RESUMO
We describe cumulative pregnancy probabilities among women who underwent quinacrine pellet sterilization in Chile between 1977 and 1989 (N = 1492). We interviewed the women or relatives in 1991-93 and 1994-96, and reviewed hospital records. Mean follow-up was 9.6 years (median 9 years). We recorded 120 pregnancies, including 40 that went to term or near-term. There were nine adverse outcomes in eight infants: one fetal death at 18 weeks gestation; three infants born prematurely; one stillbirth (placental infarct); and four infants with birth defects. There was no clustering of any particular kind of birth defect. For two insertions, the 10-year cumulative pregnancy probability was 8.9 (95% confidence interval 3. 7, 14.1). For 3 insertions, the 10-year rate was 7.0 (4.4, 9.5). For women who were under 35 years at insertion, the 10-year rate was 10. 7 (7.4, 14.1). For women who were 35 or older at insertion, the 10-year rate was 3.1 (0.6, 5.7). The pregnancy rate varied little for 2 vs. three insertions, but the rate did vary significantly by age, with women who received quinacrine at 35 years or older 0.3 (0. 2, 0.5) times as likely to become pregnant as younger women. The 10-year cumulative ectopic pregnancy probabilities for women with two and three insertions of quinacrine were 0.9 (<0.1, 2.6) and 0.5 (<0.1, 1.2), respectively. Pregnancy rates after quinacrine insertion are higher than after surgical sterilization, but ectopic pregnancy rates appear similar.
Assuntos
Quinacrina/administração & dosagem , Esterilização Tubária/métodos , Adulto , Envelhecimento , Chile , Estudos de Coortes , Feminino , Humanos , Gravidez , Resultado da Gravidez , Gravidez Ectópica/epidemiologia , ProbabilidadeRESUMO
Tubo-ovarian abscess usually results from ascending infection of the lower genital tract. In a few cases it can occur as a result of direct contamination at the time of tubal sterilization. We describe a case that presented seven years after post partum tubal sterilization, showing both acute and chronic components.
PIP: This paper presents the case of a 32-year-old woman who developed a tubo-ovarian abscess 7 years following tubal ligation via minilaparotomy. Symptoms experienced included pain, which was exacerbated by walking, and mild deep dyspareunia. Abdominal and pelvic examinations revealed pain in the left iliac fossa, cervical excitation tenderness, and an ill-defined left adnexal mass. Sonographic evaluation of the pelvis showed an irregularly shaped, cystic mass (8.0 x 4.5 x 5.3 cm) with thickened internal septations and solid parts. A left tubo-ovarian multilobulated complex mass adherent to the omentum and the pelvic side was found upon laparotomy. There was pus in the Pouch of Douglas, and the uterus was 10 weeks in size with symmetrical enlargement. The previously ligated right fallopian tube and the ovary were unremarkable. Management includes left adnexectomy, omental biopsy, and 5-day course of antibiotics against Staphylococcus aureus, which was cultured from the purulent material in the Pouch of Douglas. Tubo-ovarian abscess should be considered in diagnosing patients presenting symptoms of pelvic inflammatory disease.
