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PubMed2006

Onset of epilepsy and menarche--is there any relationship?

PURPOSE: Women with epilepsy have increased frequency of reproductive health problems compared to women without epilepsy. In puberty, reproductive hormonal changes during sexual maturation may affect epilepsy and induce the debut of seizures as indicated in some studies. On the other hand, epileptic activity affects sex hormone function, which may induce alterations in pubertal endocrine maturation and thereby menarche age. We wanted to investigate the relation between epilepsy and menarche age in a larger population of female epilepsy patients. METHODS: A retrospective, questionnaire study of a cohort of 265 female outpatients from three Norwegian hospitals and 142 controls, aged 18-45 years was conducted. Parameters regarding epilepsy and reproductive health issues were registered. Perimenarche was defined as 2 years before and 2 years after the year of menarche. RESULTS: There was a significantly higher frequency of patients with epilepsy debut between 10 and 18 year compared to 0-9 years (p<0.01). There was, however, no significant difference in occurrence of epilepsy debut in the perimenarche period compared to the 5 year periods before and after perimenarche, and no significant difference in epilepsy debut in the year of menarche compared to the 5 years before or after. Menarche age was not significantly different in those with epilepsy debut before or after menarche. Epilepsy type (idiopathic generalised or partial) did not influence the menarche age. CONCLUSIONS: The study did not confirm the former observations of clustering of epilepsy debut at menarche or in the perimenarche period or alterations in menarche age in girls with epilepsy. However, onset of epilepsy is more frequent in the adolescent years (10-18), than in childhood (0-9).

Adolescent↗
PubMed1997

Multicenter study of the Lactational Amenorrhea Method (LAM): I. Efficacy, duration, and implications for clinical application.

A multicenter study of the Lactational Amenorrhea Method (LAM) was carried out to test the acceptability and efficacy of the method. Additionally, the data are used to test new constructs for improvement of method criteria. A protocol was designed at the Institute for Reproductive Health (IRH), Department of Obstetrics and Gynecology, Georgetown University Medical Center, a World Health Organization (WHO) Collaborating Center, and was reviewed and modified in collaboration with the co-sponsors, the World Health Organization and the South to South Cooperation for Reproductive Health, and the principal investigators from each site. Data were gathered prospectively on LAM acceptors at 11 sites. Data were entered and cleaned on-site and further cleaned and analyzed at IRH, using country-level and pooled data to produce descriptive statistics and life tables. The 98+% efficacy of LAM is confirmed in a wide variety of settings. In addition, the results yield insight on the possibility of continued use beyond 6 months. LAM is found to be highly effective as an introductory postpartum method when offered in a variety of cultures, health care settings, socio-economic strata, and industrial and developing country locales. In addition, LAM acceptance complements breastfeeding behaviors without ongoing breastfeeding support services. The parameters studied yield high efficacy and method continuation. Therefore, the basic tenets of the 1995 Bellagio consensus on LAM is reconfirmed and it is recommended that LAM be reconfirmed and it is recommended that LAM be incorporated into hospital, maternity, family planning, maternal and child health, and other primary health care settings.

Adult↗
PubMed1997

Multicenter study of the Lactational Amenorrhea Method (LAM): II. Acceptability, utility, and policy implications.

A multicenter study of the Lactational Amenorrhea Method (LAM) was carried out to determine acceptability, satisfaction, and utilization in 10 different populations, and to confirm the efficacy of the method. Efficacy data are presented in a companion paper. A protocol was designed at the Institute for Reproductive Health (IRH), Department of Obstetrics and Gynecology, Georgetown University Medical Center, and reviewed and modified in collaboration with the co-sponsors, the World Health Organization, the South-to-South Cooperation for Reproductive Health, and the principal investigators from each site. Data were gathered prospectively on LAM users at 11 sites. Data were entered and cleaned on-site, and further cleaned and analyzed at IRH, using country-level and pooled data to produce descriptive statistics. The overall satisfaction with LAM was 83.6%, and continuation with another method of family planning was shown to be 67.6% at 9 months postpartum, in most cases exceeding previous use of contraception prior to use of LAM. Knowledge and understanding of the method at discontinuation were high, ranging from 78.4 to 88.6% for the three criteria. LAM can be used with a high level of satisfaction and success by women in a variety of cultures, health care settings, socio-economic strata, and industrial and developing country settings. The results confirm that LAM is acceptable and ready for widespread use, and should be included in the range of services available in maternal and child health, family planning, and other primary health care settings.

