RESUMEN

OBJECTIVE: To describe factors associated with subsequent abortions in Colombia and evaluate whether high-efficacy contraceptive availability (IUD) post-index abortion was associated with higher efficacy contraceptive initiation and fewer subsequent abortions within 2 years. METHODS: The study population comprised patients aged 15-44 years who underwent index abortion in 2017 at four clinics in Bogotá, Colombia. Using charts, we conducted a retrospective cohort study with 2-year follow-up (2017-2019) after the index abortion for outcomes of contraceptive initiation and subsequent abortion. We evaluated associations between demographic or clinical characteristics and outcomes using Pearson chi-square and multivariate logistic regression. RESULTS: Of 9175 patients with index abortion, 3409 (37.2%) initiated an intrauterine device (IUD) and 467 (5.1%) had a subsequent abortion within the study period (2017-2019). IUD availability (adjusted odds ratio [aOR], 1.64; 95% confidence interval [CI], 1.39-1.93) and insurance use (aOR, 5.03; 95% CI, 4.37-5.78) were associated with high-efficacy contraceptive initiation; medication abortion was inversely associated (aOR, 0.24; 95% CI, 0.22-0.27). Initiation of no (aOR, 4.94; 95% CI, 3.59-6.80) or moderate-efficacy (injection: aOR, 4.21 [95% CI, 3.14-5.62]; oral contraceptive pill: aOR, 4.60 [95% CI, 3.21-6.59]) methods were associated with subsequent abortion. CONCLUSION: Subsequent abortion is inversely associated with initiated postabortion contraceptive efficacy, which is modifiable on a systems level by improving access to effective postabortion contraception.

Asunto(s)

Aborto Inducido , Aborto Espontáneo , Embarazo , Femenino , Humanos , Aborto Legal , Colombia , Estudios Retrospectivos , Anticoncepción/métodos , Estudios de Cohortes , Anticonceptivos Orales , Accesibilidad a los Servicios de Salud

RESUMEN

Contraceptive stock-outs are a world-wide problem, yet published research on the impacts of contraceptive stock-outs have not been comprehensively reviewed and synthesised. This systematic review highlights findings about the impacts of contraceptive stock-outs on users, providers, and facilities and identifies topics that should be explored to ensure everyone can access their preferred method of contraception. We systematically searched PubMed, Embase, Web of Science, Popline, and JSTOR for studies addressing the impacts of contraceptive stock-outs. Of 435 studies, 25 publications addressed the impacts of contraceptive stock-outs. Only two articles focused solely on contraceptive stock-outs; the remaining studies examined stock-outs alongside other factors that may influence contraceptive service provision. Studies discussed how stock-outs limited individuals' ability to use their preferred contraceptive method, influenced where contraceptive methods were obtained and how much they cost, and limited providers' and facilities' abilities to provide contraceptive care. Comparing the impacts of contraceptive stock-outs across studies was challenging, as reliability of stock was sometimes not distinguished from overall method availability, and studies used variable methods to measure stock-outs. Evidence presented in this review can inform efforts to ensure that preferred contraceptive methods are consistently available and accessible to all.

Asunto(s)

Anticoncepción , Anticonceptivos , Anticoncepción/métodos , Humanos , Reproducibilidad de los Resultados

