French abortion drug RU 486: U.S. research battles heat up.

PIP: With increasing evidence that the controversial French-made abortifacient RU-486 may serve as a treatment to some diseases, Congress and researchers have stopped up the pressure on the Food and Drug Administration to make the drug more available for clinical trials. The FDA has banned the import of RU-486 for personal use, and has placed strict restrictions on importations for clinical studies, having approved only 10 Investigational New Drug applications as of December 1990. Legislators and researchers say that RU-486's maker, Roussel-UCLAF, has also kept tight control of the drug because its parent company, Hoechst, fears reprisals from anti-abortion groups. Nonetheless, preliminary clinical results have shown the drug to have positive results in the treatment of unresectable meningioma, breast cancer. Cushing's syndrome, and endometriosis. A clinical trial conducted at the University of Southern California showed that a daily dose of RU-486 led to minor tumor regressions in 6 of 24 patients with the normally untreatable unresectable meningioma. These results have not gone unnoticed by Congress; the House Small Business Subcommittee on Regulation held a meeting to discuss the issue. The Subcommittee heard from researchers who say that their studies have been affected by the FDA's actions. An FDA representative explained the tight control over the drug by saying the possibility exists that a black market for the drug might arise. Nonetheless, he said that the FDA is not trying to prevent legitimate research. But Subcommittee Chairman Ron Wyden, who favors abortion rights, criticized the FDA's ban as politically motivated.^ieng

Measuring and monitoring quality of care in family planning: are we ignoring negative experiences?

Despite decades of emphasis on quality of care, qualitative research continues to describe incidents of poor quality client-provider interactions in family planning provision. Using an emerging framework on disrespect and abuse (D and A) in maternal health services, we reviewed the global published literature for quantitative tools that could be used to measure the prevalence of negative client experiences in family planning programs. The search returned over 7,000 articles, but only 12 quantitative tools included measures related to four types of D and A (non-confidential care, non-dignified care, non-consented care, or discrimination). We mapped individual measurement items to D and A constructs from the maternal health field to identify measurement gaps for family planning. We found significant gaps; current tools are not adequate for determining the prevalence or impact of negative client experiences in family planning programs. Programs need to invest in tools that describe all aspects of client experiences, including negative experiences, to increase accountability and maximize the impact of current investments in family planning programs.

Women's experiences after Planned Parenthood's exclusion from a family planning program in Texas.

OBJECTIVE: We assessed the impact on depot medroxyprogesterone continuation when a large care provider was banned from a state-funded family planning program. STUDY DESIGN: We used three methods to assess the effect of the ban: (a) In a records review, we compared how many state program participants returned to two Planned Parenthood affiliates for a scheduled dose of depot medroxyprogesterone acetate (DMPA) immediately after the ban; (b) We conducted phone interviews with 224 former Planned Parenthood patients about DMPA use and access to contraception immediately after the ban; (c) We compared current contraceptive method of our interviewees to that of comparable DMPA users in the National Survey of Family Growth 2006-2010 (NSFG). RESULTS: (a) Fewer program clients returned for DMPA at a large urban Planned Parenthood, compared to a remotely located affiliate (14.4%, vs. 64.8%), reflecting different levels of access to alternative providers in the two cities. (b) Among program participants who went elsewhere for the injection, only 56.8% obtained it at no cost and on time. More than one in five women missed a dose because of barriers, most commonly due to difficulty finding a provider. (c) Compared to NSFG participants, our interviewees used less effective methods of contraception, even more than a year after the ban went into effect. CONCLUSIONS: Injectable contraception use was disrupted during the rollout of the state-funded family planning program. Women living in a remote area of Texas encountered more barriers. IMPLICATIONS: Requiring low-income family planning patients to switch healthcare providers has adverse consequences.