Assuntos
Abscesso/etiologia , Doenças Ovarianas/etiologia , Infecções Estafilocócicas/etiologia , Esterilização Tubária/efeitos adversos , Abscesso/diagnóstico , Adulto , Feminino , Humanos , Laparotomia , Doenças Ovarianas/diagnóstico , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus/isolamento & purificaçãoRESUMO
PIP: The first hospital to offer no-scalpel vasectomy services in La Paz, Bolivia, introduced its program in 1996. However, over the course of 2 years, only 1 vasectomy was performed. Vasectomy services in La Paz are underutilized due to inadequate counseling, outreach, and use of educational materials. While the national health and population policy mandates the provision of comprehensive reproductive health care for both men and women, Bolivian men rarely seek health care services of any kind because most services are designed mainly for women and children. The only services offered to men are urology related, which focus upon screening for STDs, and workplace-related services, such as for factory workers and miners. Nongovernmental organizations (NGO) are exploring how to increase men's involvement in health care and family planning services. Men need to be made aware of gender issues related to reproductive and sexual health. The Centro de Investigacion Social Tecnologia Apropriada y Capacitacion (CISTAC), a Bolivian NGO which focuses upon research and training in health and social issues, plans to use research, training, and information dissemination to broaden the male role and identity in Bolivia, which will also affect men's access to and receipt of health care services. Toward that end, CISTAC and AVSC co-sponsored a workshop to teach health care program managers about the relationship between gender issues and men's involvement in reproductive health care.^ieng
Assuntos
Atitude , Cultura , Currículo , Relações Interpessoais , Organizações , Medicina Reprodutiva , Vasectomia , América , Comportamento , Bolívia , Países em Desenvolvimento , Educação , Serviços de Planejamento Familiar , Saúde , América Latina , Psicologia , Comportamento Social , América do Sul , Esterilização ReprodutivaRESUMO
PIP: Female sterilization is the method of family planning most preferred by women in the Dominican Republic. For the past 20 years, minilaparotomy has been successfully performed under local anesthesia by hundreds of trained general practitioners throughout the country. As such, minilaparotomy has become an important family planning option for Dominican women. Given this success with the procedure in the Dominican Republic, AVSC and its partners in the country plan to share their knowledge and expertise with the world by offering international training in the delivery of the method. The senior director of AVSC's technical resources worldwide believes the program has succeeded because of its focus upon meeting clients' needs and its strong commitment to the technique by all who are involved. AVSC continues to be a catalyst for positive change in the Dominican Republic.^ieng
Assuntos
Educação , Cooperação Internacional , Laparotomia , Organizações , América , Região do Caribe , Países em Desenvolvimento , República Dominicana , Serviços de Planejamento Familiar , América Latina , América do Norte , Esterilização ReprodutivaRESUMO
In a joint pilot study by Family Health International (FHI), AVSC International, and the Instituto Mexicano del Seguro Social (IMSS), information was gathered on the determinants of azoospermia following vasectomy on 38 healthy men who chose vasectomy for contraception. The time and number of ejaculations associated with loss of sperm motility and loss of sperm eosin vital staining were also evaluated. "Azoospermia" was defined on the basis of two consecutive azoospermic semen samples collected at least 3 days apart. The single decrement life table method was used to calculate weekly gross cumulative life table rates for the time to azoospermia, zero motility, and zero viability. The Kaplan-Meier method was used to calculate the product-limit estimates of the cumulative rates for the total number of ejaculations to azoospermia, 0% motility and 0% viability. The median time to azoospermia was 10 weeks and at the end of week 20, the life table rate (+/- standard error) was 93.0 (+/- 6.30) weeks/100 men. The median number of ejaculations to azoospermia was between 25 and 30, and the cumulative rate (+/- standard error) at 60 ejaculations reached 94.5 (+/- 5.16)/100 men.
PIP: The time and number of ejaculations to azoospermia after vasectomy were investigated in a prospective pilot study of 38 vasectomy acceptors conducted by Family Health International and the Instituto Mexicano del Seguro Social. Two consecutive azoospermic semen samples collected at least 3 days apart were required for azoospermia to be declared. 25 men (65.8%) demonstrated azoospermia during the 24-week follow-up period; however, 9 (23.7%) discontinued prior to the study's end or before achieving azoospermia. The median time to azoospermia was 10 weeks. At the end of week 20, the single decrement life table rate was 93.0 +or- 6.30 weeks per 100 men. The median number of ejaculations to azoospermia was 25-30 and the cumulative rate of azoospermia at 60 ejaculations was 94.5 +or- 5.16 per 100 men. It took approximately 5 weeks longer for men with fewer than three ejaculations per week to reach azoospermia than their counterparts with a higher number of ejaculations. The median time to sperm motility was 3 weeks, while that to 0% viability was 9 weeks. There were two pregnancies, one of which involved a man who had been declared azoospermic. An expanded study based on this pilot study is underway.
Assuntos
Oligospermia , Vasectomia , Adulto , Seguimentos , Humanos , Tábuas de Vida , Masculino , México , Projetos Piloto , Estudos Prospectivos , Fatores de TempoRESUMO
Outpatient laparoscopy procedures have made sterilization possible for millions of women in developing countries. This report describes the experience of a team of doctors, nurses, and support staff that performed 107 laparoscopic tubal sterilizations during on eight-day sojourn in a remote north-central area of Nicaragua. Minimal analgesia (oral ibuprofen) and anesthesia (1% lidocaine) were used since most of the patients walked to and from the hospital-some up to 15 miles. Because the Nicaraguan government's support for birth-control programs is unreliable and because illegal abortion is the leading cause of maternal mortality in Nicaragua, this safe, minimally invasive surgical method is the favored means of birth control.
