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Between 1973 (the year the Supreme Court ruled in Roe v. Wade that women have the right to decide whether or not to terminate their pregnancies) and 1982, the number of abortion providers increased by 81 per cent. However, between 1982 and 1992, a period of increasing state-level abortion regulation, the number of abortion providers decreased by 18 per cent. We know very little about the factors that influence the willingness and ability of hospitals, clinics, and physicians to provide abortion services over time. Based on state data from 1978 to 1992, the results of this paper suggest that large abortion providers are better able to compete and survive in the market. Also clinics and physicians' offices appear to be gaining market share relative to hospitals. Further, this paper includes analysis of the impact of state-level Medicaid funding regulations on the number, size, and type of abortion provider. These results have important implications for women's access to abortion services and thus have important implications for infant and maternal health. [ABSTRACT FROM AUTHOR]

After briefly describing the purpose, structure, and Junctions of a typical family planning center, the paper suggests and gives support for a more relationship-centered service delivery system. The major thesis of the paper is that these centers should adopt a system which recognizes and promotes intimate human relationships, and that marriage and family counselors would be highly valuable resources in such a system. The paper stresses the importance of attending to the myriad relationship issues involved in the entire process of enabling individual couples to more effectively plan and control their own fertility. Several ways in which the marriage and family counselor can work with and within the family planning center are outlined. [ABSTRACT FROM AUTHOR]

From its beginning in 1885, the Hull House was beacon for social progress and urban reform. Founders Jane Addams and Ellen Gates Starr recruited talented, passionate partners from diverse fields to address issues from street sanitation to education in Chicago’s immigrant communities. Among residents’ many projects, their involvement in the “social hygiene” movement for sex education and contraception is perhaps the least recognised, in part because the Hull House did not save materials directly related to these services. As a result, the professional activities of Hull House residents Drs Rachelle Yarros and Alice Hamilton reveal a productive relationship between the Hull House and the social hygiene movement. Part of their critical work was to dismantle the cultural association of contraceptives and sex education with “fallen women” and reframe these services as necessities for maternal health. The papers of their professional organisations chronicle their delicate efforts to challenge assumptions about reproductive healthcare while preserving Victorian ideals about sex as a private, procreative endeavour strictly between married, monogamous people. Rachelle Yarros was particularly active, producing a dearth of literature on sexual health, teaching classes on the subject, and overseeing the opening of Chicago’s first public birth control clinics. Each of these advancements, including the birth control clinic, was available on Hull House grounds. By capitalising on the financial and medical resources available to them as physicians and reformers, Yarros and Hamilton achieved significant gains in women’s healthcare and initiated a national conversation about sexual health as a human right. [ABSTRACT FROM AUTHOR]

Context: Ambivalence in pregnancy intentions is well-documented in sub-Saharan African (SSA) settings and has been associated with inconsistent use of contraception, thereby exposing women using contraception to the possibility of unintended pregnancies. A better understanding of the potential role for client counseling interventions in enabling women to achieve their pregnancy intentions is essential for aiding program efforts to reduce unintended pregnancies. Objective: To measure ambivalence in pregnancy intentions longitudinally and determine its association with the quality of care received, controlling for demographic, socio-economic and contextual factors among a cohort of family planning (FP) clients in Kenya. Methods: This paper uses data drawn from a prospective cohort study of FP clients to investigate the relationship between the quality of care received during FP service delivery and the decisiveness of their pregnancy intentions over time. The study tests the hypothesis that higher quality of care enables women to be less ambivalent about their pregnancy intentions. Binary logistic regression with random effects and multinomial logistic regression were used to assess the predictive effect of the quality of care received by a woman on the decisiveness or ambivalence of her pregnancy intentions, and on any shifts in ambivalence over time, controlling for background characteristics. The study recruited 1,957 women aged 15–49 years attending twelve family planning clinics in four counties in Central Kenya; of these, 1,053 women were observed for four rounds of data collection over a period of 24 months and form the sample for analysis. Findings: A substantial proportion (43%) of women expressed ambivalence about their intentions to become pregnant at some point during the study period, while over half (57%) remained unequivocal throughout the study. Almost one third of women (31%) shifted from being unequivocal to ambivalent and 12% shifted from ambivalence to being unequivocal. Women experiencing higher quality of care have lower odds of ever expressing ambivalence and higher odds of remaining unequivocal over time, net of other factors. Quality of care was not associated with a shift in ambivalence over time. Conclusion: FP programs offering higher quality of care are likely to support women to be more decisive in their pregnancy intentions. Improving the quality of care can contribute to reduced ambivalence and consequently reduced likelihood of unintended pregnancy among contraceptive users. This study provides further evidence of the benefits gained through providing high quality services. Trial registration: ClinicalTrials.gov [ABSTRACT FROM AUTHOR]

Background The mere availability of family planning (FP) services is not sufficient to improve reproductive health; services must also be of adequate quality. The introduction of new contraceptive methods is a means of improving quality of care. The Standard Days Method (SDM) is a new fertility-awareness-based contraceptive method that has been successfully added to reproductive health care services around the world. Content Framed by the Bruce-Jain quality-of-care paradigm, this paper describes how the introduction of SDM in developing country settings can improve the six elements of quality while contributing to the intrinsic variety of available methods. SDM meets the needs of women and couples who opt not to use other modern methods. SDM providers are sensitised to the potential of fertility-awareness-based contraception as an appropriate choice for these clients. SDM requires the involvement of both partners and thus offers a natural entry point for providers to further explore partner communication, intimate partner violence, condoms, and HIV/STIs. Conclusion SDM introduction broadens the range of FP methods available to couples in developing countries. SDM counselling presents an opportunity for FP providers to discuss important interpersonal and reproductive health issues with potential users. [ABSTRACT FROM AUTHOR]

