Family Planning and Contraception

Le Vade-mecum pour la prise en charge des demandes de contraception d’urgence réalisé par la Fédération laïque de centres de planning familial contient :
-    Une synthèse de la littérature scientifique
-    Un arbre décisionnel pour la prise en charge médicale
-    Des recommandations de bonne pratique
-    Un questionnaire

Just over 20% of white women in America will never bear children, the highest percentage in modern history.  Only half of this group-10% of women without children- are considered infertile.  Many women in the fertile but childless group are voluntarily so:  the self-proclaimed childfree.

Yet despite the growing acceptability in remaining a childfree adult, doctors are resistant to sterilizing women without children. Access to sterilization is usually repeatedly denied, often with tactics of humiliation, hoop jumping, or second-guessing the legitimacy of the patient’s desire for sterilization, despite the legal status of voluntary sterilization for any competent person over the age of 21- regardless of parity.     

This paper will examine the many reasons why a woman who does not have children would want to continue in her childfree lifestyle, evaluate the accessibility of sterilization for women who are childfree by examining the reported reasons for denial of sterilization- both from the woman’s and the physicians’ perspective, and assess the legal status of voluntary sterilization for nonparous women. The paper will conclude that sterilization for childfree women is an ethical, legal option and that willing doctors should follow recommended guidelines for counseling women who desire sterilization, and urge hesitant doctors to reconsider their oppositions to voluntary sterilization for childfree women and provide the contraception of preference to women.

Introduction: Family planning is a means by which individuals or couples space pregnancy and childbirth at intervals, mutually determined by husband and wife in order to have the desired number of children. Unintended pregnancy is a worldwide problem and may result from contraceptive misuse and failure. Adherence to short-acting contraceptives has been shown to be poor, with many women repeatedly missing short-acting contraceptives. In an effort to improve compliance, long-acting contraceptives that minimize the frequency of dosing are becoming increasingly popular. In developing countries, 20% to 30% of women who use oral contraceptives or injectable stop within two years of starting because of side effects or other health concerns.

This research explores the history of the birth control pill in America and its ties to feminism and women's reproductive rights. The Research highlights the 1970 Nelson Pill Hearings and the movements for women to have the autonomy to make their own reproductive decisions.

I consider myself a reasonably good catholic, yet I feel marginalized by the church I love. This is why. I am a retired obstetrician and gynecologist and throughout my career I have been dealing, almost on a daily basis, with issues of family planning. I am fully aware that the Catholic Church opposes any artificial methods of contraception and sterilization. Only the so called " fertility awareness methods " are condoned. That is just fine for motivated and somewhat educated couples, with some access to medical care and teaching; also this approach works best if the women has regular menstrual cycles. Medical advances have made these methods more sophisticated and precise than the original method, based on just counting the days of the menstrual cycle and abstaining from intercourse on the so called fertile days.(1) Under ideal circumstances these natural methods have a high success and low failure rate, equal or better than some artificial methods. Yet they still require a fair amount of effort. In my practice I have certainly made these methods available to couples who opted for them and I have helped these couples in their use. Many are very satisfied with them. Under less than ideal circumstances however, these natural methods have a high and unacceptable failure rate.(2) This is especially true in developing countries and areas (like refugee camps) where people live in squalor, lack food and most basic living needs, have no or inadequate medical care, and women often have very irregular or absent menstrual cycles, so that the natural methods of family planning become utterly impractical. Yet the Catholic Church insists that only these natural methods are acceptable. Proponents of the natural methods will argue that some methods of contraception might actually operate by preventing implantation of a fertilized ovum, and thus could be considered an abortifacient, which is certainly unacceptable to the Church. I acknowledge that some of the artificial methods may alter the lining of the uterus to the point that an ovum, if fertilized anyway, will not implant (abortifacient?). The majority of evidence however, points to the fact that these methods prevent either sperm transport, ovulation, or both, rather than preventing implantation, and therefor should not be considered abortifacients in the vast majority of instances.(3) One other argument that is often raised in this type of discussion is that artificial methods of family planning may have serious side effects. I also acknowledge that that may be so, even though the risks are small. As an example, the relative risk for a serious blood clot formation, a life threatening event, in a woman taking the combined oral contraceptive pill is certainly increased, but the absolute risk is very small.(4) However a consideration that is mostly overlooked, is the complication rate of failed contraception resulting in a pregnancy. As I argued earlier, that failure rate is considerably higher for natural methods when applied to the overall world population. An unwanted pregnancy, or any pregnancy for that matter, especially in developing countries, carries with it the risk of serious morbidity and even mortality associated

Contraceptive failure is a major contributor to unintended pregnancy worldwide. DHS retrospective calendars, which are the most widely used data source for estimating contraceptive failure in low-income countries, vary in quality across countries and surveys. We identified surveys with the most reliable calendar data and analyzed 105,322 episodes of contraceptive use from 15 DHSs conducted between 1992 and 2014. We estimate contraceptive method-specific 12-month failure rates. We also examined how failure rates vary by age, education , socioeconomic status, contraceptive intention, residence, and marital status using multilevel piecewise exponential hazard models. Our failure rate estimates are significantly lower than results from the United States and slightly higher than previous studies that included more DHS surveys, including some with lower-quality data. We estimate age-specific global contraceptive failure rates and find strong, consistent age patterns with the youngest users experiencing failure rates up to ten times higher than older women for certain methods. Failure also varies by socioeconomic status, with the poorest, and youngest, women at highest risk of experiencing unintended pregnancy due to failure.

