Creating options in family planning for the private sector in Latin America

The countries of Latin America and the Caribbean are facing the gradual phaseout of international-donor support of contraceptive commodities and technical and management assistance, as well as an increased reliance on limited public sector resources and a limited private sector role in providing contraceptives to the public. Therefore, those nations must develop multisectoral strategies to achieve contraceptive security. The countries need to consider information about the market for family planning commodities and services in order to define and promote complementary roles for the public sector, as well as to better identify which segments of the population each of those sectors should serve. While it is unable to mandate private sector participation, the poublic sector can create conditions that suport and promote a greater role for the private sector in meeting growing needs of family planning users. Taking steps to actively involve and expand the private sector's market share is a critical strategy for achieving a more equitable distribution of available resources, addressing unmet need, and creating a more sustainable future for family planning commodities and services (AU)

El embarazo no deseado: impacto sobre la salud y la sociedad en America Latin y el Caribe / Unwanted pregnancy: impact on health and society in Latin America and the Caribbean

Engaging in sexuality and reproduction should always be something that is wanted and planned. Unfortunately, when that is not the case, one result can be unwanted pregnancy. Unwanted pregnancies have consequences for women, their families, and their countries. This document reviews the causes and results of unwanted pregnancy, emphasizing the impact that this problem has on Latin America and the Caribbean (LAC). Four reasons why unwanted is a continuing problem in LAC are: 1) people's growing desire to have smaller families, 2) the unmet need for family planning, 3) the fact that contraceptive methods are not 100 percent effective, and 4) unwanted sexual relations. Unwanted pregnancies especially affect adolescent women, single women, and women over 40 years of age. Given their desperate situation with an unwanted pregnancy, some women opt for an unsafe abortion, which can lead to their death. Other women can go so far as to commit suicide, or be murdered by a family member or other person who is unhappy that the pregnancy has occured. It has been found that women who decide to continue with the pregnancy have higher risks of suffering an illness, and the samr is true for the child. Reducing unwanted pregnancies and treating post-abortion complications are key to lowering maternal mortality and morbidity. This necessitates developing mass communication programs for girls, and sex education programs. It is also vital to make available to all persons reproductive health services that include family planning methods. In the countries of LAC with laws that specify grounds for legally ending a pregnancy, it is necessary that healthcare be organized to actually provide this service, and that health care programs obtain the safest, most effective technologies now available for ending a pregnancy (AU)

The impact of side effects on family planning use among female clients of the public health services in Jamaica

A one-year longitudal study was undertaken in kingston, Jamaica, to examine (i) the experience of side effects among female contraceptives users, (ii) the role of side effects. The study consisted of 463 women who utilized public health centres in Kingston and were either new users of contraceptives or who were switching contraceptive methods. They were recruited over a two-month period in 1998 and followed up for one year. All follow-up, interviews were done at women's homes and complete interviews were obtained for 323 women. Information was collected about socio-economic characteristics, cotraceptive history, servive factors, experience with method and length of use. Forty eight per cent of the women experienced side effects with the method accepted on recruitment to the study. Common side efects were irregular bleeding/no period, headaches, nausea; dizziness and weight gain/loss. These side effects occurred mainly among pill and injection users. The occurrence of side effects had a negative impact on continuation rates. Forty seven per cent of the women stated that they had received counselling regarding side effects. The level and impact of side effects among family planning acceptors at public health centres in Jamaica is of significance to the family planning programme. Method options need to be widened and counselling needs to be improved to ensure that women fully understand the issue of side efects and make informed choices about contraception. (AU)

The impact of the Women's Centre of Jamaica Foundation programme for adolescent mothers on repeat pregnancies

OBJECTIVES: To assess the effect of the Women's Centre of Jamaica Foundation Programme for adolescent mothers (WCJF) on the incidence of repeat pregnancies occurring between 1995 and 1998, and on the educational attainment of programme participants. DESIGN AND METHODS: A random sample (n=260) of primiparous Jamaican adolescent mothers, 12-16 years, who gave birth in 1994 in the parishes of Kingston and St Andrew, St Catherine and Manchester was selected from vital records and interviewed in 1998 for this historical cohort study. RESULTS: Only 23.5 percent of all repeat pregnancies in the entire study population were among programme participants compared with 76.5 percent among non-participant. Programme participation reduced the risk of one or more repeat pregnancies by 45 percent (0.22-0.9). Programme participants were also 1.5 times (1.00-2.3) more likely to complete high school than non-participants. CONCLUSION: The results confirmed that WCJF Programme exerts a beneficial effect on the incidence of repeat pregnancy among participants. The benefits of programme participation were greatest among residents of the Kingston Metropolitan Area from single parent, female-headed households with average monthly incomes below J$10,000, who wanted to continue their education after the first live birth.(AU)

The impact of contraceptive side effects on family planning use among female clients of the public health services in Jamaica

