Including Family Planning Research Articles

Mother and child health care in Kabul, Afghanistan with focus on the mother: women's own perspective.

The study examined the pattern of utilization of Maternal and Child Health (MCH)-services of women with child-bearing experience in a suburb of city Kabul. A semi-structured questionnaire administered to 100 women in the community and 40 in the maternal hospital. Interviews and observations in the local MCH-clinic were used to collect the relevant information. Sixty one of the 100 women in the community delivered at home exclusively, 35 having experienced both home and institutional deliveries, four women had hospital childbirths only. Approximately half of the women decided about utilizing the modern MCH services themselves. Women valued in the MCH-clinic mainly medical care and vaccinations. Delivery was seen primarily as a technical event, but when probed more deeply it was obvious, that fear of death was the driving power for decisions made. With at-home deliveries female relatives were preferred as birth assistants. If outside assistance was required, trained midwives were preferred rather than traditional birth attendants. Institutional delivery was seen as the last resource for complicated deliveries, but was also esteemed by many because of the security and cleaness. Professional skill, but also empathy and justice were appreciated in professionals. Promoting rooming-in and early breast feeding in the maternity wards, ongoing education of the MCH-staff about communication skills, ethics and teaching methods, dialogue with decision makers on all levels in the society about MCH including family planning, ongoing training and support of community midwives (dayas) in the community by local MCH-staff, adequate supplies, inexpensive services, incentive money for the competent staff members are recommended.

El embarazo no deseado: impacto sobre la salud y la sociedad en América Latina y el Caribe

Engaging in sexuality and reproduction should always be something that is wanted and planned. Unfortunately, when that is not the case, one result can be unwanted pregnancy. Unwanted pregnancies have consequences for women, their families, and their countries. This document reviews the causes and results of unwanted pregnancy, emphasizing the impact that this problem has on Latin America and the Caribbean (LAC). Four reasons why unwanted pregnancy is a continuing problem in LAC are: 1) people's growing desire to have smaller families, 2) the unmet need for family planning, 3) the fact that contraceptive methods are not 100% effective, and 4) unwanted sexual relations. Unwanted pregnancies especially affect adolescent women, single women, and women over 40 years of age. Given their desperate situation with an unwanted pregnancy, some women opt for an unsafe abortion, which can lead to their death. Other women can go so far as to commit suicide, or be murdered by a family member or other person who is unhappy that the pregnancy has occurred. It has been found that women who decide to continue with the pregnancy have higher risks of suffering an illness, and the same is true for the child. Reducing unwanted pregnancies and treating post-abortion complications are key to lowering maternal mortality and morbidity. This necessitates developing mass communication programs that address gender issues, education programs for girls, and sex education programs. It is also vital to make available to all persons reproductive health services that include family planning methods. In the countries of LAC with laws that specify grounds for legally ending a pregnancy, it is necessary that health care be organized to actually provide this service, and that health care programs obtain the safest, most effective technologies now available for ending a pregnancy.

Rating maternal and neonatal health services in developing countries.

To assess maternal and neonatal health services in 49 developing countries. The services were rated on a scale of 0 to 100 by 10 - 25 experts in each country. The ratings covered emergency and routine services, including family planning, at health centres and district hospitals, access to these services for both rural and urban women, the likelihood that women would receive particular forms of antenatal and delivery care, and supporting elements of programmes such as policy, resources, monitoring, health promotion and training. The average rating was only 56, but countries varied widely, especially in access to services in rural areas. Comparatively good ratings were reported for immunization services, aspects of antenatal care and counselling on breast feeding. Ratings were particularly weak for emergency obstetric care in rural areas, safe abortion and HIV counselling. Maternal health programme effort in developing countries is seriously deficient, particularly in rural areas. Rural women are disadvantaged in many respects, but especially regarding the treatment of emergency obstetric conditions. Both rural and urban women receive inadequate HIV counselling and testing and have quite limited access to safe abortion. Improving services requires moving beyond policy reform to strengthening implementation of services and to better staff training and health promotion. Increased financing is only part of the solution.

Safe Abortion: A Right for Refugees?