RESUMEN

BACKGROUND: We thank Bijlmakers et al. for their interest in our article, "A never-before opportunity to strengthen investment and action on adolescent contraception, and what we must do to make full use of it", and are grateful for the opportunity to respond to their four key assertions. RESPONSE: First, we fully agree that sexual rights are controversial, which we discussed in depth in our original article. However, we reaffirm that there is global consensus on adolescent contraception as evidenced in part by recent data emerging from FP2020 on 38.8 million additional modern contraceptive users, the Global Goods and commitments emanating from the 2017 FP2020 summit, and their translated actions at the country level. Additionally, we clarify WHO's working definitions of sex, sexual health, and sexuality, and introduce WHO's newly released Operational Framework on Sexual Health and its Linkages to Reproductive Health. We welcome and agree with Bijlmakers et al.'s second point, which elaborates on the barrier of restrictive laws and policies. To address this barrier, we describe examples of resources that can help programmes understand the political/social context that drives these laws and policies at national and subnational levels, and identify programmatic gaps and best practices to address them within specific political/social contexts. We also welcome and agree with Bijlmakers et al.'s third point, which reiterates that discomfort around adolescent sexuality is a major barrier for sexuality education. In response, we point to four relevant reviews of CSE policies and their implementation, our original article's description of three programmes that have successfully addressed inadequate teacher skills, and our ongoing work on documenting strategies to build an enabling environment for CSE and deal with resistance. Lastly, we wholeheartedly agree that the harmful policies noted by Bijlmakers et al. are damaging to international efforts to improve adolescent SRH and rights. We argue, though, that these policies alone will not undermine efforts by countless other stakeholders around the world who are working in defence and promotion of adolescents' SRH and rights. CONCLUSION: Despite the many valid obstacles noted by Bijlmakers et al., we truly believe that this is "a never-before opportunity to strengthen investment and action on adolescent contraception".

Asunto(s)

Conducta Anticonceptiva/psicología , Anticoncepción/métodos , Embarazo en Adolescencia/prevención & control , Educación Sexual , Adolescente , Servicios de Salud del Adolescente , Femenino , Humanos , Embarazo , Servicios de Salud Reproductiva

RESUMEN

BACKGROUND: Increasingly, the health and rights of adolescents are being recognized and prioritized on the global agenda. This presents us with a "never-before" opportunity to address adolescent contraception. This is timely, as there are enormous numbers of adolescents who are currently unable to obtain and use contraceptives. From research evidence and programmatic experience, it is clear that we need to do things differently to meet their needs/fulfil their rights. MAIN BODY: In this commentary, we call for action in several key areas to address adolescents' persistent inability to obtain and use contraceptives. We must move away from one-size-fits-all approaches, from a 'condoms-only' mind set, from separate services for adolescents, from ignoring the appeal of pharmacies and shops, and from one-off-training to make health workers adolescent friendly. Our efforts to expand access to quality contraceptive services to adolescents must be combined with efforts to build their desire and ability to use them, and to do so consistently. In order for these changes to be made, action must be taken on several levels. This includes the formulation of sound national policies and strategies, robust programme implementation with monitoring, regular programmatic reviews, and implementation research. Further, high-quality collection, analysis, and dissemination of data must underlie all of our efforts. As we move ahead, we must also recognize and draw lessons from positive examples of large scale and sustained programmes in countries that have led the way in increasing contraceptive use by adolescents. CONCLUSION: This unprecedented moment in history gives us a real opportunity to bring about transformational change, particularly when there is so much at stake.

Asunto(s)

Servicios de Salud del Adolescente/legislación & jurisprudencia , Conducta Anticonceptiva , Accesibilidad a los Servicios de Salud , Embarazo en Adolescencia/prevención & control , Adolescente , Femenino , Humanos , Embarazo , Servicios de Salud Reproductiva , Educación Sexual

RESUMEN

BACKGROUND: Promoting condom use to prevent HIV transmission is futile if condoms are not readily available. GOAL: This study assessed condom availability in clinics, shops, and other outlets in urban and rural South Africa. STUDY DESIGN: Snowball sampling was used to select 70 private-sector and public-sector outlets. One male and one female black fieldworker were posed as clients seeking condoms to assess condom availability and provider attitudes. RESULTS: Condoms were available in nine (100%) public clinics, in five of nine (55%) private doctor's rooms, and in only 5 of 52 (10%) nonhealth outlets. Access was limited in the public sector by clinic opening times, inadequate clinic signs and markings, and by some providers' attitudes. CONCLUSION: A major opportunity to make condoms available in nonhealth outlets in rural areas and urban townships is being missed in South Africa. Above all, the high level of condom awareness is not being matched by easy availability.