Aim: This systematic literature review documented, analysed and critiqued the accessibility of contraception and sexual and reproductive health (SRH) information for women living in low- and middle-income countries who have undergone medical or surgical abortion.

Methodology: This review systematically collated relevant and recent empirical evidence regarding women's access to contraception and SRH information post-abortion within low- and middle-income countries. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework Guidelines, Flow Diagram and Checklist were utilised to undertake the review. The Ovid (MEDLINE), ProQuest, Science Direct, Web of Science, PUBMED and CINAHL databases were searched and studies that met edibility criteria were assessed for validity and analysis. A narrative synthesis of characteristics and results of the included studies is presented.

Findings: After detailed assessment of available and relevant literature, nine studies were selected for inclusion in the review. Studies highlighted barriers to contraception and SRH information including supply limitation, lack of comprehensive education and counselling, lack of skilled post-abortion care (PAC) providers and abortion stigma.

Conclusions: The review found that with access to a wide range of contraceptive methods combined with comprehensive SRH information and education, contraception uptake in women post-abortion does increase. The review also highlights the inconsistencies in clinic-reported ‘counselling’ and what this term actually involves within a PAC setting.

The contraceptive prevalence in Nigeria is generally very low in spite of the high rate of sexual activity and widespread awareness of the various contraceptive methods. This study sought to evaluate the Awareness, knowledge, attitude and use of contraceptives and to determine the sources of information on contraception and contraceptives among Niger Delta University staff and students. A 30‑item questionnaire was used to assess the objectives of the study. Data were analyzed using the Statistical Package of Social Sciences (SPSS) version‑16.0. Respectively, 50.5% and 49.5% of respondents were Students and Staff; 52% were unmarried; 65.5% were females; 46% were aged between 15-25 years; and Christianity was the dominant religion. High proportions of respondents (94.5%) were aware of contraceptives and had good knowledge of contraceptive use but only 59% have used contraceptive at a point in their sexual life. The most common method of contraceptive was condom (31%); major reason for...

Η διπλωματική εργασία μεταπτυχιακής ειδίκευσης, η οποία εγκρίθηκε από τη Γενική Συνέλευση του Τμήματος Θεολογίας Α.Π.Θ με το βαθμό «΄Αριστα» το Δεκέμβριο του 1992. Τα δύο πρωτότυπα σημεία στη μελέτη αυτή είναι ο ηθικός σχολιασμός των αντισυλληπτικών μεθόδων και τεχνικών μέσων (β΄κεφάλαιο) και η τυποποίηση των απαντήσεων των ποιμένων για την αντιμετώπιση των θεμάτων της τεκνογονίας και της αντισύλληψης στον ορθόδοξο γάμο (γ΄κεφάλαιο).

Background: In developing countries such as Zambia, couples seldom make decisions with regard to fertility solely in consultation with each other. At all stages of family formation couples are strongly persuaded by cultural and social norms. In additions couples are influenced by opinions and information provided by close friends and relatives in couple's social net works. Social net works play an important role in enabling husbands seeks information with respect to planning births. One drawback of studies on expected fertility in developing countries is that they have not adequately addressed the impact of reproductive decision making on expected fertility. Consequently, though husbands strongly influence fertility decision making, fertility studies do not pay adequate attention to the role played by husbands in fertility decisions making. The objective of this study is to examine the development of a planning process with respect to timing and spacing of children. Methods: The sample for this study consists of husbands from one hundred sixty three households randomly selected from low income communities located in Kitwe, Zambia. Two questionnaires, one for the husband and the other for the wife, were designed to gather data. Husbands and wives were interviewed simultaneously in order to limit opportunities for spouses to influence each other. We examine men's fertility decision making by analyzing data on six questions: Can a couple ever have too many children?; Have you ever talked or received advice from any one about the best length of time to have between pregnancies?; Have you ever talked to or received advice from anyone on methods how to space your children or prevent pregnancy?; Have you and your husband/wife ever talked about the number of sons and daughters you would like to have before stopping?; Have you and your wife ever discussed the best length of time to have between pregnancies and finally, is it costly to have children today? Results: Husbands who engaged in birth planning were more likely than the rest to believe that too many children are undesirable. In Zambia, a rational approach to the control of fertility among birth planers is realized in social settings rather than in isolation. The transition from natural fertility to controlled fertility is associated with modernization and accepting modern values. Knowledge of birth control is also essential and is often associated with increases in education. However, social networks also play an important role in reducing expected family size by facilitating a rational and planned approach to family building in Zambia. Conclusion: Husbands were not averse to sharing information with group members in close social networks to arrive at decisions with respect to planning births. Recognition of the social milieu in which contraceptive use takes place is necessary for the promotion of modern contraception. Husband's social networks significantly influence his fertility decisionmaking. Subsequently, from a policy point of view it appears crucial to facilitate the maintenance of the social networks involved in making contraceptive use decisions to promote prolonged use of modern contraception. The implications for family planning programs are discussed.

