Prevention Of Unplanned Pregnancy Research Articles

The Politics of Health Care

M. Joycelyn Elders The Politics of Health Care DESPITE ALL OF OUR SCIENTIFIC PROGRESS IN THE AREAS OF HEALTH and biological sciences, we still have a huge unfinished agenda and m ultiple problems that m ust be addressed. We confront problems with health care access for all of our citizens. Ours is a health-illiterate soci­ ety, yet we refuse to provide com prehensive health education for all children. Scientists have unraveled the secret of the cell, explored and m apped the hum an genome; they have developed methodology for controlling hum an reproduction, created lasers that can read license plates in Japan, designed scanning images for every part of the body, carried out stem cell research that can cure diseases. Yet, we have health policies that lim it optimal benefit for our population. We deny com prehensive health education and support abstinence -only education w hen we know that m ore than 50 percent of our children are not abstinent. We have one of the highest teenage pregnancy rates in the industrialized world; 50 percent of all of the 1.9 million sexually transm itted diseases (STDs), including hum an im m u­ nodeficiency virus (HIV), occur annually in young people less then 24 years of age. We downplay the value of condoms w hen scientific data support their use in the prevention of unplanned pregnancy and certain sexually transm itted diseases, including HIV and hum an papil­ loma virus (HPV). The illogical nature of these circumstances often is the result of short-term political gain by some who capitalize on the sensationalism of the word “sex” brought up in any context. The hum an population continues to increase exponentially; it doubled from 2.5 billion to 5 billion between 1950 and 1989, reaching 6 billion in 1996 and, if trends continue, could reach 12 billion by 2050. social research Vol 73 : No 3 : Fall 2006 805 Almost nothing is being done in m ost nations to prom ote effective family planning programs. Instead, there is widespread ideological, political, and religious resistance to contraception. This is aggravated in m any developing countries by female illiteracy and restrictions on the rights of women. The United States has been complicit in this gender inequity by cutting family planning budgets, both foreign and domes­ tic, while supporting abstinence-only education. There is major political debate about a recently developed vaccine against the HPV. Now Supreme Court judges are appointed based on their stand on abortions and pharmacists are allowed to deny women emergency contraceptives pills, which have been ordered by their physician, based on their moral stands (Gee, 2006). Politics and health care are strangely entan­ gled with little regard for the healthy outcome of the populace. We have m any crises to overcome in trying to create a healthy society for the twenty-first century. The first is a crisis of vision. W hile we have the best doctors, nurses, hospitals, support staff, and cuttingedge research, we do not have the visionaries to design the system to serve all of our people. Our present system costs too much, delivers too little, is not comprehensive, coherent, or cost effective, does not allow choice, is not equitable, and is not universal. Our second crisis is a crisis of anticipation. We are not look­ ing to the future, not using all available resources, not realizing that prevention is far better th an intervention or th at if a school nurse prevents one girl from getting pregnant or one boy from using drugs, that she has saved her state m ore than she is paid. The third is a crisis of creativity. We in medicine m ust learn to think out of the box and develop a health care system that is available, affordable, assessable, high quality, and culturally competent. There are m any social and behavioral problem s that affect the health of our people: smoking, poor dietary habits, lack of exercise, alcohol abuse, the use of illicit drugs, abuse of prescription drugs, and violence. These determ ine up to 50 percent of our health status, but receive only 4 percent of our national health expenditures. At the same time, access to care influences...

A novel school-based strategy for the prevention of HIV/AIDS, Sexually Transmitted Disease (STDs), and teen pregnancies

To introduce the study design of an HIV/AIDS and unplanned pregnancy prevention program targeting high school students, and to present the results from the baseline survey. A school curriculum was developed to inform adolescent students about HIV/AIDS/STD prevention, which included information on emergency contraception (EC) for adolescent students. A randomized controlled study was conducted to simultaneously evaluate the effect of this intervention. The baseline survey collected data on contraception knowledge and attitudes regarding sexual behaviors. A total of 11,117 students from 40 schools participated in the baseline (52% female, the mean age of both males and females was 15.5). A total of 10% of the females and 24% of the men surveyed were sexually active at baseline, but only 39% of those sexually active reported using a condom at the time of their first sexual intercourse. Among the sexually active students surveyed, a third of the males and a fifth of the females reported at least one condom slip or breakage. Most of the students were aware of EC. The low proportion of students that report using condoms accompanied by their incorrect use points to the need for HIV/AIDS and unplanned pregnancy prevention efforts. This novel approach offers adolescents EC, a backup method to the condom. The approach is feasible as students know what EC is and furthermore it appears that they are willing to use this method.

