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Results for “Reproductive Health”

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PubMed1998

The evaluation of the health care needs of women with disabilities.

There are 27 million disabled women in the United States. These women face many unique challenges in accessing medical care and frequently report an insensitivity to their specific health care needs. Disabled women also have a wide array of health-related issues, including multiple concurrent medical disorders, psychosocial issues, and socioeconomic concerns. Their overall experience is that of a fragmented health care delivery system that often is inadequate in many important areas such as reproductive health, post-reproductive health, sexuality, etc.In order to address these issues, the departments of neurology and gyn/ob formed a multidisciplinary Women's Health Collaborative Research Group (WHCRG). Its mission is to develop a wellness model of comprehensive women-centered care that meets the special health care requirements of women with chronic disabling conditions. The Women's Health Issues Survey is a 72-item self-report needs assessment that was administered to over 300 women with multiple sclerosis, stroke, and other neurologic disorders. The results of the survey were critical to the planning and implementation of a center for women with disability.Approximately 50% of the women (median age 45 years) were moderately to severely disabled, as measured by the Kurtzke Expanded Disability Status Scale. Over 20% of those surveyed reported a history of uterine fibroids, endometriosis or ovarian cysts, irregular menstrual periods, and deterioration of their neurologic condition (eg, multiple sclerosis) during menstruation. Forty percent were sexually inactive. Seventy percent of the postmenopausal cohort were not taking hormone replacement therapy.The ability to identify and survey a representative sample of disabled women and develop a database linking demographic, physical disability, economic, and health care access information is a key step in implementing a cross-functional approach toward improving the level and scope of health care for disabled women.

Journal Article↗

PubMed1987

Health and reproductive status of female workers in dry cleaning shops.

This study concerns 67 women working in 53 dry cleaning shops in the city of Rome. The survey includes data on work habits, health problems and reproductive histories. Exposure to the prevalent solvent used in dry cleaning (tetrachloroethylene) was evaluated by the trichloroacetic acid (TCA) concentration in the urine. Exposure was four times higher among dry cleaners than among women doing only ironing and among the controls. However, the TCA values were still low, thus suggesting ambient concentrations within the acceptable limits. The health of these women was satisfactory, and no overt reproductive pathology was detected. The methodological limitations and the small sample size, however, do not permit firm conclusions.

Adult↗

PubMedDate not supplied

Gender double standards in young people attending sexual health services in Northern Thailand.

Concern about the sexual and reproductive health of young people has been mounting recently in Thailand. Unequal gender relations have a considerable influence on the lives of young people, especially young women, yet few studies have explored the ways in which they have impacted on provision of sexual health care. Drawing upon data from a qualitative study in Northern Thailand, this paper explores the views and experiences of young people in seeking health care, highlighting the kinds of gender double standards and power imbalances that may pose obstacles to their use of sexual and reproductive health services. Findings reveal the vulnerability of sexually active young women in seeking support and care from partners, parents, and service providers. Those who experience adverse outcomes of sexual activity, such as unwanted pregnancy or infection, report facing indifference, victim blaming, or the threat of abandonment by their partners. Because of their fear of disclosure to their parents and communities, of their sexual activity, they opt for clandestine and unsafe abortion and seek the counsel of peers and drugstores rather than parents and providers. At the service provider level, young women report facing threatening and judgemental attitudes, indifferent counselling, and possible violation of confidentiality. This is in marked contrast to the treatment of young men, who generally meet with a more sympathetic and accepting response.

Adolescent↗

PubMed2006

Reproductive knowledge, attitudes and behavior among adolescent males in Tehran, Iran.

