RESUMO
Despite available strategies to prevent sex risk behaviours in Puerto Rico, heterosexual transmission of HIV continues to increase. Since 1990, heterosexual contact has been the fastest growing infection risk category among the island's general population, and the primary transmission route for women and children. To understand change in sex risk behaviours and factors related to change, 911 drug injectors and 359 crack smokers were recruited from the San Juan metropolitan area following a stratified cluster design. This study comprised a total of 1,004 (79.1%) drug users who were assessed at follow-up. Abstinence from sex behaviour increased from 54.6% to 61.1% (p < 0.01), use of condoms during vaginal sex also increased from 26.4% to 36.9% (p < 0.01). In multivariate analysis, significant predictors of abstinence were gender, injection drug use, HIV seropositivity and not having a steady partner. Predictors of using condoms during vaginal sex were HIV seropositivity, STD diagnosis and participation in an HIV preventive programme. These findings indicate that additional HIV preventive efforts are needed to reduce sex risk behaviours among drug users who have a steady sex partner, as well as among drug users who are HIV-negative.
PIP: Factors associated with changes in HIV risk behaviors were investigated in a prospective study of 911 injecting drug users and 359 crack smokers recruited on the basis of a stratified cluster design in metropolitan San Juan, Puerto Rico, in 1992-93. The findings presented in this paper are based on the 1004 drug users (79.1%) who were available for a follow-up interview 6 months after the baseline interview. Respondents were randomly assigned to receive a standard HIV prevention intervention (pretest counseling, optional HIV testing, and provision of HIV results) or the standard intervention plus a site-specific enhanced intervention entailing access to condoms and needle hygiene equipment, development of a personal risk reduction plan and training in the skills required to implement it, and ongoing contact with outreach workers. Overall, abstinence from sexual behavior increased from 54.6% at baseline to 61.1% at follow-up (p 0.01) while condom use during vaginal sex rose from 26.4% to 36.9% (p 0.01). In multivariate analysis, significant predictors of abstinence were male gender, injecting drug use, a positive HIV test at baseline, and not having a steady partner. Significant predictors of condom use were HIV seropositivity and a sexually transmitted disease diagnosis. Participation in the enhanced compared to the standard HIV prevention program was associated with an odds ratio of 1.29 (95% confidence interval, 0.95-1.74) for abstinence and 1.97 (95% confidence interval, 1.18-3.29) for condom use in vaginal sex.
Assuntos
Cocaína Crack , Infecções por HIV/prevenção & controle , Comportamento Sexual , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto , Terapia Comportamental/métodos , Preservativos/estatística & dados numéricos , Aconselhamento , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Promoção da Saúde , Humanos , Masculino , Porto Rico/epidemiologia , Assunção de Riscos , Parceiros Sexuais , Abuso de Substâncias por Via Intravenosa/epidemiologia , Abuso de Substâncias por Via Intravenosa/psicologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologiaRESUMO
Some attributes of LAM are unquestionably positive, such as the fact that it is effective. Clinical trials of LAM have upheld the Bellagio Consensus that the chance of pregnancy is less than 2% in the first 6 months postpartum in amenorrheic women who are fully or nearly fully breastfeeding. Secondary data analyses in numerous settings have drawn the same conclusion. Whether as a strategy or a method, used correctly or even if used imperfectly, LAM is a reliable way to avoid pregnancy. To the extent that LAM represents an additional contraceptive option, this is also clearly positive since a broad array of contraceptive options maximizes the likelihood of finding a good fit between user and method, and increases contraceptive use. Other characteristics of LAM represent potentially positive impacts. If LAM is shown to be an effective conduit to other modern methods, the implications are profoundly positive. If LAM is cost effective, for households and/or for programs, this will also make the method extraordinarily attractive. Conversely, some aspects of LAM are negative, such as the fact that it affords no protection against STDs, it requires counseling from a well-informed provider, and intensive breastfeeding can make heavy demands on the woman's time. Many of the remaining attributes of LAM may not be important to a policy decision about LAM promotion. For example, whether LAM is actualized as a strategy or a method may not be important to a decision to promote LAM, although it has a huge impact on how services are delivered. Some factors may be profound on a local or individual level. For example, one simple factor, such as the absence of full/nearly full breastfeeding, can rule out the method as an option, while another, such as the fact that it provides the needed waiting period during vasectomy counseling, can make LAM the method of choice. Although LAM seems unlikely to have widespread popularity in societies like the United States, within such settings are breastfeeding women for whom other contraceptive choices are not satisfactory and to whom LAM is attractive. Although clinicians cannot be expected to directly provide LAM education in every setting, women should be informed about LAM as an effective contraceptive choice, and clinicians should be prepared to make referrals to competent sources. The future of LAM, especially in terms of formal, programmatic initiatives, may continue to be focussed in transitional and less developed settings. Comparative cost/benefit analyses for both the family planning program and the household will contribute meaningfully to decisions about whether to use LAM and whether to include LAM in national and local family planning policies and programs. The most important call to action is to implement operations research designed to determine what factors, if any, will maximize the uptake of a second modern contraceptive method after LAM protection expires among never-users of family planning, to compare this with other contraceptive strategies, and to evaluate the cost aspects. If the potential of LAM to be a conduit to other modern contraceptive methods is effectively realized, the method can be profoundly important in the development of communities and in family formation. Because LAM is effective in preventing pregnancies, and because it extends the range of contraceptive choices, considering LAM on the policy level is always appropriate. Despite the array of drawbacks to LAM, as with any other family planning method, the potential assets of LAM, especially the promise to introduce nonusers to contraception, are sufficiently important to warrant the introduction of LAM within an operations research framework to both capitalize on its intrinsic strengths and determine its programmatic robustness. In the 10 years since the concept of LAM was pronounced as the Bellagio Consensus, claims have been made both for and against its use. During this time, program and policy leaders have been giv
PIP: This paper explores the advantages and disadvantages of the lactational amenorrhea method (LAM) and their implications for policy and use. Clinical trials of LAM have upheld the Bellagio Consensus that the chance of pregnancy is less than 2% in the first 6 months postpartum in amenorrheic women who are fully or nearly fully breast-feeding. Secondary data analyses in numerous settings have resulted in the same conclusion. LAM, if used correctly or even if used imperfectly, should be a reliable strategy or a method to avoid pregnancy. To the extent that LAM represents an additional contraceptive option, this is also positive because a broad array of contraceptive options maximizes the likelihood of finding a good fit between user and method and increases contraceptive use. Other characteristics of LAM represent potentially positive impacts. If LAM is shown to be an effective conduit to other modern methods, the implications are profoundly positive. If LAM is cost-effective for households and/or programs, this will also make the method extraordinarily attractive. Conversely, some aspects of LAM are negative, such as the fact that it offers no protection against sexually transmitted diseases, it requires counseling from a well-informed provider, and intensive breast-feeding can make heavy demands on the woman's time. Because LAM is effective in preventing pregnancies, and because it extends the range of contraceptive choices, considering LAM at the policy level is always appropriate.