Sexual health care in persons with intellectual disabilities

In the past, preventive health concerning sexuality of people with intellectual disabilities was addressed through surgical sterilization as part of nationwide eugenic programs in many countries. For more than 30 years now, it has come progressively to light in the scientific literature that, besides major ethical and legal problems, these programs also failed to assess many of the individual's needs in sexual health. The fact that an increasing number of people with intellectual disabilities live in the community rather than in institutions has heightened public awareness that these individuals have sexual expectancies, desires, and needs that must be supported through both education and health services. The emergence of AIDS, including descriptions of cases among people with intellectual disabilities, has further demonstrated that surgical sterilization cannot be considered a global option to achieve preventive sexual health. The aim of this paper is to review scientific studies that have assessed the expectancies and support needs of persons with intellectual disabilities in terms of sexual health. These needs vary widely from one individual to another, according to life milieu, level of disability, and potential comorbidity. From this review, it appears that hygiene management, global gynecological care, and prevention of unplanned pregnancy, sexually transmitted diseases, and abuse have been frequently identified as areas in which the presence of intellectual disability dictates specific support needs. Different approaches that have been evaluated to address these issues will also be discussed.

S2.3 Microbiological risks associated with antimicrobial drug use in food-producing animals

The elimination of new HIV infections in infants and children is part of a broader global commitment by the United Nations. Prevention of Mother to Child transmission (PMTCT) programmes have prevented 350 000 new HIV infections with the use of antiretroviral therapy (ARVs) for pregnant women who are HIV infected, and the majority of these gains were in sub-Saharan Africa. Coverage of PMTCT programmes throughout Africa is variable resulting in many women not having access to the appropriate interventions in the antenatal care setting to prevent vertical transmission. The global elimination target requires a 90% reduction of new child infections and to decrease MTCT to <5% which potentially can be achieved utilising the four pronged approach proposed by the World Health Organization. Family planning messages and provision of contraception methods to avoid unplanned pregnancies are shown to be more effective than HIV Counselling and Testing [HCT] and single dose Nevirapine in averting transmission of perinatal HIV infection. Child survival goes beyond HIV-free survival and safe breastfeeding prevents 13% of deaths under 5 years of age rendering it essential to reduce under-5 mortality. Health systems strengthening to deliver more complex regimens either for prevention purposes or the mothers own health is an important part of a broader continuum of interventions which will depend on the effective delivery of current treatment modalities, development of new prevention interventions including a vaccine, and include prevention of unplanned pregnancies and primary prevention of HIV infections in the mother.

Diabetes, impaired fasting glucose, and development of cognitive impairment in older women.