Thanks to initiatives since 1994, most reproductive health programmes for refugee women now include family planning and safe delivery care. Emergency contraception and post-abortion care for complications of unsafe abortion are recommended, but provision of these services has lagged behind, while services for women who wish to terminate an unwanted pregnancy are almost non-existent. Given conditions in refugee settings, including high levels of sexual violence, unwanted pregnancies are of particular concern. Yet the extent of need for abortion services among refugee women remains undocumented. UNFPA estimates that 25–50% of maternal deaths in refugee settings are due to complications of unsafe abortion. Barriers to providing abortion services may include internal and external political pressure, legal restrictions, or the religious affiliation of service providers. Women too may be pressured to continue pregnancies and are often unable to express their needs or assert their rights. Abortion advocacy efforts should highlight the specific needs of refugee women and encourage provision of services where abortion is legally indicated, especially in cases of rape or incest, and risk to a woman's physical and mental health. Implementation of existing guidelines on reducing the occurrence and consequences of sexual violence in refugee settings is also important. Including refugee women in international campaigns for expanded access to safe abortion is critical in addressing the specific needs of this population.RésuméGrâce à des initiatives menées depuis 1994, la plupart des programmes de santé génésique pour réfugiées incluent désormais la planification familiale et les soins obstétriques. La contraception d'urgence et le traitement des complications d'avortements non encadrés sont recommandés, mais ces services tardent à venir, alors que les services pour les femmes souhaitant interrompre une grossesse non désirée sont presque inexistants. Compte tenu des conditions de vie des réfugiés, notamment les niveaux élevés de violence sexuelle, les grossesses non désirées sont particulièrement préoccupantes. Pourtant, on n'a pas évalué le besoin de services d'avortement chez les réfugiées. Le FNUAP estime que dans les sites de réfugiés, 25–50% des décès maternels sont dus aux complications d'avortements non encadrés. Les obstacles aux services d'avortement incluent des pressions politiques internes et externes, des restrictions juridiques ou l'appartenance religieuse des prestataires de services. Les femmes sont aussi incitées à poursuivre leur grossesse et se révèlent souvent incapables d'exprimer leurs besoins ou de faire respecter leurs droits. Les efforts en faveur de l'avortement doivent cerner les besoins des réfugiées et encourager la prestation de services quand l'avortement est juridiquement indiqué, particulièrement en cas de viol ou d'inceste, et de risque pour la santé physique ou mentale de la femme. L'application des directives sur la réduction de la violence sexuelle et de ses conséquences dans les sites de réfugiés est également importante. Pour satisfaire les besoins des réfugiées, il est essentiel de les associer aux campagnes internationales prônant un accès élargi à un avortement sûr.ResumenGracias a iniciativas impulsadas desde 1994, la mayorı́a a de los programas de salud reproductiva para mujeres refugiadas incluyen la planificación familiar y la atención al parto. Para las complicaciones de abortos practicados en condiciones de riesgo se recomiendan la anticoncepción de emergencia y la atención post-aborto, pero la provisión de estos servicios ha quedado rezagada mientras que los servicios para las mujeres que quieren terminar un embarazo no deseado a penas existen. Dadas las condiciones en que se encuentran las refugiadas, donde los niveles de violencia sexual suelen ser altos, los embarazos no deseados son especialmente preocupantes. Sin embargo no está documentada la demanda de servicios de aborto entre mujeres refugiadas. FNUAP calcula que entre el 25 y el 50 por ciento de las muertes maternas de refugiadas se debe a las complicaciones de abortos inseguros. La provisión de servicios de aborto puede estar obstaculizada por presiones polı́ticas internas y externas, restricciones legales, o la afiliación religiosa de los proveedores de dichos servicios. Las mujeres pueden estar presionadas para continuar sus embarazos sin poder expresar sus necesidades ni exigir que se les respeten sus derechos. Al promover la disponibilidad de servicios de aborto sin riesgo se debe hacer hincapié en las necesidades especı́ficas de las mujeres refugiadas e impulsar la provisión de dichos servicios en las circunstancias en que el aborto esté legalmente indicado, especialmente en casos de violación e incesto, y riesgo de daños a la salud fı́sica y mental de la mujer. Es igualmente importante implementar las pautas existentes para reducir tanto la violencia sexual a que estén expuestas las refugiadas como sus consecuencias. Al abordar las necesidades especı́ficas de esta población, es preciso incluir a mujeres refugiadas en las campañas internacionales a favor de ampliar el acceso al aborto seguro.

Disobedient Distributors: Street‐level Bureaucrats and Would‐be Patrons in Community‐based Family Planning Programs in Rural Kenya

The implementation of social welfare programs, including family planning programs, is strongly conditioned by the needs, desires, and agendas of those who carry them out, known as "street-level bureaucrats." In this study, the strategies of CBD agents in western Kenya are examined in order to understand how they use their job as a means to achieve their own personal goals. The concept of clientelism, borrowed from the field of political science, can help to explain what the CBD agents are trying to achieve for themselves in their communities, at the same time as they promote the use of contraceptive pills and injections. CBD agents are concerned with building up their own stocks of prestige and respect from their community members, while avoiding blame for any possible negative outcomes of family planning.