Asunto(s)

Condones/provisión & distribución , Infecciones por VIH/prevención & control , Salud Rural/estadística & datos numéricos , Salud Urbana/estadística & datos numéricos , Atención a la Salud/estadística & datos numéricos , Humanos , Masculino , Sudáfrica/epidemiología

RESUMEN

PIP: This article focuses on the contraceptive options of adolescents to prevent unintended pregnancy. Based on the Contraceptive Technology Update 2000 Contraceptive Survey involving health care providers, 90% of the respondents will provide injectable depot medroxyprogesterone acetate (Depo-Provera or DMPA) to young teens. Meanwhile, in surveying providers¿ practices with regard to the possible link between DMPA use and diminishing bone mass, about half of the providers inform patients of such an effect and about 30% use other methods, such as counseling on calcium supplementation and weight-bearing exercise. However, just-released research revealed that DMPA's impact on bone density might be a short-term or current-user effect, apparently without long-term implications. On the other hand, when providers were asked for the treatment of severe dysmenorrhea in women who are not sexually active and have no plans to engage in such activity, 45% of respondents said they would prescribe an oral contraceptive and a prostaglandin inhibitor.^ieng

Asunto(s)

Adolescente , Agentes Comunitarios de Salud , Anticoncepción , Recolección de Datos , Accesibilidad a los Servicios de Salud , Embarazo en Adolescencia , Factores de Edad , Américas , Demografía , Países Desarrollados , Servicios de Planificación Familiar , Fertilidad , Planificación en Salud , América del Norte , Población , Características de la Población , Dinámica Poblacional , Investigación , Muestreo , Conducta Sexual , Estados Unidos

RESUMEN

PIP: This paper presents the findings of the Contraceptive Technology Update 2000 Contraception Survey in the US involving 275 health service providers, which examines the leniency of health care providers in dispensing emergency contraceptive pills (ECPs). According to the survey, three-quarters of the respondents say they prescribe ECPs on-site and provide them at any time. While 41.8% say their facility dispenses standard birth control pills for ECP use, almost 60% say they use products specifically marketed for emergency contraception. In addition, many believe that ECPs should be available over-the-counter (OCT). Advocates for taking emergency contraception OCT are preparing supporting materials for submission to the Food and Drug Administration.^ieng

Asunto(s)

Agentes Comunitarios de Salud , Anticonceptivos Poscoito , Recolección de Datos , Accesibilidad a los Servicios de Salud , Américas , Anticoncepción , Anticonceptivos , Anticonceptivos Femeninos , Países Desarrollados , Servicios de Planificación Familiar , Planificación en Salud , América del Norte , Investigación , Muestreo , Estados Unidos

RESUMEN

PIP: More than 100 general medical practices in Lothian, Scotland, have agreed to take part in the 2-year research project designed to see if improving the availability of emergency contraception will reduce unplanned pregnancies and lower the abortion rate. At the end of 2 years, the change in the abortion and unplanned pregnancy rate of women attending the 100 general practices will be compared with any change in rates among other practices in the region. Both the BMA and the Royal College of Obstetricians and Gynaecologists have supported moves to make emergency contraception available over the counter in pharmacies. However, this has been strongly resisted in Great Britain by anti-abortion groups and the Catholic Church. Expectations are bright that the project will reduce the number of abortion cases in Lothian by about 15%.^ieng

Asunto(s)

Anticonceptivos Poscoito/provisión & distribución , Adolescente , Femenino , Humanos , Embarazo , Embarazo en Adolescencia/estadística & datos numéricos , Escocia/epidemiología

RESUMEN

This study was designed to determine the familiarity of medical advanced individual training (AIT) students with current methods of birth control and to evaluate the accessibility of these methods. A survey was distributed to 578 medical specialist AIT students assigned to Fort Sam Houston, Texas, for training. Results obtained show a lack of knowledge concerning the newer forms of contraceptives available. This study also indicates that barriers may exist that limit a soldier's ability to acquire prescription forms of contraception while in training.

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PIP: This cross-sectional study evaluates the knowledge and use of contraceptives in medical advanced individual training students and the availability of these contraceptive methods. A 15-item proctored self-administered questionnaire was given to 564 soldiers from the 232nd Medical Battalion assigned to Fort Sam Houston, Texas. Results revealed that majority of the active duty service members were well informed on the current birth control methods. About 55.6% females and 50.8% males reported knowing emergency contraceptive pills as a method of pregnancy prevention. Condom was reportedly the most popular method of contraception among 98.8% females and 99.4% males. Lack of knowledge on newer forms of contraceptive devices was observed. Inability of obtaining contraceptives was due to unavailability of condoms, lack of time for routine check-ups, barriers in the medical system, and a general lack of information.