Assuntos
Amenorreia/etiologia , Intervalo entre Nascimentos , Serviços de Planejamento Familiar/métodos , Política de Saúde , Lactação , Serviços de Planejamento Familiar/economia , Feminino , Humanos , Lactente , Guias de Prática Clínica como Assunto , Gravidez , Saúde da MulherRESUMO
This article examines gender differentials in the reporting of contraceptive use and offers explanations regarding the sources of these differences. Data from five countries where DHS surveys were conducted recently among men and women are used in exploring these differences. The gap exists in all five countries, with men (or husbands) reporting greater practice of contraception than women (or wives). Results from the bivariate analysis suggest that the gap is attributable to polygyny and to gender differences in how the purpose of contraception is understood, rather than to male extramarital sexual relations. Additionally, gender differences in the definition of certain contraceptive methods and differences in the interpretation of questions about contraception contribute to the observed gap. These findings are also consistent with results of the multivariate analysis.
PIP: An analysis of Demographic and Health Survey data from Central African Republic, Ghana, Haiti, Kenya, and Zimbabwe revealed large gender differentials in the reporting of contraceptive use. In all five countries, men/husbands reported greater practice of contraception than women/wives. This gap ranged from 5 percentage points in Ghana to 25 percentage points in Kenya. The reporting of contraceptive use by only one partner of a couple may result from multiple sexual relationships, secret contraceptive use, or differential perceptions of what constitutes contraception. In these five countries, most of the gender gap was associated with condoms, abstinence, and (in Zimbabwe) the pill. An analysis of these differentials suggests more overreporting of current use among husbands than underreporting among wives. To the extent that polygynous men are more likely than their wives to report use of methods of which the wife would have equal or more knowledge than the husband (e.g., the pill), a polygyny effect is indicated in Zimbabwe. The results for Ghana and Kenya (the only surveys where information on knowledge of the ovulatory cycle is available for husbands) suggest the gap in reporting of periodic abstinence results mainly from husband's inaccurate knowledge of the reproductive cycle and this method. Finally, if all the gaps in condom use between marital partners are attributed to the assumption of the differential role of condom use (pregnancy and sexually transmitted disease prevention), this factor would explain 12% (Haiti) to 38% (Ghana and Zimbabwe) of the net gap in contraceptive prevalence rate estimates. More detailed questioning on the use of condoms and periodic abstinence would improve the reliability of these surveys.
Assuntos
Anticoncepção/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Cônjuges , África , Preservativos/estatística & dados numéricos , Anticoncepção/métodos , Anticoncepção/psicologia , Demografia , Escolaridade , Relações Extramatrimoniais , Serviços de Planejamento Familiar , Feminino , Haiti , Inquéritos Epidemiológicos , Humanos , Masculino , Casamento/etnologia , Modelos Estatísticos , Prevalência , Análise de Regressão , Estudos de Amostragem , Fatores Sexuais , Abstinência Sexual , Infecções Sexualmente Transmissíveis/prevenção & controle , Controles Informais da Sociedade , Cônjuges/psicologia , Cônjuges/estatística & dados numéricosRESUMO
Lactational amenorrhea (LA) is associated with postpartum infertility and is known to be related to breast-feeding frequency and duration, but the exact role of complementary feeding of the infant has not been clearly defined. Data on LA were collected during and after a 2-mo intervention trial in which low-income Honduran women who had breast-fed fully for 4 mo were randomly assigned to one of three groups: continued full breast-feeding until 6 mo (FBF, n = 50), introduction of complementary foods at 4 mo with ad libitum breast-feeding from 4 to 6 mo (SF, n = 47), or introduction of complementary foods at 4 mo with maintenance of baseline breast-feeding frequency from 4 to 6 mo (SF-M, n = 44). Women were followed up until the infant was 12 mo of age, or later if menses had not occurred by then. All but six of the women continued to breast-feed for > or = 12 mo. With the exclusion of those whose menses returned before 18 wk postpartum (which could not have been due to the intervention), the proportion of women who were amenorrheic at 6 mo was 64.5% in the SF group, 80.0% in the FBF group, and 85.7% in the SF-M group (chi-square test = 4.13, P = 0.02; one-tailed test with the latter two groups combined). The total duration of LA did not differ significantly among groups. The most significant determinant of LA was time spent breast-feeding (min/d), which was in turn negatively associated (P = 0.06) with the infant's energy intake from complementary foods in regression analyses. These results indicate that there is a significant effect of introducing foods at 4 mo on the likelihood of amenorrhea at 6 mo postpartum, but not thereafter, and that this effect is not seen in mothers who maintain breast-feeding frequency.