Family Planning Programs and National Prosperity

David E. Bloom and David Canning's Policy Forum “The health and wealth of nations” (18 Feb., p. [1207][1]) does a commendable job of characterizing the feedback loop connecting positive public health outcomes and economic growth. The authors, however, do not include a critical component of this loop that has, all too often, been underfunded or excluded from primary healthcare clinics: reproductive health services including family planning. More than half of Bloom and Canning's Policy Forum is devoted to aspects of productivity growth that researchers have determined to be related to declining fertility and managed birth spacing. Among these reproduction-related economic benefits are the accumulation of savings, improved maternal and child health, and the benefits of elevated ratios of working-age adults to dependent children (the “demographic dividend”). The authors appear to credit antibiotics and improved sanitation for paving the way for the East Asian economic “miracle,” although these were not unusual interventions in developing countries during the second half of the 20th century. Yet they do not mention a more distinctive and relevant intervention: the unparalleled mobilization of and the millions of dollars of investment in voluntary family planning services that occurred in these countries in the late 1960s and 1970s ([1][2], [2][3]). Much of this investment was assisted by foreign aid programs in the United States and other industrialized-country governments. Few policymakers would object to improving sanitation, water treatment, or vaccination. Reproductive health programs, despite their importance to reducing maternal mortality and slowing both population growth and the onslaught of HIV/AIDS, still face religious and political opposition in many countries, including the United States. During every budget cycle, some members of Congress attempt to eliminate U.S. assistance to international family planning programs. Congress has cut this program's budget by 35% from 1994 levels, in the face of increasing worldwide demand for such assistance. The population of women and men of reproductive age is growing rapidly, and higher proportions of this population seek reproductive health services. Scientific evidence of these programs' contribution to economic development is mounting, but the political will needed to maintain them is fragile and now waning. It is critical that demographers and economists give family planning and reproductive health programs the credit they deserve when discussing the connections between the health and wealth of nations. 1. [↵][4]1. A. O. Tsui , “Family planning programs in Asia: approaching a half-century of effort” (Asia-Pacific Population Research Reports, East-West Center, Honolulu, HI, 1996). 2. [↵][5] Emerging Asia: Changes and Challenges (Asian Development Bank, Manila, 1997). # Response {#article-title-2} Coen and Cincotta are right to emphasize the important role of family planning programs in the demographic transition. We are well aware of its importance and noted so in our Policy Forum (indeed, one of us was a principal author of the “Emerging Asia” report Coen and Cincotta cite in support of their argument). But we believe that general health deserves more emphasis than reproductive health and family planning, because it was the trigger mechanism that set off cumulative economic development; family planning entered the picture at a later stage of development, when desired fertility began to decrease. For example, desired and actual fertility in Africa are generally close in magnitude, so the availability of contraceptives is not at present the decisive issue. Later in the development process, however, family planning does become crucial, as it was in the East Asia “miracle” and is now in South Asia. [1]: /lookup/doi/10.1126/science.287.5456.1207 [2]: #ref-1 [3]: #ref-2 [4]: #xref-ref-1-1 View reference 1 in text [5]: #xref-ref-2-1 View reference 2 in text

Remembrance of Things Past: "Les Silences du palais" by Moufida Tlatli

head of the Tunisian Office of the Family and Women, explains that women in Tunisia enjoy many rights, including family planning and education. A succession of progressive presidents and governments have put in place policies which have enabled women to have access to professions traditionally reserved for men, such as judge, policeman, or pilot.' Moufida Tlatli is the product of this society. After she graduated in 1968 from the Institut des hautes etudes du cinema (IDHEC, the Paris film school), she became a script supervisor, then film editor, and finally was able to make her own film. This was possible not only because of her training and experience, but also because the Tunisian film industry is very active and successful. Directors such as Ali Alidy, Fdrid Boughedri, and Nouri Nouzid are respected and admired; Moufida Tlatli is part of this dynamic Tunisian cinematic scene.' Les Silences du palais (Silences of the Palace, 1994) was awarded Special Mention by the Jury at the Cannes Festival in 1994. Given Tlatli's identity and gender a number of interconnected questions come to mind. What are the messages that Tlatli, as a post-colonial subject from North Africa, conveys in her film? In what ways does her Arabness have an impact on the film? To whom is she addressing her film? How does she position her spectators? I will argue that in exploring the intersection of class, gender, and history in 1950s and 1960s Tunisia, Tlatli addresses men and women in both the Arab world and the Western world in 1994; and her message is still relevant today. In other words, Tlatli re-presents the past in order to create awareness about the present.