PIP: During an 8-day visit to Jalapa, Nicaragua, in 1996, a Short-Term Volunteers in Mission team from Minnesota, US, performed 107 outpatient laparoscopic sterilizations and 14 vasectomies in this remote town near the Honduran border. Standard medical procedures were modified to adapt to the inadequate medical facilities and large patient load. The mean age of female sterilization acceptors was 28.92 years; they had an average of 4.4 living children. 75% lived in or near the town and walked a total of 1 hour or less to and from the hospital; another 20% walked an average of 4 hours round trip. Because of the women's need to walk home after the procedure, local anesthesia (1% lidocaine) was administered in conjunction with oral ibuprofen. More than 75% of acceptors experienced mild or no intraoperative pain and were sent home right after the procedure; 20% reported moderate pain and 3% severe pain, but in all cases the pain dissipated within 10-45 minutes. The length of time from admission to discharge averaged 45 minutes (range, 25-75 minutes). Civil war, overpopulation, and severe poverty limit the ability of government-sponsored programs to deliver family planning services consistently. Thus, sterilization is an ideal method of fertility control for appropriate candidates.
Assuntos
Países em Desenvolvimento , Serviços de Planejamento Familiar/métodos , Esterilização Tubária , Vasectomia , Adulto , Feminino , Humanos , Laparoscopia , Masculino , Nicarágua , Missões ReligiosasRESUMO
Close of skin with cyanocrilate in surgical wounds after tubary sterilization. The objective was to determine the use of cyanocrillate in surgical wounds coalescence, to decrease the time employed when closing the skin, as well as to aid the healing process. This is an observation, prospective, length, comparison, study. Since March, 1995, the Gyneceum-Obstetrics "Luis Castelazo Ayala" Hospital has carried out this research, forming two groups as follows. Group A: Tubary sterilization (OBT) was practiced to 36 patients applying a superficial coat of cyanocrilate. Group B included 31 patients whose skin was sutured with catgut 00. In Group A. the average time for skin closure is 14.5 seconds, in wounds with a length of 2 to 6 cm. In Group B the average time is 3.9 minutes, in wounds with a length of 1 to 4 cm. 4 cases of group A reported pain for the first 12 hours (11.1%), pruritus in wound in 3 cases (8.3%), partial dehiscence of wound, 1 case (2.7%). While in Group B the result are: Pain in 10 cases (32.2%), pruritus in 3 cases (9.6%), partial dehiscence of wound in 3 cases (9.6%), 1 case with poor edges coaptation (3.2%), and reaction to suture in 2 cases (6.4%). Not even an infection condition occurred. Cyanocrilate used in selected cases is an inexpensive, fast, easy to use efficient method, with little morbidity and likely to improve the aesthetic of surgical scar.
PIP: 100 women undergoing bilateral tubal sterilization at a hospital in Mexico City between March and September 1995 participated in a prospective study of the use of the contact adhesive cyanoacrylate for closure of the surgical wound. Cyanoacrylate was used for the patients in group A, while in group B the skin was sutured with catgut 00. The remainder of the procedure was similar in both groups. The 36 patients in group A and 31 in group B who attended follow-ups at 12 hours, 7 days, and 40 days were included in the study. Patients in group A ranged in age from 20 to 36 and averaged 31.7 years, while those group B ranged from 18 to 35 and averaged 27.5 years. Group A patients had 2.8 and group B 3.1 children on average. The wounds in group A ranged from 2 to 6 cm and averaged 3.1 cm, while those in group B ranged from 1 to 4 cm and averaged 2.5 cm in length. The time for wound closure ranged from 4 to 30 seconds and averaged 14.5 seconds in group A, and from 1 to 7 minutes with an average of 3.9 minutes in group B. 4 patients in group A had pain (11.1%), 3 had pruritus (8.3%), and 1 each had (2.7%) poorly joined borders, partial dehiscence of the wound, and bleeding. 10 patients in group B had pain (32.2%), 3 each (9.6%) had pruritus and partial dehiscence of the wound, 1 had poorly joined borders (3.2%), and 2 had reactions at the site of the sutures (6.4%). It was concluded that, in appropriately selected cases, cyanoacrylate is inexpensive, rapid, easy to use, and efficient, with few side effects.