Contraceptive counselling is seen as a major part of public health care, maternal and child health care. Therefore, antenatal and postnatal periods are regarded as the appropriate opportunities for women to receive education on contraceptives. However, not much attention has been given to the contents, materials used and frequency of the contraceptive education women receive as this is critical in understanding the contraceptive behaviour of these women. Against this backdrop, this study explores the components of contraceptive counselling postpartum women receive when they attend antenatal and postnatal health care services in order to provide insights into the various contraceptive counselling given to postpartum women who attend antenatal and postnatal clinics. The study uses exploratory methodological approaches, where qualitative data were collected through individual in-depth interviews. Thirty women of the age 20-35 years attending antenatal and postnatal clinics were interviewed at the University of Ghana Hospital and Achimota Hospital. The analysis shows that women were counselled on the direct and indirect benefits of contraceptive uses, the various types of contraceptives and duration of use. The study further found the use of teaching materials such as audio visuals and leaflets during counselling sessions. However, less education was provided on the possible side effects of using contraceptives. The study therefore recommends continuous education on the benefits of contraceptives as well as possible side effects of these contraceptives to achieve higher contraceptive use.

Background:  The global population growth rate is wreaking havoc on a wide array of health, economic, social and personal decisions. However, what may remain lost with other effects and dangers is the detailed impact on sexual reproductive health and rights, for both people in the world and around Uganda. Moreover, the unmet need for family planning has remained high among married women in the country that contributes to unplanned pregnancies.  The WISH2ACTION project uses Public-Private-Partnership working with facilities as a strategy to improved provision of services. We designed this study to evaluate the effectiveness of public-private partnership in the provision of long-acting reversible and permanent family planning methods in WISH2ACTION operation region of Uganda.
Methods: retrospective analysis of data on core Women's Integrated Sexual Health 2 Action Project (WISH2ACTION) indicators; Implants, Intrauterine devices and Permanent Methods and methods provided to youth under 20 years. Data were extracted from RHU DHIS2 and assess for compliance with MANOVA assumptions. The data was further powered to provide an appropriate sample estimation before running the MANOVA model to evaluate the effectiveness of the public-private partnership.
Results: analysed data from 228 associated facilities adequate to accept hypothesis testing based on 177 samples after power estimation. The multivariate analysis of variance (MANOVA) showed significant differences hence we infer that PPP strategy was more effective on long-acting reversible and permanent contraceptives outcome under the WISH2ACTION project and significantly different than that of the NPPP strategy. Post hoc analysis indicates that public-private partnerships strategy positively affects the provision of Implant and provision of FP to under 20 by 76% & 68% respectively.  The findings also indicate that as the modern contraceptives prevalence rate increase, the sample size for such research keeps on reducing to determine whether the unmet need for family planning reached.  However, the strategy did not show any impact on the provision of IUCD and permanent methods.
Conclusions: The study concludes that Public-Private Partnerships associated facilities (PPPF) enabled effective delivery of services to the clients. The existence of a partnership is an opportunity to achieve the goals of reducing limited access to family planning services. Young people have been engaged through dialogue meetings, radio spots, YAM under RHU rallying other young people to demand for SRHR services remains as most vigorous measures. We recommend services Integration in most facilities to improve uptake of IUCD and permanent methods of family palling, which is greatly affected.

The aim of this study is to look at the problem of contraception in the ecumenical context. A special occasion for such reflection is the fiftieth anniversary of the publication by Pope Saint Paul VI the Humanae vitae encyclical on the regulation of birth (1968). It is known that the Catholic Church in its official statements completely differently evaluates the use of contraceptives than the Evangelical Churches. Evangelicals, like other Protestant communities, already in the 1930s accepted contraception as a form of responsible spouses' approach to parenthood. In the Catholic Church, contraceptive methods are treated as wicked, opposed to the morality of a marriage act. The subject of contraception is therefore still a controversial area of ecumenical dialogue. Nevertheless, the statements of some theologians or Catholic bishops referring to the teaching of Pope Francis may perhaps change something in this matter.

