Introduction of cyclofem once-a-month injectable contraceptive in Mexico.

A large introductory study of Cyclofem, a once-a-month injectable contraceptive, was conducted in three Mexican provinces. A total of 3457 healthy women participated: 640 women from rural areas (community-based component) and 2817 women from urban and suburban areas (health center-based component). A total of 20,316 women-months of treatment experience were accumulated during a one year period. Cyclofem proved its use-effectiveness (pregnancy rate of 0.03%) and its safety under routine service conditions of family planning facilities in Mexico. The overall life table continuation rate at 1 year was 26.1%. Higher continuation rates were observed in the community-based component (36.6%) as compared to the health center component (23.7%). The most common reason for method discontinuation was change of address. Only 15% of the discontinuations were attributable to the injectable contraceptive method, with the overall 1 year discontinuation rate for bleeding problems (including amenorrhea) was < 11%. These observations underscore the importance of appropriate counseling and follow-up measures, providing convenient access to repeat injections, and other service delivery issues related to continuation of Cyclofem. The results of this trial have once again demonstrated that Cyclofem is a highly effective method with an acceptable side effect profile. In addition, the study provided the elements for its approval by local health authorities and its inclusion into the Ministry of Health Family Planning Program.

PIP: The effectiveness and continuation rates associated with the once-a-month injectable contraceptive Cyclofem were investigated in an introductory trial conducted in three Mexican provinces (Sinaloa, Guanajuato, and Veracruz). Cyclofem contains 25 mg of medroxyprogesterone acetate and 5 mg of estradiol cypionate. A total of 3457 women (640 women from rural communities and 2817 from urban and suburban family planning centers) were enrolled and 20,316 woman-months of treatment experience were accumulated during the 12-month study period. The mean age of study participants was 23.6 years; 70% had previously used at least one contraceptive method. There was only one pregnancy (rate, 0.03%). The overall life-table continuation rate at 1 year was 26.1%, but this rate was higher in the community-based group (36.9%) than in the health center group (22.4%). This discrepancy is presumed to reflect the greater access of clinic clients to other contraception options. Continuation was highest among women 30-34 years of age, those with low levels of education, women with five or more children, and those who did not want more children. Only 14% of discontinuations were method-related. The 1-year discontinuation rate for bleeding problems, including amenorrhea, was 10.2%. These findings indicate Cyclofem is a safe, effective method appropriate for inclusion in Mexico's Ministry of Health Family Planning Program.

[Health, marginality and regional development]. / Salud, marginación y desarrollo regional.

The paper discusses the close link between marginality, regional development and health. In order to do so, reference is made to some health indicators like nutrition, causes of death and health infrastructure within the low as well as the high marginality areas. The paper also presents the strategies that the Ministry of Health has established to assist the population living in the high marginality areas. It specifies the related activities that are being carried out through the national institutes of health and the sanitary regulation offices.

[The impact of family planning on the indices of social well-being]. / El impacto de la planificación familiar en algunos indicadores del bienestar social.

The impact that family planning has on social welfare was quantified for each federal entity. Considering fertility the most important variable of the population growth rate during the last years, and the demographic dynamic in the future, a package of software was adapted to elaborate population projections up to the year 2010, in order to show, through basic indicators, the effect that in a middle-term of a successful or deficient family planning program, in terms of future needs of health, education, housing and job employment. Finally, programmatic and operative strategies were expounded to reinforce family planning activities at local health systems and dispersed rural communities.

[Fertility and health in Mexico]. / Fecundidad y salud en México.

Fertility, health, and family planning are not independent factors, but rather involve a series of biological and social mechanisms in close interaction with one another. The impact that a high fertility rate has on health is reflected mainly in a rise in the rates of maternal and child mortality. Similarly, fertility has a greater negative effect upon the health of groups characterized by high reproductive risk, high parity, short intergenesic intervals, and unwanted pregnancies. On the other hand, family planning -and specifically the use of contraceptive methods-helps to achieve a lowering of the fertility rate and also has a positive effect on maternal-child health. This situation can be observed in the case of Mexico, where fertility rates and tendencies, as well as maternal and child mortality, have been reduced during the past decade.