This essay concerns a woman by the name of Adele Gordon. Adele Gordon was a nurse who, during the 1930s, operated a commercially-sponsored birth control clinic in the city of Milwaukee and who, in 1935; was arrested and tried for precisely these activities. However, while her story is the guiding theme of this narrative, her life (as well as the lessons to be learned from the history of medicine) invites us to consider the larger world in which her work took place, in particular the early days of the birth control clinic movement. Indeed, what this essay asks us to imagine is the presence of what I call the Irregular birth control clinic movement, a movement of clinics which continued to embody the supposedly lost radicalism of Margaret Sanger in the teens. And this Irregular clinic movement, in turn, invites us to re-think the efforts of the American Birth Control League in its quest for professionalization and the backing of the American Medical Association. Hence Nurse Gordon's story is an important one in part, because she is an intriguing individual who embodied an uncommon sense of modesty and determination, dignity and pride. But also because Nurse Gordon offers us a new way to tell the story of twentieth-century birth control, encouraging us to appreciate the breadth of the birth control clinic movement, the malleability of the birth control institution, and the American Birth Control League's efforts to contain them both. [ABSTRACT FROM AUTHOR]

This paper evaluates the effectiveness of the ‘Spot the Hazard’ farm safety resource which employs 3-D visual stimuli to develop rudimentary risk assessment skills in children. Primary school children from three local schools in north-west New South Wales were presented with the resource and talked about the farm hazards present. Children’s recall of the hazards and the extent to which they compared the resource to their own farm was assessed after an initial presentation at post-tests of 1, 14 and 28 days, across three experimental groups. Individual differences in achievement were controlled for using the Wechsler Individual Achievement Test-Screener (WIAT). Analysis revealed that children exposed to the resource recalled significantly more hazards and made more comparisons to their own farm experiences than controls. However, differences on individual achievement were observed between groups due to a lack of randomisation. Farm safety educational resources for children are more effective when verbal and nonverbal strategies are used and when children are exposed to such cues repeatedly. The development of farm safety educational resources for children which employ spatial cues is encouraged. Further clarification of results would entail a more rigorous randomised control trial. [ABSTRACT FROM AUTHOR]

This paper uses retrospective life history data to assess the impact of family planning services on contraceptive use in a rural Mexican township. Between 1960 and 1990 contraceptive use rose and fertility declined dramatically. Both contraceptive supply and demand factors were influential in these trends. The start of the government-sponsored family planning programme in the late 1970s was associated with a sharp rise in female sterilization and use of the IUD. However, once we controlled for the changing socio-economic and demographic characteristics of the sample, the presence of family planning services had no significant effect on the likelihood that women used modern reversible methods compared to traditional methods. Men and women expressed concerns about the safety of modern methods such as the pill and the IUD. Efforts to increase modern contraceptive use should place greater emphasis on communicating the safety of these methods and improving the quality of services. [ABSTRACT FROM AUTHOR]

Recent estimates of fertility in Botswana suggest a rapid decline of more than two births per woman between 1981 and 1988. This paper proposes that the baseline fertility was overestimated but that nonetheless fertility declined by about one birth per woman during the 1980s. The decline in fertility was linked to a deterioration in social and economic conditions caused by a major drought in the early 1980s and to the increased availability of family planning services in the same period. Fertility apparently began to rebound in the late 1980s in response to improved conditions, which came about as a result of a successful drought relief program. Future declines in fertility depend on the continued success of the family planning program, particularly in rural areas. [ABSTRACT FROM AUTHOR]

Abstract: This paper analyzes the evolution of the federal family planning program from 1960 to 1980. Political pressure to offer family planning raised the question how, best to organize services. Longstanding providers preferred a categorical approach in order to maintain a diverse political coalition for an historically invisible service. In addition, categorical funding meant financial support for non-traditional providers. A compelling argument was also made for service integration, Given an expanded definition of health and the medicalization of contraceptive technology, the health delivery system presented itself as the appropriate service provider. Neither group prevailed. By 1980, federally supported family planning services were provided in autonomous clinics but also were integrated into existing maternal and child health programs. The debate continues but under the Reagan Administration, terms and motivations differ from those of the past. [ABSTRACT FROM AUTHOR]

An essay is presented on women's history and the development of the birth control movement in Texas. The author reflects on the emergence of a network of birth control clinics providing reproductive health services to low-income married women and public reaction. Emphasis is given to the participation of socially elite women and the support of male physicians, rich businessmen, and clergymen in providing professional expertise, financing, and social acceptance.