Introduction Reduced funding to contraceptive
services in the UK is resulting in restricted access
for women. Pharmacists are already embedded
in sexual and reproductive health (SRH) care in
the UK and could provide an alternative way
for women to access contraception. The aim
of this study was to determine the views of
UK contraception providers about community
pharmacist-led contraception provision.
Methods An anonymous questionnaire was
distributed to healthcare professionals at two
UK SRH events, asking respondents about: (1)
the use of patient group directions (PGDs) for
pharmacist provision of oral contraception (OC);
(2) the sale of OC as a pharmacy medicine or
general sales list medicine; (3) the perceived
impact of pharmacy provision of OC on broader
SRH outcomes; and (4) if other contraceptive
methods should be provided in pharmacies.
Results Of 240 questionnaires distributed,
174 (72.5%) were returned. Respondents
largely supported pharmacy-led provision of
all non-uterine methods of contraception,
excluding the contraceptive implant. Provision
of the progestogen-only pill by PGD was most
strongly supported (78% supported initiation).
Respondents felt that the use of bridging
(temporary) contraception would improve
(103/144, 71.5%), use of effective contraception
would increase (81/141, 57.4%), and
unintended pregnancies would decline (71/130,
54.6%); but that use of long-acting reversible
contraception would decrease (86/143, 60.1%).
Perceived barriers included pharmacists’ capacity
and competency to provide a full contraception
consultation, safeguarding concerns, and
women having to pay for contraception.
Conclusions UK SRH providers were largely
supportive of community pharmacy-led
provision of contraception, with training and
referral pathways being required to support
contraception delivery by pharmacists.

Engelli bireyler, toplumda karşılaştıkları çeşitli durumlar nedeniyle özel bakıma ve desteğe ihtiyacı olan gruplardır. Bundan dolayı sağlık profesyonellerinin toplum sağlığını koruma ve geliştirme kapsamında engelli birey ve ailesinin bakım ve sağlık hizmetlerine yönelik sorunlarının çözümünde kilit rolleri bulunmaktadır. Sağlık profesyonelleri, engelli bireylere bütüncül bakım felsefesi doğrultusunda topluma liderlik ve eğitimci/danışman rollerini ön plana çıkararak farkındalık yaratmalıdır. Bu nedenle özellikle; hemşireler ve ebeler engelli bireylerin üreme sağlığı ve aile planlamasına yönelik problemlerini iyi tanımalı ve bireylere doğrudan iletişime geçmelidirler. Disabled individuals are groups that need special care and support due to various situations they encounter in society. Therefore, health professionals have a key role in solving the problems of the disabled individual and their families regarding care and health services within the scope of protecting and improving public health. Health professionals should raise awareness by emphasizing leadership and educator/counselor roles in the society in line with the philosophy of holistic care for people with disabilities. Therefore, especially; Nurses and midwives should know the reproductive health and family planning problems of individuals with disabilities and should communicate directly with individuals.

Background: Oral Contraceptive Pills (OCPs) are the most widely prescribed form of hormonal contraception both in developed and developing countries. They are also the most popular nonsurgical method of contraception. Objective: To determine the prevalence rate and socio-demographic characteristics of oral contraceptive pills acceptors at the Rivers State University Teaching Hospital (RSUTH), Port Harcourt. Methods: A 10 year review of all clients who accepted oral contraceptive pills in the family planning clinic of the hospital from 1 st January, 2008 to 31 st December, 2017. Data was extracted, coded and analyzed using the Statistical Package for Social Sciences (SPSS) IBM version 25.0 (Armonk, NY). Results: There were 1893 contraceptive acceptors during the study period, out of which 86 (4.5%) accepted the oral pills. Majority of the clients 66 (76.8%) were between the age range of 20 to 34,

Abstract
Objective: To describe subdermal implant use in Mexico over time, by state and by
age.
Methods: We conducted a repeated cross-sectional study using the 2009, 2014, and
2018 waves of the National Survey of Demographic Dynamics (Encuesta Nacional de
la Dinámica Demográfica [ENADID]). Our outcome was current use of contraception,
by type, with a focus on the implant. We used visualizations, descriptive and bivariate
statistics, and multinomial models to assess change over time, geographic patterns,
method mix, and factors associated with implant use (vs intrauterine device [IUD] or
other hormonal methods).
Results: Implant use is increasing over time in Mexico, from 1.1% of women who have
ever used a method in 2009 to 4.5% in 2018 (P < 0.001); the change is greatest among
adolescents (2.5% in 2009 to 12.2% in 2018; P < 0.001). Change in implant use as a
fraction of modern method use was heterogeneous across Mexican states. The adjusted relative likelihood of using an implant compared with IUD was 34% higher for
adolescents compared with women aged 20–29 years (relative risk ratio 1.34, 95%
confidence interval 1.16–1.55, P < 0.001), controlling for other variables in the model.
Conclusion: Use of subdermal implants is increasing over time in Mexico and is concentrated among adolescents. Implants have the potential to expand access to highly
effective contraception in Mexico.
KEYWORDS
adolescents, contraception, Mexico, subdermal implant

The contraceptive prevalence in Nigeria is generally very low in spite of the high rate of sexual activity and widespread awareness of the various contraceptive methods. This study sought to evaluate the Awareness, knowledge, attitude and use of contraceptives and to determine the sources of information on contraception and contraceptives among Niger Delta University staff and students. A 30-item questionnaire was used to assess the objectives of the study. Data were analyzed using the Statistical Package of Social Sciences (SPSS) version-16.0. Respectively, 50.5% and 49.5% of respondents were Students and Staff; 52% were unmarried; 65.5% were females; 46% were aged between 15-25 years; and Christianity was the dominant religion. High proportions of respondents (94.5%) were aware of contraceptives and had good knowledge of contraceptive use but only 59% have used contraceptive at a point in their sexual life. The most common method of contraceptive was condom (31%); major reason for...