The BJOG— same journal, new name

The <i>BJOG</i>— same journal, new name

The intrauterine device and its dynamics.

In the past decade, attention has shifted from family planning (often made available through population programs) to reproductive health--a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters related to the reproductive system and its function and processes. Reproductive health has three components: the ability to procreate, regulate fertility and enjoy sex; the successful outcome of pregnancy through infant and child survival and growth; and the safety of the reproductive process. According to Mitchell et al., the following are key elements in a reproductive health program: (a) Family planning services that offer complete and accurate information about all contraceptive methods and that make contraceptive services, supplies and counseling accessible. (b) Antenatal care, which research suggests lowers rates of maternal mortality. (c) Safe delivery services, so that all women deliver under some type of supervised care and so that referral systems are established to provide emergency treatment of life-threatening complications of delivery. (d) Postnatal care that contributes to a woman's ability to have a speedy and complete recovery from the stress of pregnancy and childbirth, to enjoy sexual relations without pain and to have safe pregnancies and deliveries in the future. (e) Management of the complications of abortion where safe abortions are not available. (f) Infertility services that enable women to achieve their reproductive goals; and effective screening for or control of reproductive tract infections (RTIs), because RTIs are the most common preventable cause of involuntary infertility and ectopic pregnancy, as well as of chronic pelvic pain and recurrent infection. (g) Management and treatment of systemic sexually transmitted diseases (STDs), such as HIV and hepatitis B. (h) Symptomatic treatment of urinary tract infections. (i) Detection and treatment of breast and reproductive tract cancers, such as cervical cancer. (j) Attention to and treatment of dysmenorhea, which in some cases is the first sign of other problems, such as pelvic inflammatory disease, endometriosis, fibroids, endometrial cancer and ectopic pregnancy. (k) Nutritional supplementation to meet the special needs of adolescents, pregnant or lactating women, and women older than 50 years. (1) Services for menopause and other health problems that women encounter as they grow older. (m) Services for adolescents, including family planning and STD prevention and treatment. It shall be clear that many institutions delivering reproductive health services operate significantly below their physical capacity to see clients, and that much of the equipment required for expanding reproductive health services may already be available for use in family planning and other health services. In this context, we would therefore like to discuss the dynamics of IUDs.

Hepatitis B vaccination of adolescent and adult high-risk groups in the United States

Substantial progress has been made in implementing routine infant hepatitis B vaccination in the United States. However, in 1996, an estimated 65 000 acute hepatitis B cases occurred, the majority of which were among young adults in high-risk groups. Recent surveys have found very low vaccination coverage among several high-risk groups, including men who have sex with men and patients with sexually transmitted diseases (STDs). Targeted vaccination of persons with risk factors for hepatitis B virus (HBV) infection can be provided in a variety of settings including family planning clinics, STD clinics, drug treatment centres, detention centres, jails and prisons. However, vaccination programmes have been infrequently implemented in these settings and the majority of persons with acute hepatitis B cases have had a missed opportunity for vaccination in the past. Thus, in order to accelerate elimination of HBV transmission in the United States, increased efforts are needed to implement effective hepatitis B vaccination programmes targeted to adolescents and adults in high-risk groups.

Pregnancy Among Women with a History of Injection Drug Use

SUMMARY The reproductive histories of women who use drugs have received little attention in spite of risks associated with drug use during pregnancy and the high risk settings in which children of drug users are raised. This study describes the epidemiology of pregnancy and related drug use among African-American and White women injection drug users. Almost all of the study sample had been pregnant and most used drugs during pregnancy. Treatment programs should provide multifaceted interventions that include family planning, prenatal care, and parenting skills to reduce the negative effects of drug use on mothers and children in this population.

Family planning in the 21st century: perspective of the International Planned Parenthood Federation

Many women still die as a result of pregnancy or childbirth and yet there are an increasing number of women who wish to regulate their fertility and space or limit their child-bearing. This paper, outlining some success stories, elucidates the family planning challenges and identifies key messages to indicate the role that IPPF can play in the 21st century. Issues such as advocacy for sexual and reproductive health and rights, increased male participation, serving the interests of marginalized groups, appropriate technology, quality of care and cooperation between various partners, all need to be addressed to improve sexual and reproductive health including family planning in the 21st century.