This paper reports on a qualitative study in 2007–08 on the abortion experiences of teenage women from deprived backgrounds in Hong Kong. Twenty-nine young women aged 13–24 who had undergone one or more induced abortions in their teen years were interviewed and participated in group empowerment sessions. Ten were unemployed, four were students, the rest were employed on low pay in unskilled occupations. Abortion services are legal and available in public and private services, but they charge fees ranging from HK$310 to $10,000, and do abortions only up to 24 weeks of pregnancy. Many young women resort to poor quality illegal clinics and clinics in mainland China because the cost is lower, they do not wish to tell their parents, who would be asked for consent, and/or they want to protect their sex partners, who may be reported and prosecuted if the girl is under-age. There is a need to strengthen services for teenage women in Hong Kong, especially those who are pregnant and from deprived backgrounds. There is also a need for professionals who deliver adolescent health and social welfare services, and for society to rethink and re-examine its views and attitudes towards teenage pregnancy, sexuality and abortion. En 2007–08, une étude qualitative a porté sur les expériences de l'avortement d'adolescentes issues de milieux défavorisés à Hong Kong. Vingt-neuf jeunes femmes âgées de 13 à 24 ans qui avaient avorté une ou plusieurs fois pendant leur adolescence ont été interrogées et ont participé à des séances d'autonomisation de groupe. Dix étaient au chômage, quatre étaient étudiantes, les autres occupaient des emplois non qualifiés et peu rémunérés. Les services d'avortement sont légaux et disponibles dans des services publics et privés ; mais ils perçoivent des honoraires allant de HK$310 à HK$10 000 et ne pratiquent les avortements que jusqu'à 24 semaines de grossesse. Beaucoup de jeunes femmes ont recours à des centres illégaux de mauvaise qualité ou des centres en Chine continentale car ils sont moins coûteux, elles ne souhaitent pas le dire à leurs parents qui devraient donner leur consentement, et/ou elles veulent protéger leur partenaire sexuel, qui pourrait être dénoncé et poursuivi si la fille est mineure. Il faut renforcer les services pour adolescentes à Hong Kong, en particulier celles qui sont enceintes et issues de milieux défavorisés. On a également besoin de professionnels qui assurent des services de santé et de protection sociale des jeunes alors que la société devrait repenser et réexaminer ses idées et ses attitudes à l'égard de la grossesse, la sexualité et l'avortement chez les adolescentes. En este artículo se informa acerca de un estudio cualitativo realizado en 2007–08 sobre las experiencias de aborto de mujeres adolescentes de clases carenciadas en Hong Kong. Se entrevistaron 29 jóvenes de 13 a 24 años de edad, que habían tenido uno o más abortos inducidos entre los 13 y 19 años, quienes también participaron en sesiones de empoderamiento en grupo. Diez estaban desempleadas, cuatro eran estudiantes y el resto de ellas estaban empleadas en ocupaciones no especializadas de bajo salario. Los servicios de aborto son legales y accesibles en establecimientos públicos y privados, pero estos cobran entre HK$310 y $10,000 y realizan abortos sólo hasta las 24 semanas del embarazo. Muchas jóvenes recurren a clínicas ilegales de mala calidad y a clínicas en China continental porque el costo es más bajo, no quieren informar a sus padres, a quienes se les pediría su consentimiento, y/o quieren proteger a su pareja sexual, quien podría ser denunciada y enjuiciada si la niña es menor de edad. Es necesario fortalecer los servicios para mujeres adolescentes en Hong Kong, especialmente para aquéllas que están embarazadas y son de clases carenciadas. Además, es necesario que la sociedad y los profesionales que proporcionan servicios de salud y asistencia social a las adolescentes reconsideren y reexaminen sus puntos de vista y actitudes hacia el embarazo, la sexualidad y el aborto en la adolescencia. [ABSTRACT FROM AUTHOR]

Based on articles found on the PubMed and Popline databases on the provision of first-trimester abortion by mid-level providers, this article describes policies on type of abortion provider, comparative studies of different types of abortion provider, provider perspectives, and programmatic experience in Bangladesh, Cambodia, France, Mozambique, South Africa, Sweden, the United States of America and Viet Nam. It shows that it is safe and beneficial for suitably trained mid-level health-care providers, including nurses, midwives and other non-physician clinicians, to provide first-trimester vacuum aspiration and medical abortions. Moreover, it finds that projects in Kenya, Myanmar and Uganda have successfully trained nurse-midwives to provide post-abortion care for incomplete abortion with manual vacuum aspiration, and that studies in Ethiopia and India have recommended that providers such as auxiliary nurse-midwives should be trained in abortion service delivery to ensure that they provide safe abortions for low-income women. The paper recommends the authorization of all qualified mid-level health-care providers to carry out first-trimester abortions, and it also recommends the integration of training in providing first-trimester abortion care into basic education and clinical training for all mid-level providers and medical students interested in obstetrics and gynaecology. Finally, it calls for documentation of the role of mid-level providers in managing second-trimester medical abortions to further inform policy and practice. [ABSTRACT FROM AUTHOR]

The low contraceptive prevalence rate and the existence of unmet demand for family planning services present a challenge for parties involved in family planning research in Tanzania. The observed situation has been explained by the demand-side variables such as socioeconomic characteristics and cultural values that maintain the demand for large families. A small, but growing body of research is examining the effect of supply-side factors such as quality of care of family planning services on the demand for contraceptives. This paper analyses the demand and supply factors determining contraceptive use in Tanzania using the Tanzania Service Availability Survey (1996) and the Tanzania Demographic and Health Survey (1996) data sets. The results show that access to family planning services and quality of care of services are important determinants of contraceptive use in Tanzania even after controlling for demand-side factors. [ABSTRACT FROM AUTHOR]

