Demographic consequences, client satisfaction, and reasons for selecting sterilization among vasectomy and tubectomy clients in Bangladesh.

PIP: A follow-up study of vasectomy and tubectomy clients in Bangladesh showed that the mean ages of vasectomy clients and their wives were significantly higher than the mean ages of tubectomy clients. These findings suggest that the number of births averted by vasectomy is less than what might be expected from tubectomy. Between 20-60% of tubectomy clients stated that they (or their husbands) had previously used contraception, while only 2% of vasectomy clients indicated that they or their wives had previously used contraception. More than 95% of tubectomy clients, compared to less than 48% of vasectomy clients, were satisfied with having a sterilization procedure. A large proportion of dissatisfied vasectomy clients indicated that they had chosen vasectomy rather than some other method of contraception primarily because of financial incentives. The small percentage of dissatisfied tubectomy clients indicated that their concern was about possibly having a child die and not being able to replace that child. Less than 30% of vasectomy clients compared to more than 70% of tubectomy clients indicated that they had recommended the procedure to another man (woman). While more than 80% of tubectomy clients cited themselves, their husbands, or a close family member as the most influential person in their decision to have a tubectomy, vasectomy clients never mentioned their wives, rarely another family member, and in less than 1/2 the cases, themselves. This study suggests that client satisfaction with tubectomy in Bangladesh can be attributed to the desire to terminate childbearing. Positive responses of tubectomy clients appear to be consistent in spite of urban-rural, religious, and socioeconomic differences as measured by education of clients and their husbands' occupation. On the other hand, lack of satisfaction of vasectomy clients can be attributed to use of incentives, causing recruitment of clients who were not primarily motivated by a desire to terminate childbearing, nor apparently in need of sterilization based on their limited reproductive potential.^ieng

A randomized, single blind comparative trial of norethindrone enanthate and depo-medroxyprogesterone acetate in Bangladesh.

A randomized, single blind comparative trial of norethindrone enanthate (NET-ENT) and depo-medroxyprogesterone acetate (DMPA) was conducted in the Model Clinic, Decca, Bangladesh, to determine if there were differences in reported side effects, reasons for discontinuation and discontinuation rates of these two injectables. On all follow-up visits the proportion of women reporting no bleeding (amenorrhea) was higher for the DMPA clients compared to the NET-ENT clients. Concurrent with these findings, the proportion of women reporting irregular bleeding was consistently higher for the NET-ENT clients. Concurrent with these findings, the proportion of women reporting irregular bleeding was consistently higher for the NET-ENT clients compared to those receiving DMPA. By the fourth injection, less than 15% of the clients in both drug groups still reported having regular cyclic bleeding (4 of the 26 DMPA clients and 4 of the 28 NET-ENT clients). Five of the 133 women on DMPA and 6 of the 106 women on NET-ENT became pregnant while using the injectables. At the end of one year of follow-up, 14 of the 133 DMPA and 14 of the 106 NET-ENT clients were still continuing (came back for a fifth injection).

PIP: This comparative trial of norethindrone enanthate (NET-ENT) and depo-medroxyprogesterone acetate (DMPA) was conducted in a randomized, single blind manner in a clinic in Bangladesh to assess discontinuation rates, reasons for discontinuation, and variablility of side effects between these 2 injectable contraceptives. Of a total of 239 women, 106 received NET-ENT (200 mg) and 133 received DMPA (150 mg). DMPA was given every 12 weeks after the first injection and NET-ENT was given every 10 weeks after initial injection. Oral estrogen therapy was made available to women in this study based on the following criterion: 1) spotting/bleeding lasting more than 7 days; 2) heavy bleeding; or 3) 3 or more months of amenorrhea if this disturbed the subject. For menstrual pattern variability, a larger proportion of women reported irregular bleeding when given NET-ENT than did those with DMPA. On the other hand, on all follow-up visits the proportion of women reporting amenorrhea was higher for DMPA compared with NET-ENT users. However, by the 4th injection, fewer than 15% of clients in both experimental groups still reported regular cyclic bleeding (4 of 26 in DMPA group and 4 of 28 in NET-ENT). 11 pregnancies occurred during treatment, 5 in the DMPA group and 6 in the NET-ENT group. Continuation after 1 year totaled 28 clients, 14 from each group. The primary reasons for discontinuation were pregnancy; medical reasons, including symptoms and fear of symptoms; nonmedical reasons such as desire for more children, or death of husband; or loss to follow-up: the number of clients in the DMPA group discontinuing for these reasons were 5, 48, 17, and 49, respectively, and the respective numbers among NET-ENT users were 6, 34, 24, and 28.

