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PIP: Oral contraceptives have many advantages, but sometimes also have side effects which can cause users to switch appropriately or inappropriately to less effective methods or abandon contraception. In Brazil, 2/3 of married women of childbearing age were using contraception in 1981, and 1/2 of these were using orals. Contraceptive behavior following reported side effects in users of oral contraceptives in Southern Brazil is examined in this study, in relation to diverse factors. Among 2904 currently-married women, aged 15-44, almost 75% reported that they had used the pill at some time, and of these, 45.6% were still doing so. Data on perceived side effects were gathered for all women. There was no independent medical evaluation of the effects, so the data did not necessarily represent actual prevalence of pill related problems. Women who reported problems with the pill were less likely to be current users (25%) than women who did not (65%). However, overall contraceptive prevalence was about the same in both groups (66.2% and 67.0% respectively), indicating that women who stop using oral contraceptives usually switch to another method. However, they are more likely to be using traditional methods than women in the general population, especially if they want more children. Termination of pill use varies little according to the type of problem reported. Women with problems who sought medical attention were more likely to stop using the pill, and 82.4% of women advised to stop by their physician did so, but the major factor affecting discontinuation was the reported experience of a problem. The most frequently reported problems were headaches (38.1%), nausea (34.1%), nervousness (27.9%), and vertigo (18.3%). Physician intervention should help to avoid women's abandoning oral contraceptives unnecessarily.^ieng

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This study presents information on cesarean section rates for the last baby born to 1,746 women in Northeast Brazil between January 1978 and the date of a 1980 household survey. For hospital deliveries, the c-section rate is 19 per cent. Rates were highest in the major urban areas and lowest in rural areas. Within residence categories, the section rate was related directly to education, early prenatal care, and delivery in private hospitals.

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In 1980, a study to determine interest in and access to sterilization for females was initiated at two Ministry of Health hospitals in Honduras. Results of the baseline study showed that 42 percent of women desiring sterilization from the Tegucigalpa hospital and 21 percent from the San Pedro Sula hospital had had a tubal ligation. A second study was conducted two years later, following up the interested but unsterilized women from the baseline study. Results show that 33 percent of women in the Tegucigalpa group, compared to 15 percent in the San Pedro Sula group, had been sterilized. Part of this difference can be attributed to an increase in sterilization facilities in Tegucigalpa over the two years after the baseline study was conducted. Among the major reasons women gave for not having been sterilized were financial and time constraints. Over the two-year period, the authors estimate that, of women interested in sterilization at delivery, 52 percent in total were sterilized in Tegucigalpa and 29 percent in San Pedro Sula.

PIP: In 1980, a study to determine interest in and access to sterilization for females was initiated at 2 Ministry of Health hospitals in Honduras. Results of the baseline study showed that 42% of women desiring sterilization from the Tegucigalpa hospital and 21% from San Pedro Sula hospital had had a tubal ligation. A 2nd study was conducted 2 years later, following up the interested but unsterilized women from the baseline study. Results show that 33% of women in the Tegucigalpa group, compared to 15% in the San Pedro Sula group, had been sterilized. Part of this difference can be attributed to an increase in sterilization facilities in Tegucigalpa over the 2 years after the baseline study was conducted. Among the reasons women gave for not having been sterilized were financial and time constraints. Over the 2-year period, the authors estimate that, of women interested in sterilization at delivery, 52% in total were sterilized in Tegucigalpa and 29% in San Pedro Sula. Results show that in Honduras as elsewhere in Latin America, obstacles to sterilization exist in the form of cost, travel time and family-related constraints. Institutional requirements and availability of facilities also creat barriers for clients. Fear of surgery was not a very important reason for not getting sterilized among women in the baseline study, only those who said they still wanted to be sterilized were interviewed for the 1982 study. The fees for sterilization are US$17.15 at Materno Infantil (or blood can be given instead) and US$10.0 at Leonardo Martinez and Centro Medico Quirurgico, but financial help is available for women who cannot pay. A new study will be carried out in Tegucigalpa to determine the impact of the various changes aimed at improving access to sterilization there. Programs to be studied include the availability of new facilities to provide postpartum sterilization at Materno Infantil and the provision of travel money and additional facilities that make it easier for a women to complete sterilization requirements at Centro Medico Quirurgico.

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RESUMO

The purpose of this study was to evaluate and compare the availability of sterilization services at two hospitals in Honduras. Approximately 7,000 women who had given birth at the Hospital Materno Infantil in Tegucigalpa and the Hospital Leonardo Martinez in San Pedro Sula were asked about their desire for sterilization. Of the women who wanted to be sterilized, a considerable percentage had not been sterilized four months after they had given birth--58 percent of those who had delivered at Materno Infantil and 79 percent of those who had delivered at Leonardo Martinez. Twenty-three percent of the women who delivered at Materno Infantil and 4 percent of the women who delivered at Leonardo Martinez were sterilized before they were discharged. The difference may be attributed to the poor quality of the facilities at Leonardo Martinez.

PIP: The percentages of women sterilized postpartum or within 4 months of delivery hwere much higher for women delivering at Materno Infantil than at Leonardo Martinez, both being hospitals in Honduras. Of the 829 women from the former who said they were interested in a tubal ligation, 42% were sterilized either before being discharged from the hospital or within 4 months of delivery. In contrast, only 21% of the women from the latter hospital had sterilizations. The differences between the 2 hospitals in the percentage of women sterilized may be attributed to availability of facilities. The poor quality of the facilities at Leonardo Martinez (LM) results in women having access to health care, including postpartum sterilization. And while Materno Infantile (MI) has done better in making postpartum sterilization available, it was difficult for a woman to obtain a postpartum sterilization on other than medical grounds in both hospitals. A higher percentage of women who delivered at MI than at LM obtained interval sterilizations within 4 months of delivery. Even though the women from LM had to travel farther to be sterilized than the women from MI, neither this nor any differences in the characteristics of the women accounted for this percentage difference. Since it is unknown if any women tried to get sterilized and failed, it is not possible to determine if the difficulty of scheduling sterilizations or in meeting the requirements at each hospital could have accounted for the difference. Neither is it known what percentage not sterilized within 4 months of delivery were sterilized later, though this information will be forthcoming as the result of a follow-up. In both study populations, a large percentage of those not sterilized were still interested in having a tubal ligation. On 1 August 1982, new operating rooms were put into use at MI and data indicate that 362 procedures were performed from that time to the end of the year.

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From December 1979 to February 1980, data were collected on access to postpartum sterilization for all obstetric patients at a large maternity hospital in Campinas, Brazil. Of the 827 women wanting no additional children and having knowledge of sterilization, 481 (58%) reported that they wanted to be sterilized. Of these women, 226 (47%) were sterilized postpartum. One year following their deliveries, follow-up forms were administered to the women desiring sterilization, but who had not been sterilized postpartum, to determine if they had been sterilized over the course of the year. Only 13% of the women had been sterilized, but almost 75% of the women not sterilized said they were still interested in getting sterilized. Of the women interviewed, 18% either had become pregnant again since the initial survey or were currently pregnant.

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