Family planning was once a sensitive issue in Indonesia, but today it is considered essential. This paper reports on a study in 1997–98 of the role of village family planning volunteers and the cadres who worked under them in West Java, Central Java and DI Yogyakarta, in implementing the national family planning programme in Indonesia. A total of 108 village family planning volunteers, 108 family planning cadres, 108 local leaders and 324 couples eligible for family planning from 36 villages in the three provinces were interviewed. The volunteers and cadres have made a significant contribution to the implementation of the family planning programme. They promote family planning, organise meetings, provide information, organise income-generation activities, give savings and credit assistance, collect and report data and deliver other family welfare services. Teachers, wives of government officials and others recognised by the community as better off in terms of education and living conditions were most often identified to become family planning volunteers. Because they are women and because they are the most distant arm of the programme, their work is taken for granted. As their activities are directed towards women, especially in women's traditional roles, the programme tends to entrench the existing gender gap in responsibility for family planning and family welfare. La planification familiale était jadis une question sensible en Indonésie, mais elle est aujourd'hui jugée essentielle. Une étude, menée en 1997-98 à Java occidental, Java central et DI Yogyakarta, a analysé le rôle des bénévoles villageois de planification familiale et des cadres qui ont travaillé sous leur direction dans l'application du programme national de planification familiale en Indonésie. Elle a interrogé 108 bénévoles villageois et 108 cadres de planification familiale ainsi que 108 décideurs locaux et 324 couples pouvant prétendre aux services de planification familiale de 36 villages dans les trois provinces. Les bénévoles et les cadres ont fait une contribution importante à la réalisation du programme. Ils encouragent la planification familiale, organisent des réunions, distribuent des informations, créent des activités rémunératrices, apportent une aide pour l'épargne et le crédit, recueillent et transmettent les données et assurent d'autres services de protection familiale. Le plus souvent, ce sont des enseignantes, des épouses de fonctionnaires et d'autres personnes jugées plus instruites ou plus aisées par la communauté qui ont été choisies pour devenir bénévoles. Parce que ce sont des femmes et qu'elles sont le bras le plus éloigné du programme, leur travail semble aller de soi. Comme les activités sont axées sur les femmes, particulièrement dans les rôles féminins traditionnels, le programme tend à conforter l'écart existant entre les sexes dans la responsabilité de la planification familiale et du bien-être de la famille. Antes un tema delicado en Indonesia, la planificación familiar (PF) es considerada esencial hoy en día. En este artículo se informa de un estudio realizado en 1997–98 de la función de los voluntarios de planificación familiar y los sub-voluntarios bajo su mando en Java Occidental, Java Central y DI Yogyakarta, en la implementación del programa nacional de PF en Indonesia. Se entrevistó a un total de 108 voluntarios comunitarios en PF, 108 sub-voluntarios en PF, 108 líderes locales y 324 parejas elegibles para la PF provenientes de 36 poblados en las tres provincias. Los voluntarios y sub-voluntarios han ayudado en gran medida a implementar el programa de PF. Ellos promueven la PF, organizan reuniones, proporcionan información, organizan actividades para generar ingresos, brindan ayuda con ahorros y crédito, recolectan e informan datos y proporcionan otros servicios para el bienestar de la familia. Los maestros, las esposas de los funcionarios gubernamentales y otros reconocidos por la comunidad por estar en mejor posición en cuanto a su formación y condiciones de vivienda, fueron señalados con más frecuencia como buenos candidatos para ser voluntarios en PF. Por ser mujeres y el brazo más distante del programa, su trabajo no es valorado. Dado que sus actividades están dirigidas hacia las mujeres, especialmente en sus papeles tradicionales, el programa tiende a afianzar la brecha actual entre sexos en la responsabilidad de PF y el bienestar de la familia. [ABSTRACT FROM AUTHOR]

Abstract: This paper analyzes data on approximately 30,000 women from a survey in Uttar Pradesh in 1995 together with the data from surveys of public and private providers of healthcare and family planning services. A framework was developed for analyzing the effects of quality of services on utilization, and for understanding the gradual evolution of the healthcare infrastructure. The empirical results from logistic regressions for use of female sterilization and IUD showed significant effects of quality of services in government and private hospitals, and of socioeconomic variables such as education, caste, and an index of household possessions. Secondly, models for infant mortality of children born in the preceding 3-year period showed significant effects of socioeconomic variables, quality of healthcare services and birth spacing. Lastly, analysis of data at a more aggregated (Primary Sampling Unit) level indicated differential effects of economic development on the quality of services available in the public and private facilities. [Copyright &y& Elsevier]

The article presents information on a sampling of various kinds of programs and contraceptive services offered by family planning agencies for hard-to-reach populations like substance abusers and the disabled. The paper also examines some of the problems that agencies encounter in their efforts to serve these groups. Some agencies provide services at their clinics, while others conduct outreach and provide education and family planning services in substance-abuse treatment centers, homeless shelters, prisons and other nontraditional sites where hard-to- reach populations live or congregate.

Analyzes trends in access to family planning services among poor women and young women in the United States. Decline in family planning visits in the 1980s; Need to modernize the health insurance system with respect to family planning; Dependence of improvements on infant health on prevention of unplanned pregnancies.

The article focuses on the presentation of an institutional framework for the communication of the information on population issues and the attempt to provide guidelines for formulating a communication policy on limiting population growth in Sub-Saharan Africa. It says that the realization that Sub-Saharan Africa faced increasing population growth rates that exceeded increases in agricultural output is necessitated by the few family planning programs that had been initiated in the region. It adds that delaying the policy reform on population issues will increase the burden on nations and families. It suggests that family planning clinics must be encouraged by the local government agencies in the region.