OBJECTIVES: To examine (i) the experience of contraceptive side effects among women (ii) the role of side effects in method continuation, and (iii) the counselling regarding such side effects. METHODS: The study consisted of 463 women who utilised public health centres and were either new users of contraceptives or were switching contraceptive methods. They attended government health centres in Kingston and were recruited over a two-month period in 1998 and followed for 1 year. All follow-up interviews were done at the women's homes and complete interviews were obtained for 323 women. Information was collected about socio-economic characteristics, contraceptive history, service factors, experience with method and length of use. RESULTS: Forty-eight per cent of the women experienced side effects with the method accepted on recruitment to the study. Common side effects were irregular bleeding/no period, headaches, nausea/dizziness and weight gain/loss. The side effects occurred mainly among pill and injection users. The occurrence of side effects had a significantly negative impact on continuation rates. Forty-seven percent of women stated that they had received counselling regarding side effects. CONCLUSIONS: The level and impact of side effects among family planning acceptees at public health centres in Jamaica is of significance to the public health family planning programme. Method choice needs to be widened and counselling needs to be improved to ensure that women make informed choices about contraception.(Au)

Patterns of contraceptive use among female clients utilizing the public health services in Jamaica

OBJECTIVE: To determine the factors which influence continued use of a family planning method. DESIGN AND METHODS: Primary data were collect from 463 women utilizing the public health services in Kingston, Jamaica. The women were interviewed at six-mon th intervals during one year to determine their patterns of contraceptive use. They were recruited fro eight health centers. RESULTS: The overall continuation rate of the sample of respondents at the end of 3 months, 6 months, 9 months and 12 months were 90 percent, 70 percent, 60 percent and 56 percent, respectively. The short- term method with the highest continuation rate (65 percent) was the injection; the pill registered the lowest continuation rate (39 percent). A respondent was more likely to use a family planning method if her partner was in favour of contraception. She was likely to continue if the method was the condom or the pill. CONCLUSION: The use of the injection should be encouraged in order to improve overall continuation rate. Efforts should be made to include the partner in the counselling of a female client.(AU)

Preparing for family planning in Jamaica in the 21st century

A quantitative goal of Jamaica's National Population is the achievement of replacement level fertility by the year 2000. The total fertility was 2.8 in 1997. Despite an increasing contraceptive prevalence, the total fertility rate has remained stable around 3, since 1989. Contraceptive use and fertility vary depending on area of residence, health region and age cohort. The contraceptive methods used based on reproduction intention are inappropriate. Contraceptive discontinuation is high. The failure of fertility to decline as predicted is due to a lack of factual information on side effects of contraception, health concerns and the ambivalence to the 2-child family as a norm by women in the reproductive age group. Additionally, the technical competence of providers and the quality of counselling need strengthening. The challenges for the 21st century include operationalising family planning into reproductive health sustainability as well as identifying needs.(AU)

Adolescents' access to health care and the constraints they face in acquiring good health

In this study adolescents' access to health care is analyzed, based on a survey done in two secondary schools. Two hundred adolescents 14 -19 years old were selected. A pretest and a focus group were used in the formulation of a quantitative and qualitative questionnaire. Questions were identified by number in order to maintain confidentiality. Data were collected over a 2 week period, and analyzed manually by a prepared coding system and by using the computer program SPSS. Results showed that adolescents' main health problems were preventable, mostly stress and tension related. The health services available were utilized. Seventy eight point five percent of respondents accessed the private services, and 61.0 percent of the sample had health insurance. Access to contraceptive source was over the counter (65.0 percent), from pharmacies (53.0 percent), from medical sources and 12.0 percent from supermarkets. Adolescents utilized health services for general health problems, but accessed services for sensitive areas such as contraceptives from an additional source. The study has demonstrated that adolescents' access is constrained when relating to reproductive health.(Au)

Reproductive Health Policies and Programs in eight countries: Progress since Cairo

Looks at reproductive health policies and programs in eight countries. In-depth interviews in 1997 with stakeholders in Bangladesh, India, Nepal, Jordan, Ghana, Senegal, Jamaica and Peru; Adoption of the 1994 International Conference on Population and Development in six of the eight countries studied; Discussion of implementation problems.(AU)

Cyclofem/Cyclo-Provera: emerging countries' perspective

Cyclo-Provera, the original name of the combination of 25 mg medroxyprogesterone acetate and 5 mg estradiol cypionate, later known as Cyclofem and hereafter referred to MPA/E2C, has proven its use- effectiveness (pregnancy rate less than 1 percent) in routine service delivery conditions. Overall, the life-table discontinuation rates at 1 year ranged from 33.5 percent to 71.8 percent. Only a third of total discontinuations were attributable to the injectable contraceptive method, thus raising the importance of service delivery issues related to its continued use. The results of introductory trials in Mexico, Indonesia, Thailand, Tunisia, Jamaica and, more recently, Brazil, Colombia, Chile and Peru have demonstrated that MPA/E2C is a highly effective contraceptive that could be offered as an alternative to current fertility regulation methods for many women around the world. In addition, the results of studies were the basis for the approval of MPA/E2C by local health authorities and its inclusion in the Ministries of Health Family Planning Programs.(Au)