Assuntos
Cianoacrilatos , Esterilização Tubária/métodos , Suturas , Adulto , Feminino , Idade Gestacional , Humanos , Gravidez , CicatrizaçãoRESUMO
PIP: A study conducted by AVSC International between 1992 and 1995 found that couples around the world go through a highly similar decision-making process when they choose vasectomy as their family planning methods. Study findings are based upon in-depth, qualitative interviews with couples using vasectomy in Bangladesh, Mexico, Kenya, and Rwanda, where the prevalence of vasectomy is relatively low, and Sri Lanka and the US, where it is relatively high. 218 separate interviews were conducted with male and female partners. Concerns about the woman's health were cited by respondents in each country as reasons to cease childbearing and to opt for vasectomy as the means to achieving that end. Also, almost all respondents mentioned varying degrees of financial hardship as contributing to their decision to end childbearing. These findings highlight the concept of partnership in relationships and family planning decision-making, and demonstrate the importance of going beyond traditional stereotypes about gender roles in decision-making. Social influences and the potential risks of using other forms of contraception also contributed to the choice of using vasectomy. The decision-making process and lessons learned are discussed.^ieng
Assuntos
Cultura , Tomada de Decisões , Características da Família , Saúde , Fatores de Risco , Vasectomia , África , África Subsaariana , África Oriental , África do Norte , América , Ásia , Bangladesh , Comportamento , Biologia , Países Desenvolvidos , Países em Desenvolvimento , Serviços de Planejamento Familiar , Quênia , América Latina , México , América do Norte , Ruanda , Sri Lanka , Esterilização Reprodutiva , Estados UnidosRESUMO
Brazil has one of the highest prevalence rates of female surgical sterilization in the world. At the same time there is an increased demand for sterilization reversal. In order to understand which women tend to later request reversal of the procedure, a case-control study was carried out comparing 216 women who requested reversal with sterilized women who did not, paired by year of surgery. The relative risk of requesting reversal for women sterilized before age 25 was 18 times that of women sterilized after age 29. The elevated risk remained even after controlling for a number of variables present at the time of surgery. Multiple regression analysis showed that request for reversal was associated with younger age, less information about the procedure, and fewer contraceptive methods known before sterilization. These results support the recommendation that women should be fully informed about the tubal ligation procedure and have access to other contraceptive options before being sterilized.
Assuntos
Educação de Pacientes como Assunto , Reversão da Esterilização/psicologia , Esterilização Tubária/psicologia , Adulto , Brasil , Estudos de Casos e Controles , Feminino , Humanos , Razão de Chances , Fatores de Risco , Reversão da Esterilização/estatística & dados numéricos , Esterilização Tubária/estatística & dados numéricos , Fatores de TempoRESUMO
PIP: Fertility in developing countries has declined by about 1/3, from an average of 6 children per woman in the 1960s to 4 in 1990. 38% of reproductive-age women in the developing countries excluding China use a family planning method, as do over 70% in developed countries. 81% of contraception in the developing world is provided by the IUD, male or female sterilization, and oral contraceptives (OCs). 25% of couples in the developing world who use contraception use IUDs, 12% use OCs, and 44% use voluntary sterilization. Injectables are used by approximately 12 million women in developing countries, 3% of married women currently using a method. Almost 1/2 sterilized couples are in China and 1/4 in India. Sterilized women outnumber sterilized men by 3 to 1 worldwide, and voluntary female sterilization is the world's most widely used method. Nearly 138 million women of reproductive age have been sterilized. Voluntary female sterilization is less popular in developed countries except the US, where 23% of married women of reproductive age have undergone the procedure. 42 million couples worldwide use vasectomy. Some 120 million married women in developing countries are estimated to have unsatisfied needs for family planning. Each year, over 20 million women are believed to undergo unsafe abortions, and approximately 70,000 die as a result. Each day, nearly 1 million persons are believed to be infected with sexually transmitted diseases. Approximately 19 million persons had been infected by HIV by late 1994.^ieng
Assuntos
Comportamento Contraceptivo , Anticoncepção , Anticoncepcionais Orais , Países Desenvolvidos , Países em Desenvolvimento , Dispositivos Intrauterinos , Esterilização Reprodutiva , Serviços de Planejamento FamiliarRESUMO