Contraceptive use in Vietnam: the effect of individual and community characteristics.

Data from the 1988 Vietnamese Demographic and Health Survey and the 1990 Vietnam Study of Accessibility of Contraceptives were used in this analysis to determine how selective individual and community characteristics influenced the use of modern methods of contraception in Vietnam. Although there were no significant differences in the use of contraceptives between women with a primary education and those with a higher educational attainment, the illiterate women with no formal education were significantly less likely to use modern methods of contraception. Women living in provinces with high infant mortality rates were significantly less likely to use modern methods of contraception than women in low-infant-mortality provinces. Independent of other individual and community characteristics, there were no significant differences in the use of contraception between urban and rural women.

Community health nurses' perceptions, knowledge, and involvement in abortion services.

PIP: To learn more about the abortion-related experiences and value orientation of nurses, questionnaires were mailed to 1900 randomly selected community health nurses in the US; 844 (45%) responded. Although only 7% worked in settings where abortions are performed, half provide abortion counseling or referral. Their knowledge about the epidemiology of abortion in the US and recent abortion-related legislation was inadequate, and only 28.6% had received training about the clinical aspects of abortion in nursing school. Respondents' attitudes toward induced abortion were generally supportive; 82.0% believed federal funds should be provided for the procedure, 81.6% agreed women in the first trimester of pregnancy should have the right to choose abortion, and 70.3% supported abortion on demand. However, 27.8% indicated that abortion services in their communities were being negatively impacted by anti-abortion groups; only 9.7% felt that pro-choice groups were having a significant impact in their area. 56.0% reported they had been involved in some political activity relating to abortion, largely voting for a pro-abortion rights candidate or writing letters to legislators. 56.4& indicated they would vote against a candidate they otherwise supported if his or her views on abortion were unacceptable. 21.9% and 16.8% of nurses were involved with local or national Planned Parenthood; under 3% were members of anti-abortion groups. In-service training programs on the abortion issue are recommended to enable community health nurses to expand their counseling and political advocacy skills.^ieng

A follow-up of vasectomy clients in rural Bangladesh.

A one-year follow-up of 585 vasectomy clients sterilized at vasectomy camps in Shibpur and Shalna in rural Bangladesh showed that almost half of the clients were dissatisfied with their vasectomies. The majority of dissatisfied clients stated that their primary reasons for dissatisfaction were: (a) their ability to work had decreased and (b) they had not received all of the incentives they had been promised. However, 58% of the matched nonvasectomized controls also felt that their ability to work had decreased in the last year. Only 2%--7% of the dissatisfied clients cited decreased sexual performance as their primary reason for dissatisfaction. Satisfied vasectomy clients most frequently cited: (a) the permanence of this method of birth control and (b) the incentives they received as their reasons for satisfaction.

A follow-up of tubectomy clients in Bangladesh.

Five hundred twenty-one tubectomy clients from two health centers and one sterilization camp were interviewed 1-4 years after their tubectomies to determine: (a) demographic characteristics, (b) reasons for selecting tubectomy and (c) long-term satisfaction. Essentially no differences in demographic characteristics or long-term satisfaction were observed between urban and rural clients or by the type of center where the tubectomies were performed. Means ages of the clients were 31-32 years; mean parity was 7. Fifty-four percent of the rural and 85% of the urban patients had used contraceptives before tubectomy. Ninety-five percent or more of the patients stated that they were satisfied with the tubectomy.

Menstrual perceptions and preparation among female adolescents.

Seventy-four 8th- and 10th-grade students attending a private girls' school in Hawaii were queried about their perceptions of and preparation for menstruation using a questionnaire administered in a health education class. Eighty percent had already started menstruating. The most frequently cited perceptions by the respondents referred to both the inconveniences and the normalcy of menstruation. Many were first informed about menstruation by their mothers and stated that they also first informed their mothers when they started menstruating. Surprise, fear, and embarrassment were common initial reactions, while strong negative or positive emotions were more rare. Only 35% wanted boys and girls together during class discussion, but 89% stated that boys needed to be informed about menstruation. The most frequent reasons cited for noncoed settings were the girls' concern about their comfort in openly discussing menstruation. Thirty-eight percent thought parents should inform other siblings when they started menstruation, although almost half gave specific conditions the parents should consider. The majority thought the fifth to sixth grades were the best times to introduce menstruation content.