Impacto do planejamento familiar na vida sexual e reprodutiva de adolescentes / Impact of family planning on the sexual and reproductive life of adolescents

Introdução: O programa de planejamento familiar é uma importante ferramenta na redução dos índices de gravidez na adolescência, que é considerada uma questão de saúde pública. Objetivos: Compilar as publicações científicas nacionais e internacionais acerca do impacto do planejamento familiar na prevenção da gravidez em adolescentes. Métodos: Foi realizada uma revisão de literatura nos bancos de dados da Biblioteca Virtual de Saúde (BVS), Google Scholar, SciELO e PubMed, no período de agosto a dezembro de 2020, a partir de estudos experimentais e observacionais. Resultados: Dos 20 artigos incluídos, foi realizado agrupamento dos dados que possibilitou a construção de três unidades temáticas: programa de planejamento familiar-potencialidades e fragilidades; fatores determinantes e condicionantes da gravidez na adolescência; educação sexual como ferramenta de prevenção da gravidez na adolescência. Conclusão: A eficácia dos programas de planejamento familiar, dependem de vários fatores: treinamento adequado dos profissionais envolvidos, fornecimento gratuito de insumos, metodologia de educação sexual aplicada, local da instalação da sede física do programa e o público-alvo atingido.

Introduction: The family planning program is an important tool in reducing teenage pregnancy rates, which is considered a public health issue. Objective: To compile national and international scientific publications on the impact of family planning on pregnancy prevention in adolescents. Method: A literature review was carried out in the databases of the Virtual Health Library (VHL), Google Schoolar, Scielo and PubMed, from August to December 2020, based on experimental and observational studies. Results: Of the 20 articles included, data were grouped, which enabled the construction of three thematic units: family planning program - strengths and weaknesses; determining and conditioning factors of teenage pregnancy; sex education as a tool to prevent teenage pregnancy. Conclusion: The effectiveness of family planning programs depends on several factors: adequate training of the professionals involved, free supply of inputs, applied sex education methodology, location of the program's physical headquarters and the target audience reached.

Basic data on visits to family planning services sites: United States, 1980.

PIP: Cross tabulations of data from the National Reporting System for Family Planning Services are presented. Information was collected on the sociodemographic characteristics of patients as well as family planning service utilization. A sample of private facilities as well as those supported by Public Health Services family planning grants were selected to participate in the survey. The family planning visit is the basic sampling unit and the proportion of visits selected from each site varies with geographic location and annual visit volume. Only visits made by women were included. The Clinic Visit Record (i.e., the data collection form) contains 14 items: identifying information (2 items), date, sex, determination of hispanic origin, race, birthdate or age if unknown, prior utilization of family planning services, educational attainment, family income and family size, pregnancy history, contraceptive history, medical services received, and contraceptive method chosen at conclusion of visit. The results are presented in 12 tables. The data estimate 9,261,000 family planning visits were made in 1980, only 19% were 1st visits. 89% of the visits were made by women under the age of 30; teenagers comprise 1/3 of this group. Women of hispanic origin made 12.6% of the total visits. 80% of all visits were made by women with 12 years of education or less and 14% by women from families receiving public assistance. 54% of the women were nulliparous. In 89% of the visits, some method of contraception was adopted or continued (68% chose oral contraceptives, 7.2% IUDs and 6.5% diaphragms). Prior contraception use was reported by women comprising 82% of the visits. 40.3 million medical services, including blood pressure checks, pelvic examinations, breast examinations and Pap smears, were provided.^ieng

Fertility rates in 238 HIV-1-seropositive women in Zaire followed for 3 years post-partum.