Assuntos
Fatores Etários , Amenorreia , Alimentos Infantis , Lactação , Período Pós-Parto , Desmame , Adolescente , Adulto , Aleitamento Materno , Ingestão de Energia , Feminino , Honduras , Humanos , Lactente , Masculino , Análise de Regressão , Fatores de TempoRESUMO
The purpose of this study was to compare the CUE method for family planning with the Ovulation Detection Method for defining the fertile phase of the menstrual cycle. We evaluated 42 cycles from 10 women in Monterrey, Mexico, who were monitored by basal body temperatures, urinary LH, pelvic ultrasound, and the CUE monitor. The fertile phase of the cycle was adequately defined in all cycles using the CUE method, and in 35 cycles (83.3%) by the Ovulation Method. Using our protocol, the period of recommended abstinence with the CUE method is 9 days and with the Ovulation Method 11 days. The CUE method accurately defines the fertile phase of the menstrual cycle, thus improving the predictability of ovulation for women who use natural methods of birth control.
PIP: To evaluate the potential utility of the CUE method in natural family planning (NFP), this method was compared with a standard NFP technique, the Ovulation Method, in 39 cycles of 10 women from Monterrey, Mexico. All women had more than 2 years' experience with the Ovulation Method. In the CUE method, ovulation prediction is based on a peak in salivary electrical resistance and its confirmation by a rise in vaginal resistance as monitored by a hand-held electronic instrument attached to a specially designed sensor. The CUE method defined the fertile period of all 39 cycles adequately, while the Ovulation Method resulted in incorrect definition of the fertile phase in 4 (10%) of 39 cycles. The salivary peak predicted ovulation an average of 8 days in advance of its occurrence and the increase in vaginal readings in the periovulatory period was seen within 1 day of follicle collapse in all subjects. The duration of abstinence required by the CUE method would have averaged 9.0 +or- 1.5 days (range, 6-13 days). In contrast, the average duration of abstinence associated with the Ovulation Method was 11.0 +or- 2.9 days (range, 6-16 days). 82% of cycles monitored by the CUE method compared with only 53% of those monitored by the Ovulation Method would have required a period of abstinence of 10 days or less. The simplicity and objectivity of the CUE method, combined with its requirement for fewer days of abstinence, offer the potential for improving NFP compliance and continuation.
Assuntos
Métodos Naturais de Planejamento Familiar , Detecção da Ovulação/métodos , Adulto , Temperatura Corporal , Feminino , Humanos , Hormônio Luteinizante/urina , México , Ultrassonografia , Vagina/diagnóstico por imagem , Vagina/fisiologiaRESUMO
PIP: Exclusive and extended breast feeding is responsible for much of the fertility limitation and child spacing throughout the world. In many developing countries, where breast feeding is almost universal and of long duration, postpartum amenorrhea protects women from closely spaced subsequent pregnancies. However, at the same time, increased pressures toward modernization, rapid rural-to-urban migration, frequent advertisements of powdered milk substitutes, and the increased employment of women outside of the home are adversely affecting traditional breast feeding practices. In Bolivia, almost all women breast feed their newborn infants, for periods up to 2 years. This paper reports findings which describe and compare patterns of women's differential knowledge of breast feeding and lactational amenorrhea resulting from data collection using a survey instrument and a focus group guide. The findings are part of a larger study on infant feeding and child spacing conducted in periurban communities in Bolivia. Current and historical trends with regard to paradigm and methodology in social science research are reviewed and the survey/focus group research method is described.^ieng
Assuntos
Amenorreia , Aleitamento Materno , Serviços de Planejamento Familiar , Grupos Focais , Conhecimento , Lactação , Métodos , Inquéritos Nutricionais , População Urbana , América , Bolívia , Coleta de Dados , Demografia , Países em Desenvolvimento , Saúde , Fenômenos Fisiológicos da Nutrição do Lactente , América Latina , Fenômenos Fisiológicos da Nutrição , População , Características da População , Período Pós-Parto , Reprodução , Pesquisa , América do SulRESUMO
PIP: A Bolivian woman with three daughters became pregnant while practicing the rhythm method. Method failure occurred seven years after she bore her most recent child and prompted her, with her husband's consent, to obtain an unsafe abortion. The decision to abort the fetus was based upon her husband's lack of employment, the meager monthly income of US$45 which she earns, and the inability of her to continue working once pregnant. The abortion process consisted of a three-hour scraping/general cleaning which left the woman dizzy. She returned to the physician several days later, bloated and in pain, when the possibility of a perforated uterus was voiced and surgery conducted. The woman regrets having the abortion, for the couple wanted to bear a fourth child once they could afford it.^ieng
Assuntos
Aborto Induzido , Anticoncepção , Características da Família , Renda , Métodos Naturais de Planejamento Familiar , América , Bolívia , Comportamento Contraceptivo , Países em Desenvolvimento , Economia , Serviços de Planejamento Familiar , América Latina , Fatores Socioeconômicos , América do SulRESUMO
This paper reports the results of a 12-month implementation study documenting the process of integrating the Lactational Amenorrhea Method (LAM) into a multiple-method family planning service-delivery organization, the Céntro Médico de Orientación y Planificación Familiar (CEMOPLAF), in Ecuador. LAM was introduced as a family planning option in four CEMOPLAF clinics. LAM was accepted by 133 breastfeeding women during the program's first five months, representing about one-third of postpartum clients. Seventy-three percent of LAM acceptors were new to any family planning method. Follow-up interviews with a systematic sample of 67 LAM users revealed that the method was generally used correctly. Three pregnancies were reported, none by women who were following LAM as recommended. Service providers' knowledge of LAM resulted in earlier IUD insertions among breastfeeding women. Relationships with other maternal and child health organizations and programs were also established.