Attitudes toward research among undergraduate nursing students.

Attitudinal changes about research among undergraduate nursing students during their two years in a baccalaureate nursing program showed no significant improvements except for significant improvements in confidence about understanding research terminology methods and evaluating the adequacy of research studies. These improvements were apparent after the course and in the second year when the students were queried again. The overall research attitude score was essentially the same in the senior year as it had been on the pre-test when the students began the program. Although 52.9% of the students indicated they wanted to go on for a master's degree, 6.2% said they definitely wanted to take additional research courses. In the senior year, 31.9% of the students indicated they definitely wanted to go on to graduate school, while 60.4% said they were uncertain; 7.7% indicated they definitely did not want to return to graduate school.

Responses of schools of nursing to physically, mentally, and substance-impaired students.

Responses of schools of nursing to physically, mentally, and substance-impaired applicants and matriculating students were assessed in a 12% simple random sample (n = 132) of the 383 baccalaureate and 715 associate degree nursing schools and programs accredited by the National League for Nursing. A self-administered questionnaire concerning experiences, policies, procedures, and factors influencing decision-making was sent to the 132 deans and directors of the nursing schools and programs. Criteria for defining impairments, resources for developing criteria, methods of identifying impairments, actions taken, and individuals involved in the decision were also assessed. While the schools used external resources to guide decision-making, the majority of the responsibility was with the school of nursing faculty and administration. Schools offered a range of options for impaired individuals continuing in the program while under treatment; nevertheless, seeking treatment was a frequent requirement for continuation in the program.

Imagery associated with menstruation in advertising targeted to adolescent women.

Education about menstruation is not restricted to school instruction or information provided by adults and peers; exposure to advertisements in teen media provides imagery depicting menstruation and feminine role expectations. This paper analyzes the imagery in advertisements for sanitary products and products for the relief of menstrual symptoms. A 25% random sample of Seventeen magazine issues from 1976 to 1986 stratified by year were reviewed. A total of 135 ads for sanitary products and 32 ads for products for the relief of menstrual discomfort were analyzed. Each ad was examined for recurrent themes in text, context and tone. Data collected were examined for similarities in themes across both product type and time. The ads depict menstruation as a "hygienic crisis" that is best managed by an effective "security system" affording protection and "peace of mind." The failure of adequate protection places the woman at risk for soiling, staining, embarrassment and odor. Menstruating women are depicted as dynamic, energetic and always functioning at their optimal level. Such imagery may encourage guilt and diminished self-esteem in the adolescent who experiences discomfort. A lack of maternal, teacher or male figures in the ads is evident; the importance of peer support is reinforced.

A content analysis of educational media about menstruation.

Researchers and practitioners frequently have criticized educational media's coverage of menstruation as being too oriented toward the "hygienic crisis" while de-emphasizing the emotional and other developmental aspects of puberty. In the present study, 31 audiovisual media currently available for sale/rental were reviewed for content related to the physical and psychological aspects of menstruation, the portrayal of adolescent girls, parents, and peers, and the relationship of menstruation to the developmental process. Seven films were produced by sanitary product manufacturers; 24 by other commercial filmmakers. The majority of the media depicted female anatomy by animated images and related the menstrual process to pubertal development. The relationship between menstruation and reproduction was mentioned in three cases. In general, variations in physical and emotional responses were described as normal. In all cases, fear and embarrassment were acknowledged. Openness in discussions among peers and with female adults was emphasized.

A profile of young adolescents attending a teen family planning clinic.

The purpose of this study was to assess the client records of adolescents attending a teen family planning clinic to determine the reported episodes of sexually transmitted diseases, sexual abuse, alcohol and drug use, and other dysfunctional situations in the family. In addition, information about the initiation of sexual activity and sexual partners was assessed in the record review. Data were obtained from a county health department located in a metropolitan area of a southeastern state. A review of the records of 183 adolescents 15 years of age or younger provided information on ethnicity, grade in school, and assessment data from the clinic interviews and exams. Twenty-five clients said they were not sexually active when they came to the family planning clinic for the first time, and were brought to the clinic by a parent (usually the mother). Those clients who came without parents said they were sexually active. Forty-one percent had their first sexual experience between 12 and 13 years of age, 18% between the ages of 14 and 15, and the remainder before the age of 12. While over 7% specifically stated that they had been sexually abused or raped, an additional 19% described situations in the home or exhibited symptoms associated with a history of sexual abuse. Eleven percent had a history of two to three different sexually transmitted diseases, and 26% had three or more diseases. Seventy-two percent indicated that there was conflict in the home; several had left home because of abuse. Fourteen percent admitted using drugs, mostly cocaine or marijuana, and 17% reported that they used alcohol at least occasionally.