Birth-control use and fertility rates were prospectively determined in 238 HIV-1-seropositive and 315 HIV-1-seronegative women in Kinshasa, Zaire, during the 36-month period following the delivery of their last live-born child. No women delivered children during the first follow-up year. Birth-control utilization rates (percentage use during total observation time) and fertility rates (annual number of live births per 1000 women of child-bearing age) in the second year of follow-up were 19% (107.4 per 1000) for HIV-1-seropositive women and 16% (144.7 per 1000) for HIV-1-seronegative women. In the third year of follow-up these rates were 26 (271.0 per 1000) and 16% (38.6 per 1000) for HIV-1-seropositive and HIV-1-seronegative women, respectively (P less than 0.05 for the difference in birth-control utilization and fertility rates between seropositive and seronegative women in the third year of follow-up). Seven (2.9%) of the 238 HIV-1-seropositive women initially included in the study brought their sex partners in for HIV-1 testing; three (43%) of these men were found to be HIV-1-seropositive. New HIV-1 infection did not have a dramatic effect on the fertility of seropositive women. The nearly uniform unwillingness of HIV-1-seropositive women to inform husbands or sexual partners of their HIV-1 serostatus accounted in large part for the disappointingly high fertility rates in seropositive women who had been provided with a comprehensive program of HIV counseling and birth control. Counseling services for seropositive women of child-bearing age which do not also include these women's sexual partners are unlikely to have an important impact on their high fertility rates.

The family planning attitudes, practices, and motivations of mental patients.

PIP: The family planning attitudes, practices and motivations were studied by interview in 21 patients of the Massachusetts Mental Health Center, 18-45 years of age, with varying racial, religious and socioeconomic backgrounds and a broad range of mental illness. Without investigating the relationships of mental illness to marital discord, an impressive frequency of divorce, unhappy marriages and lack of communication between the spouses was noted. Frequency patterns of sexual intercourse and orgasm in these patients reflected normal patterns as determined by sexual research. The patients also closely resembled normal women in responses on desired family size and the right of women to control the number of children they have. Behavior was found to differ strongly from attitudes in that contraceptive knowledge and approval, though low, was comparable to normal women, but actual contraceptive use was infrequent with a total of 26 unwanted pregnancies reported in 13 of the women. 9 of the unwanted pregnancies were aborted and 8 of the 13 women felt that raising the unwanted child contributed to their mental illness. Though all the patients thought hospitals should provide the postnatal family planning counseling, contraceptive motivation was determined to be poor in these women due to excessive dependency needs, passive-aggressive ambivalence towards men, and excessive use of the mechanism of denial. Greater communication between doctor and patient is needed on sexual attitudes and practices.^ieng

Use of services for family planning and infertility: United States.

PIP: The statistics presented in this report on the use of family planning and infertility services in the United States are based on interviews with a national sample of 6428 currently married women 15-44 years of age, which were conducted by the National Center for Health Statistics. The statistics are presented in text tables, figures, and detailed tables. 2 measures of the use of family planning services are included in this report: ever use refers to ever having had a discussion with a health care provider regarding family planning methods to delay or prevent a pregnancy; and recent use refers to those discussions in the 3 years before interview. Most nonsterile married women had talked with a physician or other professional about family planning in the 3 years before their interview in 1976 (58.6%). Recent family planning visits were more common among white (59.9%) than among black (46.9%) or Hispanic women (51.8%). Younger women (15-29 years of age) were more likely than older women (30-44 years of age) to have made a recent family planning visit (70.8% and 44.5%, respectively). This difference by age existed independently of race or ethnicity. Among women with a family planning visit in the 3 years before the interview in 1976, most made their latest visit to their personal physician. Only 15.9% made their latest visit to a family planning clinic or other organized medical services. Recent visitors who were black or Hispanic women, were more likely than white recent visitors to have made their latest visit to an organized medical service. Young visitors were more likely to have gone to an organized medical services (18.3%) than older women (11.5%). During their most recent family planning visit, it was recommended to many women that they begin using a method of contraception or that they change from 1 method to another. The method most often recommended by both personal doctors and organized medical services was the oral contraceptive. About 6.9% of nonsterile married women used infertility services in the 3 years before their interview in 1976.^ieng

Use of oral contraceptives in women with cystic fibrosis.

Oral contraceptive pills (OCP) represent the most common contraceptive method among teenagers and young adults. Because many women with cystic fibrosis (CF) are now surviving into childbearing age and are at risk for the complications of pregnancy in CF, oral contraceptive use may be indicated. However, it has been suggested that OCP use by CF patients may be associated with deterioration in pulmonary function. Ten adolescent and young adult women with CF and moderate-to-severe obstructive lung disease were studied while taking a combination oral contraceptive pill (Ovral 28). No significant deterioration was found in clinical status or pulmonary function. Careful follow-up should nevertheless be continued to monitor for other adverse effects of oral contraceptive use in CF, such as cholelithiasis.