Abstract: Using a national sample of hospital discharges, we found identical seasonal patterns for spontaneous abortions and conceptions but no significant seasonal variation in the rate of spontaneous abortions per 1,000 conceptions. The difference between our findings and those of previous investigators of spontaneous abortion, our more complete estimate of the monthly number of conceptions, and our more rigorous statistical analysis. The periodic regression analysis. (PRA) reported in our study may be useful in other studies that monitor short-term trends. [ABSTRACT FROM AUTHOR]

Abstract: During the first five months after the restriction of public funds for abortion, a large percentage of low-income women seeking abortions in a metropolitan area in Texas obtained abortions that were partially subsidized using a combination of reduced clinic fees and public funds for ancillary non-abortion services. Their own personal funds made up the difference between the subsidy and the full cost of the procedure. (Am J Public Health 69:948-950, 1979) [ABSTRACT FROM AUTHOR]

Women receiving induced abortions or postabortion care are at high risk of subsequent unintended pregnancy, and intervals of less than six months between abortion and subsequent pregnancy may be associated with adverse outcomes. This study highlights the prevalence and attributes of postabortion contraceptive acceptance from 2,456 health facilities in six major Indian states, among 292,508 women who received abortion care services from July 2011 through June 2014. Eighty-one percent of the women accepted postabortion contraceptive methods: 53 percent short-term, 11 percent intrauterine devices, and 16 percent sterilization. Postabortion contraceptive acceptance was highest among women who were aged 25 years and older, received first-trimester services, received induced abortion, attended primary-level health facilities, and had medical abortions. Doctors receiving post-training support were more likely to offer contraceptives, but no association was observed between such support and acceptance of IUDs or sterilization. Comprehensive service-delivery interventions, including ensuring availability of skilled providers and contraceptive commodities, offering clinical mentoring for providers, identifying and addressing provider bias, and improving provider counseling skills, can increase postabortion contraceptive acceptance and reduce unintended pregnancy. [ABSTRACT FROM AUTHOR]

The article presents an historical overview of the emergence of birth control clinics throughout Scotland from 1926 to the outbreak of World War II, noting its distinctions from trends of larger Great Britain. Topics addressed include the legal and administrative context surrounding their establishment, the dynamics between clinics and their support by individuals, voluntary organizations, and local governing bodies, and the role of Scottish religious views on birth control within the period.

Information was obtained from over 200 males visiting a family planning service either to obtain free-of-charge condoms or incidental to accompanying their female partner. The former group was younger and more likely to reside near the health department; over 40 percent of this group used the health department as sole condom source. Both groups indicated willingness to share in costs for male services. Future programs need to more effectively plan public health family planning for these males. (Am J Public Health 1990; 80:611-612.) [ABSTRACT FROM AUTHOR]

The article presents a model for personnel planning as well as the establishment in a family planning service in the U.S. It has been focused on the capability of the planning service in dealing the patients. It gives explanation as to the use of this service in the required personnel. It has been observed that various personnel in a family planning clinic are not interchangeable. This shows that the nurse cannot execute the duties of the doctor. It also indicates that a clinic where doctors are fully occupied, an increase in the number of nurses would not contribute anything to the output.

Background: Malaysia has relatively liberal abortion laws in that they permit abortions for both physical and mental health cases. However, abortion remains a taboo subject. The stagnating contraceptive prevalence rate combined with the plunging fertility rate suggests that abortion might be occurring clandestinely. This qualitative study aimed to explore the experiences of women and their needs with regard to abortion. Methods: Women from diverse backgrounds were purposively selected from an urban family planning clinic in Penang, Malaysia based on inclusion criteria of being aged 21 and above and having experienced an induced abortion. A semi-structured interview guide consisting of open ended questions eliciting women's experiences and needs with regard to abortion were utilized to facilitate the interviews. Audio recordings were transcribed verbatim and analyzed thematically. Results: Thirty-one women, with ages ranging from 21-43 years (mean 30.16 ±6.41), who had induced surgical/medical abortions were recruited from an urban family planning clinic. Ten women reported only to have had one previous abortion while the remaining had multiple abortions ranging from 2-8 times. The findings revealed that although women had abortions, nevertheless they faced problems in seeking for abortion information and services. They also had fears about the consequences and side effects of abortion and wish to receive more information on abortion. Women with post-abortion feelings ranged from no feelings to not wanting to think about the abortion, relief, feeling of sadness and loss. Abortion decisions were primarily theirs but would seek partner/husband's agreement. In terms of the women's needs for abortion, or if they wished for more information on abortion, pre and post abortion counseling and post-abortion follow up. Conclusions: The existing abortion laws in Malaysia should enable the government to provide abortion services within the law. Unfortunately, the study findings show that this is generally not so, most probably due to social stigma. There is an urgent need for the government to review its responsibility in providing accessible abortion services within the scope of the law and to look into the regulatory requirements for such services in Malaysia. This study also highlighted the need for educational efforts to make women aware of their reproductive rights and also to increase their reproductive knowledge pertaining to abortion. Besides the government, public education on abortion may also be improved by efforts from abortion providers, advocacy groups and related NGOs. [ABSTRACT FROM AUTHOR]

This article adds a comparative perspective to a growing body of research exploring the establishment and provision of local birth control clinics in the UK before and after 1945. The cities of Liverpool and Bradford represent two extremes of birth control clinic development in the twentieth century. In Liverpool, a voluntary Mother's Welfare Clinic opened in 1926 and had three branch clinics in the city by 1960. Bradford did not obtain its first voluntary birth control clinic until 1960. To explain this differential in clinic development, the article draws on the role played by individuals, voluntary, medical and municipal authorities, religious opposition, patient demand, as well as population and immigration debates. [ABSTRACT FROM PUBLISHER]