CONTEXT: Iran's culture and religion prohibit sexual contact prior to marriage. Due to the sensitivity of the topic, little is known about the sexual activity of unmarried adolescent males or about their knowledge of, and attitudes toward, sexuality and reproductive health. METHODS: A population-based study of 1,385 males aged 15-18 in Tehran was conducted using a self-administered questionnaire. Participants were questioned about their beliefs and knowledge regarding reproductive health, and asked whether they had engaged in sexual activity. Bivariate and multivariate analyses were performed to identify factors associated with sexual knowledge, attitudes and behavior. RESULTS: Twenty-eight percent of the sample reported having engaged in sexual activity. Sexual experience was associated with older age, access to satellite television, alcohol consumption and permissive attitudes toward sex. Substantial proportions of respondents held misconceptions regarding condoms, STIs and reproductive physiology. Attitudes toward premarital sex were more permissive among respondents who were older, were not in school, had work experience, had access to the Internet or satellite television, lived separately from their parents, or reported having used alcohol, cigarettes or drugs. CONCLUSION: The relatively high prevalence of sexual activity and the lack of knowledge regarding STIs and contraceptives pose a significant threat to the sexual and reproductive health of adolescent males in Iran. Programs are needed to provide adolescents with the information and skills to make safe sexual decisions.

Adolescent↗

PubMed2000

Family planning services at school-based health centers: findings from a national survey.

Although nearly 1000 school-based health centers (SBHCs) operate in the United States, little is known about SBHCs' sexual and reproductive health services. This study investigated reproductive and sexual health services delivery in SBHCs, specifically the types of services available in SBHCs. A 16-page, self-administered questionnaire asked center staff to identify the reproductive health services provided on site as well as which services were restricted and by whom. The results suggest that whereas most SBHCs provided at least one reproductive health service, most centers were restricted from providing contraceptive services, usually by school district policy.

Adolescent↗

PubMed1996

Great tits Parus major trade health for reproduction.

Reproduction and maintenance compete for resources within a single individual. But do individuals invest in reproduction just as much as remains after the requirements of maintenance are covered, or do they sacrifice their health for the sake of still further increase the investment in current reproduction? This question has been found hard to answer because of difficulties of demonstrating that individuals naturally make a reproductive effort of such a magnitude as to inflict health damage. In this paper we present evidence for a trade-off between reproductive effort and health state in great tits, indicated by a positive correlation between total prefledging brood weight and both intensity of Haemoproteus blood parasite infection and heterophile: lymphocyte (H:L) ratio. H:L ratios, which signal stress in birds, were high both among individuals making an intense reproductive effort and among aberrantly behaving individuals, such as females incubating in empty nests and birds which abandoned their broods after blood sampling. Experimental reduction of clutch size resulted in decreased intensity of Haemoproteus parasitemia, providing further evidence that individual great tits accept immunosuppression to increase their reproductive investment.

Animals↗

PubMed2004

Family planning in the balance.

Family planning has long been acknowledged as an effective public health intervention. In recent years, however, family planning has come under increased scrutiny from conservative politicians and constituents. National US policies instituted since 2001 are resulting in cutbacks in family planning programs worldwide. In the long run, these conservative initiatives may set back several decades of progress in reproductive health and reproductive rights. In promoting an ideologically driven approach to sexual and reproductive health, the recent policy developments threaten to subvert ethical standards of medical care and the principle of evidence-based policy.

Abortion, Induced↗

PubMedDate not supplied

Mercury in the environment: effect on health and reproduction.

Mercury is a heavy metal that is found naturally in the environment in various forms. Human activity can release mercury into the air, water, and soil. Mercury is also released into the environment after its conversion to methylmercury by bacteria. Mercury was once used in medicine, but the medicinal aspect changed because of its devastating poisoning effect on humans and animals. Today, mercury is one of the most potent neurotoxins known, having a number of adverse health effects in animals and humans. As the sources of mercury are many, the general population is exposed to mercury in day-to-day life, in occupational settings, and in cases of accidental exposure. In addition, ignorance about the use of mercury in cosmetics and religious materials has opened an additional source of exposure. Therefore, making people aware of mercury's effects on health, its sources of entry into the environment, and its chelating remedies becomes a necessity so that strategies can be adopted to minimize use and exposure.

Biotransformation↗

PubMed1989

Work, environment and the fetus.