Adult↗
PubMed2004

Gender issues in contraceptive use among educated women in Edo state, Nigeria.

BACKGROUND: While traditional contraception is widely used, in southern Nigerian modern contraception is a relatively recent phenomenon. Modern contraception is more wide spread among the educated and sexually active youth in Nigeria. Few studies have been done on contraception among educated women in Nigeria. OBJECTIVES: This study was carried out in December 2000 to determine factors that influence the choice of contraceptives among female undergraduates at the University of Benin and Edo State University Ekpoma. METHODS: Data was collected from a sample of 800 female undergraduates matched ethnic group, socio economic status, religion and rural urban residence. Subjects were selected by proportional representation and the instrument used was closed ended questionnaire. RESULTS: The responses obtained were analysed using Spearman Rank Correlation co-efficient and regression analysis. Findings revealed the highest correlation for availability (r =.96) vis a vis the use of various types of artificial contraceptive and cost (r =.96), next was safety (r =.95) and effectiveness (r =.95). Others were peer group influence (r =.80) and convenience (r =.77). CONCLUSION: An important step in improving women's reproductive health is the involvement of men. Health programmes should conduct campaigns to educate men about reproductive health and the role they can assume in family planning.

Adult↗
PubMed2000

Integration of STI services into FP/MCH services: health service and social contexts in rural Ghana.

Ghana, like many countries, has taken up the call to integrate STI management with MCH/FP services. Since 1994 a range of policies has been developed on safe motherhood and family planning, as well as syndromic STI management guidelines for 'mid-level' staff and an all-encompassing 'reproductive health' policy. The success of these policy initiatives depends to a large extent on the processes and contexts of implementation, yet analysis of this has rarely been undertaken. This paper analyses the rural context of policy implementation in the rural Upper East Region of northern Ghana and suggests that a 'blanket' policy to integrate STI and FP/MCH services may be inappropriate in particular contexts. It illustrates how the implementation of health policies is influenced--and often impeded--not only by local service contexts, economic and epidemiological factors but also by culturally defined social attitudes and behaviours. These can influence not only whether a policy is accepted by a population but also how it is implemented by health staff. Future reproductive health policy needs to address these issues in order to develop goals which can realistically be implemented in specific settings. Enhancing at district level the voice of nurses working at community level and promoting collaborative, culturally-specific and community-based initiatives could facilitate this.

Attitude to Health↗
PubMed2004

Use of maternal health services in rural China.

We use data from the nationally representative 1997 Demographic and Reproductive Health Survey to examine use of maternity services in rural China. The data indicate that roughly 60 per cent of women had at least one prenatal visit, while 40 per cent had a professionally assisted birth over the period 1988-97. Despite China's shift from a more socialist to a more privatized health care system, use of maternity services increased over this period. These increases are consistent with the push toward integration of reproductive health into family planning that emerged after the 1994 International Conference on Population and Development and the 1995 Fourth World Women's Conference held in Beijing. At the same time, we find indirect evidence that the target-based population policy may well have exerted downward pressure on use of maternity services; differences by parity are marked and multilevel models predicting use of maternity services indicate underdispersion at the individual level.

Adult↗
PubMed2006

Community attitudes towards sexual activity and childbearing by HIV-positive people in South Africa.

