RESUMO
Title X of the Public Health Act has provided access to confidential reproductive care for low-income adolescents and adults since 1970, helping to bring adolescent pregnancy rates to historic lows. Recent regulatory changes in program funding eligibility and provider counseling options may reverse this trend. This policy brief will address the history and impact of Title X funding on adolescent access to reproductive health care, explain the implications of these recent regulatory changes in Title X implementation, and encourage advocacy to protect health care provider practice and adolescent access to confidential care.
Assuntos
Saúde do Adolescente/legislação & jurisprudência , Saúde Pública/legislação & jurisprudência , Serviços de Saúde Reprodutiva/legislação & jurisprudência , Adolescente , Saúde do Adolescente/história , Confidencialidade/legislação & jurisprudência , Feminino , Regulamentação Governamental , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , História do Século XX , História do Século XXI , Humanos , Gravidez , Gravidez na Adolescência/prevenção & controle , Gravidez na Adolescência/estatística & dados numéricos , Saúde Pública/história , Serviços de Saúde Reprodutiva/história , Estados Unidos , Adulto JovemRESUMO
BACKGROUND: Early menarche is associated with increased risks for several diseases such as cardiovascular diseases and breast cancer. This analysis aimed at generating evidence on a historical trend towards younger age at menarche among Lebanese girls. METHODS: A secondary analysis was conducted on data consolidated from three serial cross-sectional national surveys of women in Lebanon (2007, 2009 and 2012). A total of 6150 women were included in order to study the association between date of birth intervals and age at menarche. RESULTS: The mean age at menarche was 13.06 years, with a peak of the distribution at age 12. Women born before 1950 had a significantly higher mean age at menarche (13.21) compared to those born in 1970 and thereafter (12.95). A stratified analysis showed that women living outside the metropolitan Greater Beirut (GB) area were characterized by an older mean age at menarche (13.11) in all date of birth intervals compared to those in GB (12.89). However, age at menarche declined more significantly over the last two decades among women outside GB, compared to those living in GB. CONCLUSIONS: Epidemiological figures emerging from this study confirm that trends in Lebanon are in line with a global pattern of decreasing age at menarche. Urban-rural differences suggest that higher caloric content of diet and consequent early overweight, more evident in urban areas, are likely determinants of younger menarche. Evidence from this study calls for an urgent implementation of comprehensive multisectoral obesity prevention in children in Lebanon.