Epidemiological models and related simulation results for understanding of contraceptive adoption in India.

BACKGROUND: For the first time, models using multilevel analysis of Indian data and related simulation results are reported. They take hierarchical structure into account and incorporate variables from all levels to get correct analysis and proper interpretation of data on current contraceptive use (including sterilization and modern methods). METHODS: The data from an Indian State, Uttar Pradesh (UP), collected by the National Family Health Survey (NFHS) conducted during 10 October 1992 to 22 February 1993 was used. For model I, 7851 currently married women who were neither pregnant nor had continuing post-partum amenorrhoea (PPA) were considered. For model II, these women with at least one child (n = 6748) were used. Two-level logistic regression analysis was carried out for which women's level (level 1) and PSU (Primary Sampling Unit) level (level 2) variables were considered. The results were considered significant at the 5% level of significance. Simulation analysis using each model was also carried out. RESULTS: Model I reveals that those more likely to adopt contraception were women exposed to a TV message (odds ratio [OR] = 1.3; 95% CI: 1.1-1.6); whose houses were pucca (bricks and mortar) (OR = 1.3; 95% CI: 1.1-1.5); who were educated to high school level and above (OR = 2.9; 95% CI: 2.2-3.7); whose husbands were literate with schooling of > or =11 years (OR = 1.7; 95% CI: 1.4-2.1); and who had > or =2 living sons (OR = 2.2; 95% CI: 1.1-4.4). Muslim and other religious women were less likely than Hindu women to adopt contraception (OR = 0.5; 95% CI: 0.4-0.6). Also, the PSU level availability of all weather road was positively associated with contraceptive adoption (OR = 1.4; 95% CI: 1.1-1.7). The PSU level variance, which is the unexplained PSU level variation after controlling for the considered characteristics, was significantly higher. The simulation results revealed that public health education (a TV message) was found to be more effective among less educated women. The PSU level availability of all weather road was as effective as public health education. Similar results were evident from the analysis of second data set (model II) with the noticeable finding that those whose last child is surviving are most likely to adopt contraception (OR = 8.82; 95% CI: 1.01-77.38). CONCLUSIONS: These results reveal that the survival status of the last child has a marked effect on the adoption of contraception in UP. They further support the idea that public health education (a TV message) is more effective among less educated women. Also, the PSU level presence of all weather road is equally effective. Consideration of higher level variables provides not only more accurate results but also important public health clues to help the policy planners.

PIP: This study examined models for contraceptive adoption in Uttar Pradesh (UP) using a multilevel analysis technique. Data were obtained from an Indian State, UP, collected by the National Family Health Survey conducted from October 1992 to February 1993. 7851 currently married women who were neither pregnant nor had continuing postpartum amenorrhea were considered for model I, while 6748 women with at least one child were used for model II. Two-level logistic regression analysis was carried out, for which women's level (level 1) and primary sampling unit (PSU) (level 2) level variables were taken into account. Findings revealed that, in model I, women who were exposed to a TV message (odds ratio [OR] = 1.3; 95% confidence interval [CI]: 1.1-1.6), whose houses were made of bricks and mortar (pucca) (OR = 1.3; 95% CI: 1.1-1.5), who had a secondary education or above (OR = 2.9; 95% CI: 2.2-3.7), who had literate husbands (OR = 1.7; 95% CI: 1.4-2.1), and who had 2 or more living sons were more likely to adopt contraception. In addition, the PSU level availability of all weather road was positively associated with contraceptive adoption (OR = 1.4; 95% CI: 1.1-1.7). The PSU level variance, which was the unexplained PSU level variation after controlling for the considered characteristics, was significantly higher. In conclusion, the survival status of the last child has a marked effect on the adoption of contraception in UP.

Oral contraceptive use: interview data versus pharmacy records.