Asunto(s)

Anticoncepción/métodos , Conocimientos, Actitudes y Práctica en Salud , Personal Militar/educación , Personal Militar/psicología , Estudiantes del Área de la Salud/psicología , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Encuestas y Cuestionarios , Texas , Estados Unidos

RESUMEN

OBJECTIVE: To compare the knowledge of emergency contraception in women attending hospital for termination of pregnancy in 1984 and 1996. DESIGN: A questionnaire survey. SETTING: Ninewells Hospital, Dundee. SUBJECTS: Cohorts of 100 consecutive women undergoing termination of pregnancy in 1984 and 1996. RESULTS: Over this 12 year period, there has been a significant improvement in the knowledge of emergency contraception. Seventy three per cent had a good knowledge of the postcoital pill in 1996 compared to 12 per cent in 1984 (p=

PIP: Although the Yuzpe emergency contraception regimen has been available in the UK since 1984, the expected reduction in the number of induced abortions has not occurred. To assess whether poor knowledge of postcoital contraception is a significant factor in induced abortion, questionnaires were administered to two cohorts of 100 consecutive women undergoing pregnancy termination at Ninewells Hospital (Dundee, UK) in 1984 and 1996. Over the 12-year study period, there was a trend toward increased reliance on condoms for pregnancy prevention (32% in 1984 and 60% in 1996). Condom accident was the main reason for unwanted pregnancy in the 1996 cohort (38%) compared with nonuse of contraception in 1984 (58%). True method failure accounted for 24% of conceptions in 1984 and 20% in 1996. 28% of women in the 1984 cohort and 17% in 1996 considered the possibility they might be pregnant after the index unprotected intercourse or condom accident. Good knowledge of emergency contraception (i.e., how long it is effective after sexual intercourse and where to obtain the method) increased from 12% in the 1984 cohort to 73% in 1996. These findings indicate that a lack of awareness of emergency contraception is no longer a substantial obstacle. Utilization of emergency contraception would likely be improved by easier accessibility (e.g., making the method available from pharmacies without a prescription).

Asunto(s)

Aborto Inducido/psicología , Anticonceptivos Poscoito , Conocimientos, Actitudes y Práctica en Salud , Mujeres/educación , Aborto Inducido/estadística & datos numéricos , Aborto Inducido/tendencias , Adolescente , Adulto , Condones , Escolaridad , Urgencias Médicas , Femenino , Humanos , Embarazo , Embarazo no Deseado/estadística & datos numéricos , Escocia , Encuestas y Cuestionarios

RESUMEN

CONTEXT: The personal and social costs associated with teenage pregnancy in the United States concern many policymakers and researchers, yet the role of contraception in preventing these pregnancies has not been adequately quantified. METHODS: Published estimates of contraceptive effectiveness were applied to 1995 National Survey of Family Growth data on sexual and contraceptive practices in order to estimate the number of pregnancies averted through the use of contraceptives by U.S. teenagers. Four scenarios of contraceptives access--from current levels of access to highly restricted access--and teenagers' sexual and contraceptive practices in response to such restrictions are used to project the potential impact on pregnancies among teenagers. RESULTS: Current levels of contraceptive use averted an estimated 1.65 million pregnancies among 15-19-year-old women in the United States during 1995. If these young women had been denied access to both prescription and over-the-counter contraceptive methods, an estimated one million additional pregnancies (ranging from 750,000 to 1.25 million) would have occurred, assuming some decrease in sexual activity. These pregnancies would have led to 480,000 live births, 390,000 abortions, 120,000 miscarriages, 10,000 ectopic pregnancies and 37 maternal deaths. CONCLUSIONS: Contraceptive use by teenage women prevents pregnancies and negative pregnancy-related health consequences that can disrupt the lives of adolescent women and that have substantial societal costs. Continued and expanded access to contraceptives for adolescents is a critically important public health strategy.