PIP: Client records of 1833 adolescents attending a county health department teen family planning clinic in a metropolitan area of the southeastern US were reviewed to gain insight into reported episodes of sexually transmitted diseases (STDs), sexual abuse, alcohol and drug use, initiation of sexual activity, sexual partners, and family life characteristics. Clients were aged 15 or younger,k with 82.8% aged 14 or 15 years; 80% were black. 25 stated that they were not sexually active at the time of their 1st visit to the clinic, while the remaining clients were sexually active. 41% began sexual relations between ages 12 and 13, 18% between ages 14 and 15, and the remainder prior to age 12. 7% claimed to have been sexually abused or raped, 19% described home situations or showed symptoms associated with history of sexual abuse, 80% had not been pregnant, 17% had 1 child, and 3% had 2 children. 11% had histories of 2-3 different STDs, 26% had 3 or more, and 7% stated that they had had sex with more than 2 partners. The majority of STD cases reported involved chlamydia and gonorrhea, followed by herpes. 14% admitted using drugs, primarily cocaine or marijuana, and 17% reported consuming alcohol at least occasionally. 72% cited conflict in the home, with several clients leaving the home due to abuse.

Community health nurses' knowledge of, attitudes toward, and involvement with adolescent contraceptive services.

A national sample of community health nurses were surveyed to assess their knowledge of, attitudes toward, and involvement with reproductive health services. Results indicated that slightly more than half of the nurses provided or administered contraceptive services to adolescents, although 73% worked in settings where contraceptive services were provided to adolescents. However, only 3.6% indicated that adolescents were their primary client population. The majority (64.3%) stated that they felt as prepared to work with adolescents as they did with adult clients. While 98% were aware that most adolescents are sexually active before seeking family planning services, a minority correctly answered questions about pregnancy and contraception among adolescents. Ninety-five percent agreed that contraceptives should be available to adolescents, and 90% agreed that parental consent should not be required for adolescents seeking contraceptive services. Yet only 21.5% were aware of the implications of the Adolescent Family Life Act.

PIP: A national sample of 1,900 community health nurses was surveyed to learn of their knowledge, attitudes, and involvement with reproductive health services, especially where adolescent populations are concerned. Questionnaire response rate was 47.6%. While 73% worked where contraceptive services were available and provided to adolescents, approximately 1/2 of the nurses actually provided or administered such services. 3.6% stated that adolescents were their primary client population, with the majority indicating that they were as prepared to work with adolescents as with adults. Approximately 1/3, however, do not feel equally comfortable in service provision to adolescents. 98% were aware of the nature of adolescents' sexual activity prior to seeking family planning services, yet only a small percentage correctly answered questions regarding pregnancy and contraception in such populations. 95% felt that contraceptives should be available to adolescents, and 90% felt that parental consent should not be required for adolescents seeking contraceptive services. 21.5% were aware of the implications of the Adolescent Family Life Act designed to promote premarital chastity. Findings suggest the need for special attention placed upon educational programs preparing community health nurses to deal with reproductive health issues in adolescent populations. Counseling skills, clinical knowledge, knowledge of legislation, and the epidemiology of adolescent sexual activity, pregnancy, and contraceptive use should all be components of these education programs.

Menstruation, menarche, and sexuality in the public school curriculum: school nurses' perceptions.

Nurses employed by schools and health departments have varying responsibilities for curricula related to menstruation, menarche, and sexuality. Nevertheless, the school nurse is usually a source of information on these subjects whether employed full-time in school health or also participating in other nursing roles in the community. This survey examines the involvement of school nurses in curricula related to human reproduction including contraception. Data about their involvement in these classroom topics provides a basis for evaluating their roles and making recommendations for subsequent continuing education programs for school health nurses.

Birth weight, Apgar scores, labor and delivery complications and prenatal characteristics of Southeast Asian adolescents and older mothers.