BACKGROUND: If women tend to forget and underreport their past oral contraceptive (OC) use, but the recall among cases is enhanced by the presence of disease, recall bias may explain some reported health effects of OC use. METHODS: Two different sources of information on lifetime OC use were compared for 427 (84%) of a community-based sample of 511 women aged 20-34: (i) structured interviews, using a life event calendar and picture display as memory aids, and (ii) a register of all prescriptions dispensed by pharmacies in the county since 1970. RESULTS: Interview data and pharmacy records showed high levels of agreement for any OC use, current use, time since first and last use, total duration of use, and for duration of use in different 'time windows'. But there was a tendency to under-report specific kinds of OC used in the past. CONCLUSION: Underreporting of OC use among non-cases would usually introduce little or no bias (as compared to pharmacy records) for this kind of interview and women. However, it may be preferable to use interviews for current OC use, and pharmacy records for specific kinds of OC used in the past.

PIP: In studies where women are interviewed about oral contraceptive (OC) use only after the emergence of disease (e.g., breast cancer), the experience of disease may enhance recall and reporting of OC use, resulting in overestimation of relative risks. This community-based study compared two sources of information on ever-use of OCs--structured interviews and pharmacy prescription records--in 427 women 20-34 years of age who were long-term residents of Sweden's Jamtland County where registration of prescriptions has been virtually complete since 1970. A life-events calendar and photographs of OCs in use since 1970 were used in the interviews to facilitate recall. 153 women reported current OC use; the pharmacy register failed to document a current prescription for 37 (24%). Only 4 (1.5%) of the 274 women who denied current OC use had an active prescription on file. Of the 37 women identified as never-users by interview, 2 (5%) had records of OC prescriptions (for under 2 years of use). Of the 36 women identified as never-users by pharmacy records, only 1 reported ever-use. Compared to the pharmacy registry, 13% reported a shorter and 28% a longer duration of OC use. Of women who reported OC use within 5 years of interview, 5-10 years earlier, and more than 10 years ago, 2.6% (8/312), 4.6% (14/307), and 12.8% (26/203), respectively, had no prescriptions on file for that time period. Discrepancies between the two data sources in time since first OC use were usually less than 2 years; the tendency was for women to overestimate rather than understate the actual duration of OC use. These findings suggest that interview data on OC use introduce minimal--if any--bias. Agreement between interviews and records in terms of the specific brands of OCs taken was less satisfactory. 19% of users of high-dose OCs, for example, did not recall the type of pill dispensed by the pharmacy. Thus, use of pharmacy records is recommended over interview data in studies where the specific OC formulation is of interest.

Evaluation of blood pressure in vasectomized and nonvasectomized men.

We assessed the effect of vasectomy on blood pressure by collecting cross-sectional data on the systolic and diastolic blood pressure of 946 male volunteer blood donors; of these, 30% were vasectomized. We used analysis of multiple covariance to correct both pressures for variation in age, weight, and height. Vasectomized and nonvasectomized men did not differ significantly in mean systolic or diastolic blood pressures. However, many of these men had been vasectomized for only a short period of time. We analysed the vasectomy subsample by multiple regression to determine whether blood pressures adjusted for age, body mass index, and height changed with time since vasectomy and found a slight, but non-significant, rise in the systolic pressure with square of time since vasectomy. The data are sufficiently strong to raise concern that data from a sample of men who have been vasectomized for longer periods of time would have shown a more dramatic increase.

PIP: This study evaluates the extent to which vasectomy might affect blood pressure thus contributing to hasten the rate of atherogenesis in men. Data were collected from 946 men, of whom 30.1% had been vasectomised; variables considered were number of years since vasectomy, weight, height, body mass and age. No significant differences were found in mean systolic or distolic blood pressure between the 2 groups of men, it was noted, however, that many men had been vasectomized only for a short period of time. When the group of vasectomized men were analyzed by multiple regression to determine the relation of blood pressure, age, body mass index, and height with time since vasectomy, a slight rise in systolic pressure was found, related with time since vasectomy. Conclusions from this investigation may not be correct for the general population since the sample studied here was nontypical and was not checked for factors such as race, diet, smoking habit, or physical fitness, which may potentially affect blood pressure. However, if the data are consistent with the hypothesis that there are no effects on blood pressure attributable to vasectomy, they also are consistent with a moderate rise in the systolic blood pressure of vasectomized males; the effect seems to accelerate with time. This problem should be further investigated on a larger number of males vasectomized for a period of 15 years or more.