Reproductive health in Mexico and Latin America.

In 1974 Mexico responded to a population growth rate of 3.4% by including family planning (FP) as a constitutional right and establishing a new population law and population program which sought to reduce fertility levels as well as maternal-child mortality. By 1994 Mexicos growth rate was reduced to 1.8 and maternal-child mortality had declined. Reproductive health (RH) was made a priority issue for the National Development Plan for 1995-2000 and applies a gender perspective to FP the needs of adolescents safe motherhood womens health sexually transmitted diseases male responsibility and infertility management. The quality and accessibility of FP programs were strengthened through an intensive program of training in logistics to improve contraceptive distribution and introduce methods such as no-scalpel vasectomy monthly injectables IUDs and subdermal implants. The mass media is being used to promote the concept of RH and specific initiatives target adolescents promote safe motherhood promote breast feeding provide screening for birth defects seek to improve access to and quality of prenatal care help diabetic women plan pregnancies and contraception create a network of laboratories for cervical and breast cancer screening provide information and services for peri- and postmenopausal women and continue RH research. The Latin American region is characterized by large variation in health status among countries limited epidemiological data early entry into reproductive life mortality due to HIV/AIDS and illegal abortion and low levels of contraceptive use among young people. A network of collaborating institutions has conducted 250 RH research projects during the past 20 years and a South-South Partnership has been formed to implement the Programme of Action of the 1994 International Conference on Population and Development.

Pregnancy rates among women infected with human immunodeficiency virus

To examine pregnancy rates among women infected with human immunodeficiency virus (HIV). We used data from an ongoing survey of medical records of 3915 women who were 15-44 years of age, infected with HIV, and who received care between January 1990 and August 1994 in more than 90 clinics, hospitals, and private practices in 11 United States cities. At enrollment, 570 (14%) of these women were pregnant. Pregnancy rates at entry varied significantly (P < .05) by age in years (15-19 [47%], 20-24 [30%], 25-29 [18%]; 30-34 [11%]; 35-39 [5%]; 40-44 [2%]); clinical status (with AIDS opportunistic illness [3%], without AIDS opportunistic illness [17%]; and race-ethnicity (white [12%], black [17%], Hispanic [8%], Asian [0%], Native American [30%]) but not by mode of exposure (injecting drug use [10%], heterosexual contact [15%], and blood transfusion [12%]). After enrollment, 5.8% of women became pregnant each year. New pregnancies were significantly less likely to occur among women with an AIDS opportunistic illness (adjusted rate ratio 0.4, 95% confidence interval [CI] 0.2-0.6), and significantly more likely to occur among women who were less than 25 years of age (adjusted rate ratio 8.3, 95% CI 5.3-13.2) and who were black (adjusted rate ratio 1.6, 95% CI 1.2-2.1). Among women who were pregnant at enrollment or during observation, 12% were pregnant more than once. High rates of pregnancy at entry to medical care among HIV-infected women stress the importance of counseling and voluntary testing as routine obstetric-gynecologic practice. In some groups, rates of new pregnancies remain high; standard HIV care for women should include family planning services and assurance that if a woman chooses to practice contraception, contraceptives will be available and affordable.

The Cairo Conference: Achievements and Canadian Contributions

A significant achievement of the International Conference on Population and Development (ICPD) was the considerable work of consciousness-raising about population and its relationship to other key issues. ICPD participants reached a consensus on a 99-page document with only a few countries having reservations about only parts of the document. 90% of the text had been agreed upon before ICPD but the texts sections on abortion were worked out during the conference thus the issue of abortion received much press coverage. The document stresses in almost every chapter the interrelationships of underdevelopment poverty environmental degradation low status and lack of education among women and inadequate reproductive and other health services including family planning. It called for the approach to population and development to be fully integrated. ICPD did not discuss population control but the need to address the interrelated factors that if pursued comprehensively will likely result in lower fertility. The text dedicates a whole chapter to international migration. Nongovernmental organizations played a key role in the text. The biggest accomplishment of ICPD was the implicit assumption that women when informed and having the needed services will tend to make sound and enlightened choices about their fertility that benefit themselves their family and society in general. Canadians contributed in a meaningful way to ICPD. Canada had a representative in seven of eight special groups charged to thrash out tough issues. Canadians were largely responsible for guiding consensus on qualitys being as important as quantity in family planning programs. They were active in promoting agreement on the concept of reproductive health. Canada is involved in the UN Population Commission the agency overseeing follow-up to ICPD. Canadian demographers have formed a Contact Group on Population and Development to facilitate their involvement in population and development activities.