To investigate the association between diabetes and impaired fasting glucose (IFG) and cognition and risk of developing both dementia and mild cognitive impairment (MCI) in older women. The authors analyzed data from a 4-year randomized trial of raloxifene among 7,027 osteoporotic postmenopausal women (mean age, 66.3 years) at 178 sites. Diabetes was defined by history, fasting blood glucose > or =7.0 mmol/L (> or =126 mg/dL), or use of hypoglycemic agents; IFG was defined as fasting glucose <7.0 mmol/L but >6.11 mmol/L (110 mg/dL); all others were considered to have normal glucose (NG). The main outcome was baseline and 4-year change on five standardized cognitive tests (z scores with lower scores indicating worse performance) and risk of developing clinically significant impairment (dementia, mild cognitive impairment, or very low cognitive score). A total of 267 (3.8%) women had diabetes and 297 (4.2%) had IFG. Women with IFG had worse baseline cognitive scores compared to women with NG but better scores than diabetics (age-adjusted composite z score based on five tests: NG 0.40, 95% CI 0.30 to 0.49; IFG 0.14, 95% CI -0.36 to 0.64; diabetics -0.78, 95% CI -1.23 to -0.33; p < 0.001). There was greater 4-year decline among diabetics (age and treatment-adjusted composite z score: NG -0.05, 95% CI -0.16 to 0.05; IFG 0.11, 95% CI -0.53 to 0.75; diabetics -1.00, 95% CI -1.50 to -0.50; p = 0.001). Further adjustment for education, race, and depression led to similar results. Risk of developing cognitive impairment among women with IFG or diabetes was increased by almost twofold (age and treatment-adjusted OR = 1.64; 95% CI 1.03 to 2.61 for IFG; OR = 1.79; 95% CI 1.14 to 2.81 for diabetics). Diabetic as well as pre-diabetic women have impaired cognitive performance and greater risk of developing cognitive impairment.

Medical and social aspects of pregnancy termination

The article examines the attitude of women to the problem and the abortion procedure and the organization of the work of the gynecological service to provide assistance in connection with an unplanned pregnancy. The questionnaires of women who decided to terminate a pregnancy were analyzed, as well as the qualitative indicators of the activities of institutions.&#x0D; It was shown that the main reason for the termination of pregnancy was dissatisfaction with the financial situation (28.1%). 96.3% of women knew that abortion is fraught with serious complications. 48.6% of women prefer to terminate pregnancy by mini-abortion, 33.7% by medication. Less than half of the patients are satisfied with the quality of care for termination of pregnancy. Risk groups are adolescents and women of older reproductive age. 67.6% of the respondents need advice on methods of contraception. Satisfied with the quality of consulting 38.8%.&#x0D; Along with educating the population about the dangers of abortion and teaching family planning methods, it is necessary to create comfortable conditions for abortion, ensure maximum safety of the procedure, conduct rehabilitation after an abortion in order to eliminate negative consequences, advise on the prevention of unplanned pregnancy in the future, and select adequate contraception.

Estimates of induced abortion in urban and rural Sri Lanka

Objectives: To estimate the incidence of induced abortion during the year 1998. The present study quantifies for the first time, the extent of the problem of induced abortion in Sri Lanka. Methodology: A survey was conducted among women 15 ~ 49 years old, living in 10,000 households sampled to represent the urban and rural populations of all provinces of the country, other than the Northeastern province. A total of 12,168 women were interviewed. This consisted of 94.2%of all women in the 15-49 age group, living in the households selected for the survey. The Randomised Response Technique was used to estimate the incidence of induced abortion during the year 1998. This method ensures anonymity in estimating induced abortion rates. Results: The abortion rate for the year 1998 was estimated to be 45/1000 women of 15-19 years of age (95% C.L 38/1000 — 52/1000), and 13/1000 population (95% C.L. 11/1000 - 15/1000), The total abortion rate was estimated as 1.6 (95% CLL. 1.06-2.18), for women of15-49 years. For currently married women it was estimated to be 1.9 (95% C.L. 1.2-2.6). Induced abortion rates were noted to be low among the unmarried, students and among the adolescent women. It was seen to. Be concentrated largely around the middle of the childbearing years. Married women, those with a low educational level and rural populations were noted to have higher rates of abortion. A high rate of abortion is resorted to space or limit families. The study identifies sub groups in the population who need knowledge, motivation and quality service for the prevention of unplanned pregnancies.

Education for contraceptive use by women after childbirth.