Background: Peer education is an interactive method of teaching or learning which is widely used for educating school and college students, in a variety of different forms. However, there are few studies on its effectiveness for in-service education. The aim of this study was to evaluate the effect of an educational programme including peer discussions, based on a needs assessment, on the providers' knowledge and reported performance in family planning services. Methods: An educational programme was designed and applied in a random selection of half of in-charges of the 74 family health units (intervention group) in Tabriz at a regular monthly meeting. The other half constituted the control group. The programme included eight pages of written material and a two-hour, face-to-face discussion session with emphasis on the weak areas identified through a needs assessment questionnaire. The educated incharges were requested to carry out a similar kind of programme with all peers at their health facilities within one month. All in-charges received one self-administered questionnaire containing knowledge questions one month after the in-charge education (follow-up I: 61 responses), and another one containing knowledge and self-reported performance questions 26 months later (follow-up II: 61 responses). Also, such tests were done for the peers facilitated by the in-charges one (105 responses) and 27 months (114 responses) after the peer discussions. Multiple linear regression was used for comparing mean total scores, and Chi square for comparing proportions between control and intervention groups, after defining facility as the unit of randomization. Results: The mean total percentage scores of knowledge (percent of maximal possible score) in the intervention group were significantly higher than in the control group, both at follow-up I (63%) and at follow-up II (57%); with a difference of 16 (95% CI: 11, 22) and 5 (95% CI: 0.4, 11) percentage units, respectively. Only two of the nine reported performance items were significantly different among the non in-charges in the intervention group at follow-up II. Conclusions: The educational programme including peer discussions using existing opportunities with no need for additional absence from the workplace might be a useful complement to formal large group education for the providers. [ABSTRACT FROM AUTHOR]

The article discusses the role of family planning for preventing vertical HIV transmission in Uganda. It mentions the country has one of the highest total fertility rates (TFR) across the world. It compared the effects of antiretroviral (ARV) prophylaxis for the prevention of mother-to-child HIV transmission (PMTCT). Further it concludes that family planning use contributes more than ARV-PMTCT in mitigating pediatric HIV in the country. Further it suggests to expand family planning services PMTCT.

In an effort to discover what can improve family planning services for recently immigrated Hispanic women and to foster cultural competence among health care providers in this arena, the authors conducted four focus groups of recently immigrated Hispanic women in a medium-sized Midwestern community. The focus group discussions covered such topics as health care, knowledge of birth control, domestic life, and economic issues in the United States. The participants demonstrated knowledge of and support for the concept of family planning and specific birth control methods. They also identified issues that challenge the use of birth control at the individual, family, system, and cultural levels. [ABSTRACT FROM AUTHOR]

Objectives To compare two post-abortion family planning (FP) service packages on contraceptive use and repeat abortion rate among young women in three cities in China. Methods In this cluster-randomized trial, one FP service package included provision of limited information and referral to existing FP services, and the other, more comprehensive, package consisted - in addition to the above simple package - of individual counselling, free provision of contraceptive materials, and involvement of the male partner. Eight matched pairs of hospitals were certified by centralized randomization. Women undergoing abortion were followed up for six months, and data were collected in two rounds, before and after the intervention. Results We followed a total of 2336 women younger than 25 years (555 before and 555 after the simple intervention package; 634 before and 592 after the comprehensive intervention package). Both packages increased use of any contraceptive method, but the comprehensive approach also increased use of more effective methods. Odds ratios for consistent and correct use of condoms were 2.32 (95% confidence interval 1.55-3.46) and 2.78 (1.81-4.26), respectively, compared with the simple package. The rates of unwanted pregnancies and repeat abortions were somewhat reduced for both packages, with no significant statistical difference between them. Conclusion Couples who received the comprehensive post-abortion FP service appear to use more effective contraceptive methods and show better compliance. [ABSTRACT FROM AUTHOR]

As antiretroviral treatment becomes more available, community home-based care (CHBC) clients may begin to resume normal daily activities including the resumption of sexual relationships. This study examines sexual behavior, contraceptive use, unmet need for family planning and attitudes toward pregnancy in the context of HIV among CHBC participants (clients and caregivers), many of whom are HIV-positive or at risk for HIV, of the COPHIA project in Kenya. The COPHIA project was implemented by Pathfinder International with support from USAID/Kenya. We interviewed 171 CHBC clients and 183 CHBC caregivers and conducted four focus groups with caregivers. Data were collected from randomly selected COPHIA-affiliated CHBC programs in Western Province and in Nairobi between September and November 2004. Forty-four percent of clients and 55% of caregivers had been sexually active in the past six months. The reproductive health needs of this population are complex; a significant percentage of study participants have an unmet need for family planning and some desire more children. A small proportion of study participants were pregnant during the time of the interview. The majority of those who use contraception reported relying solely on the male condom to prevent pregnancy. While vital for HIV prevention and easily distributed by CHBC programs, the male condom is not as effective as other methods in preventing pregnancy. Community home-based care program participants need counseling related to contraception, fertility desires and pregnancy. The promotion of dual method use is crucial to this population. Besides referring participants to family planning services, CHBC programs need to consider how and if they can meet the family planning and other reproductive health needs of their participants. [ABSTRACT FROM AUTHOR]

There is now an increasing body of research on the history of birth control and family planning. However, little work has yet been carried out on the provision and establishment of clinics at a local and regional level after 1945. This article seeks to fill this gap by describing and interpreting the establishment of a family planning service in Northern Ireland from the 1950s onwards. The distinctive religious, social, political and cultural situation in the province ensured that the manner in which clinics were established and the issues and difficulties that were faced differed from those elsewhere in the United Kingdom. Northern Ireland provides a valuable case-study of how local and regional differences influenced the establishment and growth of family planning services. [ABSTRACT FROM AUTHOR]

An essay is presented on the traveling medical clinic called Women on Waves, founded by the Dutch physician Rebecca Gomperts. The clinic provides gynecological services to women in countries with limited access to birth control and abortions. The clinic can legally be within twelve miles of the nation into which it has docked. The effects of criminalizing abortion, including the increase of unsafe abortions, are discussed and the relationship between Women on Waves and the art world is explored.

