Involving men in reproductive health: the Young Men's Clinic.

OBJECTIVES: This report describes the population of young men who use the Young Men's Clinic in New York City, presents a profile of their reproductive behaviors, and describes the clinic's model of service delivery. METHODS: Data were gathered through a routine clinic visit form administered by clinic staff. RESULTS: The clinic sees approximately 1200 predominately Dominican young men each year for a wide range of clinical and mental health services. Two thirds of clients had ever been sexually active, three quarters had ever used birth control, and 69% had used birth control at their last sexual encounter. CONCLUSIONS: The Young Men's Clinic may serve as a model for health care delivery to adolescent and young adult males.

Early-onset respiratory failure caused by severe congenital neuromuscular disease.

Two unrelated infants with low Apgar scores, pneumothoraces, and severe pulmonary hypertension were treated with extracorporeal membrane oxygenation while receiving chemical sedation and neuromuscular paralysis. After decannulation from extracorporeal membrane oxygenation, hypotonia and hypoventilation persisted. Neurologic evaluation confirmed that both infants had a congenital myopathy.

Public policy and female sterilization in Costa Rica.

For 20 years, female sterilization has been increasing in popularity as a contraceptive method in Costa Rica. However, contraceptive sterilization has never been allowed explicitly under Costa Rican law. In 1976 the Costa Rican National Assembly instituted more stringent guidelines regarding medical sterilizations in order to eliminate contraceptive sterilizations, which had been occurring under relatively loose interpretations of national policy. Data from the 1976 National Fertility Survey and the 1981 Contraceptive Prevalence Survey indicate that the change in policy had only a short-term effect. Period sterilization rates fell substantially after 1976 but rebounded considerably by 1980, and the estimate of the proportion of married women who will ultimately be sterilized was approximately .5 for the periods both before and after 1976.

PIP: There has been a rapid decline in fertility in Costa Rica in the past 2 decades as a result of dramatic increases in the use of contraceptives, female sterilization being one of the most popular. The objection of certain groups to contraceptive sterilization was responsible for a change in procedures designed to eliminate sterilization for contraceptive purposes. However the enforcement of this policy has had little or no long term effect since medical versus contraceptive indications for the procedure cannot be defined precisely, and surgical sterilization for medical reasons is an important part of any modern health program for women. Other examples of government effort to eliminate access to certain forms of contraception or to reverse fertility declines, especially Eastern European countries such as limiting the availability of abortion, have had only very short-lived impact on birth rates. Romania provides the most striking example. In 1966, before stringent regulations in regard to abortion went into effect, the abortion ratio per 1000 live births was 3050; in 1967 it was 333, when abortion was legally limited to women over 45; or women having 4 or more children; or with specific medical indications. But the ratio increased to a level close to 1000 by 1972; abortions were being performed more frequently on the grounds of adverse mental health consequences, which were classified as a medical indication. The general conclusion from the cases cited in this paper is that once low fertility norms are widely accepted in a society that is accustomed to access to the effective contraception needed to fulfill those norms, the ability of a government to restrict access to certain methods of contraception is substantially limited. Studies of family planning in developing countries show that the task of initiating a fertility decline is very difficult as high fertility norms are deeply integrated into social systems and not easy to dislodge. However, once low fertility norms and associated behavior are firmly established, they are equally difficult to dislodge.

Contraceptive sterilization in four Latin American countries.

PIP: Reports on sterilization rates for women in Colombia, Costa Rica, the Dominican Republic and Panama in relation to demographic characteristics. Comparisons are made with nonsterilized women using other efficient contraceptive methods. The sterilization rates range from 0.161 in Colombia to 0.552 in Panama; births averted are calculated as 1/4 in Colombia, 1/2 in Costa Rica, and 1 in the Dominican Republic and Panama.^ieng

Who pays the bill for neonatal intensive care?

The Children's Hospital Newborn Emergency Service conducted 174 transports to the Newborn Center during a four-month period in 1976. The transport charge directly related to the distance between the referring hospital and the NBC. Two years after the NBC discharged the last study infant, 150 of 174 accounts have been paid in full. Insurance paid 85%, families paid 4%, and the hospital wrote off 11% of all hospital charges. The Children's Hospital referred 2% of all hospital charges to a bill collection agency. One hundred-forty-four infants (84%) survived and 27 (16%) died. The mean charge per day for survivors was $338; the mean charge per day for nonsurvivors was $607.