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PIP: An analysis of the number of adolescent pregnancies and pregnancy outcomes that are averted in the US each year by contraceptive use highlighted the importance of continued and expanded access on the part of young people to contraception. In this analysis, published estimates of contraceptive effectiveness were applied to 1995 National Survey of Family Growth data on sexual and contraceptive practices among US teenagers. Four scenarios of contraceptive access--from current levels to highly restricted access--and sexual and fertility control practices in response to such restrictions were constructed. The 651 sexually active female adolescents enrolled in the national survey had used contraception during 80% of the times in which they were at risk of pregnancy. Current levels of contraceptive use averted an estimated 1.65 million pregnancies among 15- to 19-year-old US women in 1995. If these adolescents had been denied access to prescription and over-the-counter contraceptive methods, an estimated 750,000 to 1.25 million additional pregnancies would have occurred, assuming some decrease in sexual activity. These pregnancies would have resulted in 480,000 live births, 390,000 induced abortions, 120,000 miscarriages, 10,000 ectopic pregnancies, and 37 maternal deaths. The prevalence of adolescent sexual activity would have to decrease by 83% over current levels to avert the same number of pregnancies that are presently prevented by contraceptive use.

Asunto(s)

Conducta del Adolescente , Conducta Anticonceptiva/estadística & datos numéricos , Anticonceptivos/provisión & distribución , Embarazo en Adolescencia/prevención & control , Adolescente , Anticonceptivos/uso terapéutico , Estudios Transversales , Femenino , Predicción , Encuestas de Atención de la Salud , Humanos , Embarazo , Embarazo en Adolescencia/estadística & datos numéricos , Embarazo no Deseado/estadística & datos numéricos , Factores de Riesgo , Muestreo , Estados Unidos/epidemiología

RESUMEN

PIP: In 1997, the US Department of Health and Human Services instructed all Title X delegate agencies to provide emergency contraceptive pills as part of their standard family planning services. The results of a survey conducted in the state of Michigan in October 1996, prior to this policy development, elucidate potential obstacles to implementation of this directive. Questionnaires were completed by the family planning coordinator of all 53 Michigan health departments and Planned Parenthood affiliates that receive Title X funding. At the time of the survey, only 32 programs were providing emergency contraception and 27 of these agencies were offering the method to no more than one woman per month. 75% of providers agreed that poor or underprivileged women would benefit from more widespread access to emergency contraception through Title X programs. Barriers to translating this commitment into practice included inadequate staffing, the logistics of scheduling emergency appointments, lack of federal service guidelines, few client requests, and reservations about the impact on sexual risk-taking and contraceptive practice. In several cases, the decision not to dispense emergency contraception was made by a medical doctor or health officer who viewed the method's medicolegal status as unclear or considered the associated political risk too great. The subsequent marketing of a product specifically designated for emergency contraception should alleviate provider concerns about the method's status. The logistic concerns suggest a need to consider provision of emergency pills to clients in advance of actual need.^ieng

Asunto(s)

Actitud del Personal de Salud , Anticoncepción/psicología , Anticonceptivos Femeninos/administración & dosificación , Servicios de Planificación Familiar , Organización de la Financiación/normas , Guías de Práctica Clínica como Asunto/normas , Abortivos/clasificación , Anticoncepción/normas , Anticoncepción/tendencias , Anticonceptivos Femeninos/clasificación , Control de Medicamentos y Narcóticos , Urgencias Médicas/psicología , Servicios de Planificación Familiar/métodos , Servicios de Planificación Familiar/organización & administración , Gobierno Federal , Femenino , Regulación Gubernamental , Encuestas de Atención de la Salud , Conocimientos, Actitudes y Práctica en Salud , Política de Salud/tendencias , Accesibilidad a los Servicios de Salud , Humanos , Difusión de la Información , Michigan , Aceptación de la Atención de Salud , Embarazo , Embarazo no Deseado/psicología , Estados Unidos