PIP: The family planning organization Profamilia established its mobile clinic program in 1976 with the purpose of reaching remote rural and urban areas with voluntary surgical contraceptive services. The success of the mobile clinical-surgical program depends on surveying the area where the work is to be provided, determining the date of activities to start, providing information and education to motivate the community, selecting the contraceptive method and service, and providing follow-up service after the intervention. Profamilia was founded in September 1965, and 30 years later it provides 70% of family planning services in Colombia. Initially, the mobile programs of Profamilia offered only voluntary surgical contraception for women and men. Clients who were far from a family planning center were reached by the mobile clinic and transported to a nearby center. Since 1992 Profamilia has also begun a mobile program with a wide variety of services: temporary methods of family planning, cervical-uterine cytological tests, gynecological and prenatal consultations, infertility tests, and pregnancy tests. This has allowed the recovery of the costs of the program to increase from 50% when only surgical services were offered to 85% currently. This effort is one of the reasons why Colombia has a contraceptive prevalence rate of 72%, one of the highest in Latin America.^ieng
Assuntos
Anticoncepção , Planejamento em Saúde , Unidades Móveis de Saúde , Esterilização Reprodutiva , América , Colômbia , Comportamento Contraceptivo , Atenção à Saúde , Países em Desenvolvimento , Serviços de Planejamento Familiar , Saúde , Instalações de Saúde , América Latina , América do SulRESUMO
PIP: No-scalpel vasectomy was developed by Dr. Li Shunkiang in China in 1974. In 1989 Profamilia carried out 18 tubal ligations for every vasectomy procedure, and this year in Bogota the first group of Profamilia surgeons underwent training in no-scalpel vasectomy. By 1995 the ratio of tubal ligations to vasectomy dropped to 10 to 1 at the national level and to 4 to 1 in Bogota. The evaluation of no-scalpel vasectomy procedures was conducted at the Men's Clinic in Bogota covering the period of 1989-94. 7513 procedures were done by 5 trained surgeons during this period. The expected incidence of complications was 3%. A sample of 2257 was obtained for evaluation. Variations in the management of the vas deferens included: 1) 1898 cases of ligation with silk and the interposition of the fascia; 2) 227 cases of monopolar electrocoagulation and interposition of the fascia; 3) 21 cases of monopolar electrocoagulation without interposition of the fascia; 4) 9 cases of ligation with silk without interposition of the fascia; and 5) 15 other cases with some kind of technical difficulty. There were no significant differences with respect to the distinct variants. The major complications were: 1) 0.3% had hematoma, 2 cases required surgical drainage; 2) 0.26% had infection, 2 cases required surgical drainage and intravenous antibiotics for scrotal abscess; 3) 1.14% had epididymitis, a congestive type that responded well to anti-inflammatory drugs, while in some cases tetracycline was needed; 4) 0.22% had vasocutaneous fistula, which were resected without problems; and 5) 0.30% had other complications including granulomas of the cord or the scrotal wall. Only 1.27% patients had to see a doctor for postoperative pain.^ieng
Assuntos
Eletrocoagulação , Epididimite , Estudos Retrospectivos , Vasectomia , América , Colômbia , Países em Desenvolvimento , Doença , Serviços de Planejamento Familiar , Cirurgia Geral , Infecções , América Latina , Pesquisa , América do Sul , Esterilização Reprodutiva , TerapêuticaRESUMO
PIP: Scarcity of long-term funding has influenced Family Health International (FHI) to stop new animal studies on the safety of quinacrine pellets that are used in nonsurgical female sterilizations. These studies would have lasted 8 years and cost $8 million. FHI planned to examine quinacrine's potential toxicity, including life-time carcinogenicity in rodents. In the early 1980s, it sponsored toxicology studies but the US requirements for evaluating toxicity were different then. In 1994, a meeting of experts evaluated quinacrine research and FHI then decided to conduct short-term genetic toxicity tests on quinacrine. These tests proved that quinacrine causes genetic damage in vitro. FHI sent both the World Health Organization (WHO) and the US Agency for International Development (USAID) these results. FHI is presently conducting follow-up of two clinical studies in Chile (USAID-funded) and in Vietnam (Mellon Foundation-funded). A small cancer cluster promoted the follow-up study of 1492 women in Chile. One woman had developed the rare form of uterine cancer called uterine leiomyosarcoma. Data up to 1991 reveal that quinacrine did not increase the risk of cancer, but the sample size was too small to confirm quinacrine's safety relative to cancer. The Vietnamese government asked FHI to conduct a follow-up study that includes more than 2000 quinacrine acceptors and about 1500 controls. Ministry of Health providers had inserted the quinacrine pellets in the cases. Based on the findings of the original study, WHO recommended that Vietnamese officials suspend quinacrine sterilizations until more toxicologic evaluation of quinacrine could be performed.^ieng