The study population included 337 adolescents and 876 mothers who delivered live-born, singleton infants in the Maternity and Infant Care Program at the Minneapolis Health Department between 1980-1982. Whites and blacks on the average experienced menarche 1-2 years earlier than the Southeast Asians although age of first pregnancy was 2 years later for the Southeast Asians. In spite of the significantly later ages of entry into prenatal care, lower weight gains, and hematocrits among the Southeast Asians, compared to the white and black populations, overall height-weight status on admission compared favorably with whites and blacks. The virtual absence of alcohol and tobacco consumption among the Southeast Asians may in fact contribute to the generally favorable Apgar scores, length of gestation, and birth weights. The high frequencies of alcohol and tobacco consumption among white adolescents during pregnancy suggest the need for more intervention to discourage smoking in this population. Further, the potential adoption of these substances needs to be discouraged among the Southeast Asian adolescents. While 2-4% of the whites, blacks and Hmong adolescents experienced eclampsia, 1% of the older Hmong mothers and none of the other Southeast Asians experienced eclampsia. The most frequent complication for all groups was perineal laceration.

Fertility, menstrual characteristics, and contraceptive practices among white, black, and Southeast Asian refugee adolescents.

This study compares fertility and menstrual characteristics and contraceptive practices of white, black, and Southeast Asian refugee adolescents participating in the Minneapolis Health Department's Maternal and Infant Care Program between 1980 and 1982. Mean ages were similar among all racial groups; however, half the Hmong adolescents had a live birth as compared to less than 25% of the other racial groups. More than 75% of the Hmong and other Southeast Asian adolescents were married as compared to 11% of the whites and 8% of the blacks. Menarche was significantly later (2 years) for Hmong and other Southeast Asians, and the interval between menarche and first pregnancy was significantly shorter for the Hmong. While more than half of the whites and blacks previously used contraception, 14% of the Hmong and 29% of the other Southeast Asians had used contraception. Oral contraceptives were the most frequently used method for whites, blacks, and Southeast Asians; the Hmong were equally likely to choose oral contraceptives or barrier methods. The Hmong were less likely to choose contraception postpartum than were the other groups.

PIP: This study compares fertility and menstrual characteristics and contraceptive practices of white, black, and Southeast Asian refugee adolescents participation in the Minneapolis Health Department's Maternal and Infant Care Program between 1980 and 1982. Mean ages were similar among all racial groups; however, 1/2 the Hmong adolescents had a live birth as compared to less than 25% of the other racial groups. More than 75% of the Hmong and other Southeast Asian adolescents were married as compared to 11% of the whites and 8% of the blacks. Menarche was significantly later (2 years) for Hmong and other Southeast Asians, and the interval between menarche and 1st pregnancy was significantly shorter for the Hmong. While more than 1/2 of the whites and blacks previously used contraception, 14% of the Hmong and 29% of the other Southeast Asians had used contraception. Oral contraceptives were the most frequently used method for whites, blacks, and Southeast Asians; the Hmong were equally likely to choose oral contraceptives or barrier methods. The Hmong were less likely to choose contraception postpartum than were the other groups.

Nursing administrators' responses to physically, mentally, and substance-impaired nurses.

Impaired nurses--whether the impairment is physical, mental, or substance use--can be a potential hazard in a healthcare setting, both to themselves and to patients. It is therefore imperative that nursing administrators identify such nurses in order to take the proper actions. But just how do administrators react toward nurses with impairments? The authors of this article present the results of a survey in an attempt to answer this question.

Malpractice coverage for health professionals with physical, mental, or substance-abuse impairments. How do insurance companies make their decisions?

How do insurance companies decide whether or not to provide malpractice insurance to health professionals? What information do they gather on applicants and renewing policyholders? Who has the responsibility to determine if health professionals are suffering from physical, mental, or substance-abuse impairments that make them unfit to care for patients? The authors conducted a survey to find the answers to these questions.

Nurses counseling patients about smoking cessation--why, when, and how.

In patient health education, nurses are a natural choice for on-the-spot counsellors and teachers. Yet many nurses feel uncomfortable about broaching subjects such as smoking cessation with their patients or the patients' families. The authors argue that it is time for nursing programs and hospitals to prepare and encourage nurses to take the initiative in smoking-cessation counseling.

Hospital smoking policies: who enforces them?

As opprobrium is increasingly given to the act of smoking, many institutions--hospitals especially--are seeking to curtail the amount of smoking that occurs within their buildings through various policies. This, however, raises two necessary questions: What does policy enforcement mean? And who shall enforce the rules? The article below discusses the results of a survey of North Carolina hospitals that asked these questions and more.