Objective The objective of this study was to compare efficacy for four medical abortion regimens used in one clinic setting: (1) misoprostol alone, (2) oral methotrexate + buccal misoprostol, (3) oral methotrexate + vaginal misoprostol, and (4) intramuscular methotrexate + vaginal misoprostol. Design Retrospective analysis of data from clinical records. Setting An anonymous women’s health centre in Latin America, providing medical abortion services since 2001 in a highly restrictive setting. Population A total of 8678 women with gestations <56 days, who sought a medical abortion between April 2002 and December 2004. Methods Chi-square test was performed to compare patient characteristics by abortion outcome (success/failure). The impact of selected variables on method success was explored through logistic regression. A second regression analysis was conducted with a subsample ( n= 4022), for which data on parity and previous abortion(s) were available. Main outcome measure Abortion outcome (success/failure) at 2-week follow up. Results Success rates for the three methotrexate regimens ranged from 81.7 to 83.5% and did not differ significantly; misoprostol-alone regimen had a success rate of 76.8%. Efficacy was significantly higher for the three combined methotrexate regimens compared with misoprostol alone and remained so in the multivariate model (OR = 1.35). In the final regression, lower gestational age, being nulliparous, and having no previous abortions were positively correlated with method success. Conclusions In this real-use setting, methotrexate appears to confer a significant advantage over misoprostol alone for early medical abortion. This finding is important for settings where mifepristone remains unavailable. Additional factors such as gestational age limits and patient preference should be considered in regimen selection. [ABSTRACT FROM AUTHOR]

Favorable client perceptions of provider's interpersonal behavior in contraceptive delivery, documented in clinic exit questionnaires, appear to contradict results from qualitative evaluations and are attributed to clients' courtesy bias. In this study, trained simulated clients requested services from Ministry of Health providers in three countries. Providers excelled in courteousness/respect in Peru and Rwanda; in India, providers were less courteous and respectful when the simulated clients chose the pill. Privacy and two-way communication were less prevalent in all three countries. The findings challenge the courtesy bias interpretation. Global results from qualitative studies may have expressed the views of the minority of clients who are not treated well by providers. [ABSTRACT FROM AUTHOR]

Objectives: This study sought to determine whether selected structural and organizational characteristics of publicly available family planning facilities are associated with greater availability. Methods: A survey was sent to 726 publicly available family planning facilities in four states. These included local health departments, federally qualified health centers (FQHC), Planned Parenthood sites, hospital outpatient departments, and freestanding women’s health centers. Usable responses were obtained from 526 sites for a response rate of 72.5%. Availability variables included the provision of primary care services; the contraceptives offered; professional staffing; scheduling, waiting time, and transportation; and cultural congruence and competency. The structural and organizational variables were state, type of organization, and funding source. Results: Some states were more likely to offer emergency contraception while others were more likely to have weekend hours. FQHCs were most likely to provide primary care and Planned Parenthood sites most likely to offer emergency contraception. Title X funding was associated with increased likelihood of providing emergency contraception and staffing by midlevel practitioners and registered nurses. Conclusions: This study found that availability varied by structural and organizational variables, many of which are determined by federal and state policies. Revising some of these policies might increase utilization of family planning facilities. [ABSTRACT FROM AUTHOR]

CONTEXT: In addition to contraceptive services, publicly funded family planning clinics provide low-income women with a range of reproductive diagnostic, treatment and educational services. Nationally representative information about the scope of services available from clinics is needed to formulate policy and programmatic recommendations. METHODS: In 2003, more than 1,000 U.S. clinics responded to an eight-page survey on service availability and clinic policies. Differences in the proportions of clinics reporting each service or policy were examined by clinic type and receipt of Title X funding. RESULTS: Nearly all clinics offer pills, injectables and condoms; 75% offer the patch; and 80% offer emergency contraception. Most clinics (73%) typically use a conventional Pap smear for initial cervical cancer screenings; 27% use liquid-based Pap tests. For follow-up, 68% of clinics use liquid-based or other advanced testing. Virtually all clinics screen at least some clients for chlamydia; Planned Parenthood and Title X--funded clinics, more than others, tend to focus screening efforts on sexually active women aged 25 and younger. Single-dose treatments are provided by 58% of clinics. Nine in 10 clinics offer HIV testing on-site, most of them to any client who requests it. Services targeted to specific populations include counseling about abstinence for minors (91%); non-reproductive health services for men (36%); and availability of staff such as translators (81%) and bilingual administrative (59%) or clinical personnel (57%) for non-English-speaking clients. CONCLUSIONS: More public funding is imperative for clinics to keep up with the demands of new technologies and a diverse client base. [ABSTRACT FROM AUTHOR]

Background: Central booking services have been proven to facilitate access to abortion services. This in turn should reduce morbidity and mortality. City-wide models have previously been described. A nationwide central booking service has been developed in the UK.Development: A nationwide central booking service was introduced in 1993. Initially a manual booking system was used. In 1996 the appointment system was computerised.Output: More than a quarter of a million calls are now received each year. The highest demand weekday is a Monday. The volume of calls peaks at mid-morning. There is a sustained rise in calls from the second week in January through to mid-February, peaking in the fifth week of the year. More than a quarter of calls originate from mobile phones.Conclusions: The computerised central booking service has radically improved the efficiency of the organisation. Waiting times can be actively managed using data from the system. [ABSTRACT FROM AUTHOR]