PIP: The aim of this inquiry was to describe the planning and process of integration of the Lactational Amenorrhea Method (LAM), as a viable contraceptive option, into an existing family planning service network. LAM was introduced as a demonstration project in 1991 in 4 out of 20 available clinics nationwide operated by the private, nonprofit Centro Medico de Orientacio y Planificacion. Study sites included Quito in an urban mountainous area, Latacunga in a mixed urban/rural mountainous area, Cajabamba in an isolated area with indigenous populations, and Santo Domingo in a mixed urban/rural coastal area. A needs assessment of clients, staff, and organizational information system factors was conducted 4 months prior to introducing LAM into the pilot clinics. Organizational materials were prepared for clients, and a staff training program was implemented. Baseline information was obtained from 58 clients and 24 staff on the prevailing knowledge, attitudes, and practices of breast feeding and contraception. The educational materials included a wall chart on breast feeding promotion, a wall poster on contraception including LAM, a 12 page booklet for LAM clients, and a desk-size flip chart for one-to-one instruction. Record keeping was improved. LAM was introduced to all mothers with infants 6 months old, who were fully or nearly fully breast feeding and were amenorrheic, and identified by intake staff. Follow-up was after 3 months, unless there was a change in desires or a change in the LAM requirements. After 6 months of implementation, a qualitative evaluation was made. 50% of acceptors were interviewed (67, of which 23 were still using LAM). The results showed that 73% used LAM as their first ever contraceptive method. Compliance with follow-up and LAM instructions varied with each clinic. 87% of users and 67% of Quechua users expressed satisfaction with LAM. A number of observations were made about clinic operations. A refined training model was developed, and there was consensus that the 12-page booklet was the most useful. A well child program was integrated into the LAM program. A surprise finding was the low use among rural traditional ethnic groups. LAM is being included in outreach efforts and the expertise passed along to other health programs. The Pearl pregnancy index was 6.8%, which was comparable to other temporary methods in Andean countries.
Assuntos
Amenorreia/etiologia , Serviços de Planejamento Familiar/organização & administração , Lactação , Período Pós-Parto , Desenvolvimento de Programas , Adulto , Intervalo entre Nascimentos , Protocolos Clínicos , Árvores de Decisões , Equador , Feminino , Seguimentos , Humanos , Avaliação de Programas e Projetos de SaúdeRESUMO
PIP: The choice of the most appropriate contraceptive method, when its use is begun, and the motivation of adolescents to use it, are significant factors in adolescent contraceptive continuation. The contraceptive method must suit the personality of the adolescents, who are insecure in most cases, less stable emotionally, rebellious, and uninformed. This pattern can induce constant changes of partners, and accidental and unpredictable sexual activity. Since adolescence is a period of biological and psychological transformation, the contraceptive must be highly effective, safe, and well-tolerated, so that its side effects should not prejudice the continuation of its use. The behavioral contraceptive methods, coitus interruptus, ovulation, and sympto-thermal methods, are contraindicated for adolescents because of their low effectiveness and the requirement of a great deal of discipline. The condom, diaphragm, and spermicides can prevent sexually transmitted diseases, thus they are optimal for adolescents. Their effectiveness is higher than that of behavioral methods but could be better, and they require a certain discipline, which limits sexual spontaneity. The IUD is contraindicated in adolescents and in women who have never given birth, because of the possibilities of pelvic inflammation resulting in pain and bleeding and expulsion of the IUD. The use of hormonal contraception is recommended only two years after the first menstruation, for fear of interference in the biological development of the adolescent. Recent studies have shown that modern low-dose oral contraceptives (OCs) do not exert harmful effects on the adolescent organism. While paying heed to contraindications, OCs can be indicated for this age group. Hormonal contraceptives are effective, safe, and well-tolerated by the majority of patients. They regulate menstruation, and provide beneficial effects such as the reduction of dysmenorrhea and the protection against pelvic inflammatory diseases, benign diseases of the breast, and even uterine and ovarian cancer.^ieng
Assuntos
Adolescente , Anticoncepção , Anticoncepcionais Orais , Serviços de Planejamento Familiar , Dispositivos Intrauterinos , Aceitação pelo Paciente de Cuidados de Saúde , Fatores Etários , América , Brasil , Comportamento Contraceptivo , Demografia , Países em Desenvolvimento , América Latina , População , Características da População , América do SulRESUMO
Energy, protein, lactose and fat were studied in the milk of mothers who were using different types of contraceptives. One hundred and eleven mothers made up the following groups. C: control (barrier and natural methods, or sterilization), n = 22; combined pill: LDP (low dose pill (levonorgestrel 0.15 mg + ethinylestradiol 0.03 mg)), n = 12 and MDP (medium dose pill (levonorgestrel 0.25 mg + ethinylestradiol 0.05 mg)), n = 13; MP (minipill (norethindrone 0.35 mg)), n = 37; DMPA (injectable progesterone (depot medroxiprogesterone acetate 150 mg)), n = 17; and IUD (plastic or copper intrauterine device), n = 10. The mean stages of lactation were, respectively, 15, 17, 5, 9, 5 and 9 weeks. The mean duration of observation for the study groups ranged from 2 to 4 weeks. Milk samples were collected before and after initiation of treatment (mean = 20 days; range = 14-103 days). The stage of lactation and the interval of nursing before sampling were recorded so that statistical account could be taken of these uncontrollable sources of variability. When incorporated as covariates, they showed that no significant differences existed between the groups tested, either before or after treatment.
