Patient characteristics and service trends following abortion legalization in Mexico City, 2007-10.

Legal abortion services have been available in public and private health facilities in Mexico City since April 2007 for pregnancies of up to 12 weeks gestation. As of January 2011, more than 50,000 procedures have been performed by Ministry of Health hospitals and clinics. We researched trends in service users' characteristics, types of procedures performed, post-procedure complications, repeat abortions, and postabortion uptake of contraception in 15 designated hospitals from April 2007 to March 2010. The trend in procedures has been toward more medication and manual vacuum aspiration abortions and fewer done through dilation and curettage. Percentages of post-procedure complications and repeat abortions remain low (2.3 and 0.9 percent, respectively). Uptake of postabortion contraception has increased over time; 85 percent of women selected a method in 2009-10, compared with 73 percent in 2007-08. Our findings indicate that the Ministry of Health's program provides safe services that contribute to the prevention of repeat unintended pregnancies.

Right to protection from unsafe abortion and postabortion care.

The International Congress on Population and Development (ICPD) Programme of Action urged governments and intergovernmental and nongovernmental organizations to reduce women's recourse to abortion through improved family planning services; reliable information and counseling should be readily accessible to women who have unwanted pregnancies; where abortion is legal, it should be safe; and in all cases, quality services for management of abortion complications should be accessible. Review of the extent to which these recommendations have been implemented over the last 15 years shows that, with few exceptions, little attention has been given to this serious problem. Because of its political and religious implications, abortion is mostly ignored. Those with the power to promote change have an obligation to raise the issue of abortion from the darkness in which it is currently hidden, and bring it into the public light as a human drama and a health problem that is not difficult to solve if the ICPD recommendations are taken seriously.

Marcos normativos da anticoncepção de emergência e as dificuldades de sua institucionalização nos serviços públicos de saúde / Legal framework of emergency contraception and the difficulties of its institutionalization in public health services

Este artigo discute as dificuldades de implementação da Anticoncepção de Emergência (AE) nas práticas do Sistema Único de Saúde, no período de 2000 a 2008, mediante revisão crítica da literatura sobre o tema e análise de documentos oficiais. Aponta avanços no âmbito da legislação em saúde para a utilização da AE, os quais permitem oficialmente reconhecê-la no país como alternativa contraceptiva em situações emergenciais, para além dos casos de violência sexual. O levantamento da literatura nacional e internacional, centrada na América Latina e em alguns estudos da Europa, dos EUA e do Canadá, suscita questões referentes à não-incorporação dessas normas nas práticas cotidianas dos serviços de saúde, revelando representações sociais difíceis de serem revertidas em pouco tempo. Documentos oficiais do MS e do CFM foram analisados para construção do marco legal e político-institucional que pauta a discussão. Os resultados mostram paradoxos entre as normas asseguradas e as práticas existentes nos serviços de saúde: dificuldade no acesso e utilização da AE via serviços públicos de saúde; a pílula do dia seguinte (PDS) é comumente considerada abortiva por profissionais de saúde, usuárias e seus parceiros; embora pesquisas apontem aumento significativo do uso desse método, há resistência dos serviços a disponibilizá-lo; persiste a ideia recorrente no senso comum de que a AE levaria os usuários, principalmente adolescentes, a abandonar outros métodos contraceptivos de uso regular, inclusive preservativo, fato não confirmado pelos estudos realizados, pois eles indicam que os adolescentes que recorrem à AE são os que usam tal método.