Background: Effective confirmation of pregnancy is a basic component of reproductive health services. It is a prerequisite for accessing antenatal care (AnC) if the pregnancy is wanted and abortion services if the pregnancy is unwanted. This study examined the role of urine pregnancy testing in the timing of presentation for pregnancy-care. Method: A cross-sectional study was conducted among 158 women presenting for antenatal care and 164 women presenting for abortion at public sector clinics in Cape Town, South Africa. Results: The median gestational age at first presentation was 23 weeks for AnC clients and 13 weeks for abortion clients. Obtaining a urine pregnancy test of one's own accord was associated with a decrease in the gestational age at presentation of 3.6 and 1.4 weeks for antenatal and abortion clients, respectively, independently of all other factors. Conclusion: Given the proven clinical benefit and public health impact of early presentation for antenatal and abortion services, strategies to decrease gestational age at presentation for pregnancy care should be given priority. 'Fast-track' urine pregnancy testing services should be established in public sector clinics in South Africa. [ABSTRACT FROM AUTHOR]

CONTEXT: Hormonal contraceptive users may be at increased risk for HIV and other STDs. An understanding of their decisions and abilities to use condoms is needed to focus intervention programs aimed at improving their protective behaviors. METHODS: Between 1999 and 2001, 426 new users of depot medroxyprogesterone acetate (DMPA) and oral contraceptives were recruited from public clinics providing family planning services to low-income women and surveyed when they began their method and again three months later. Bivariate analyses examined the consistency of condom use across subgroups, and multivariate analyses assessed associations between consistent use and various characteristics. RESULTS: Among women who had used condoms consistently before starting on DMPA or the pill, 54% discontinued consistent use after taking these contraceptives. Overall, 20% of women consistently used condoms with their hormonal method, and such use did not vary significantly by contraceptive type. Seventy-five percent of women in nonmonogamous relationships were inconsistent users, though nearly a third had been consistent users prior to beginning a hormonal method. Factors associated with an elevated likelihood of consistent use were the male partner's positive opinion of condoms (odds ratio, 3.3) and the woman's strong belief that condom use is important for vaginal intercourse (3.5) and even if the couple is using another form of birth control (4.1). CONCLUSIONS: Many women at highest risk for disease have a decreased likelihood of using condoms, and disease prevention programs should be customized to target these women. Educational efforts focusing on women's attitudes and negotiation skills may be the best means of increasing dual method use. [ABSTRACT FROM AUTHOR]

This article reviews field experiences with provision of family planning services in prevention of mother-to-child transmission (PMTCT) programs in ten countries in Africa, Asia, and Latin America. Family planning is a standard component of most antenatal care and maternal-child health programs within which PMTCT programs are offered. Yet PMTCT sites often miss opportunities to provide HIV-positive clients with family planning counseling. Demand for family planning among HIV-positive women varies depending on the extent of communities' openness about HIV/AIDS, fertility norms, and knowledge of PMTCT programs. In Kenya and Zambia, no differences were observed in use of contraceptives between HIV-positive and HIV-negative women in the study communities, but HIV-positive women have more affirmative attitudes about condoms and use them significantly more frequently than do their HIV-negative counterparts. In the Dominican Republic, India, and Thailand, where HIV prevalence is low and sterilization rates are high, HIV-positive women are offered sterilization, which most women accept. This article draws out the policy implications of these findings and recommends that policies be based on respect for women's right to informed reproductive choice in the context of HIV/AIDS. [ABSTRACT FROM AUTHOR]

Objectives: In Pakistan, the role of men has always been considered to dominate in the decision-making process pertaining to women's fertility and birth spacing. This study was done to explore men's knowledge, perceptions and behavior on various reproductive health issues.Methods: A cross-sectional survey was carried out among 180 married adult males in 12 rural districts of Pakistan in 2000. The study was qualitative, utilizing tools such as in-depth and key-informant interviews.Results: The findings pointed out gaps in knowledge and misconceptions among men on a range of reproductive health issues and stress the need for health education. The findings suggest that strategies such as couple counseling, door-to-door campaigns by village-based male family planning workers and small group meetings could be effective. This study indicates a pressing need for incorporating effective intervention strategies, both at the community and the clinic level, backed with efficient counseling, motivation, and provision of services with appropriate education of males in rural areas.Conclusion: The findings suggest that investment into promotion of healthy fertility control practices among men will be effective in the near future, as they are interested in acquiring new knowledge and are willing to become partners. [ABSTRACT FROM AUTHOR]

Cervical cancer screening services in South Africa have failed to reach the majority of the population and to significantly reduce mortality. A household survey in a predominantly Black African population living in a low-income township on the outskirts of Cape Town was undertaken to ascertain the characteristics of women reporting never having been screened. In our group of 664 representatively sampled women, 45% of women reported having had a cervical screening test. However, in what at first glance appears to be a fairly homogeneous population, there were significant differences in the types of women who access and who do not access cervical smear services. The underserved tend to be the older, poorer, less educated, and unemployed (or working in the informal sector) women. They tend to live in nonpermanent dwellings without a partner, they do not know anyone else who has had a cervical smear, and they have not recently sought care for other ailments, or used contraception. Cervical cancer is a slow-to-develop, eminently preventable disease, and yet opportunistic screening through antenatal and family planning services has failed to reach the women most at risk. Efforts in the future must include targeting older women in health centres where they present for other curative services (diabetes, hypertension). Most importantly, areas of the community with the greatest concentration of marginalized women need to be targeted through peer education and other innovative programs. As the underserved tend to be the poorer and less educated women in the community, we must ensure that messages are culturally relevant and appropriate and have a holistic focus on women's physical, mental, and emotional health. [ABSTRACT FROM AUTHOR]

Describes the status of abortion service accessibility in the U.S., on the basis of data collected in a survey of U.S. providers conducted in 2001-2002 by the Alan Guttmacher Institute. Types of providers; Factors affecting the access of women to abortion services; Development that increases women's options.