RESUMEN
PIP: Although abortion has been legal in India since 1971, there are an estimated 2-10 times as many illegal as legal terminations, and sepsis resulting from abortions performed by nonqualified practitioners is a major contributor to maternal mortality. Continued reliance on illegal abortion is believed to reflect fear of surgery and anesthesia, a lack of access to abortion clinics, and social and cultural factors, especially a lack of confidentiality and privacy. RU-486 offers the potential to overcome these obstacles and extend the availability of safe abortion to Indian women. At present, 2 clinical trials are underway in India to test the acceptability and effectiveness of RU-486 with prostaglandins in various doses. In the 78 cases reviewed to date, compliance was 96%, acceptability was 83%, and 97% had a complete abortion. All but 1 participant indicated she would select RU-486 if a subsequent unwanted pregnancy occurred. Reasons given for preference of this methods included the lack of pain and discomfort, no need for hospital admission or surgery, and the protection of privacy. Use of a single 200 mg tablet has been found to reduce side effects such as nausea, vomiting, and diarrhea. More research is needed, however, to identify the optimum minimal effective does in India's many anemic, malnourished women.^ieng
Asunto(s)
Aborto Criminal , Legislación como Asunto , Mortalidad Materna , Mifepristona , Investigación , Aborto Inducido , Asia , Biología , Demografía , Países en Desarrollo , Economía , Sistema Endocrino , Servicios de Planificación Familiar , Antagonistas de Hormonas , Hormonas , India , Mortalidad , Fisiología , Población , Dinámica Poblacional , TecnologíaRESUMEN
PIP: Various approaches of measuring acceptability used in contraception research can be used to measure acceptability of abortions induced by RU-486. The primary acceptance method determines whether women will or will not choose RU-486 in the absence of other abortion methods, if offered it, and how many women will indeed undergo a medical abortion. The comparative acceptance method determines how many women will choose RU-486 if other methods are available. Another acceptability approach is interviewing women to learn if they suffered any side effects or have any complaints. Researchers can also see if women think that they would choose RU-486 again should the need arise. This method would work best with women who have undergone both surgical and medical abortions. It is important to examine acceptability because medical service delivery systems in developing countries cannot always perform safe and effective surgical abortions and individual choice is important in matters concerning stressful and intimate issues, such as abortion. Research is beginning to show that women in both developed and developing countries tend to be motivated by the same issues when choosing RU-486 over surgical abortion. For example, women in Cuba, India, and Europe chose RU-486 because it avoids surgery and hospital admission and is easy and convenient. More than 90% of the women in studies in India and Cuba considered their RU-486 experience to be at least satisfactory. 83% who had earlier undergone a surgical abortion preferred RU-486 induced abortion. 90% of repeat abortion seekers would choose RU-486 again. Feasibility studies examine whether medical institutions can handle medical abortion technology. Feasibility depends on cost, clinic facilities (e.g., availability of sonograms), clinic management, professional training, and the presence of back-up systems (e.g., high quality surgical services with transfusion capability). Researchers also need to determine whether medical abortion burdens medical systems and patients.^ieng
Asunto(s)
Abortivos , Aceptación de la Atención de Salud , Mujeres Embarazadas , Países en Desarrollo , Estudios de Factibilidad , Femenino , Humanos , Internacionalidad , Satisfacción del Paciente , Embarazo , Medición de Riesgo , Control Social FormalRESUMEN
PIP: Safe motherhood will require a multi-faceted strategy of improving girls' education and employment opportunities, providing primary and reproductive health care for women, taking a high risk approach with referral for all at-risk pregnant women, and including maternal mortality as part of the quality of life index. The World Health Organization in 1986 reported that 99% of maternal mortality occurred in developing countries: 640 per 100,000 live births in Africa, 420/100,000 in Asia, 270/100,000 in Latin America, 100/100,000 in Oceania, 450/100,000 in developing countries on average, and 30/100,000 in developed countries. The chances of maternal death ranges in the extremes from 1/9850 in northern Europe to 1/21 in Africa. In India, the chance of maternal mortality was estimated at 1/18; the surviving also might suffer from perineal tears, genital infections, uterovaginal prolapse, and vesico-vaginal fistula. Direct obstetric causes include those directly related to pregnancy, labor, and the postpartum period. Indirect causes include those resulting from previous existing diseases that were aggravated by the pregnancy. 75% of maternal mortality was caused by hemorrhage, obstructed labor, infection, eclampsia, and abortion. Proper handling could prevent maternal mortality in an estimated 63-80% of direct causes and 88-98% of all causes. Risk factors for postpartum hemorrhage include multiparity, age over 35 years with stretched uterus, and slight episodes of bleeding. Treatment must be immediate and sustained with oxytocic drugs and plasma expanders; the means of referral to an equipped facility must be available to women with hemorrhage. Risk factors for obstructed labor include very young age, height below 145 cms, previous prolonged labor or stillbirth, and previous cesarean, abnormal presentation, or labor progression. Delivery for these women must be in a facility offering trained doctors and well-equipped operating rooms. Prevention of infection is possible with pre-sterilized delivery kits, antibiotics in kits or within facilities, cleanliness of hands and delivery areas, and maternal tetanus immunization. Identification of edema in pregnancy would prevent eclampsia. Abortion complications could be prevented with safe and early practices and women's control over fertility.^ieng
Asunto(s)
Países en Desarrollo , Estudios de Evaluación como Asunto , Mortalidad Materna , Morbilidad , Características de la Población , Atención Primaria de Salud , Derechos de la Mujer , Asia , Atención a la Salud , Demografía , Enfermedad , Economía , Salud , Servicios de Salud , India , Mortalidad , Población , Dinámica Poblacional , Factores SocioeconómicosRESUMEN
A total of 2388 subjects, 1181 for 60 +/- 5-day and 1207 for 90 +/- 5-day treatment regimen with norethisterone oenanthate (NET OEN) 200 mg injection, were observed for 24 months, constituting 28,513 woman-months. This clinical trial represents the largest clinical trial undertaken on NET OEN. The observations indicated that NET OEN given at 60 +/- 5-day intervals provides adequate contraceptive protection. However, as compared to the published studies elsewhere, higher method failures were seen during the first six months of NET OEN usage, when all women were receiving the drug at 60 +/- 5-day intervals. The reasons for this discrepant observation in the present study cannot be explained. The higher method failures reported with 90 +/- 5-day regimen were mainly during the third month following the injection, suggesting reduced contraceptive efficacy of the drug during this period. Thin build women (body weight less than or equal to 40 kg) were at higher risk of involuntary pregnancy. Disrupted menstrual pattern was the major reason for discontinuation ranging between 42-43 per 100 users at the end of 24 months. Amongst these, amenorrhoea was the commonest reason for discontinuation. No change in blood pressure was observed during contraceptive usage. The majority of NET OEN users did not show any change in body weight. The overall continuation rates with NET OEN were lower than those observed in similar conditions with Cu-T 200 mm2 IUCD.