RESUMEN

OBJECTIVES: A postal questionnaire survey was conducted to assess what staff in UK accident and emergency (A&E) departments thought of providing an emergency contraception service, the degree of enthusiasm in and level of provision of the service, and staff attitudes to the introduction or continuation of provision of the service. METHODS: A questionnaire was sent to all 560 departments providing A&E services in the UK. RESULTS: Of the 560 units sent questionnaires, 355 (63.4%) replied. Half the units were located in small county towns, and a quarter in large towns. Requests for emergency contraception were received by 96% of responding units, but only 57% provided treatment. Requests for emergency contraception in 84 of these units ranged between one and 50 per month. The A&E senior house officer (SHO) and the gynaecology SHO and registrar prescribed most of the pills. Nurses were more involved in nurse led or general practitioner (GP) led units. Initial treatment only was given by 77% of providing units while the remainder also discussed subsequent contraception. Follow up was arranged with GPs by 92 units, and with family planning clinics by 66 units. Information packs were available in only 37 providing units. A total of 155 of providing units felt it was worthwhile and 56% of respondents thought emergency contraception should be provided by A&E departments. However, 91 units could identify one or more groups within the hospital who were antagonistic to provision by A&E departments, of which non-A&E medical staff formed the largest group. Over the counter availability of emergency contraception was not supported by 62% of respondents. CONCLUSION: The results show that while the female population appears to see a need for emergency contraception services to be provided in A&E departments, there is some reluctance by UK A&E departments to provide the service. Given the current interest in approaches to reducing unplanned pregnancies, especially in teenagers, provision of emergency contraception by A&E departments requires a pragmatic approach to ensure their cooperation in providing the service when alternative sources of provision are not available.

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PIP: Attitudes toward emergency contraception were assessed in a questionnaire mailed in 1995 to the 560 UK departments that provide accident and emergency services. Consultants, general practitioners, and nurses from 355 departments (63.4%), half of which were located in small county towns, replied. Although 338 units (96.3%) reported they had received requests for emergency contraception, only 198 (57.2%) provided such treatment. Initial treatment only was offered by 150 of the providing units (76.9%); only 45 (23%) also discussed subsequent contraception. Follow-up was organized with general practitioners by 92 units and with family planning clinics by 66 units. 155 of the providing units (82.9%) felt emergency contraception was a worthwhile service. Overall, 177 respondents (55.8%)--78.9% of those already providing emergency contraception and 28.1% of nonproviding units--thought this regimen should be available from emergency departments. Among the reasons cited for opposing such a strategy were unprotected sexual intercourse is a social rather than an acute medical problem, lack of adequate time for counseling and follow-up, and sufficient family planning programs in the area to provide this service. 91 units (42.1%) could identify professional groups (primarily other medical staff) within the hospital who would oppose the introduction or continuation of emergency contraceptive services in the emergency room. Finally, 201 respondents (61.7%) did not support over-the-counter availability of emergency contraception. These findings indicate there is a lack of consensus on whether unprotected intercourse constitutes a medical problem requiring emergency treatment and revealed an appreciable degree of reluctance on the part of accident and emergency departments to provide this service.

Asunto(s)

Actitud del Personal de Salud , Anticonceptivos Orales/provisión & distribución , Servicio de Urgencia en Hospital/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud , Humanos , Encuestas y Cuestionarios , Reino Unido

RESUMEN

PIP: This article discusses the importance of emergency contraception in family planning. Widespread availability of emergency contraception can help reduce the estimated 50 million abortions carried out annually and can help save women's lives and health. However, emergency contraception is not widely known or available in many countries and most family planning providers have not been trained in this method of contraception. Thus the Program is striving to make emergency contraception better known among users and health workers. It is also undertaking efforts to improve the methods. Moreover, the Consensus Statement on Emergency Contraception issued during an international family planning experts meeting in Bellagio, Italy, urged family planning providers to ensure that all women have access to emergency contraception to avoid unwanted pregnancy. The meeting also established an international Consortium for Emergency Contraception, which aims to increase the availability of emergency contraception throughout the world.^ieng

Asunto(s)

Comunicación , Anticonceptivos Poscoito , Estudios de Evaluación como Asunto , Servicios de Planificación Familiar , Accesibilidad a los Servicios de Salud , Anticoncepción , Anticonceptivos , Anticonceptivos Femeninos