Child mortality in a rural Javanese village: a prospective study.

Mortality in the first two years of life was studied in a cohort of 510 children born in a rural Javanese village. Lower risk of death was associated with younger maternal age, maternal schooling, ownership of a well, smaller sibship, longer gap between child and next oldest sibling and, in particular, with good nutritional status. Diarrhoea, pneumonia and immunizable diseases accounted for over half the deaths, with malnutrition contributing to most. A primary health care programme focusing on malnutrition, immunization and early treatment for diarrhoea and pneumonia could reduce mortality by half or more in this population.

PIP: A study, initiated in May 1976, was conducted in the rural village of Ngaglik located 15 km north of Yogyakarta city, Indonesia in an attempt to provide definitive information on child mortality. 510 mothers who gave birth between January 1, 1976 and March 31, 1977 were followed. Each woman was interviewed monthly in her home from May 1976 through July 1978 when information on women's activities, diet, illness, and fertility was obtained. Once in every 35 days each neighborhood was visited by a specially trained anthropometric team who carried out body measurements on each woman and her child with accurate and standardized instruments. Measurements included body weight; height, head, arm, and chest circumferences; and skinfold thickness. A detailed history of illness during the past month and treatment response was recorded for each child and mother. Each death was reported and a visit was made immediately to the family of the deceased child. An open-ended interview was conducted, covering the terminal illness, preceding symptoms, treatment efforts, and presumed cause of death. Data on each deceased child were hand tabulated and compared with the entire cohort of 458 survivors. A comparison group of children or "controls" was established. 2 age matched surviving children were chosen and matched for village, economic indicators, maternal education level, and maternal age. Analysis of these 104 survivors was carried out as a control group for comparison with the 52 deceased children. There was a significant relationship between maternal age and mortality, the mortality rate more than doubling for births to mothers over age 30, i.e., 6.8% in those mothers aged 15-29 and 14.7% for children with mothers aged 30 and older. Educational level of the mother indicated a higher mortality among children whose mothers had never attended school, i.e., 13.8% compared to 8.4% for those with some education. This relationship was not statistically significant. Absence of a drinking water well, close child spacing, and size of sibship were also associated with increased risk of dying. Family economic status failed to demonstrate the expected direct correlation with risk of death, the highest rates being found in the middle income and medium land holding groups. The causes of death found were preventable infections, readily treated infections, and undernutrition. Some 90% of the postneonatal deaths need not have occurred had even the most basic of primary health services been provided for these families. Effective family planning programs aimed at higher parity, older mothers, and increased child spacing could reduce some of the risk factors.

Perinatal mortality in Matlab, Bangladesh: a community-based study.

Perinatal deaths, comprising stillbirths and deaths during the first week of life, were monitored over the eight-year period 1979 to 1986 in a rural Bangladeshi population of 196,000. The perinatal mortality rate was 75 per 1000 total births. The rate was 13% higher in males than females. Stillbirth and early neonatal mortality rates were 37 and 38 per 1000 total births, respectively. The major causes of perinatal deaths are presented, as well as some of the maternal determinants. During the period under study, perinatal mortality declined regularly and significantly over time in an area covered by an intensive Family Planning and Health Services programme, but not in the adjacent control area. This raises the issue of the impact of such a programme upon perinatal mortality, and the need to include a strong maternity care component into primary healthcare strategies if further reductions of perinatal mortality are to be achieved.