While the ability to lead a healthy sexual life and to choose whether and when to have children are well-established features of reproductive health and human rights, issues surrounding sexual activity and childbearing among HIV-infected women and men have received little attention in sub-Saharan Africa. We conducted a semi-structured, cross-sectional survey at 26 primary health care clinics in South Africa to investigate community attitudes towards sexual activity and reproduction by HIV-infected individuals. Of the 843 women interviewed, slightly less than half (43%, n = 361) thought that people living with HIV/AIDS should remain sexually active if they choose, while 13% (n = 113) said they thought that people living with HIV/AIDS should have children if they wished to do so. In multivariate analysis, negative attitudes towards both sexuality and childbearing were persistently associated with not knowing someone infected with HIV (p = 0.001 and 0.043, respectively). These findings suggest that the sexual and reproductive health rights of HIV-infected women and men may be an important target as part of efforts to reduce HIV/AIDS-related stigma. Health policies and services are required to reinforce the reproductive rights of HIV-infected individuals in South Africa and other countries in sub-Saharan Africa where HIV is most prevalent.

Adult↗
PubMed2005

Reproductive disorders of crossbred dairy cows in the central highlands of Ethiopia and their effect on reproductive performance.

The study was conducted to estimate the proportion of reproductive disorders and to determine factors affecting reproductive performance of crossbred dairy cows under four different production systems in the central highlands of Ethiopia. The principal postpartum reproductive disorders were retained fetal membranes (14.7%) and uterine infection (15.5%). Anoestrus was the major postpartum reproductive problem in the mixed crop-livestock production system (38.6%) and was significantly associated with this production system. Apart from anoestrus, the occurrence of reproductive disorders was not significantly associated with a production system. Most of the reproductive disorders occurred as a complex rather than as a single abnormality. Two or more abnormal conditions were seen in 11.4% of the cases. Each reproductive trait measured was affected adversely by reproductive disorders. Cows with reproductive disorders in each production system, lactation group and suckling and non-suckling group had longer intervals from calving to first service and to conception (p < 0.001) and required more services per conception (p < 0.001). Pregnancy rate and conception to first service were 84.7% and 51.7%, respectively, for cows without reproductive health problems; and 64.2%, and 15.1%, respectively, for cows with reproductive disorders (p < 0.001). Overall, intervals from calving to first service were shorter (p < 0.05) than in younger cows. Intervals from calving to first service and to conception were longer in suckling than in non-suckling cows (p > 0.05). Cows with a good body condition score (> 3.5) at calving had shorter calving to first service and conception intervals than cows in poor condition (p < 0.001). The results showed that reproductive abnormalities, coupled with poor body condition, are important factors that contributed to reproductive inefficiency. An appropriate reproductive health management, a reliable artificial insemination service and supplementary feeding could be the management options to reduce or alleviate some of the problems.

Anestrus↗
PubMed2006

The effect of husbands' fertility preferences on couples' reproductive behaviour in rural Bangladesh.

Bangladesh society is profoundly gender stratified, and yet male roles in reproductive health processes have not been rigorously investigated. This study examines the association between men's reproductive health knowledge, attitude and behaviour and their wives' subsequent reproductive behaviour using longitudinal data from the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B). A total of 4969 matched husband-and-wife data from a 1998 survey and women's contraceptive use history data following this survey are used. Results show a significant association between husbands' fertility preferences and current use of any family planning method. When wives' background characteristics, and husbands' background and socioeconomic characteristics are controlled for, the predicted probability of using a method of contraception among non-educated wives whose husbands want more children is 0.49 compared with 0.64 for those whose husbands do not want more children. However, the net effect of husbands' preference for additional children diminishes as wives' level of education increases. Among wives who had completed high school, the predicted probability of using a method of contraception is 0.70 for those whose husbands want more children compared with 0.69 for those whose husbands do not want more children.

Adult↗
PubMed2003

Unplanned teenage pregnancy.