PIP: Researchers compared data on 22 women using either a barrier method or a natural family planning method or had undergone female sterilization (controls) with data on 89 women using either a low dose combined oral contraceptive (OC), a medium dose combined OC, a low dose progestin only OC, the injectable Depo-Provera, or an IUD to examine the hormonal contraceptives' effects on the concentration of total protein, lipids, lactose, and energy in human milk. They recruited the women from private and public family planning clinics in Brasilia, Brazil between 1984 and 1987. The mean stages of lactation were 15 weeks for controls, 17 weeks for women using the combined low dose OC, 5 weeks for those using the combined medium dose OC, 5 weeks for those using the combined medium dose OC, 9 weeks for those using the low dose progestin only OC, 5 weeks for those using Depo-Provera, and 9 weeks for those using the IUD. Almost all the concentrations of total protein, lipids, lactose, and energy both before and after contraceptive therapy fell within the range for healthy women. The mean value of total protein in women using Depo-Provera was the only value higher than that range. The low dose OC was associated with a considerable increase in fat (3 g/dL vs. 4.8 g/dL; p=.035). Women taking the medium dose OC experienced a significant decrease in lactose (6.8 g/dL vs. 7.25 g.dL; p=.004). The time between last nursing and milk sample collection (nursing interval) caused considerable variation in fat (p=.03) and total energy (p=.02) in those samples collected before contraceptive therapy. When the researchers adjusted the data for stage of lactation and nursing interval from all 6 groups, the contraceptives had no significant effect on total protein, lipids, lactose, and energy.
Assuntos
Anticoncepcionais Femininos/farmacologia , Estrogênios/farmacologia , Leite Humano/efeitos dos fármacos , Progesterona/farmacologia , Adulto , Metabolismo Energético/efeitos dos fármacos , Feminino , Humanos , Dispositivos Intrauterinos , Lactação , Lactose/análise , Lipídeos/análise , Proteínas do Leite/análise , Proteínas do Leite/efeitos dos fármacos , Leite Humano/química , Fatores de TempoRESUMO
The effect of lactation on menstrual cycles, ovulation and conception was studied in a group of non-contracepting Amerindian Mopan Mayan women. Anthropological observations of relevant events were made over a 21-month period. Blood samples were assayed to determine the plasma concentrations of prolactin, luteinising hormone, follicle stimulating hormone, human chorionic gonadotrophin, placental lactogen, oestrogen, progesterone and cortisol. The data show that: frequent and prolonged breast-feeding was associated with a marked increase in plasma prolactin concentrations to levels similar to those in lactating Gaing but higher than those in lactating Scottish women; ovulatory menstrual cycles and pregnancy occurred during frequent lactation; in lactating menstruating women there was an inverse correlation between fat weight and months post-partum. These data suggest that other factors as well as suckling account for the effects of lactation on fecundity.
PIP: Lactation, ovulation and conception were observed as part of an anthropological study of Amerindian Mopan Mayan women from the village of San Jose Hawaii in western Belize from March 1985-January 1987. Single blood samples from each subject were immunoassayed for prolactin, LH, FSH, hCG, placental lactogen, estrogen, progesterone and cortisol. Anthropomorphic data analyzed were body mass index (BMI), fat/weight percentage, total body water and lean body weight. 117 women had at least 1 child during the study; 91 were lactating; 51 reported no menstrual cycles. 50 submitted to blood testing. Almost all infants were breast fed for 18 months or longer, up to 3 years, typically at least 6 times per day and 3 times per night. Women averaged 9 live births and 8 surviving children, with a mean birth interval of 28 months. 25 of the 29 women known to be pregnant conceived while lactating. 16 lactating women were pregnant. Their culture requires them to have 3 menses before conception to nourish the fetus, yet forbids speaking about menstrual blood: women fabricated menstrual dates, but in confidence 51 of 81 stated that they did not menstruate before the last conception. Most often menses began 12 months postpartum. Lactating women had heightened prolactin levels even if supplementing their children's diet. Thus frequent lactation delayed onset of menses, but supplementation had no effect. Most of the women were within the normal range of BMI, but 13% were below normal. In lactating menstruating women there was a significant negative correlation between fat weight and postpartum month. The data suggest that the interval to conception or menstruation was inversely correlated with fat weight. Here suckling frequency rather than prolactin levels seems to postpone fertility. In this society, with 10-12 births and 9-10 children in the completed family, the largest in the world, prolonged frequent lactation has little effect on fertility. Instead, birth trauma, maternal mortality, fetal and infant mortality, and perhaps nutrition, have more effect on completed family size.