PIP: In 1986, as part of the ongoing Demographic Surveillance System of the International Centre for Diarrhoeal Disease Research, Bangladesh, health workers regularly visited households in Matlab district to record vital events and other demographic data. They recorded 497 fetal deaths and early neonatal deaths. Low birth weight contributed to 25% of fetal deaths followed by prolonged labor (19%), maternal medical problems (13%), malpresentation at term (12%), and twins (2%). The cause of fetal death for 28% could not be determined. Similarly, low birth weight causes 63% of very early neonatal deaths followed by prolonged labor (31%) and 37% and 15% respectively in 4-7 day old neonates. The 2nd leading cause of death for 4-7 day old neonates was neonatal tetanus (25%w0. Males were more likely to die from tetanus than females (relative risk=4.3; p=.015). The women at lowest risk included those 20-24 years old who were pregnant for the 2nd-3rd time, those 25-29 years old who were pregnant for the 4th-5th time, and those 30-34-years old who were pregnant for the 6th-7th time. Even though the perinatal mortality rates in the study and comparison areas in Matlab did not significantly differ (74 and 75 total births/1000), the rate fell significantly from 82 (1979) to 65 (1986) in the area where maternal and child health and family planning services (MCH-FP) existed (p.001). Further, the rate declined significantly more in the 2nd half of the study period (1983-1986) than in the 1st half (1979-1982) in the MCH-FP area (p.002). Moreover the difference between the 2 areas was only significant in the 2nd half (p.04). Perinatal mortality was highest from August to December. The researchers credit the tetanus toxoid as having more of an impact on reducing the perinatal mortality in the study area than family planning interventions.

Determinants of the utilization of maternal and child health services in Jordan.

The utilization of antenatal, delivery and postnatal services by a random sample of married women in Jordan during their most recent pregnancy resulting in a live birth is analysed. Marked variations are shown in the use of these services and of preventive infant care for women living in urban and rural areas. Women with increasing levels of formal education and those living near services were significantly more likely to use services. If effective coverage of these services is to be achieved then it is suggested that greater emphasis should be placed upon outreach and realistic social marketing.

PIP: A survey of 1765 married women in Jordan with a recent live birth revealed wide variations in the utilization of antenatal, delivery, and postnatal services. The respondents were representative of the total population of Jordan, with 46% living in the 3 main cities, 20% in the other urban localities, and 34% in smaller settlements. 50% of respondents received no antenatal care; this rate was highest (69%) among rural women and lowest (38%) among those from the urban centers. 48% delivered in a hospital, with a range from 38% among rural women to 60% in urban centers. 43% of those living in towns compared with only 35% of those in rural areas made use of postnatal services. 72% of respondents in rural areas versus 7% of those in the 3 main cities and 10% of women in other urban areas lived further than 5 km from a maternal-child health clinic. 53% indicated they had not received any health education dealing with pregnancy and delivery. The use of antenatal services was significantly associated with the following individual and health service access variables: level of female education, duration of marriage, increasing female age, parity 4-6, and low distance to health facility. Time and cost involved in travelling to services were significantly associated with nonuse. These findings suggest a need for more effective maternal-child health program coverage and outreach.

Characteristics of women using different methods of contraception--some preliminary findings from a prospective study.

PIP: Some items of information collected on admission from each of 8774 women attending clinics of the British Family Planning Association up to the end of April 1971 are reported. Patients selected were willing to participate, were married, aged 25-39 years, were white British subjects, and had completed at least 5 months use of some form of contraception. Each filled out an admission questionnaire and patient and medical histories were completed. Results showed that women using oral contraceptives were younger than those using the diaphragm. IUD users were of intermediate age. Users of oral contraceptives were more frequently nulliparous. Almost all with an IUD had married early and borne 1 or more children. Most of the women interviewed were in the upper social classes, especially those using the diaphragm. Smoking was more frequent among users of oral contraceptives. Thrombophlebitis affe cted 1% of the oral contraceptive users, 5% of the diaphragm users, and 11% of the IUD users. These variations may have been due to the fact that those with a past history of thrombophlebitis would most likely have been prescribed either an IUD or a diaphragm. Although the relationship between oral contraceptives and venous thrombosis and pulmo nary embolism is now established, prospective studies are still required to provice better quantification of the risk. Analysts will need to take into consideration the strong selective factors now operating which tend to place women at highest risk from contraceptive complications in other categories of contraception use. Vaginitis and cervicitis were common in all groups but more so in those using oral contraceptives. This variation may have been due to the closer supervision of these patients.^ieng

Long-acting hormonal contraception.