Postpartum education on contraceptive use is a routine component of discharge planning in many different countries with a wide variety of health care systems. This education is based on assumptions concerning women's receptivity to contraceptive education during the postpartum period and their presumed lack of access to such education after that time. The objective of this review is to assess the effects of education about contraceptive use to postpartum mothers. We searched the Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL, Psychlit, Popline, citations indexes and reference lists of relevant articles. We contacted subject experts to locate additional research, in addition to the Group's Specialised Register of Controlled Trials. Date of the most recent search: April 1999. Trials using random or quasi-random methods of allocation which evaluated the effectiveness of postpartum education about contraceptive use. Two independent reviewers abstracted data on trial characteristics and results. Three trials were identified with 5438 women. These trials were conducted in Lebanon, Peru and Nepal. None of the trials examined all major prespecified endpoints. Postpartum education about contraceptive use influenced short-term use assessed between 40 days and three months post-partum. Women in the intervention groups were less likely to be non-users than women in the comparison groups (Odds Ratio (OR) = 0.47, 95% Confidence Interval (CI) 0.39 to 0.58). This benefit was not apparent following analysis of data from better quality studies (OR = 0.67, 95% CI 0.41 to 1.13). An apparent benefit on contraceptive use at six months post-partum (OR = 0.52, 95% CI 0.37 to 0.74) was not apparent following sensitivity analyses (OR = 0.59, 95% CI 0.33 to 1.06). Data are inadequate to assess the impact on cessation of breast feeding and non-attendance at family planning clinics. Unplanned pregnancies, knowledge about contraception and satisfaction with care were not assessed in any trial. The effectiveness of postpartum education about contraceptive use has not yet been established in randomised controlled trials. Such education may be effective in increasing the short-term use of contraception. However, there are only limited data examining a more-important longer-term effect on the prevention of unplanned pregnancies. Research needs to be undertaken to assess the effectiveness of the minimalist education provided in more developed countries and the variety of programs provided in less developed regions. Such research should examine the content, timing, range and organisation of postpartum education on contraceptive use, as well as its impact on breast feeding rates.

Contraception, Unintended Pregnancies, and Sexually Transmitted Diseases: Why Isn't a Simple Solution Possible?

Epidemiologists have shown us the importance of using a population-level approach to public health problems. Geoffrey Rose for example quantified the relationship between exposure to a causal agent and the associated risk of developing a disease. He also described the several forms that this relationship could take including a threshold effect a linear construct a U-shaped relationship and an inverted U-shaped curve. Based on this quantification Rose showed that prevention strategies that focus on high-risk individuals may benefit those individuals but will likely have little impact on the total disease burden in the population because more cases of disease occur among the many who are at low risk than among the few who are at high risk. Applying these concepts to the relationship of contraceptive choices and the prevention of unplanned pregnancies and sexually transmitted diseases (STDs) allows the description of a natural history of the sexual and reproductive events in a population of females which reveals that the risk of unplanned pregnancies and STDs exists for nearly the entire reproductive period. Unfortunately no currently-available contraceptive provides good protection against both outcomes and a wide variation has been found in the level of contraceptive effectiveness against these outcomes in different populations. A further complication is that the best available method to date the male condom is not female-controlled (and the female condom is not widely accepted). Therefore to move toward a social norm of the lowest risk for any sexual exposure we need a spectrum of imperfect yet cumulatively effective strategies made possible by a wide array of contraceptives.

Promotion of Sexual Abstinence

The prevention of unplanned pregnancies has become a national public health priority. To assure that every newborn child in America is planned and wanted, three strategies are to be implemented: expansion of school-based sex education, expansion of free condom distribution, and expansion of the role of school-based health clinics. Studies show that these strategies may not prevent unplanned pregnancies; furthermore, their implementation may be associated with public health risks. Sexual abstinence is not associated with public health risks and needs to be presented and promoted as the most effective primary prevention for unplanned pregnancies.