PIP: Little information is more significant in the field of public health than data on the size, territorial distribution, composition, and demographic behavior of the population. Health is dependent to a considerable extent on the same factors that determine whether population will increase, remain stable, or shrink. The relationship between health and fertility can most effectively be analyzed in countries where mortality has declined but fertility has remained at traditional high levels. Family planning has various impacts on health, including the effects of the methods themselves, the additional effects of family planning service delivery such as the clinical examination prior to prescription of oral contraceptives, effects that result from substituting contraception for abortion, the effects of declining fertility rates, and the effects of changes in reproductive patterns including increased birth intervals, changes in age distribution of births, and declining total parity of women. Each year throughout the world some 500,000 women die during pregnancy and delivery. 4 groups of factors have been identified as related to maternal mortality, including medical, health service, reproductive, and socioeconomic factors. Reproductive factors include maternal age, parity, personal medical and obstetric history, birth intervals, and body size, as well as undesired pregnancy and abortion. Important socioeconomic factors include nutrition, education, place of residence, and income. In Mexico the maternal mortality rate declined from 94/100,000 live births in 1980 to 81/100,000 in 1983, a 7.1% drop. Infant mortality, despite substantial underregistration, is also known to have declined, from an estimated 83.2/1000 live births in 1967-71 to 46.9 in 1982-87, a 43.6% decline. In 1984, rural infants still had mortality rates twice as high as urban infants, and the rural decline in infant mortality was much slower than the urban. Children of illiterate mothers had an infant mortality rate 3 times as high in 1984 as children of mothers with primary educations. Infant mortality rates were 50.9 for children of mothers under 20, 39.2 for mothers 20-29, and 72.3 for mothers 35 and over. Rates were 33/1000 for 1st order births, 36.2 for 2nd and 3rd order births, 55.6 for 4th- 6th order births, and 84.1 for 7th order and above. The infant mortality rate was 71.7 for births occurring less than 24 months after the preceding birth and 42.3 for those occurring 24-47 months later. Mexico's total fertility rate declined from 6.31 in 1973 to 3.84 in 1986, a decline of 40%. Higher educational status, labor force participation, and urban residence are associated with fertility decline. The proportion of fertile-aged women using some form of contraception increased from 47/7% in 1982 to 53% in 1987. Rural levels of contraceptive usage were much lower than urban levels. Mexico's experience demonstrates that family planning helps achieve a lowering of fertility and significant improvement in maternal and child health.

[Psychosocial research and family planning services in Mexico]. / La investigación psicosocial y de servicios sobre planificación familiar en México.

PIP: Psychosocial and service studies round out data from the demographic and contraceptive prevalence studies that have been conducted every 3 years since 1976 in Mexico. The studies can be formative, providing basic information for development of a program, or evaluative, indicating how well a program is performing. Among formative psychosocial studies in Mexico have been knowledge, attitude, and practice (KAP) studies, which are usually helpful in the initial stages of family planning program implementation. A 1964 study of knowledge and practice in 7 Mexican cities showed that attitudes toward family planning were more traditional and disapproving in Mexico City than in other areas, but that many women wanted no more children. About 1/4 of the population of Mexico City knew no contraceptive methods and about 1/2 knew only less effective traditional methods. By 1979, 72% of women knew at least 1 effective method. KAP studies have demonstrated differences in the family size desires of men and women and in the determinants of attitudes toward birth control. Formative studies of surgical contraception have been psychologically oriented, and have helped provide a rational basis for making the operation accessible to the public. Despite some passing problems, most women have adapted to sterilization and their libidos have normalized by 18 months postoperative. Studies of the knowledge and attitudes of physicians conducted in the early days of family planning programs have helped in the design of programs to inform them of the advantages and side affects of contraceptive methods. Other studies have helped identify traditional midwives with large practices in rural areas who could be trained to deliver family planning services and have demonstrated that they develop a good understanding of contraindications and side effects of oral contraceptives. Teaching materials for IEC programs have been evaluated with small samples, but minimal attention has been given to research on the best ways of providing family planning education for physicians, nurses, students, promoters, husbands, or other population groups. The greatest effort appears to have focused on development of educational materials for illiterates. Evaluative research on messages transmitted in IEC campaigns has however been abundant since the start of the programs. Careful studies of IEC c ampaigns in 1980-81 indicated that they improved knowledge of basic aspects of family planning considerably but had little effect on values and beliefs associated with family planning. Data on new acceptors in Mexico have come primarily from institutional registration systems, special studies, and as a subproduct of demographic surveys. Careful studies done by private organizations have provided information needed to reformulate commercial distribution programs and design supporting IEC campagns for their users and agents. Evaluative service studies have focuses on identifying factors in differential continuation rates for different methods and programs. Research on service delivery in rural areas has helped identify the most productive type of community worker and has uncovered causes of dissatisfaction and high turnover among workers which impairs their performance.^ieng