Assuntos
Animais de Laboratório , Ensaios Clínicos como Assunto , Anticoncepção , Administração Financeira , Neoplasias , Organizações , Esterilização Reprodutiva , América , Ásia , Sudeste Asiático , Chile , Países Desenvolvidos , Países em Desenvolvimento , Doença , Economia , Serviços de Planejamento Familiar , América Latina , América do Norte , Pesquisa , América do Sul , Estados Unidos , VietnãRESUMO
This report approaches the concept of quality of care by looking at the covariates of sterilization regret in the Dominican Republic according to the results from the 1991 Demographic and Health Survey. The main variables observed are the women's satisfaction with sterilization, their decisionmaking process, sterilization experience, use of family planning, and socioeconomic characteristics. The more detailed measurement and analysis of the outcomes of care point to a need for improvement in the public program effort with regard to sterilization. Substantial proportions of women were sterilized who were younger than 30, who had three or fewer living children, and who had the operation before they had used any other method of contraception. Because a greater proportion of sterilization regret is observed among these groups, women must be enabled to make a free and informed decision about sterilization by means of programs that offer a more balanced choice of methods, as well as better counseling, education, and access to high-quality services.
PIP: A quality of care study examined the covariates of sterilization regret by analyzing data from the 1991 Demographic and Health Survey for the Dominican Republic. The leading contraceptive method was female sterilization (about 40% of women in union) followed by oral contraceptives (10%). Over time, an increasing number of younger women chose sterilization. In fact, 60% of all sterilized women underwent sterilization when they were younger than 30. Almost 40% of women in union who underwent sterilization when they were younger than 30 had no more than three living children. Sterilization was the first and only contraceptive method that 34% of sterilized women in union had ever used. 56% of them were younger than 30. 44% had fewer than four children. These women were more likely to report regret, dissatisfaction with their decision to undergo sterilization, and to not choose sterilization again than did all respondents (11% vs. 5%). Some variables significantly associated with dissatisfaction and regret were: age; no other modern family planning methods used; reasons for sterilization (recommended by medical/family planning worker and side effects/health concerns); a less than 6 month interval between last birth and sterilization; sterilization was first method used; family size less than four; sterilized at delivery; and sterilization was discussed with husband. These findings suggest a need for the family planning program to provide information about all contraceptive methods and their effective use, quality counseling, and access to high quality services to optimize levels of satisfaction among clients.
Assuntos
Atitude Frente a Saúde , Países em Desenvolvimento , Emoções , Garantia da Qualidade dos Cuidados de Saúde , Esterilização Tubária/psicologia , Adolescente , Adulto , Comportamento Contraceptivo , República Dominicana , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Pessoa de Meia-IdadeRESUMO
Results of the use of a special protocol for evaluation of patients requiring tubal ligation is presented after applied by a multidisciplinary group. The authors conclude that the use of defined parameters of age, parity, marital union duration, number of children alive and the presence of maternal clinical pathology are useful to identify patients with smaller chances of regret after surgery.
PIP: 27% of reproductive-age women in Brazil have chosen surgical sterilization as their contraceptive method. Most of these women who have undergone tubal sterilization opted for cesarean surgery. However, given the young ages of many of these women, many regret having been sterilized. This paper summarizes the experience of a multidisciplinary group in evaluating women who apply for surgical sterilization at the Department of Tocogynecology, Faculdade de Ciencas Medicas, Universidade Estadual de Campinas in Sao Paulo. Detailed descriptions are presented of the medical and social characteristics of cases seen between June 1988 and July 1989. The authors conclude that the use of the defined parameters of age, parity, marital union duration, number of living children, and the presence of maternal clinical pathology are useful in identifying the patients who are least likely to regret undergoing surgical sterilization.