RESUMEN

PIP: This article provides an overview of changes in the population policies of African governments since 1974. Since the 1974 World Population Conference in Bucharest, trends have shifted from the satisfied, nonintervention attitude to a heightened concern about high fertility levels, resulting in the adoption of several strategies to lower growth rates. Between 1976 and 1996, the percentage of countries desiring to lower the fertility level increased from 23 to 66. The shift in the perception of population-development interrelationships is reflected in the responses of African governments to the UN Eight Population Inquiry on views and policies on population growth and distribution, national fertility levels, and family planning programs. In 1998, 30 out of the 53 states in Africa had explicit national population policies. However, the family planning programs of 12 countries exist primarily for health reasons and are not intended to modify existing fertility levels. Moreover, the number of countries with explicit government-supported programs for access to contraceptives has greatly increased from 4 in 1974 to 43 in 1996. With the adoption of regional and global frameworks such as the Dakar/Ngor Declaration and the International Conference on Population and Development Programme of Action in the 1990s, several African countries have had the opportunity to review and reformulate their previous population and development policies.^ieng

Asunto(s)

Fertilidad , Accesibilidad a los Servicios de Salud , Regulación de la Población , Crecimiento Demográfico , Política Pública , Investigación , África , Anticoncepción , Demografía , Países en Desarrollo , Servicios de Planificación Familiar , Población , Dinámica Poblacional

RESUMEN

PIP: This article reports on the public debate on whether condoms should be made publicly available on the streets, in neighborhoods, and in schools, which could trigger discussions about sex in China. Condom vending machines have been installed in China since August 1999, and most regard the installations as a symbol of China's openness and progress, as well as an improvement in livelihood. However, some have objected to the public display and sale of condoms. Some teachers see it as damaging the reputation of the schools. Others suggest that they represent greater tolerance for premarital sex among youths, and a professor of sexual ethics stated that, while breaking the sex taboo is evidence of progress, condoms are a special type of commodity which should not be made available anywhere. In addition to the public debate concerning condoms, the banning of commercials featuring a condom-shaped cartoon character overcoming AIDS and sexually transmitted diseases touched off a debate between reproductive health advocates and government regulators. Reports indicate that the commercial was banned because it contravened the Advertisement Law, which provides that no sex product advertisement be aired or printed in the media. However, Zhang Konglai contended that condoms are not sex products but merely a means for preventing pregnancy and diseases and should be promoted actively. Moreover, Qui Renzong described the government's ban as a mistake and called on them to revise the law.^ieng

Asunto(s)

Comunicación , Condones , Gobierno , Accesibilidad a los Servicios de Salud , Medios de Comunicación de Masas , Investigación , Asia , China , Anticoncepción , Países en Desarrollo , Servicios de Planificación Familiar , Asia Oriental , Política

RESUMEN

PIP: By mid-May 1999, more than one third of US state legislatures had adjourned for the year, and a considerable amount of legislative and court activity on issues relating to family planning, teen pregnancy prevention, and abortion had occurred across the country. On April 19, Georgia joined Maryland as the only states in the US which guarantee coverage of contraceptives in most private insurance plans. More than 60 bills related to contraceptive insurance coverage had been introduced in 32 states by mid year. In Missouri, court-imposed restrictions have temporarily forced one of the state's 2 Planned Parenthood abortion providers to suspend its abortion-related services. Measures to change state sexuality education or adolescent pregnancy prevention programs have been slow to emerge out of this legislative session, while partial-birth abortions remain the most controversial abortion-related topic among state legislatures. Other proceedings and developments on parental involvement in minors' abortion decisions, abortion clinic regulations, the public funding of abortion, and fetal rights are discussed.^ieng

Asunto(s)

Financiación Gubernamental , Geografía , Planificación en Salud , Accesibilidad a los Servicios de Salud , Legislación como Asunto , Embarazo en Adolescencia , Aborto Inducido , Américas , Anticoncepción , Demografía , Países Desarrollados , Economía , Servicios de Planificación Familiar , Fertilidad , Administración Financiera , América del Norte , Población , Dinámica Poblacional , Conducta Sexual , Estados Unidos