Background:  The global population growth rate is wreaking havoc on a wide array of health, economic, social and personal decisions. However, what may remain lost with other effects and dangers is the detailed impact on sexual reproductive health and rights, for both people in the world and around Uganda. Moreover, the unmet need for family planning has remained high among married women in the country that contributes to unplanned pregnancies.  The WISH2ACTION project uses Public-Private-Partnership working with facilities as a strategy to improved provision of services. We designed this study to evaluate the effectiveness of public-private partnership in the provision of long-acting reversible and permanent family planning methods in WISH2ACTION operation region of Uganda.
Methods: retrospective analysis of data on core Women's Integrated Sexual Health 2 Action Project (WISH2ACTION) indicators; Implants, Intrauterine devices and Permanent Methods and methods provided to youth under 20 years. Data were extracted from RHU DHIS2 and assess for compliance with MANOVA assumptions. The data was further powered to provide an appropriate sample estimation before running the MANOVA model to evaluate the effectiveness of the public-private partnership.
Results: analysed data from 228 associated facilities adequate to accept hypothesis testing based on 177 samples after power estimation. The multivariate analysis of variance (MANOVA) showed significant differences hence we infer that PPP strategy was more effective on long-acting reversible and permanent contraceptives outcome under the WISH2ACTION project and significantly different than that of the NPPP strategy. Post hoc analysis indicates that public-private partnerships strategy positively affects the provision of Implant and provision of FP to under 20 by 76% & 68% respectively.  The findings also indicate that as the modern contraceptives prevalence rate increase, the sample size for such research keeps on reducing to determine whether the unmet need for family planning reached.  However, the strategy did not show any impact on the provision of IUCD and permanent methods.
Conclusions: The study concludes that Public-Private Partnerships associated facilities (PPPF) enabled effective delivery of services to the clients. The existence of a partnership is an opportunity to achieve the goals of reducing limited access to family planning services. Young people have been engaged through dialogue meetings, radio spots, YAM under RHU rallying other young people to demand SRHR services remains as a most vigorous measure. We recommend services Integration in most facilities to improve uptake of IUCD and permanent methods of family palling, which is greatly affected.

Despite widespread knowledge of family planning among the tribal population, the contraceptive prevalence is dismal. The present study is an attempt to examine the prevalence and determinants of contraception use in the Northeastern states of India. Methods: We have utilized the fourth round of the National Family Health Survey (NFHS-4, 2015-16) dataset. The final sample size used in the present study is 65,941 women aged 15-49 years. Bivariate and multivariate techniques have been used. This study used the Chi-square test to confirm the relationship between variables for a robust multivariable model. Results: Despite widespread knowledge about contraception across Northeastern states, only 35% of women used modern contraception. The Pill is the most commonly preferred contraception among tribal and non-tribal women. About 60% of tribal women were not using any contraceptives as against 48% of non-tribal women. Tribal women in the age group 20-24, 25-29, and 30-34 are about two times more likely to use any methods of contraception than tribal women in the age group 15-19. Conclusion The study indicates that having extensive knowledge about family planning does not promote the use of contraception. Family planning is crucial, and subsequent efforts are needed to improve access and strengthen the health system to cater to the unmet need for family planning. There is also a need to prioritize Information, Education, and Communication (IEC) activities among tribal women. Since settlements are scattered over the vast area in northeastern states, there is a need to have strategies that allow easy access to contraception among tribal and non-tribal women.

This paper was presented at the Conference on Communication, Mass Media and Development, Northwestern University, October 13-15, 1983. 