The opportunities for women to work in traditionally male oriented industries will increase substantially within the next 10 years exposing them to substances and processes which might adversely affect their reproductive health. The effects which known and putative reproductive toxins may have on pregnancy outcome are reviewed against the knowledge of normal development. Any epidemiological study which looks for an association between exposure and outcome must take into account confounding factors and sources of bias which may influence the result and lead to unsound conclusions. Some of these sources of error are discussed in relation to adverse reproductive outcomes. Where there is positive evidence of an adverse effect on reproduction policies must be formulated to provide equal protection for male and female reproductive health whilst, at the same time, allowing for the unique role of women in providing a safe internal environment for the developing fetus.

Embryonic and Fetal Development↗

PubMed2000

The reality of unsafe abortion in a rural community in South India.

Though the law in India has permitted medical termination of pregnancy on broad legal grounds for over two decades, unsafe abortions carried out by unqualified providers show no signs of decreasing. A community-based study was undertaken in rural South India to determine the prevalence of induced abortion, women's reasons for seeking abortion, who was providing abortions and whether the procedures were safe or unsafe. A cross-sectional study design was used that included focus group discussions with 88 women and a quantitative survey with 195 married women who had a birth interval of two or more years since their last pregnancy. There was a high prevalence of induced abortion (28 per cent) among the study population, mainly among women who were not using contraception. Most abortions were carried out in the first trimester of pregnancy and unqualified practitioners performed 65 per cent of terminations. The preference for illegal, untrained providers in a country where abortion is legally available exposes the ambiguity in the status of abortion and how inadequacies in legal service provision have served to promote and sustain unsafe providers and practices. An integrated approach to family planning and reproductive health which includes abortion is imperative if the reproductive health status of Indian women is to be improved. The poor utilisation of existing government facilities suggests the need for improving the quality of services, expansion of abortion facilities and the introduction of safer methods of abortion. To do this, a re-examination and re-framing of aspects of the 1971 abortion law is needed.

Abortion, Induced↗

PubMed2003

Maternal attitudes and values to youth sexuality-related activities in Delta State, Nigeria.

This descriptive study assessed maternal attitudes to youth-related activities in Delta State. Using an adapted questionnaire, 300 women with adolescent children were chosen through a multistage sampling technique and relevant data obtained regarding their socio-economic status, perceptions and values as well as their knowledge of basic reproductive health concerns. Most of the women interviewed (95%), believed it was very important that young people completed secondary education and another 72% said they would normally set rules in their homes regarding what young people should read or watch. Sixty-seven percent of those studied, discussed sexuality issues regularly with their adolescent children, though only 46.4% of them were comfortable discussing these issue and about 50% admitted having enough information in such discussions. Another 76% of the women would approve of their children receiving reproductive health information and service including contraceptive condoms. The mothers studied believed that guided reproductive health information and services should be routinely provided for young people. The findings strongly suggest that the mothers who are important stakeholders in Adolescent Health would most likely be supportive of youth programmes. Most of the findings differ from those of other studies, and a qualitative study would be carried out to identify the reasons for these interesting findings.

Adolescent↗

PubMed2003

Changes in the spatial pattern of low birth weight in a southern California county: the role of individual and neighborhood level factors.

Individual-level maternal risk factors have been able to explain only a small proportion of low birth weight (LBW) births in the US to date and neighborhood-level factors have not been recognized as important predictors of reproductive outcomes. At the US/Mexico border, tremendous demographic changes have taken place between 1980 and 1990. Whether high population growth, economic pressures, and community instability have affected reproductive health in this region is not known. We used spatial epidemiologic methods to investigate the importance of changes in neighborhood and individual-level risk factors in predicting changes in two measures of adverse reproductive health: term and preterm LBW. Using approximately 16,000 births in 1980 and 24,000 births in 1990, we produced a continuous surface of LBW change (Z scores for difference in proportions) for southern San Diego County, CA, and identified statistically significant "hot spots" of elevated risk. Using a geographic information system, data from the 1980 and 1990 US Census were smoothed to link neighborhood-level variables with individual-level data from the 1980 and 1990 California birth certificates. Multivariate regression models were developed to identify individual- and neighborhood-level variables of 1980-1990 changes which were predictive of Z scores of LBW change. Results of conditional autoregressive models were used to assess effects of spatial autocorrelation. The continuous surface of LBW identified areas with statistically significant increases (17 areas for term LBW and 14 areas for preterm LBW). While individual- and neighborhood-level variables explained about an equal amount of variance in term LBW, only neighborhood-level variables were significant predictors of preterm LBW. While changes in maternal race/ethnicity composition and a measure of stability were related to term LBW, measures of affluence were related to preterm LBW. This study highlights the importance of socioeconomic and demographic changes in a woman's neighborhood on reproductive health.