RESUMEN

PIP: Recent data demonstrate the continuation of a trend of declining teen pregnancy rates in the US. Between 1995 and 1996, the national teenage pregnancy rate fell 4% to 97.3 pregnancies/1000 women aged 15-19 years, contributing to a 17% decline since the rate peaked in 1990. Birth and abortion rates also fell during the same time period. Pregnancy rates declined for younger and older teens, Blacks, Whites, and throughout the country during the first half of this decade. However, rates vary widely by state, and the pregnancy rates among Hispanic teens increased during 1990-92, and then fell off slightly. While these new data are encouraging, the US still has one of the developed world's highest teen pregnancy rates, with almost 1 million pregnancies occurring each year among women aged 15-19 years. Most of the observed decline in teen pregnancy rates in the US is due to the somewhat more consistent and significantly more effective use of contraception among sexually active teens, although about 20% of the decline can be attributed to increased abstinence and the delayed onset of sexual intercourse. Sexually active teens' access to a range of contraceptive methods has been key to their avoiding pregnancy. The conservatives' threat to minors' access to contraceptives, teens and the need for confidentiality, and public policy implications are considered.^ieng

Asunto(s)

Aborto Inducido , Adolescente , Tasa de Natalidad , Confidencialidad , Conocimientos, Actitudes y Práctica en Salud , Planificación en Salud , Accesibilidad a los Servicios de Salud , Necesidades y Demandas de Servicios de Salud , Política , Índice de Embarazo , Embarazo en Adolescencia , Consentimiento por Terceros , Factores de Edad , Américas , Actitud , Conducta , Anticoncepción , Demografía , Países Desarrollados , Economía , Ética , Servicios de Planificación Familiar , Fertilidad , América del Norte , Organización y Administración , Población , Características de la Población , Dinámica Poblacional , Psicología , Conducta Sexual , Estados Unidos

RESUMEN

PIP: In 1999, contraceptive coverage laws proliferated both in the government and private sectors in the US. On September 29, President Clinton signed a bill ensuring federal employees' access to contraceptives. While Congress has been creating initiatives of providing contraceptive coverage for its employees, individuals insured under private employers do not enjoy such coverage. In response to this, the Equity in Prescription Insurance Act was introduced to provide contraceptive coverage in private sector employment-based plans. Between April and September, 9 states enacted an almost similar contraceptive coverage law; these were California, Connecticut, Georgia, Hawaii, Maine, Nevada, New Hampshire, North Carolina, and Vermont. All require private insurance coverage of contraceptives and devices approved by the Food and Drug Administration. California, Connecticut, and Georgia require coverage of contraceptive services. In most states, however, addressing difficult questions concerning the scope of exemption for employers who object to contraceptive coverage was central to the ultimate success of the bill.^ieng

Asunto(s)

Accesibilidad a los Servicios de Salud , Seguro de Salud , Legislación como Asunto , Servicios de Salud del Trabajador , Sector Privado , Investigación , Américas , Anticoncepción , Países Desarrollados , Economía , Servicios de Planificación Familiar , Administración Financiera , América del Norte , Organización y Administración , Estados Unidos

RESUMEN

PIP: While Malaysia already had policies for a balanced, equitable, and sustainable development before the 1994 International Conference on Population and Development (ICPD), the conference gave Malaysia the chance to pursue specific and more complex issues. Reproductive health services including family planning have been integrated and are available, accessible, and affordable within the existing health care system, both public and private. Since Malaysia's government needs help implementing Cairo's goals, regular consultations are held with advocacy groups, the private sector, and community groups on program design and implementation. Annual grants to nongovernmental organizations are made to ensure that programs and services ultimately reach the various target groups. While Malaysia has made progress implementing the ICPD program of action, it has more to accomplish. Economic conditions leading to a 20% across-the-board budget cut in July 1998 have not adversely affected the country's population and reproductive health programs.^ieng

Asunto(s)

Administración Financiera , Accesibilidad a los Servicios de Salud , Necesidades y Demandas de Servicios de Salud , Cooperación Internacional , Organización y Administración , Población , Medicina Reproductiva , Cambio Social , Asia , Asia Sudoriental , Anticoncepción , Países Desarrollados , Países en Desarrollo , Economía , Europa (Continente) , Servicios de Planificación Familiar , Salud , Agencias Internacionales , Malasia , Países Bajos , Organizaciones , Naciones Unidas