Assuntos
Seleção de Pacientes , Esterilização Tubária , Adolescente , Adulto , Fatores Etários , Criança , Feminino , Humanos , Masculino , ParidadeRESUMO
PIP: Sterilization in Brazil is discussed in a racial context and contrasted with the experience of the United States, demonstrating the historical differences between these two societies regarding race relations and reproductive rights. The American feminist Angela Davis referred to the control of fertility as genocide, especially as practiced in the first half of the 20th century. In 1906 President Theodore Roosevelt characterized the drop of White fertility caused by rapid urbanization as racial suicide. In 1932 the development of the eugenic movement resulted in inducing 26 states to adopt compulsory sterilization laws for persons considered unfit for reproduction. Margaret Sanger, the protagonist of fertility control, advocated a program of compulsory sterilization for imbeciles, illiterates, criminals, epileptics, the mentally retarded, prostitutes, and drug traffickers. 7686 sterilizations were performed in North Carolina, of which about 5000 were performed on Blacks to prevent the reproduction of mentally retarded persons. It was only in 1974 that guidelines were drawn up to prevent sterilization abuses. Under federal programs 100,000-200,000 persons were sterilized in 1972, and 35% of Puerto Rican women of reproductive age underwent sterilization. In Brazil 44% of the population of 147 million is Black. In 1940 the White population was the majority, but by 1980 a steady increase of the mulatto population had occurred. From 1965 on the White population began to decrease both because of oral contraceptive use and intermarriage. The fertility rate of the mulatto population was 4.1% in 1980 and 2.3% in 1990, less than the 2.4% rate of whites. The total fertility rate (TFR) in Brazil was 3.5 children per woman in 1986, which dropped to 2.5 in 1991. In the northeast, where the majority of the population is Black, the TFR was 3.7 in 1991 vs. 7.5 in 1970. Although in Brazil racial intolerance is not acceptable, there is still inequality of opportunity for Blacks. In 1990, 69.2% of the women used contraception and 43.9% of them relied on sterilization, especially in the northeast.^ieng
Assuntos
Etnicidade , Fertilidade , Política Pública , Relações Raciais , Esterilização Reprodutiva , América , Brasil , Cultura , Demografia , Países Desenvolvidos , Países em Desenvolvimento , Serviços de Planejamento Familiar , América Latina , América do Norte , Política , População , Características da População , Dinâmica Populacional , Pesquisa , América do Sul , Estados UnidosRESUMO
In this article, a new methodology that employs parity-progression ratios to estimate the effect of female sterilization on fertility is described, and results using data from Ecuador are compared to those obtained using a previously existing approach that classifies women by marital duration. The methods differ in how they disaggregate marital fertility and in the assumption they make about what the subsequent fertility of sterilized women would have been if they had not been sterilized. The analysis of the Ecuadoran data shows that the estimate of births averted by sterilization has diminished over time, even as sterilization prevalence has been increasing. This situation is attributed to a decline in the fertility of nonsterilized women resulting from increased use of reversible methods of contraception.
PIP: Two methods are used to show the impact on fertility of sterilization: births averted in a single five-year period before the survey and the parity progression ratio approach for 1979-84 and 1984-89 used to estimate births averted by birth order and duration since first union. The births averted analysis revealed that fertility among nonsterilized women declined from 5.93 in 1979-84 to 5.01 in 1984-89. The births averted approach showed almost no change in total births averted and a shift in the distribution of births averted by marital duration. Births averted were greater during 1984-89 among marital durations under 15 years and during 1979-84 at marital durations of 15-24 years. The actual percentage of ever married women who were sterilized increased over the decade, but the hypothetical proportions being sterilized in a given duration remained almost unchanged. This approach underestimated births averted, because it did not account for future declines in fertility among nonsterilized women. The parity progression ratio (PPR) approach indicated a nonsterilized fertility decline of 1.28 births per woman and a marital fertility decline of 1.04 births. Between the two periods, sterilization contributed to a reduction of 0.24 births. The preferred PPR approach accounted for the effects of sterilization on individual PPRs and proportions of ever-married women. This method offered consideration of increased sterilization prevalence, but declining births averted by sterilization. A comparison of both methods shows that the parity progression approach yielded higher estimates of the average number of births averted by sterilization and higher total nonsterilized marital fertility rates (total marital fertility rates in the absence of sterilization). Marital fertility rates remained similar. Data are obtained from the 1989 Ecuador Demographic and Health Survey and the World Fertility Surveys of 1979 and 1989.