Assuntos
Fertilidade , Gonadotropinas/sangue , Lactação/sangue , Estado Nutricional , Prolactina/sangue , Belize , Intervalo entre Nascimentos , Composição Corporal , Índice de Massa Corporal , Peso Corporal , Estudos de Avaliação como Assunto , Humanos , Indígenas Sul-Americanos , Mortalidade Infantil , Recém-NascidoRESUMO
Data from two prospective studies of the ovulation method were used to assess pregnancy rates and users' fertility-related behaviors among breastfeeding women. The rate of unplanned pregnancy was less than 1% during the first 6 months of lactational amenorrhea. However, the unplanned pregnancy rate was elevated among breastfeeders during the months after menses return compared with the pregnancy rate during nonlactating cycles. Rates were also elevated at the time when infant feeding supplementation was started. This increase in unplanned pregnancies was not directly attributable to nonadherence to the ovulation method rules; there was some indication that adherence to the rules actually may be increased during those months. Therefore, special emphasis on both the need for improved breastfeeding support to delay menses return and the increased potential for method failure among new users during this period of time should be incorporated into ovulation method training and support programs.
PIP: Data from two prospective studies of the ovulation method in Nyahururu, Kenya, and Santiago, Chile, were analyzed to assess the occurrence of pregnancy and related behaviors among breastfeeding women. The rate of unplanned pregnancy was less than 1% during the first six months of lactational amenorrhea, but was elevated among breastfeeding women during the months after menses return compared with the pregnancy rate during nonlactating cycles. Rates were also elevated at the time when infant feeding supplementation was started. The authors note that the increase in unplanned pregnancies cannot be directly attributed to nonadherence to the ovulation method rules. In fact, there was some indication that adherence to the rules may even be increased during those months. The authors also encourage special emphasis in ovulation method training and support programs upon both the need for improved breastfeeding support to delay menses return and the increased potential for method failure among new users.
Assuntos
Aleitamento Materno , Serviços de Planejamento Familiar/métodos , Ovulação/fisiologia , Chile , Feminino , Humanos , Quênia , Gravidez , Estudos Prospectivos , Fatores de RiscoRESUMO
PIP: This work seeks to assess rural-urban and regional fertility trends and differentials in Bolivia since 1965, and to examine the relationship between the level of fertility and the proximate fertility determinants in the different regions using the Bongaarts method. Important social and cultural differences in Bolivia's 3 principal geographic regions are reflected in reproductive patterns. The 2 Andean regions, the Altiplano and the Valles, are inhabited predominantly by Quechua and Aymara speaking indigenous populations, while the Llanos or lowlands are inhabited primarily by persons of Spanish-speaking origin. The 1976 population census, the 1988 National Survey of Population and Housing, and the 1989 Demographic and Health Survey were the basis for fertility estimates for Bolivia during 1965-90. The estimate for 1990 was an extrapolation based on recent trends. The total fertility rates estimated for the country as a whole, the urban population, and the rural population, respectively, have declined from 6.50, 5.50, and 7.00 in 1965 to 6.00, 4.90, and 6.90 in 1980 and 5.20, 4.00, and 6.30 in 1985. Total fertility rates in the Altiplano, Valles, and Llanos, respectively, were 6.00, 6.60, and 7.00 in 1965, 5.80, 6.20, and 6.00 in 1980, and 5.00, 5.40, and 5.10 in 1985. The fertility levels of the 3 geographic regions thus differ less than those of urban and rural zones. The apparent similarity of fertility levels in the 3 ecological zones masks significant differences between the regions in the proximate fertility determinants of nuptiality, contraceptive usage, and lactation. Compensatory mechanisms result in the apparent similarity. The Llanos are characterized by an earlier age at union than the other 2 regions. Almost all women marry or enter a union at some point, and about 1/3 of unions are consensual. Nuptiality patterns are consistent with maximizing the reproductive potential of women and are more similar to those of Central America than those of the rest of Bolivia. The 1989 Demographic and Health Survey showed an average age at 1st union of around 20 years for Bolivia, 18.8 for the Llanos, 21 for the Valles, and 20.5 for the Altiplano. Women in the Llanos also breast fed their infants for a shorter time on average than women in the other 2 regions. The average duration of breast feeding was 16.4 months for Bolivia, 17.8 months for the Altiplano, 16.1 months for the Valles, and 13.4 months for the Llanos. Postpartum abstinence was also 3 months shorter on average in the Llanos than in the Altiplano. These differences were clearly reflected in the durations of postpartum insusceptibility to pregnancy, which were 13.5 months in Bolivia, 14.8 and 13.8 months in the Altiplano and Valles, and only 10.1 months in the Llanos. But contraceptive usage was much more common in the Llanos, where 42.9% of women in union used a method vs. 24.7% in the Altiplano and 30.8% in the Valles. Women in the Llanos were also much more likely to use a modern method.^ieng
Assuntos
Coeficiente de Natalidade , Comportamento Contraceptivo , Anticoncepção , Demografia , Etnicidade , Fertilidade , Geografia , Lactação , Casamento , Dinâmica Populacional , População Rural , Abstinência Sexual , Comportamento Sexual , Classe Social , População Urbana , América , Biologia , Bolívia , Cultura , Países em Desenvolvimento , Economia , Serviços de Planejamento Familiar , América Latina , Fisiologia , População , Características da População , Gravidez , Pesquisa , Fatores Socioeconômicos , América do SulRESUMO
