Clinical assessment of treatments for prolonged bleeding in users of Norplant implants.

The effectiveness of three drugs in controlling prolonged bleeding in the first year of NORPLANT implants use was tested. The drugs were levonorgestrel (L-Ng, 0.03 mg twice a day for 20 days), ethinylestradiol (EE, 0.05 mg per day for 20 days) and ibuprofen (Ib, 800 mg three times a day for 5 days) and were given orally. A control group received a placebo (PL, one pill of lactose for 20 days). Treatment should start each time a woman experienced eight consecutive days of bleeding or spotting. The 183 volunteers were not aware of the drug administered. A daily record of bleeding and spotting and of treatment intake was maintained. One-hundred-forty women completed the study period; 60 never used the prescribed treatment. Women treated with the three test drugs had significantly fewer bleeding and spotting days during the treated month and also throughout the study year than women using the placebo. The mean number of bleeding plus spotting days per actually treated subject in the first year was 77, 94, 101 and 129 days for the EE, Ib, L-Ng and PL groups, respectively. The administration of EE might help in the management of prolonged bleeding during the first year of NORPLANT implants use.

Use effectiveness of the Prentif cervical cap in private practice: a prospective study.

Of two-hundred-sixty women seeking cervical cap contraception, exactly half subsequently used the Prentif cavity rim cap as their sole method of contraception. The one year continuation rate for these exclusive cap users was 56.7 per hundred. No major side effects related to the use of the Prentif cap were observed in the course of this study, involving 918 women-months in year 1. Pregnancy and dislodgement of the cap during use were the principal reasons for discontinuation of exclusive use, with gross rates of 19.1 and 12.9 per 100 at one year, respectively.

The international postpartum family planning program: eight years of experience.

The International Postpartum Program was begun in 1966 in order to demonstrate the feasibility of providing efficient and effective family planning services in the context of the obstetrical care provided by hospitals. The project included 138 institutions in 21 countries. Over an eight-year period, 1.14 million women were recruited, representing 33 acceptors per 100 obstetrical/abortion patients in these hospitals. Relying primarily on modern methods of contraception, the pill, the IUD, and sterilization, the program provided about 124 years of contraceptive protection for each 100 obstetrical/abortion patients, or somewhat more than four years' protection per acceptor. Predischarge insertion of IUDs was found to be safe and effective. In all countries, the program acceptors experienced important changes in fertility over and above the effects of aging. The demonstration showed that basing a program on activities in the obstetrical wards permits a rapid buildup of services, without great cost for construction. Whether using specially trained additional staff to provide family planning education and information or relying on the existing staff, hospitals were able to recruit a substantial proportion of women on the maternity wards as acceptors. Cost per acceptor averaged about US$5.00 during the eight-year period--considerably below the cost per acceptor in the majority of national programs. Such economy arose because acceptance ratios for the International Postpartum Program were higher than ratios for national programs where the target population is more dispersed, and because only direct costs for the services needed to be considered. The idea of uniting family planning information and services with the maternity services of hospitals has been seized upon and replicated outside the International Postpartum Program. The governments of India, Pakistan, Indonesia, Colombia, Thailand, and the Philippines, among others, now operate such systems. Postpartum programs still do not reach substantial segments of the urban population in the developing world, but the expansion of such services is continuing. Also, adaptations of maternity-centered family planning programs are now being tested in rural areas in the world, where most children are born.