This chapter addresses unplanned teenage pregnancy from a human-rights-based perspective. Many programmes focus only on the negative aspects of young people's sexual and reproductive health; putting rights at the centre of teenage sexual health avoids treating adolescents as a homogeneous collection of discrete problems. Taking a rights-based approach to adolescent sexual and reproductive health encompasses the inter-relationships and complexity of factors influencing choices and decisions. In this chapter we explore the meaning of a rights-based approach and examine its implementation in the provision of sexuality, education and health services. We provide examples of international strategies for ensuring the participation of diverse young people and generating youth-friendly services to meet their sexual and reproductive needs and rights.

Adolescent↗
PubMedDate not supplied

An evaluation of the impact of community health field stations in Burkina Faso.

The UERD (Unite d'Enseignement et de Recherche en Demographie) carries out an ongoing research project that aims to evaluate community-based strategies in the provision of reproductive health services in the Bazega community health field station in Burkina Faso. UERD evaluates the effectiveness of two different strategies: 1) the improvement of Health Center based FP services and 2) the recruitment and training of agents selected from the local community (community-based service agents, or CBS agents). 18 months after the interventions began UERD made an evaluation of its impact on the general population based on a quasi-experimental research design and a detailed protocol. The results indicate a significant increase in contraceptive prevalence (from 3.6% to 8%) in the zone of CBS intervention over the course of the period. However, the prevalence levels remain weak. The growth in contraceptive prevalence was not determined to be the result of an increased demand brought about by the CBS agents, but instead by improving accessibility due to the proximity of the supply. The research sample comprised 1600 randomly selected compounds (2000 women and 1500 men), which allows for another evaluation in the year 2000. It was designed to permit research in other areas of reproductive health such as HIV/AIDS and STDs, FGM, abortion, etc.

Africa↗
PubMed1996

Abortion: the antithesis of womanhood?

The debate regarding the practice and role of abortion has been an enduring and problematic area of discourse within the nursing literature, with a tendency towards a polarized and inevitably simplistic analysis of what, for many practitioners, women and families, remains a highly complex and morally fraught concept. This paper attempts to explore the concept of abortion from within a feminist epistemology, to present a review of the literature as regards women's reproductive health and responsibilities, and thereby to contribute to the process of better understanding the role of abortion within contemporary health care practice. In order to facilitate the study it has been necessary to explore the wide spectrum of historical, philosophical, legal, moral and political imperatives pertaining to the meaning of abortion as represented within contemporary society, not only in relation to women and their reproductive health, but to feminism, women's well-being and self-determinism per se.

Abortion, Legal↗
PubMed2003

[From disease-oriented andrology to health-oriented andrology].

One of the main current trends of andrology is the paradigm shift from disease-oriented to health-oriented andrology. One of the major tasks we are faced with now is to establish an holistic concept of male reproductive health, then, starting from the needs and demands of male reproductive health, to identify the scope of andrology, as well as to develop a new research priorities and agenda. The progress and perspective of three main areas in the field of health-oriented andrology, namely, molecular andrology, andrology for aging and environment and male reproduction, were briefly reviewed and discussed.

Aging↗
PubMed2002

Qualitative analysis of African-American adolescent females' beliefs about emergency contraceptive pills.

STUDY OBJECTIVE: This project was initiated to better understand why some African-American adolescent females do not use emergency contraceptive pills (ECP), despite their widespread availability. Adolescents are considered likely candidates for ECP because they are more likely to inconsistently use birth control and have sporadic sexual behavior patterns. These factors increase the risk of unprotected intercourse and unplanned pregnancy. DESIGN: A qualitative study design was employed to assess the knowledge of African-American adolescent females regarding ECP and their beliefs affecting use and nonuse of ECP. SETTING: An adolescent clinic at a large, urban, academic children's hospital. PARTICIPANTS: Twenty-nine African-American adolescent (age 13-18) females.Interventions. Semi-structured, qualitative interviews lasting 15-20 minutes. MAIN OUTCOME MEASURES: Interviews yielded qualitative data that was coded and categorized into themes. RESULTS: Through the interviews, eight themes emerged: Taking Care of Self, Lack of Knowledge of ECP, Inaccurate Information, Sources of Information, Acceptability of Adolescent Pregnancy, Partner's Influence on Adolescent Choices, Discomfort Talking About Sex, and Concern About Sexually Transmitted Infections (STIs). CONCLUSIONS: The results from this qualitative study will contribute to future quantitative research efforts by providing insight into the decision-making process regarding ECP among this population. The themes provide a foundation for clinical implications and educational interventions. Although a large proportion of the sample (24%) had used ECP, misinformation about ECP and basic reproductive health issues was prevalent. Most of the adolescents report they obtain reproductive health information from a complex network of information sharing, in which their primary sources tend to be peers.