This paper discusses the difficulties to implement emergency contraception (EC) in Brazilian Public Health Service, from 2000 to 2008, based on critical literature review and analysis of official documents on the theme. It shows advancements in health legislation, concerning the use of EC, that allow to recognize officially EC in Brazil as an emergency contraceptive alternative, beyond cases of sexual violence. The critical literature review - which includes data from Latin America, mainly, and some European, American, and Canadian studies - brings out issues related to the non-use of these norms by public health services in its everyday practice. This situation reveals strong social representations that are not easy to be reversed at once. Official Health Ministry and National Medical Professional Board documents were analyzed, in order to establish the legal, normative, and politicalinstitutional frameworks that guide the discussion. The analysis displays paradoxes between the established norms and the health services practices, such as: trouble accessing and using EC through public health services; health professionals and potential users commonly relate the morning after pill (MAP) to abortion; there is noticeable resistance of health services to making that method available, although researches point out substantial increase in its use; and there persists the idea that EC would lead users, especially teenagers, to abandon regular contraceptive methods, like condom - a fact not confirmed by the reviewed studies, once they show that teenagers that resort to EC are the ones that regularly use condom.

[Nursing and family planning: the interfaces of contraception]. / Enfermagem e o planejamento familiar: as interfaces da contracepção.

This work analyses some aspects of family planning policy in Brazil related to contraceptive methods as published in Revista Brasileira de Enfermagem between 1960 and 1997. The subject analysis considers three categories: Catholic church, feminist and official state discourse. According to the records, in the decade of 1960 the Catholic church discourse was predominant. This situation continued in the decade of 1970, accompanied with emerging voice of the official state discourse. In the decade of 1980, the feminist discourse joined. Finally, in the decade of 1990 the feminist discourse continued, the official state discourse was consolidated and that of the Catholic church was not found any more. In conclusion, the journal established family planning on the agenda of Brazilian nursing by the means of scientific production. The methodology used enabled us to identify what are the obligations of nursing with respect to family planning in the context of its relationship with state policies and with the society.

The relationship between intimate partner violence and unintended pregnancy: analysis of a national sample from Colombia.

CONTEXT: Intimate partner violence is associated with a number of reproductive and mental health problems. However, the relationship between intimate partner violence and women's ability to control their fertility has not been adequately explored, especially in developing countries. METHODS: Data from the 2000 Demographic and Health Survey for Colombia were used in multivariate logistic regressions to explore the relationship between intimate partner violence and unintended pregnancy, which was included as a measure of fertility control. Regional differences in the relationship were also explored, and population-attributable risk estimates were calculated. The sample consisted of 3,431 ever-married women aged 15-49 who had given birth in the last five years or were currently pregnant. RESULTS: Fifty-five percent of respondents had had at least one unintended pregnancy, and 38% had been physically or sexually abused by their current or most recent partner. Women's adjusted odds of having had an unintended pregnancy were significantly elevated if they had been physically or sexually abused (odds ratio, 1.4); the association was observed in the Atlantica and Central regions (1.7 each), but was not significant elsewhere in the country. Eliminating intimate partner violence in Colombia would result in an estimated 32,523-44,986 fewer unintended pregnancies each year. CONCLUSIONS: These findings indicate the need to include intimate partner violence screening and treatment in reproductive health programs, to promote men's involvement in fertility control programs, and to improve the social and political response to intimate partner violence.

Contracepção transdérmica semanal: expandindo os limites do planejamento familiar / Weekly transdermal contraception: expanding the limits of family planning

Novos contraceptivos hormonais têm-se tornado disponíveis recentemente no arsenal médico, com características próprias, apresentando vantagens em face dos já conhecidos. Objetiva-se descrever um novo sistema transdérmico contraceptivo (CT) recentemente disponibilizado no Brasil, analisar a experiência internacional com esse método e fornecer dados de uma pesquisa comportamental realizada para conhecer a opinião de possíveis usuários do CT. O CT é utilizado uma vez por semana, por três semanas consecutivas, e, na quarta semana, livre do adesivo, ocorre o sangramento de privação. Pode ser utilizado em diversas partes do corpo, exceto as mamas. Libera diariamente 20 ug de etinilestradiol e 150 ug de norelgestromina, progestágeno de 3ª geração, em níveis constantes. A eficácia do CT é de 99,4 (percentual), Índice de Pearl de 0,7. O controle do ciclo/perfil de efeitos colaterais são adequados, comparáveis aos das pílulas. A adesão da paciente ao uso é superior no CT (88,7) comparada à pílula (79,2), p<0,001, não variando nas diferentes faixas etárias. A adesividade, estudada sob variadas condições de clima e atividade física, indicou taxa de descolamento total em torno de 1,7 (percentual). Estudo brasileiro recente demonstrou que 91 (percentual)de 500 pacientes estudadas referiram que usariam o método e 78 (percentual) o caracterizaram positivamente como "excelente", "muito bom" ou bom