A model of the interrelationship between socioeconomic status, knowledge, communication, and behavior (contraceptive use) was developed, and the model was tested using Egyptian data derived from 4 fertility surveys, the 1980 Communication Baseline Survey, and a 1982 communication follow-up survey. In the model, knowledge is treated as an independent variable which influences behavior. The model assumes that during the development process, the knowledge levels of different socioeconomic groups in the population increasingly diverges due to differences in access and exposure to information. As development proceeds, the higher socioeconomic groups are exposed to and accumulate knowledge at an ever increasing rate, and the knowledge gap between the socioeconomic groups increases. Since knowledge influences behavior, the gap in behavior between socioeconomic groups also increases. Intervening variables which influence the relationship between knowledge and behavior are 1) demographic factors, 2) convenience factors, 3) norms, and 4) attitudes. Norms and attitudes can be influenced by communication strategies. The model can resolve the conflict between those who advocate development and those who advocate family planning as the most feasible mechanism for reducing fertility. Both groups ignore the vital role of knowledge and communication. Differences in behavior, i.e., contraceptive use, are associated with differences in socioeconomic status. These socioeconomic behavioral differences are, in reality, a product of differences in knowledge. If the knowledge gap is lessened through appropriate communication strategies, the behavior gap will also decrease. In Egypt, fertility survey data indicates that differences in contraceptive acceptance are clearly associated with demographic and socioeconomic differences. High status groups are more likely to use family planning than low status groups. The communication surveys also confirm that there are marked differences in media exposure and access for different socioeconomic status groups. To test the model, a contraceptive knowledge index was developed. Discriminant analysis was used to assess the relative power of knowledge, compared to other factors, to explain differences in contraceptive current and ever use. The other factors were socioeconomic status, attitudes, convenience (availability and affordability of contraceptives), and whether a couple had at least 1 child. The latter factor was a social norm variable. In Egypt, a couple is not expected to contracept until they have at least 1 child. Analysis revealed that attitude and convenience were weak predictors of contraceptive behavior. Socioeconomic status was also a weak predictor when the effects of the other variables were taken into account. Knowledge along with the intervening social norm variable was by far the best predictor of contraceptive use. Egypt's family planning communication program, conducted between 1980-82, was a failure. The follow-up survey found that only 44% of the population was aware of any of the 4 messages communicated in the program, and that the program failed to reach those most in need of information, i.e, the illiterate, low income groups, and rural residents. The communication program widened rather than lessened the knowledge gap. The failure was due to the communication strategy used in the program. For example, ads were placed in elite newpapers, radio and television ads were presented in classical Arabic, and radio ads were run between programs with elite appeal. In the future, communication programs should take into account the media habits of the target audiences, tailor messages to the target group rather than to decision makers and funding groups, and develop simple and easily understood messages.

Levonorgestrel (LNG), a progestin widely used for regular hormonal contraception, is also used for emergency contraception (EC) to prevent pregnancy after unprotected intercourse. However, its mode of action in EC is only partially understood. One unresolved question is whether or not EC prevents pregnancy by interfering with postfertilization events. Here, we report the effects of acute treatment with LNG upon ovulation, fertilization and implantation in the rat. LNG inhibited ovulation totally or partially, depending on the timing of treatment and/or total dose administered, whereas it had no effect on fertilization or implantation when it was administered shortly before or after mating, or before implantation. It is concluded that acute postcoital administration of LNG at doses several-fold higher than those used for EC in women, which are able to inhibit Ovulation, had no postfertilization effect that impairs fertility in the rat.

Despite the launching of a family planning programme in Ghana about 5 decades ago, the country’s family planning prevalence rate remains relatively low and its total fertility rate is still considerably high compared with other African countries. One of the factors that may contribute to the low family planning prevalence rate and thus the slow fertility decline in Ghana is the perception of family planning use among married men and women in Ghana. This study sought to examine the perception of family planning use among married men and women at Anomabu community in the Mfantseman Municipality of the Central Region of Ghana. Data were collected among married men and women who were in their reproductive ages (15-49 years). Questionnaires were administered to 200 randomly selected respondents. The data collected were analyzed with Statistical Product and Service Solution (SPSS) software version 21 and presented using graphs and tables. The results revealed that 82.5% of the respondents...

Making universal access to sexual and reproductive health care a reality, and thus building momentum for comprehensive family planning by 2030, is key for achieving sustainable development goals. However, in the last decade, India has been retreating from progress achieved in access to family planning. Family planning progress for a large country such as India is critical for achieving sustainable developmental goals. Against this backdrop, the paper investigated the question of how far family welfare expenditure affects contraceptive use, sources of contraceptive methods, and method-mix using triangulation of micro and macro data analyses. Our findings suggest that, except for female sterilizations, modern methods of contraception do not show a positive relationship with family welfare expenditure. Notwithstanding a rise in overall family welfare expenditure, spending on core family planning programs stagnates. State-wise and socio-economic heterogeneity in source-mix and method-mi...

Making universal access to sexual and reproductive health care a reality, and thus building momentum for comprehensive family planning by 2030, is key for achieving sustainable development goals. However, in the last decade, India has been retreating from progress achieved in access to family planning. Family planning progress for a large country such as India is critical for achieving sustainable developmental goals. Against this backdrop, the paper investigated the question of how far family welfare expenditure affects contraceptive use, sources of contraceptive methods, and method-mix using triangulation of micro and macro data analyses. Our findings suggest that, except for female sterilizations, modern methods of contraception do not show a positive relationship with family welfare expenditure. Notwithstanding a rise in overall family welfare expenditure, spending on core family planning programs stagnates. State-wise and socio-economic heterogeneity in source-mix and method-mi...