Condom use relative to knowledge of sexually transmitted disease prevention, method of birth control, and past or present infection

The purpose of this study was to assess knowledge regarding STD spread and prevention, and to assess motivational and behavioral factors that influence the use of condoms to prevent STD acquisition among inner-city women at high risk for STD infection. In addition, the effect of past and/or current STD infection on a woman's knowledge of the mechanism of STD acquisition and subsequent use of a condom to prevent STD infection was explored. We utilized three inner-city clinics offering family planning or gynecologic care located in Brooklyn, New York. Our study linked clinical findings regarding current infection with chlamydia or Trichomonas vaginalis. One thousand four hundred and four sexually active black and Hispanic women participated in the study. A past history of STD (37%) or current infection (29%) was recorded for 54% of the study population (12% were positive for both past and current infection). On average, only 60% of women who reported prior treatment for STD infection reported receiving any information regarding prevention of re-infection during the course of treatment. Depending on the specific STD, from 6.8% to 42.9% of women reporting prior treatment for an STD did not know the disease they were being treated for was sexually transmitted. Condom use for disease prevention was more frequently reported by women who had previously been treated for an STD (OR = 1.62, 95% CI 1.23-2.13). However, condom use for contraception was a stronger predictor of use for STD prevention. Women who relied on condoms for contraception were almost 10 times more likely to also report condom use for STD prevention relative to women who did not use condoms for contraceptive purposes (OR = 9.71, 95% CI 7.0-13.5). In addition, condom use was associated with the perceived attitude of their sexual partner toward such use. Condom use to prevent STD acquisition was more than twice as frequently reported when a favorable attitude was perceived by a male sexual partner (OR = 2.30, 95% CI 1.54-3.43). Our findings suggest that prevention of unplanned pregnancy was a stronger motivator for condom use than disease prevention among the women comprising our study group. The findings also indicate the need for more extensive information regarding STD prevention among women at high risk for STD acquisition.(ABSTRACT TRUNCATED AT 400 WORDS)

Induced abortion. Effects of marital status, age and parity on choice of pregnancy termination.

To study the impact of marital status, age and parity on the decision regarding pregnancy termination over time among pregnant Norwegian women. National surveillance data of induced abortions and births. All women terminating their pregnancies (n = 174,590) as registered in the Abortion File in the Central Bureau of Statistics and all women giving birth (n = 639,551) as registered in the Medical Birth Registry of Norway between January 1, 1979 and December 31, 1990 were eligible for the study. Included in the analysis of pregnancy outcome were records with complete information on marital status, age and parity, which comprise 93.8% (n = 163,826) of all women having had an induced abortion and 99.0% (n = 633,542) of all women giving birth during the time period. The proportion of pregnancies terminated as induced abortions and the relative risk of pregnant women choosing abortion in strata of marital status, age and parity. Trend analysis of the proportion of pregnancies terminated as induced abortions in different time periods in categories of marital status, age and parity. From the first three-year period 1979-81 to the last three-year period 1988-90 there was a decreasing tendency to choose abortion among unmarried pregnant women above 20 years of age and married women with two or more children. In the other strata of marital status, age and parity there were no changes over the time period, except for married women 20-24 years of age which was the only group that showed an increasing abortion tendency over the time period. The prospect of single parenthood was the strongest determinant for choosing abortion independent of age and parity. Within all age groups of married women the abortion tendency increased more with parity than age. Cohabiting women chose abortion significantly more often than married women did. However, the true estimate of choosing abortion among cohabiting women was closer to married women than to single women. In order to find out the importance of other social factors and attitudes in the decision making process regarding pregnancy outcome, adjustments must be made for marital status, age and parity.

Cross-cultural perspectives on coping with the risks of maternal phenylketonuria

Abstract Maternal phenylketonuria (PKU) refers to the deleterious effects on a fetus due to high maternal phenylalanine levels. Prevention of these effects requires that women with PKU reduce their blood phenylalanine levels prior to and throughout pregnancy which means that they plan their regnancies and adhere to a phenylalanine restricted diet. According to a psycho-social model of maternal PKU, a first necessary step in preventing the effects of maternal PKU is prevention of unplanned pregnancies i.e.: using effective family planning practices. In the present study, findings are presented on seventy-five phenylketonuric women (60 from the United States and 15 from Israel) who participate in a prospective longitudinal study, to reveal the reasons why the proportion of pregnancies treated prior to conception has consistently been higher in Israel than in the United States. The two groups were interviewed and administered a battery of tests and questionnaires measuring a wide range of variables associate...