PIP: Over 1 million people live on 8 small islands in the Eastern Caribbean: St. Kitts-Nevis, Montserrat, Grenada, St. Vincent, Antigua, Barbados, St. Lucia, and Dominica. Starting in 1985 the International Planned Parenthood Federation, Western Hemisphere Region has carried out a series of contraceptive prevalence surveys in these countries. Current information is provided by these surveys in the areas of fertility levels and preferences, contraceptive knowledge and use. Also, socioeconomic, historical and demographic background and analysis such as fertility patterns, desire for additional children, and breastfeeding data; contraceptive awareness including family planning methods and sources; contraceptive use by method, source, and timing, satisfaction, and male attitudes are provided in the surveys, but not in the report abstracted here. The total fertility rate (TFR) and the contraceptive prevalence rate (CPR) for the 8 islands are as follows: St. Kitts-Nevis (1984) 2.9 TFR, 40.6 CPR; St. Vincent (1988) 2.9 TFR, 58.3 CPR; Antigua (1988) 1.8 TFR, 52.6 CPR; Barbados (1988) not given, 55.0 CPR; St. Lucia (1988) 3.2 TFR, 47.3 CPR; Dominica (1987) 3.2 TFR, 49.8 CPR. The islands have unusual demographic patterns related to extensive out-migration.^ieng
Assuntos
Anticoncepção , Coleta de Dados , Serviços de Planejamento Familiar , Agências Internacionais , Pesquisa , América , Antígua e Barbuda , Barbados , Região do Caribe , Países em Desenvolvimento , Dominica , Granada , América do Norte , Organizações , São Cristóvão e Névis , Santa Lúcia , São Vicente e Granadinas , Índias OcidentaisRESUMO
PIP: 682 mostly rural, Spanish speaking women in the Province of Vallegrande, Bolivia, participated in a survey of infant feeding practices to determine the proportion of women still in amenorrhea at different stages of the postpartum period. Vallegrande Province has a maternal mortality rate of 480/100,000 live births and a rural infant mortality rate of 300/1000, among the highest in Latin America. The crude birth rate is 35/1000. The decline in living standards caused by Bolivia's economic crisis has particularly affected women and children. Many families expressed a desire to limit the size of their families and to terminate existing pregnancies. The 682 respondents had all given birth within the past 18 months. The data were analyzed using a World Health Organization program based on the life table method to calculate the duration of breast feeding and amenorrhea. At the time of the survey, 83% of the women breast fed totally or partially. 72% of primiparas and 88% of multiparas breast fed at least partially. 94% of the women had breast fed at some time. The average duration of breast feeding was 15 months. The average duration of amenorrhea in the province as a whole was 9 months. Among the women who had terminated breast feeding before the survey, 50% were menstruating by the 4th postpartum month. Prolonged lactation did not provide optimal spacing, since 44.5% of the women has an interval of less than 24 months between births. 15% of the women pregnant at the time of the survey had never resumed menstruation after the previous delivery. The survey indicated that supplementary feeding begins before the 4th month, rapidly reducing the number of nursings and hastening the return of ovulation. Very young women constitute a group at greater risk of short birth intervals because they terminate breast feeding very early. 2/3 of the women used no contraceptive method and the rest used less effective methods. The survey indicates that, despite a satisfactory overall rate and duration of breast feeding corresponding to traditional rural models, prolonged lactation is an unsatisfactory method of spacing, as demonstrated by the high proportion of closely spaced pregnancies. Educational programs should be undertaken to inform women and health care workers of the techniques and advantages of breast feeding as well as the availability of effective contraceptive methods to space births.^ieng
Assuntos
Aleitamento Materno , Fertilidade , Bolívia , Serviços de Planejamento Familiar , Humanos , Qualidade de VidaRESUMO
PIP: 10-20% of all pregnancies in most developing countries and in some developed countries (e.g., US) occur in adolescents. The number of such pregnancies is steadily rising. Adolescent pregnancies tend to be high risk pregnancies. Many adolescent pregnancies are unwanted and unplanned and often occur to unmarried youth. They often end in legal or illegal abortion, practiced under poor medical and psychological conditions. The health consequences of adolescent pregnancy and even the consequences on one's life are grave: death and morbidity (e.g., infertility). Education programs on sexually responsible behavior prevent unwanted pregnancies and sexually transmitted diseases (STDs). Youth are uncertain about family planning. Hormonal contraceptives perfectly suit youth with no contraindications (e.g., cardiovascular conditions). They are reversible and do not affect future fertility. IUDs tend to be contraindicated for youth due to risk of pelvic infection or infertility. Condoms protect against STDs and AIDS. Diaphragms and cervical caps are not well suited for youth because these barrier methods depend on prior knowledge about having sexual intercourse and require manipulations a bit complicated for youth. Periodic abstinence is difficult to use when menstrual cycles are irregular and because sexual intercourse is unexpected. Youth cannot depend on withdrawal because male youth are not used to practicing it. Spermicides have no contraindications but can be costly for youth. They also do not protect against HIV. Jamaica has a reception center for young mothers, which aims to get mothers to return to school. Young fathers also participate in center activities. The center provides confidential information on contraception. The Family Guidance Association of Ethiopia targets urban street-youth. It distributes condoms and diaphragms while educators provides counseling. It hopes to next have voluntary educators throughout Addis Ababa.^ieng
Assuntos
Adolescente , Anticoncepção , Países Desenvolvidos , Países em Desenvolvimento , Educação em Saúde , Gravidez na Adolescência , Abstinência Sexual , Infecções Sexualmente Transmissíveis , África , África Subsaariana , África Oriental , Fatores Etários , América , Região do Caribe , Demografia , Doença , Educação , Etiópia , Serviços de Planejamento Familiar , Fertilidade , Infecções , Jamaica , América do Norte , Organização e Administração , População , Características da População , Dinâmica Populacional , Comportamento SexualRESUMO
A significant increase occurred in the initiation and duration of breast-feeding among Honduran women between 1981 and 1987. Changes in population characteristics (e.g. level of education of women) would be expected to lead to a decrease in breast-feeding at each infant age, but these were offset by behavioural changes that led to an increase in the likelihood of initiation and continuation of breast-feeding. An exploration of relevant factors suggests that the PROALMA breast-feeding promotion programme has had a profound effect on the breast-feeding behaviour of Honduran mothers.
