RESUMO
This paper reviews the historical development of the IUD, describing the challenges and successes, and attempts to offer a balanced perspective for family planning service workers today. Modern IUDs are an important component of family planning services and an excellent contraceptive choice for properly screened women, providing contraception that is safe, effective, long lasting and cost effective. Potential research strategies for the future are also discussed.
PIP: Although there are 100 million current IUD users on a global level, unwarranted apprehension about the device's safety persists on the part of both service providers and potential acceptors. Much of this concern is based on experiences with IUDs such as the Dalkon Shield that are no longer in use and unsubstantiated assertions emerging from past IUD research (e.g., the existence of an IUD-pelvic inflammatory disease link). The development of medicated copper IUDs has renewed confidence about the effectiveness and safety of this form of contraception. The Copper T 380A, Multiload Copper-375, Nova-T, and levonorgestrel-releasing IUD are expected to be the pillars of IUD contraception for the 1990s and beyond, although high production and distribution costs are jeopardizing widespread use in developing countries. Current research is focused on reducing expulsions and medical removal rates through innovative design modifications. At this point, there is sufficient data from prospective multicenter clinical trials to enable evaluation of rare side effects. There is a need, however, to widen the scope of research activities to focus on users' needs and expectations and the impact of sociocultural context. Educational campaigns directed both at the public and the medical community would help to dispel remnants of misinformation.
Assuntos
Serviços de Planejamento Familiar/história , Dispositivos Intrauterinos/história , Feminino , Previsões , História do Século XX , HumanosRESUMO
The objective of this study was to evaluate possible factors associated with discontinuing use of TCu 380A IUDs due to personal reasons among 2748 users. Overall, a total of 88 subjects discontinued using the TCu 380A IUD within 12 months postinsertion for personal reasons. The most common reasons were planned pregnancy (32%) and husband or family opinion against IUD use (26%). The gross cumulative 12-month life table discontinuation rate for all personal reasons was 4.0 per 100 women. Having no education and/or living in a rural area were the sociodemographic characteristics associated with an increased risk of discontinuation for personal reasons. Effective and regular counseling about IUD use, especially among illiterate women, may help prevent IUD discontinuations related to personal reasons.
PIP: The objectives were to examine the rates and timing of IUD discontinuation for personal reasons, and to analyze the users' discontinuation characteristics. Data were used from randomized clinical trials with a total of 2748 TCu 380A users, healthy and sexually active women, between 18 and 40 years of age; and comparing the performance of the TCu 380A3 with that of various other IUDs conducted by Family Health International, from 1985 to 1989, in family planning clinics located in Cameroon, Chile, Egypt, El Salvador, Malaysia, Mexico (2 centers), Nigeria, Pakistan, Peru, Philippines (3 centers), Sri Lanka (2 centers), Thailand, Turkey, and Venezuela. The last pregnancy ended at least 40 days before IUD insertion. Participants were asked to return for follow-up visits at 1, 3, 6, and 12 months after insertion. Subjects discontinuing IUD use for personal reasons were more likely to be married or in a consensual union and to have fewer years of education; to reside in rural areas; to have had fewer children and to want additional children; and less likely to have been previous IUD users than were women who discontinued IUD use for medical reasons or who were lost to follow-up or continued IUD use after the 12-month follow-up visit. At 12 months of use, the discontinuation rate for personal reasons was 4.0/100 women, compared to 5.8/100 women for medical reasons, and 3.7/100 women for pregnancy and expulsion. 31.8% of the 88 cases discontinuing for personal reasons had a planned pregnancy; and the husband's objection or family influence against IUD use contributed to 26.1% of the IUD removals for personal reasons. 18.2% no longer needed contraception and 13.6% wished to switch methods. Dissatisfaction with the method, moving to another country, and unspecified reasons together were responsible for 10.3% of the discontinuations for personal reasons. Other variables which were not statistically significant constituted: age, parity, additional children wanted, previous contraceptive method used, and months after last pregnancy.
Assuntos
Comportamento do Consumidor , Dispositivos Intrauterinos de Cobre , Atitude , Comportamento do Consumidor/estatística & dados numéricos , Escolaridade , Família , Feminino , Humanos , População RuralRESUMO
Two-hundred-ninety-seven women at a Panamanian center and 148 women at a Philippine center had their tubal sterilization performed during their postpartum hospital stay after an uncomplicated vaginal delivery of a live birth. The sterilizations were all performed with the use of the Filshie clip via minilaparotomy. The timing of the sterilization varied from two hours to six days after delivery. At each of the two centers, women sterilized within 48 hours after delivery were compared with those sterilized at 49 or more hours with respect to surgical difficulties, tubal injuries, complications/complaints, technical failures and lengths of hospitalization after sterilization and before discharge. The one-year gross cumulative pregnancy rates were also compared. No significant differences were detected in any of the above outcome variables between the two timing groups at each center. While the data suggest that tubal sterilizations by the Filshie clip performed two to six days following childbirth are as safe and effective as those performed within 48 hours of delivery, further studies are urged.
PIP: 297 women at a Panamanian center and 148 women at a Philippine center had their tubal sterilizations performed during their postpartum hospital stays after uncomplicated vaginal deliveries of livebirths. The sterilizations were all performed with the use of the Filshie clip via minilaparotomy. The timing of the sterilizations varied from 2 hours-6 days after delivery. At each of the 2 centers, women sterilized within 48 hours after delivery were compared with those sterilized at 49 or more hours with respect to surgical difficulties, tubal injuries, complications/complaints, technical failures, and lengths of hospitalization after sterilizations and prior to discharge. The 1 year grossed cumulative pregnancy rates were also compared. No significant differences were detected in any of the above outcome variables between the 2 timing groups at each center. While the data suggest that tubal sterilizations by Filshie clip performed between 2-6 days postpartum are as safe and effective as those performed within 48 hours of delivery, further studies are necessary.