Making universal access to sexual and reproductive health care a reality, and thus building momentum for comprehensive family planning by 2030, is key for achieving sustainable development goals. However, in the last decade, India has been retreating from progress achieved in access to family planning. Family planning progress for a large country such as India is critical for achieving sustainable developmental goals. Against this backdrop, the paper investigated the question of how far family welfare expenditure affects contraceptive use, sources of contraceptive methods, and method-mix using triangulation of micro and macro data analyses. Our findings suggest that, except for female sterilizations, modern methods of contraception do not show a positive relationship with family welfare expenditure. Notwithstanding a rise in overall family welfare expenditure, spending on core family planning programs stagnates. State-wise and socio-economic heterogeneity in source-mix and method-mix continued to influence contraceptive access in India. Method-mix continued to skew towards female sterilization. Public sector access is helpful only for promoting female sterilization. Thus, the source-mix for modern contraceptives presents a clear public-private divide. Over time, access to all contraceptive methods by public sources declined while the private sector has failed to fill the gap. In conclusion, this study identified a need for revitalizing family planning programs to promote spacing methods in relatively lower-performing states and socio-economic groups to increase overall contraceptive access and use in India through the rise in core family planning expenditure.
Keywords: contraceptive use; family welfare expenditure; sources of contraception; method-mix; India

Introduction: Harmful use of alcohol result in 3 million people die each year, which means 5.3% of all deaths worldwide. Alcohol has a contribution on the global burden of disease and injury which accounts approximately 5.1 per cent of the disability-adjusted life years (DALYs), and approximately 13.5 per cent of the total deaths in the age group 20-39 years were caused by alcohol consumption. Objectives: To understand the changes and differentials in alcohol consumption in India and its states, and to examine the determinants of alcohol consumption in India. Data Source and Methodology: The present study has used the national representative Indian Human Development Surveys (IHDS) I (2004-05) and II (2011-12). Bivariate analysis was used to show the prevalence of alcohol consumption concerning some selected socioeconomic and demographic background variables. The Chi-square and multivariate logistic regressions were also employed to estimate the odds ratio (95% CI) for alcohol consumption. STATA and Arc GIS 10.1 software were employed to carry out the analyses. Findings: The alcohol consumption was two per cent higher in 2004-05 (37%) than the recent survey of IHDS (2011-12) (35%) in India. In addition to that, there were some states where the consumption of alcohol had increased from 2004 to 2012 like Mizoram (44%), Kerala (19%), and Jammu and Kashmir (16%). In contrary to that, there were also a few states where alcohol consumption had decreased from 2004 to 2012 like Rajasthan (8%) and Tamil Nadu (5%).

In recent times, the showcasing of professional ethical standards at workplaces has become an imperative issue of interest in almost all professions including the health profession in general and nursing. This study investigated patient's knowledge and perception of patients on Nurses' adherence to their professional codes of ethics in Ghana, using Eastern Regional Hospital, Koforidua as a case study. A Cross-sectional survey was conducted among 400 patients at the Eastern Regional Hospital, Koforidua using a simple random sampling in selecting participants. A structured questionnaire was used to collect data from the participants. Females (64.8%) dominated the study and a Majority (68.5%) of respondents were between the ages of 21-40 years. Most of the respondents (83.2%) did not have any knowledge about nurses' professional code of ethics. The majority (59.8%) of patients agreed nurses do not introduce themselves with their name, title and professional role to patients. However, most of the respondents (60.3%) agreed that nurses carried out all nursing interventions and procedures with respect to preserving the patient's dignity. The respondents indicated that majority of nurses (78.5%) did not discriminate in attending to patients. Most nurses (66.0%) obtained the consent of the patient before any nursing intervention is performed. Majority of patients (83.3%) do not have knowledge of the nurses' professional code of ethics in Ghana. Ghanaians need to be sensitized on professional ethics of nurse to understand and know what is expected of nurses so they can be able to put nurses in check.

Introduction: Harmful use of alcohol result in 3 million people die each year, which means 5.3% of all deaths worldwide. Alcohol has a contribution on the global burden of disease and injury which accounts approximately 5.1 per cent of the disability-adjusted life years (DALYs), and approximately 13.5 per cent of the total deaths in the age group 20-39 years were caused by alcohol consumption. Objectives: To understand the changes and differentials in alcohol consumption in India and its states, and to examine the determinants of alcohol consumption in India. Data Source and Methodology: The present study has used the national representative Indian Human Development Surveys (IHDS) I (2004-05) and II (2011-12). Bivariate analysis was used to show the prevalence of alcohol consumption concerning some selected socioeconomic and demographic background variables. The Chi-square and multivariate logistic regressions were also employed to estimate the odds ratio (95% CI) for alcohol consumption. STATA and Arc GIS 10.1 software were employed to carry out the analyses. Findings: The alcohol consumption was two per cent higher in 2004-05 (37%) than the recent survey of IHDS (2011-12) (35%) in India. In addition to that, there were some states where the consumption of alcohol had increased from 2004 to 2012 like Mizoram (44%), Kerala (19%), and Jammu and Kashmir (16%). In contrary to that, there were also a few states where alcohol consumption had decreased from 2004 to 2012 like Rajasthan (8%) and Tamil Nadu (5%).