Adolescent↗
PubMed2003

Assessment of andropause awareness and erectile dysfunction among married men in Ile-Ife, Nigeria.

Andropause (also known as androgen decline in aging males) has implications for the reproductive health and quality of life of older males. Very few studies have, however, been reported among the Nigerian population on andropause-related issues. This study assesses the perspective and level of awareness of married men in Ile-Ife, South-west Nigeria, of andropause. We also assessed their experience of erectile dysfunction, using a questionnaire based on the review of the International Index of Erectile Dysfunction. The study involved 355 married men, aged between 30 and 70 years. Our result shows a high level of misconception about andropause among our respondents, with 38.9% indicating that it is a myth, and another 23.6% attributing it to various causes other than being a natural aging process. We recorded a prevalence of erectile dysfunction of 43.8% (8.0% severe dysfunction and 35.8% moderate dysfunction). The prevalence of erectile dysfunction increased significantly with age, varying from 38.5% for age 31-40 years to 63.9% for the older age group of 61-70 years. The trend in prevalence of erectile dysfunction with age was significant (p < 0.05). An odds ratio of 2.82 (95% confidence interval 1.19-6.76) was recorded for the prevalence of erectile dysfunction at age 61-70 years compared with age 31-40 years. Our findings indicate a need for health education about andropause in Nigeria, and increased attention to the reproductive health concerns of males, and the older population.

Adult↗
PubMed2002

Adolescent sexual health in Sweden.

In Sweden, society's attitudes towards teenage sexual relationships are liberal, and sexual and reproductive health issues are given high priority. Family and sex education has been taught in schools since the 1950s. The age of sexual consent is 15 years. Since 1975, abortion has been free on demand. Contraceptive counselling is free, easily available at family planning and youth health clinics. Screening for genital chlamydial infection is performed at these clinics, thus providing a "one stop shop" service. Condoms and oral contraception are available at low cost, emergency contraception is sold over the counter. Teenage childbearing is uncommon. However, sexual and reproductive health problems are on the increase among young people. During the 1990s, a period of economic stagnation in Sweden, schools have suffered budget cut backs. Sex education is taught less. Social segregation, school non-attendance, smoking, and drug use have increased. Teenage abortion rates have gone up, from 17/1000 in 1995 to 22.5/1000 in 2001. Genital chlamydial infections have increased from 14,000 cases in 1994 to 22,263 cases in 2001, 60% occurring among young people, and with the steepest increase among teenagers. Thus, a question of major concern is whether and how adolescent sexual behaviour has shifted towards more risky practices during the late 1990s.

Abortion, Induced↗
PubMedDate not supplied

The effects of school-based health clinics in St. Paul on school-wide birthrates.

School-based clinics in St. Paul have provided comprehensive health services, including reproductive health care, for almost two decades. This study examines the effects of those clinics on the birthrates in their respective schools, using a newly developed methodology with numerous advantages over previous methods for estimating student birthrates. Confidentially matching the names of female students from school records with the names of mothers on birth records at the Department of Health provided birthrates for each of the St. Paul public high schools with clinics for each year between 1971 and 1986. The results show that birthrates fluctuated dramatically from one year to the next, but school-wide birthrates were not significantly lower in the years immediately following the opening of a clinic than in the years preceding it.

Abortion, Legal↗