For 30 years, the combined oral contraceptive pill has been an almost automatic choice for effective contraception in sexually active adolescent women. Nevertheless, consideration of the criteria of a hypothetical "ideal" contraceptive suggests that long-acting progestogen-only methods may have considerable advantages for some adolescents. These would include greater efficacy, easier compliance, avoidance of estrogenic side effects, and potentially greater privacy. The disadvantages of menstrual irregularity, progestogenic side effects including weight gain, and the initial greater medicalization of the method, particularly implants, must be weighed against the wishes and preferences of the adolescent. A number of studies of the uptake and utilization of these methods in adolescence have arisen, particularly from the United States. These are reviewed together with experience from programs in the United Kingdom.

Emotional reaction to sterilization.

Ninety-four patients sterilized by tubal occlusion were interviewed at the time of hospitalization for surgery and followed at scheduled intervals for a 2-year period. There were no serious problems, medical or psychologic, and all but 3 patients were pleased and satisfied at the end of 2 years. There were no technical failures. Psychosomatic symptoms do develop. They are more prominent and persist longer in the younger age group. Patients having these symptoms are those who had difficulty with contraceptive technics, have a limited understanding of the sterilization procedure, and continue to question its permanency. The need for preoperative evaluation and counseling is emphasized.

PIP: Psychologic and somatic aftereffects are reported for 94 patients sterilized by tubal occlusion at Rush Presbyterian St. Luke's Medical Center, Chicago, from July 1971 to December 1971. An initial interview was conducted at hospitalization, and follow-up interviews were scheduled for 6 weeks, 3 months, 1 year, and 2 years. 3 patients at 6 months and 7 patients at 1 year had health complaints; at 2 years there were none. 40% of the younger (under 26 years old) women had minor complaints at 1 year, and 18% had sought medical attention. By the second year 30% continued to have complaints, but none sought medical attention. Menorrhagia, memometrorrhagia, and dysmenorrhea were reported by 25% of the older group at some follow-up. Among the younger patients, 40% at 6 months, 60% at 1 year, and 65% at 2 years reported menstrual irregularities. At the 2-year follow-up the responses of 93% of the older patients and 77% of the younger patients indicated normal quality of sexual relations. 95% of the older and 75% of the younger group were completely satisfied with the sterilization. The physician must explain details of the procedure and its consequences.

Graduate family planning training. An evaluation.

PIP: The National Center for Family Planning Services in response to the need to improve and expand physician training in family planning in 1972 encouraged the development of model training programs in clinical family planning. An intensive training program in family planning was presented to small groups of physicians during a 6 month period. The goal was to provide new professional skill which would be used in delivering birth control services throughout the country. The entire training course won consistent approval from the repondents. The sexuality core course was by far the most popular among the respondents. Of the 34 respondents, 29 liked the program enough to highly recommend it to others and 4 said that they would recommend it.^ieng

Contraceptive therapy following therapeutic abortion: an analysis.

PIP: Presented is a follow-up study of 823 women who were offered a contraceptive method after a therapeutic abortion. The 520 women who elected an oral contraceptive were started on the regimen the day of the abortion, and 93% were maintaining the therapy 6 weeks later. Postabortal bleeding ceased by Day 7 in 58% of the oral contraceptive users and in 59% of the control group. Virtually all bleeding had stopped by Day 28 (97%, 98%). 42% of the patients inserted with IUDs on the day of abortion had stopped bleeding by Day 7, and 85% had stopped by Day 28. About 80% of the oral contraceptors and 30% of the control group returned to menses within 28 days of the abortion. It is recommended that oral contraceptive therapy, if chosen, be initiated the day of the abortion.^ieng