Repeat Abortion and Use of Primary Care Health Services

One-third (34%) of 2,001 women who sought an abortion in 1991-1992 in Wichita, Kansas, were repeat-abortion patients. Compared with first-time abortion patients, repeat-abortion patients were significantly older, more often black, and younger at their first pregnancy (p < .001). The two groups did not vary significantly by income or age at first intercourse. However, repeat-abortion patients were significantly more likely than first-time patients to have been using a contraceptive method at the time of conception (65% compared with 59%) and more likely to say they always or almost always used a method (63% and 53%, respectively). More than 40% of women in each group reported they had no personal physician. Further, 34% of repeat-abortion patients said they had no follow-up examination after their previous abortion, and 28% said they received no contraceptive counseling. Only half of women whose pregnancy was confirmed by their personal physician obtained an abortion referral from that physician.

Knowledge, attitude and practice of family planning in rural communities in Nigeria.

Maternal and infant mortality rates, coupled with a high population growth rate, are unacceptably high in Nigeria. More recently, the Nigerian government endorsed the promotion of reproductive health, including family planning, through maternal and child health services. The Ohaozara Local Government Area (LGA) introduced a Five-Year Action Plan (FYAP) in 1989. To appraise the Ohaozara Five-Year Action Plan, 600 persons stratified by geographical location and sex were interviewed in three randomly selected autonomous communities in the Ohaozara Local Government Area to determine their knowledge, attitude and practice (KAP). The findings in this study showed a high awareness level with a moderately positive attitude and generally low level of practice. Comprehensive reproductive health education (RHE), budgetary increase, evaluation of FYAP, and program coordination are recommended.

Access to family planning services and health insurance among low-income women in Arizona.

This paper uses 1984 and 1989 Arizona survey data to explore the importance of insurance coverage for access to family planning services. In Arizona, Medicaid was provided through the Arizona Health Care Cost Containment System, a managed care model. Family planning was not provided in 1984 but had been added by 1989. Low-income women were 2.3 times more likely to receive services in 1989 than in 1984. Women in the system were 60% more likely to have received services. To improve access, health reform proposals should explicitly include family planning in managed care benefits packages.

Comparative female to male consultation rates in NHS Primary Care: Extrapolation to the Royal Navy

Prevailing wisdom accepts that women consult their GP more often than men. Those with a modicum of interest will know that across the NHS, all ages and all social classes for all grades of consultation, the approximate ratio is two female consultations for one male consultation. However, if the figures are carefully sifted to identify that group most clearly akin to Royal Naval personnel, the gap widens. The following figures and discussion describe how in Naval personnel's age, class and illness matched groups, extrapolating from NHS experience, the 'typical' Royal Naval 'Wren' might be expected to present as a fresh case (including family planning and pregnancy) three times more commonly and consult an RN GP four times more frequently than her male counterpart. In addition, a comparison of various pathology groups are compared and pronounced differences discussed.

Reproductive genetic testing from an international perspective: impact on women in underdeveloped countries.

The impact of reproductive genetic testing (preconceptional and prenatal screening for genetic diseases) on women in the third world must take into account the many aspects that characterize underdevelopment: poverty; little access to education; housing; adequate nutrition; health services, and other. In these countries women usually suffer from male domination in a number of aspects of their lives, including reproduction. Illiteracy is high, particularly among women. Infant mortality and fertility rates are high, and the primary causes of death are infectious diseases and malnutrition. Health services are poorly organized, and family planning and prenatal care programs are deficient. Although abortions are illegal, they outnumber live births 3:1. Maternal mortality is 10-100 times higher than in industrialized nations, and complications of illegal abortions are one of its main causes. This description applies to the majority of the population and contrasts with that of the small segment of well-to-do upper classes, who have access to education, housing and health services that include family planning, prenatal care and reproductive genetic testing. By and large, all main cities count with clinical genetic centers. The illegality of abortion, however, makes prenatal testing in the public sector a difficult task, while in the private sector quality control is an unheard concept and the patients frequently fall victims of the entrepreneurial and commercial goals of the providers. For the majority of the population, the impact of reproductive genetic testing is almost nil, simply because the services are not available.(ABSTRACT TRUNCATED AT 250 WORDS)