Assuntos
Aleitamento Materno , Educação em Saúde , Feminino , Comportamentos Relacionados com a Saúde , Honduras , Humanos , Lactente , Recém-Nascido , Fatores SocioeconômicosRESUMO
A comprehensive education strategy is presented that links training, community education, research, and mass-media efforts to enhance breastfeeding practices. Breastfeeding promotion models, an administrative system, and lessons learned during the project are described. The keys to effective breastfeeding promotion are shown to be accurate information; appropriate education, training, and follow-up; and a supportive administrative system.
PIP: An operations research project designed to determine what model of intervention was most successful in promoting breast feeding among 585 urban women in Mexico began in 1986. The interventions involved having trained promoters teach and counsel breast feeding mothers in Irapuato, program supervisors teach groups of mothers in Chihuahua, and both trained promoters and program supervisors train individuals or groups in Cuauhtemoc. Jalapa served as the control site. The breast feeding prevalence rate in the 4 communities varied from 64.5%-81.3% prior to intervention with a mean in the target group of 74.9%. The mean climbed to 88.8% for this group after intervention. Further, the breast feeding prevalence rate for Jalapa fell from 65.9%-56%. In addition, 70% of the women in the experimental group exclusively breast fed their infants during the 1st month whereas only 63.3% in the control did. Subsequent months' breast feeding prevalence rates decreased o 13.7% and 14.7% (5 months) and 9.4% and 3.3% (6 months) in the experimental and control groups respectively. Informal support groups of breast feeding mothers formed unexpectedly as a result of the educational and outreach activities. The data showed that the intervention model using the promoters was the most successful strategy. They also provided the researchers and other health care professionals interested in promoting community based breast feeding programs with guidelines. For example, supervisors should not discourage promoters from addressing other community needs since discouraging them can jeopardize their dedication to breast feeding promotion. Further, program planners should gather geographic and sociodemographic data of the area and population prior to planning and intervention.
Assuntos
Aleitamento Materno , Serviços de Saúde Comunitária/organização & administração , Promoção da Saúde/organização & administração , Serviços de Saúde Comunitária/normas , Feminino , Planejamento em Saúde , Promoção da Saúde/normas , Necessidades e Demandas de Serviços de Saúde , Humanos , México , Recursos Humanos de Enfermagem/educação , População UrbanaRESUMO
This research provides a multivariate analysis of factors associated with prolonged breast-feeding and conversely early infant weaning. Infant care practices associated with early infant weaning during the first four months of life were: early introduction to artificial milk, the infant sleeping in its own crib versus with its mother, and in general a more rigid feeding schedule. The weaned infant lived in a family with higher economic means, also maternal employment and the availability of a support person to care for the infant were variables more frequently found among infants weaned early. These infants had greater than average numbers of curative health care visits and gained less weight during the first four months of life than breast-fed infants. This study's findings suggest that as changes in life styles and cultural norms are molded by levels of modernization and urbanization, with greater participation of women in the workforce, the tendency to wean early may become even greater.
Assuntos
Aleitamento Materno , Tomada de Decisões , Desmame , Comportamento Alimentar , Humanos , Lactente , Cuidado do Lactente , Recém-Nascido , Estilo de Vida , Análise Multivariada , Nicarágua , Pobreza , Fatores Socioeconômicos , População UrbanaRESUMO
PIP: In 1987, staff from the Family Planning Association of Trinidad and Tobago interviewed at least 3806 women. Total fertility fell from 5.2 (1960) to 3.1 (1987). In 1987, little difference existed between rural (3.1) and urban areas (3). Fertility was lowest for women with the most education (2.3 vs. 3.6 for those with no education). Age specific fertility tended to decrease over time. For example, for 20-24 years olds it fell from 306 (1967) to 181 (1987). Women in the youngest age group wanted the least number of children (2.5 vs. 3.5 for the 35-39 years olds). Those women with the least number of children wanted the least number of children (2.5 for those with 0 children compared to 4.1 for those with 6 or more children). Total female sterilization stood at 8.3% and women with 6 or more children had the highest rate (25.4%). 42.1% of the pregnant women either did not want any more children before becoming pregnant or wanted a child later. 50% of the women used a contraceptive. Use increase with education. 40.9% of the women with no primary school used a contraceptive compared to 67.6% of those with the most education did. Oral contraceptives was the leading contraceptive (14% current users) followed by the condom (11.8% current users). Contraceptive prevalence ranged from 42.4% for 15-19 year olds to 57.1% for 30-34 year olds. It increased with the number of children until the 3rd child. Government health centers and pharmacies distributed most of the contraceptives. 34.3% of women not using a contraceptive and in a union intended to use a contraceptive in the future. The leading reasons for not using a contraceptive included no partner (25.7%) and health concerns (21.2%). Noneducated women married earlier (17.1% years) than the most educated women (22.5%). The mean length of breast feeding was 10.1 months. Infant mortality fell from 62-26 from 1960-1987. Trained nurses or midwives helped with most births.^ieng