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 fertility transition in Cuba and the Federal Republic of Korea: the impact of organised family planning.

South Korea and Cuba are dissimilar in religion, economy, culture and attitudes toward premarital sexual relations. In 1960, Korea instituted a national family planning programme to combat rapid population growth. Cuba explicitly rejected Malthusian policies, but made family planning universally available in 1974 in response to health needs. Both countries have undergone rapid fertility declines and today have less than replacement level fertility. Both countries have also used a similar mixture of methods, including a high prevalence of female sterilisation. Abortion has played a major role in the fertility decline of both countries, rising in the first half of the fertility transition and then falling, although remaining a significant variable in the second half. It is concluded that access to contraception, voluntary sterilisation, and safe abortion has a direct impact on fertility and has been associated with a rapid fall in family size in two very different countries.

PIP: It is argued that access to contraception, voluntary sterilization, and safe abortion had a direct impact on fertility decline in two countries (Cuba and Korea) that differed in religion, economic conditions, culture, and attitudes. Both countries achieved below replacement fertility through high rates of contraceptive prevalence and ready access to legal abortion. Family planning services were provided in both countries through the public sector and in Korea through a subsidized private sector. Fertility decline in both countries occurred at the same time as the initiation of family planning programs. Family planning was introduced in Korea in order to reduce population growth and in Cuba in order to reduce the incidence of induced abortion and not for demographic reasons. Both Korea and Cuba had successful family planning programs over the past ten years that combined awareness, accessibility, and perceived quality. Korea adopted legal abortion as a means of reducing high maternal mortality rates and fertility. Cuba adopted legal abortion, during a period when the government lacked hard currency and consumer items such as birth control pills. Even antibiotics were difficult to obtain, particularly for teenagers. Both countries worked to improve services for teenagers. The experiences with family planning in both countries provide support for the theory that socioeconomic forces are not needed to push fertility lower. It is suggested that access to reversible and permanent contraception and safe abortion increases the speed of the transition and permits lower fertility than would otherwise be achieved without formal family planning programs. Fertility decline occurred in Korea under rising incomes and Cuba experienced declines during a period of economic declines. Both countries need to expand options for reducing exposure to pre-union adolescent pregnancies.

Norma de planificación familiar / Norms of family planning

Presenta la Norma de Planificación Familiar de los Servicios de Atención Integral a la Mujer, describe las disposiciones generales y sus especificaciones técnicas para la prestación de los servicios de planificación familiar e incluye la selección y aplicación de métodos anticonceptivos, destacando los elementos de promoción, información, orientación y consejería. El propósito de normar los servicios de salud integral a la mujer es contribuir a reducir la mortalidad materna y perinatal mejorando la oferta de servicios de planificación familiar; brindando información adecuada y oportuna a través de la educación para la salud y la consejería, de manera que les permita a las parejas e individuos tomar decisiones informadas acerca de su vida reproductiva, así como sobre el número y el espaciamiento de los hijos. Pretende normar las actividades de planificación familiar, con el enfoque de salud reproductiva, de conformidad con las políticas y estrategias del Ministerio de Salud, en un contexto de atención integral, basado en el enfoque de riesgo, la política de descentralización y la participación social y comunitaria, a fin de mejorar la calidad de vida y salud de la población nicaragüense