OBJECTIVE The purpose of this study is to describe subdermal implant use in Mexico over time, by state, and by age. METHODS We conducted a repeated cross-sectional study using the 2009, 2014, and 2018 waves of the National Survey of Demographic Dynamics (ENADID). Our outcome was current use of contraception, by type, with a focus on the implant. We used visualizations, descriptive and bivariate statistics, and multinomial models to assess change over time, geographic patterns, method mix, and factors associated with implant use (vs. IUD or other hormonal methods). RESULTS Implant use is increasing over time in Mexico, from 1.1% of women who have ever used a method in 2009 to 4.5% in 2018 (p&lt;0.001); the change is greatest among adolescents (2.5% in 2009 to 12.2% in 2018; p&lt;0.001). Change in implant use as a fraction of modern method use was heterogeneous across Mexican states. The adjusted relative likelihood of using an implant compared to IUD was 34% higher for adolescents compared to women 20 to 29 years old (RRR 1.34, 95%CI 1.16-1.55 p&lt;0.001), controlling for other variables in the model. CONCLUSION Use of subdermal implants is increasing over time in Mexico and is concentrated among adolescents. Implants have the potential to expand access to highly effective contraception in Mexico.

Background: Mass media plays an important role in information dissemination in Nigeria and studies have shown that the interrelationship that exists between reproductive health behaviour and mass media campaigns on the use of modern contraceptives have resulted in the improvement of reproductive health outcomes. There is a need to examine the differentials in mass

"Il "laboratorio portoricano" si riconferma un luogo denso di significato per le relazioni interamericane, e sullo scenario globale, anche per il ruolo giocato nella creazione della pillola che milioni di donne oggi utilizzano per evitare gravidanze indesiderate. Nei primi anni Cinquanta costituisce infatti uno dei principali teatri di sperimentazione di Enovid" (p. 125). 1 El magnífico trabajo de investigación de Benedetta Calandra, historiadora italiana y profesora de Historia de América Latina en la Universidad de Bérgamo, resulta un so-bresaliente material que contribuye en profundizar líneas de investigación recientemente exploradas en los procesos de intercambio cultural, cientifico, eidético y político en la historia de las relaciones entre Estados Unidos y América Latina durante el siglo XX. ¿Es Puerto Rico una colonia estadounidense, dentro de un mundo postcolonial? La obra de la profesora Calandra problematiza una cuestión histórica elemental en la vinculación interamericana, que a propósito del caso puertorriqueño deja en evidencia múltiples contradicciones en los lineamientos de la política exterior de Washington no únicamente hacia la isla del Caribe, sino que también frente a la región latinoamericana. La investigación de Calandra ahonda en esta interrogante con eminente agudeza analítica, ofreciendo una mirada novedosa y concreta, circunscrita directamente a los cuerpos fe-meninos: las políticas de reproducción en Puerto Rico entre 1898 y 1993, y la influencia norteamericana en el proceso histórico de contexo. Desde su primer capítulo, la investigación da cuenta cómo el status semicolonial en la isla, heredado de la matriz de identidad latina, mestiza y católica, experimenta un foco de tensión con su vecino gigante, liberal y anglosajón, que proveerá las pautas para un esquema de modernización, confeccionado bajo medidas hegemónicas pro capitalista. 1 El "laboratorio puertorriqueño" se confirma como un lugar lleno de significado para las relaciones interamericanas, y para el escenario global, también por el papel desempeñado en la creación de la píldora que millones de mujeres usan hoy para evitar embarazos no deseados. A principios de la década de 1950, fue uno de los principales teatros experimentales de Enovid (...).

On May 22, 2006, the State of Wisconsin submitted a Citizen Petition with the Food and Drug Administration (FDA) and, on July 24, 2006, submitted a Supplement to that Petition. The State of Wisconsin sought a switch of Plan B®, an emergency contraceptive drug approved in 1999 for sale and use on a prescription basis, to over-the-counter status and a similar switch regarding any drugs equivalent to Plan B® from prescription. The State of Wisconsin, based on relevant scientific research cited in those submissions, sought that switch to OTC status for all menarchal women regardless of age. Eight years later, in the Tummino case filed in the US District Court for the Eastern District of New York, FDA was ordered to make a successor to Plan B® (Plan B® One-Step) available over-the-counter without any age restrictions.

Catholic Women Speak is an anthology of essays on women and family life that asks questions and explores issues that do not find space for open discussion in the Church. The writers are women who represent a broad international perspective and come from a variety of personal backgrounds who believe that the Church cannot come to a wise and informed understanding of family life without listening to women. "Pope Francis has repeatedly said that he wants a "messy" Church, a Church that is not afraid to take risks in order to live the joyous adventure of faith. This book expresses the messy realities of women's lives, realities that challenge the Church's current practice in many ways, realities that the Church must acknowledge in order to communicate the Gospel to future generations.

Among the contributors, who represent a rich diversity and complexity of Catholic women's lives, are: Tina Beattie, Lisa Sowle Cahill, Ursula King, Margaret A. Farley, Christine Schenk and Elizabeth Johnson