Assuntos
Coeficiente de Natalidade/tendências , Países em Desenvolvimento , Paridade , Controle da População/tendências , Esterilização Tubária/estatística & dados numéricos , Adolescente , Adulto , Equador/epidemiologia , Serviços de Planejamento Familiar/tendências , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , GravidezRESUMO
The study investigates the factors involved in the decision of a sample of women to break appointments for sterilizations at the Fertility Management Unit of the University of the West Indies. A case control study involved 50 women who did not show up (no-shows) and an equal number who did show up (shows) over the same period. The no-shows had spent a shorter time in their current union than the shows, and some had no children for their partners at the time the appointments were made. Marriage was the single most important event that would encourage the no-shows to consider sterilization in the future. As long as poor women see child bearing as a precondition for financial assistance from spouses, they will hesitate to give up this capability.
PIP: As part of a research program to identify the barriers to increasing the acceptance of sterilization in the West Indies, a study was undertaken to determine why an estimated 16% of annual registrants for sterilization failed to keep their appointments (no-shows). From 300 no-shows, a random sample of 50 was interviewed and matched for year of registration, age, parity, marital and economic status, and geographic area with a control sample of 50 sterilized women. The most important reason for considering sterilization for all of the women was the desire to have no more children. The no-shows exhibited a lack of self-motivation, citing friends and medical personnel as motivators, and in no case did motivation come from the partner. The no-shows cited partner-related reasons and fear as causing them to break the appointments. Many women were ready for sterilization but were unable to discuss the topic with their partners. Among the sterilized women, 2 regretted the procedure. Among the no-shows, there had been 8 pregnancies, 3 of which were terminated, and 7 women were attempting to become pregnant. Recent research in the Caribbean suggests that improving women's status plays a more important role in reducing fertility than that played by family planning programs. As long as childbearing is seen as a precondition for receiving financial assistance from a man, it will continue.
Assuntos
Agendamento de Consultas , Esterilização Tubária , Adulto , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
PIP: Nonsurgical female sterilization, through use of quinacrine hydrochloride pellets inserted into the uterus, has the potential to make low cost permanent contraception accessible to the millions of women in developing countries who desire no more children but do not live close to surgical facilities or cannot spend time away from their families. Family Health International (FHI) has been studying this agent in clinical trials in Chile since 1976. The efficacy rate for 2 100-minute pellets is 95-98% at 12 months. The predominant side effects, temporary and minor, are amenorrhea of 1-3 months' duration, lower back pain, heavier menstrual bleeding, and headache. In 1990, however, FHI withdrew its Investigational New Drug application to explore the agent's toxicity, teratogenicity, and carcinogenicity. In 1989, 8 cases of cancer in 6 different anatomical sites were identified among the 572 Chilean women who had received quinacrine in clinical trials in the preceding decade. A retrospective study of 1492 Chilean women who were sterilized with quinacrine in 1977-89 revealed 17 cancer cases. Small sample sizes and the lack of cancer incidence data in Chile make it impossible to draw conclusions on the drug's carcinogenicity, but FHI will monitor this group for another 5 years. Early preclinical studies in pregnant rats and monkeys have indicated high rates of fetal death but no evidence of chromosomal damage; however, these studies must be repeated to meet new requirements, including the evaluation of bacterial gene mutation, mammalian cell gene maturation, and in vitro cytogenetics. Another research site has been Vietnam, where 31,781 quinacrine pellet sterilizations were performed in 1989-92 at the request of the government. FHI researchers are collecting data on health related outcomes as well as acceptor satisfaction, provider counseling, and service delivery among 1800 of these women and will complete its study in 1994. If the toxicology study yields favorable results, clinical trials will be repeated in the US.^ieng
Assuntos
Anticoncepção , Países em Desenvolvimento , Esterilização Reprodutiva , América , Ásia , Sudeste Asiático , Chile , Serviços de Planejamento Familiar , América Latina , América do Sul , VietnãRESUMO
PIP: This article attempts to reconstruct part of a study on female sterilization in Mexico. The research began with a demographic survey, which was continued with a regional psychologically-oriented survey and has been complemented with studies that apply qualitative analysis techniques and the redrawing of conceptual frameworks for reproduction-related topics and the regulation of fertility. The author attempts to bring together the features of several analytical perspectives for the study of female sterilization. He also argues that research needs to focus more on the social normativity of reproduction and sterilization, the way in which it is put into effect by institutional health programs, and family planning services. The paper also suggests the need to study health aspects of the women who have chosen this birth control method, who are estimated to total 25% of all married women of reproductive age in Mexico. (author's)^ieng