Adult↗

PubMed1997

Implementing family planning programs in developing countries: lessons and reflections from four decades of Population Council experience.

Over the last three decades, contraceptive prevalence has risen from about 10% to nearly 60% in developing countries, but still about 1 in 4 births in developing countries (outside China) is unwanted. More than 120 million women in these countries who do not want to become pregnant do not use contraceptives. Nearly 600,000 women die each year from pregnancy-related causes, between 67,000 and 204,000 of them from unsafe abortions. At the 1994 International Conference on Population and Development in Cairo, delegates endorsed the view long advocated by the Population Council: the primary purpose of family planning programs should be to help women avoid unwanted pregnancy and achieve their fertility goals safely. That means, at the very least, that programs should address those reproductive health issues that are directly related to fertility regulation. To meet the Cairo challenge, progress is needed simultaneously on several levels. We need more and better contraceptive technologies that meet the needs of different groups; higher-quality family planning services; more outreach to underserved groups (such as men and adolescents); programs tailored to local cultures; and measures to address all the factors that prevent women who do not want to become pregnant from using contraceptives. The call for a client-centered, reproductive health approach to family planning constitutes a critique of programs driven by demographic goals. The new family planning paradigm puts a premium on 'quality of care'. Unfortunately, many family planning programs still fall substantially short of offering clients reproductive choice and supporting their reproductive health. The Population Council takes the view that contraceptive research and development is an essential component of a multilevel strategy to reduce unwanted fertility safely. New products, used ethically and provided with quality, would be of tremendous benefit to women and men throughout the world. The Population Council has developed, registered, and licensed seven products, including some of the most widely used contraceptives in the world. The Council is also one of the world centers for research on male reproductive physiology and male contraception. New contraceptive methods are only as good as the context in which they are offered. To accelerate the pace of overall fertility decline, governments must adopt policies that reduce the economic and social risks associated with having smaller families, and policies that promote later and planned childbearing.

Contraception↗

PubMed1998

Quality and costs of family planning as elicited by an adolescent mystery client trial in Nigeria.

Results are presented from a rural reproductive health project in Delta State of Nigeria. A baseline survey of Family Planning clients revealed that only 2 percent of adolescents were utilising the services. Therefore four adolescents, two males and two females posing as two couples, were used as mystery clients to assess providers response to adolescents, as well as the adolescent perspectives on the quality and costs of the family planning services in the clinics they visited. This was complemented with a participatory rural appraisal of the communities. The adolescent mystery clients reported that some providers were surprised to see them, were judgemental, and engaged them in religious counselling. The adolescents found the services unsatisfactory, but the costs were affordable. In the participatory rural appraisal, the communities found the cost of contraceptives affordable despite a recent price increase of 20-150% across the different contraceptives. Emerging practices that were detrimental to adolescent reproductive health were also discovered and innovative approaches for promoting access to reproductive health information by out-of-school adolescents through the use of artisan trade associations and home videos are suggested.

Adolescent↗

PubMed2004

Unanswered questions in contraceptive management: what do the experts do?

