extended death process in which a patient's and his or her family's suffering has been prolonged by services that are ultimately impotent. We have previously used potentially ineffective care (PIC) as a proxy measure for this type of care. OBJECTIVE: To determine if PIC is delivered less often to Medicare patients enrolled in health maintenance organizations (HMOs) than those in traditional fee-for-service health plans. PATIENTS: All Medicare patients hospitalized in intensive care units in California during fiscal year 1994. OUTCOME: Potentially ineffective care was defined as the concurrence of in-hospital death or death within 100 days of hospital discharge and resource use (total hospital costs) above the 90th percentile. METHODS: Hospital costs were adjusted for institution-specific cost-to-charge ratios and local wage indices derived from Health Care Financing Administration cost reports. A multivariate regression model adjusted PIC rates for age, sex, race, elective admission to the hospital, Charlson index diseases, the 15 most common diagnosis related groups for death by 100 days, intensive care unit size, and number of residents at the hospital. RESULTS: A total of 3914 (4.8%) of 81 494 patients experienced PIC and used 21.6% of total intensive care unit resources. The occurrence of PIC was less common among HMO members (adjusted odds ratio, 0.75; 95% confidence interval, 0.65-0.87). However, HMO members were not more likely to experience in-hospital death (adjusted odds ratio, 0.99; 95% confidence interval, 0.91-1.07) and only slightly more likely to experience death by 100 days after hospital discharge (adjusted odds ratio, 1.08; 95% confidence interval, 1.01-1.15). CONCLUSIONS: Patients who experience PIC outcomes are not uncommon in the Medicare population, and patients experiencing this outcome consume a disproportionate amount of medical resources. Medicare beneficiaries in HMO practice settings had a lower risk of experiencing PIC outcomes after adjusting for age, sex, diagnosis, comorbid conditions, and characteristics of the treating hospital. This suggests that HMO practices may be better at limiting or avoiding injudicious use of critical care near the end of life.

Adult↗