Sexually transmitted diseases are common in women attending Jamaican family planning clinics and appropriate detection tools are lacking

OBJECTIVES: To assess sexually transmitted diseases (STD) among women attending Jamaican family planning clinics and to evaluate decision models as alternatives to STD laboratory diagnosis. METHODS: Women attending two family planning clinics in Kingston were interviewed and tested for syphilis seroreactivity using toluidine red unheated serum test and Treponema pallidum haemagglutination, for gonorrhoea using culture, for chalamydial infection using enzyme linked immunoassay, and for trichomoniasis using culture. Urine was tested with leucocyte esterase dipstick (LED). The women were treated based upon a clinical algorithm. Computer simulations explored the use of risk inclusive decision models for detection of cervical infection and/or trichomoniasis. RESULTS: Among 767 women, 206 (26.9 percent) had at least one STD. The prevalence of gonorrhoea was 2.7 percent: chlamydial infection 12.2 percent, gonococcal and/or chlamydial cervical infection 14.1 percent; trichomoniasis 11.5 percent; syphilis seroreactivity 5.9 percent. The clinical algorithm was 3.7 percent sensitive and 96.7 percent specific in detecting cervical infection. Detection of cervical infection and/or trichomoniasis was 63.5 percent sensitive and 60.6 percent specific using LE and 57.7 percent sensitive and 46.2 percent specific using the risk inclusive algorithm employed in Jamaica STD clinics. Either cervical friability or LED (+) or family planning clinic attender less than 25 years old with more than one sexual partner in the past year was 72.5 percent sensitive and 53.3 percent specific. The positive predictive values of the STD clinic algorithm, LED, and two developed decision models ranged from 25.0 percent to 33.4 percent to detect cervical infection and/or trichomoniasis in these women. CONCLUSION: STDs were quite prevalent in these mainly asymptomatic family planning clinic attenders. None of the evaluated decision models can be considered a good alternative to case detection using laboratory diagnosis. Appropriate detection tools are needed. In the meantime, available STD control strategies should be maximised, such as promotion of condom use; adequate treatment of symptomatic STD patients and partners; and education of women and men (AU)

Contraceptive use during lactational amenorrhea

OBJECTIVE: The study uses data from nationally representative sample surveys in developing countries to estimate the overlap between lactational amenorrhea and contraceptive use during the first 6 months postpartum. METHOD: Secondary analyses of survey data were used to tabulate the proportion of the population in lactational amenorrhea among contraceptive users of all women, for postpartum women and for the country as a whole. RESULTS: Among postpartum women, the proportion in lactational amenorrhea was particularly high in Africa and the Near East and lower in Latin America and the Caribbean where breast-feeding practices have declined. The median duration of use for oral contraceptives is also presented as an aid to interpreting the significance of the findings. CONCLUSIONS: The significance of the findings is considered in the context of planning reproductive health services in the postpartum period. Decisions about timing of contraceptive use for postpartum women, while arrived at on an individual basis, also result from program strategies that focus counseling immediately postpartum or at a later interval, such as when menses resume. On a national level the impact of postpartum contraception policies on use of commodities may be substantial.(AU)

Disparities in access to family planning in Jamaica

In order to improve the effectiveness and subtainability of the family planning programme, the National Family Planning Board has devised a strategy to shift users to longer-acting methods and increase the role of the private sector. To design interventions, a better understanding of existing services was thought to be necessary. This study examines the distribution of family planning service delivery points in Jamaica and the services offered by the public and private sectors through an examination of records and questionnaire interviews. The study found that, because of the concentration of private sector providers - the main outlets for longer-acting methods - in urban areas, rural areas had poor access to these methods. Because rural areas are not attractive to private sector providers, the public sector should recognize the need to continue to serve these areas (AU)

Male responsibility towards family planning

This study seeks to examine the issue of male responsibilty towards family planning among school students (age 16 - 20 years) in the Business Administration Department at Excelsior Community College. The information was obtained over a two week period by the use of questionnaires. The respondents were categorized into two age groups namely; under 19 (16-18 years old) and 19 and over (19-20 years old). The variables included issues such as: Is child rearing equally the responsibility of both parents; having children with more than one woman; vasectomy as a possible method of family planning; who should ensure that a woman does not get pregnant; whether men have financial responsibility towards their children, and the concept of birth spacing. Male responsibility towards family planning in this study was reasonably high as judged from the responses from the study population. However, there was an obviously lower level of responsibility demonstrated by the respondents in the lower age group, i.e. among the 16-18 year olds. It is recommended that the government develops a planned approach, through the school system to inform young men about issues such as the fatherhood role in the home and their responsibility to their partners and children.(Au)