Spain: Setback for anti-AIDS campaign

The Ministries of Health and Social Affairs of Spain launched a campaign in November 1990 to promote condom use for the prevention of unplanned pregnancy and contracting sexually transmitted diseases. The campaign targeted youths and cost 600 million pesetas. Despite the campaign being completed some time ago it has been declared illegal by a Spanish high court. Criticized from the start by several Spanish groups especially the Roman Catholic Church and the Catholic Confederation of Schoolparents (CONCAPA) it was argued that the campaign slogan encouraging condom use actually encouraged free sexual relations among youths. CONCAPA charged in court that the campaign not only breached the laws on advertisements but that it falsely claimed that condoms protect against unplanned pregnancy and AIDS. Ruling judges agreed on the basis that the campaign did not send the message that sexually active individuals may be absolutely protected from contracting HIV only through abstinence or mutual fidelity between noninfected monogamous partners. With the support of many groups and associations including the Spanish Confederation of Association of Spanish Schoolparents the Ministries appeal to the Spanish supreme court. It is important that this verdict be overturned so that subsequent campaigns on condom use in health promotion are not hindered. Moreover Supreme Court affirmation of the legality and validity of condom promotion programs would send a powerful positive message to Catholics who fight government measures which they find offensive to their traditionally conservative religious beliefs.

Psychosocial factors in maternal phenylketonuria: prevention of unplanned pregnancies.

Women with phenylketonuria (PKU) not treated prior to conception can have a pregnancy that results in serious fetal damage. In this report, factors associated with preventing unplanned (and hence late treated) pregnancies are described. Subjects included 60 phenylketonuric women and two comparison groups composed of female acquaintances and diabetic women. All were interviewed and administered tests of intelligence, general well-being, knowledge, and personality. Thirty-five percent of the sexually active women with PKU used contraception only sporadically. The variables that best predicted reported frequency of birth control use were the extent to which women felt social support to use contraception (r = .64) along with positive attitudes about birth control (r = .66) and knowledge of family planning (r = .43). For the comparison groups, a different pattern of variables predicted contraceptive use, with locus of control figuring most prominently for the diabetics (r = .39) and social support for birth control being most important for the acquaintances (r = .46). As more girls with PKU enter childbearing ages, there will be an increased need for specific programs that address psychosocial factors in maternal PKU.

A psychosocial model of a medical problem: Maternal phenylketonuria

Treatment of maternal phenylketonuria (PKU) consists of a low phenylalanine diet, begun before conception, which is believed to prevent mental retardation, microcephaly, and congenital heart disease in offspring of women with PKU. Experiences in treating these women indicate that their cooperation with medical recommendations is generally poor. We present a psychosocial model on adjustment and coping in maternal PKU. The proposed model defines four stages in the reproductive years of women with PKU, each of which has specific behavioral goals. The four stages are: (1) prevention of unplanned pregnancies; (2) reproductive decision-making; (3) diet initiation; and (4) diet continuation through pregnancy. Review of the literature on the different behaviors expected at the different stages enabled indentification of psychosocial factors that may explain success or failure in achieving the goals at each stage. Based on this theoretical framework, practical implications for treating women with PKU have been suggested.

Sex Education in Illinois Churches: The Octopus Program

The problem of teenage pregnancy has resulted in a variety of unplanned pregnancy prevention programs. Evidence in the research literature indicates that involving parents in the sexuality education of their teens could be an important factor in encouraging responsible sexual behavior and thus preventing teenage pregnancy. OCTOPUS, a prevention program, involves the church with local agencies in offering teens and parents sexuality education with a special emphasis on teen–parent communication. This paper briefly describes OCTOPUS and presents results of a survey of agencies and churches replicating it. Demographics, program descriptions, expenses, training needs, and feedback are included. The results should help others who may be interested in replicating the program to identify personnel, time commitments, and resources needed to conduct a program.

Group work with adolescent PKU girls and their mothers.

Group therapy was the method chosen for working with PKU girls and their mothers in improving their knowledge of maternal PKU and the prevention of unplanned pregnancies. It was found effective in relieving anxiety, and the importance of including the mothers in the group was critical.