CONTEXT: Several areas exist in the practice of contraception where evidence for practice is deficient, yet clinical decisions need to be made. OBJECTIVES: The aim of the study was to find the practice habits of lead practitioners in the area of contraception in specific clinical scenarios where the published evidence is inadequate to provide clear guidance to clinicians. Results can provide 'Level V' evidence for practice for the 'nonexpert' practitioner. DESIGN: Descriptive study. PARTICIPANTS: The study was conducted as a postal questionnaire mailed to the 205 lead practitioners whose contact details were known through the Society of Consultants in Reproductive Health (hereafter referred to as 'consultants') working in reproductive health in the National Health Service. RESULTS: A total of 138 consultants returned completed questionnaires (67% response rate). Important results included 100% of respondents being prepared to prescribe progestogen-only emergency contraception more than once in a cycle (contrary to product labelling) and 71% recommending two tablets daily of the progestogen-only pill for women of high body mass. CONCLUSIONS: Some questions had responses that showed clear majorities, providing a clear guide to practice, while other areas remain doubtful. Comments from respondents indicated great interest in all areas covered and a desire for consensus on many of the issues. Certainly the licensing and the advice from pharmaceutical companies is conservative, and in many scenarios a majority of consultants indicated that in order to serve the best interests of their clients they feel constrained to practise outside the Summary of Product Characteristics.

Contraception↗

PubMed2006

Where have all the condoms gone in adolescent programmes in the Democratic Republic of Congo.

Decades of mismanagement, combined with the withdrawal of international cooperation and a protracted war, have seriously affected the health system in the Democratic Republic of Congo (DRC) and the health status of the population. As part of a Belgian development cooperation programme, we conducted a study in Kinshasa and Bukavu in April-May 2004 on how a rights-based approach could contribute to an effective and appropriate response to the sexual and reproductive health needs of Congolese adolescents. Access to condom information and supplies was studied in this context. A qualitative methodology was used, consisting of focus group discussions with adolescents and interviews with peer education programme officers. These programmes were supposed to be based on the recognition of adolescent sexual and reproductive health rights and the so-called ABC approach (abstinence, be faithful, condom use). We found, however, that sociocultural barriers and strict obedience to Vatican doctrine prevented adolescents from receiving accurate and comprehensive sexuality education and that condom supplies were blocked by peer education programme officers. The promotion of adolescent sexual and reproductive health rights is the responsibility of States, but the international community, non-governmental and faith-based organisations and donors play an essential role in assisting States in this respect and should never act in violation of adolescents' rights.

Adolescent↗

PubMedDate not supplied

[The evolution of health care in the areas of reproductive and sexual health--Brazil, 20th Century].

Technical and practical works on the reproduction and sexuality processes conducted in Brazil, in the last century, are the subject of this article. Therefore, authors review the history and emphasize three moments: the first one, until the 1950's, when the basis of public responsibility is defined specially regarding maternity and medical interventions are carried out in order to moralize the sexuality field; second, between the 1950's and 1970's, when the clinical and educative health care is consolidated and directed to women reproductive process and complications on men and women sexual apparatus; third, when broader political bases are built regarding health care, reproduction and sexuality.

Brazil↗

PubMed2002

Occupational health in physiotherapy: general health and reproductive outcomes.

Physiotherapists are exposed to many risk factors in their work environment. Their general health status is largely unknown, and conflicting studies suggest possible adverse reproductive effects of electromagnetic radiation to which they may be exposed. As part of a larger study, a systematic sample of one in four physiotherapists on a state register (N = 824) was surveyed. Each subject completed an eight page questionnaire, answering questions about musculoskeletal and general health, exposure to risk factors, exposure to electrophysical agents and reproductive outcomes. The response rate was 67.8%. The incidence of congenital malformations and miscarriage among physiotherapists was lower than that in the general community. However, physiotherapists who performed hydrotherapy were more likely to report dermatitis, rashes and fungal skin infections. The prevalence of these conditions increased with the number of hours spent doing hydrotherapy. These findings suggest that physiotherapists are unlikely to have an increased risk of negative reproductive outcomes because of their exposure to electrophysical agents. Physiotherapists who perform hydrotherapy, however, have an increased risk of skin complaints.

Adult↗