Increased contraceptive use worldwide
The UN Population Division has published data from 1997 from 153 countries on current contraceptive use for women of reproductive age who are married or in a consensual union with a spouse or regular partner. Contraceptive use increased substantially over the previous decade. The lowest level of use was in Africa (25% of 117 million married women), followed by Asia (66% of 700 million), Latin America and the Caribbean (69% of 84 million). Nine out of ten users used modern methods, most commonly female sterilisation (20%), IUDs (15%) and oral contraception (8%). Oral contraception and condoms were more popular in the developed world. Traditional methods were used more in developing countries, most frequently rhythm and withdrawal; globally, 6% of married women use them. Yet high levels of unmet need remain: 24% of married women in sub-Saharan Africa, 18% in North Africa, Asia, Latin America and the Caribbean, and 10% in Europe. [1]
Majority of world's couples are using contraception. At: 〈www.un.org/News/Press/docs/2002/dev2392.doc.htm〉, 22 May 2002.
Contraceptive supplies threatened by inadequate funding
The number of contraceptive users in developing countries is expected to reach 764 million by 2015, 212 million more than in 2000. The three main sources of funding for contraceptives in developing countries are donors, governments and users themselves. From 1992 to 1996 donors provided about 41% of the total. To ensure the same proportion of support for projected requirements, donors would have to provide US$390 million in 2002 and US$739 million in 2015. Total donor support for contraception reached US$172 million in 1996 but fell to US$131 million 1999 and US$154 million in 2000. Developing country governments' and consumers' share would have to reach $564 million in 2002 and $1,067 million in 2015 to make up for this. Countries will also need to improve their management of human resources, logistics, information systems, monitoring of supply and distribution, and forecasting and procurement of supplies. Whoever pays, much more funding for contraceptives is urgently needed to keep up with demand. [1]
Hopkins Report: Family planning logistics: strengthening the supply chain. Population Reports 2002;30(1). Series J, No. 51.
Involving young people in programmes for young people
An exercise comparing the views of young people and professionals about effective interventions to reduce the frequency of teenage pregnancy showed a stark difference in views between the two. Young people emphasised the importance of interventions being youth-centred, and suggested creative ways of communicating health and education messages. They highlighted the need for privacy and flexible hours in services for young people, and suggested using real-life experiences of young parents to educate them and to dispel myths about sex. The professionals tended to medicalise the problems and emphasised re-organisation of health services and service-based solutions. Both groups advocated peer education, developing more services for young men, and educating staff to be more responsive to young people's needs. Specialist services, better training for schools, consultation with young people, active health promotion and the role of youth services were all noted. [1] The city of Sheffield in the UK has trained ten 15–19 year-olds to go “undercover” to evaluate local sexual health services for accessibility and suitability, the first step in a ten-year strategy to reduce adolescent pregnancies by 50%. [2] Adolescents make up a large proportion of the population in Asia. The number of adolescent girls who are or have been married varies from 45% in Bangladesh, to 33% or more in India and Nepal, and 8% in Sri Lanka. Studies amongst young women in these countries show that although they are aware of contraception, knowledge of specific methods and sources of supplies are limited. Use varies from 2% in Pakistan to 44% in Indonesia. Unmarried, sexually active adolescents mostly use nothing or rely on traditional methods. [3]
Chambers R, Boath E, Chambers S. Young people's and professionals' views about ways to reduce teenage pregnancy rates: to agree or not agree. Journal of Family Planning and Reproductive Health Care 2002;28(2):85–90.
Undercover scheme to assess sexual health services. Press release. 4th November 2002.
Pachauri S, Santhya KG. Reproduction choices for Asian adolescents: a focus on contraceptive behavior. International Family Planning Perspectives 2002;28:186–93.
Low dual protection use among South African family planning users
A study involving over 500 men and women family planning users at public health facilities in South Africa revealed a low level of dual protection use, consistent with previous studies. Use of dual protection aims to prevent both unwanted pregnancy and the transmission of HIV and other STDs. Guidelines for promoting dual protection as part of primary health care services are needed at national and local levels. The integration of family planning and other reproductive health services, especially for STDs, is urgently needed in South Africa. The research also revealed a gender-based dichotomy in decision-making on contraceptive use versus protection against STDs/HIV; the majority of men and women agreed that the choice of using condoms lay with the man, whereas the decision on the type of contraceptive used was the woman's. [1]
Myer L, Morroni C, Mathews C, et al. Dual method use in South Africa. International Family Planning Perspectives 2002;28(2):119–21.
Public–private partnership for antenatal care proposed in Hong Kong
A pilot scheme has begun between the public Prince of Wales Hospital and the private Union Hospital in Hong Kong to encourage patients to seek antenatal care in the private sector while keeping open the option of giving birth in a public hospital. Such an arrangement is promoted as allowing flexibility of choice, but the cost to the woman is increased. This is part of an expanding partnership scheme which is intended to encourage patients to use the private sector for simple, low-risk, high-volume procedures, enabling public hospitals to re-allocate resources to areas where need is considered greater. [1]
Parry J. Hong Kong's public health system turns to private sector for help. BMJ 2002;325:1194.
More US women choosing medical abortion
A National Abortion Federation (NAF) survey of its members in the US indicates that 73% offer medical abortion services, and the majority of them said that the proportion of women choosing medical abortion (mifepristone + misoprostol) has been increasing since the method was introduced–a median of 18% of eligible women. In a third of NAF clinics more than 30% of eligible women were choosing it. [1] In 2002 clinics affiliated with NAF, Planned Parenthood Federation of America and independent clinics represented 83% of mifepristone sales, and private practices the rest. Mifepristone is now approved in 26 countries. Over the last decade, nearly one million women worldwide (excluding China) have used mifepristone plus a prostaglandin for medical abortion. [2,3] In China, the method has long been available and is widely used.
Availability of medical abortion among National Abortion Federation members. National Abortion Federation Early Options E-mail Update, 2 October 2002, 3(1).
Danco Laboratories releases statistics on the 2-year anniversary of FDA approval. National Abortion Federation Early Options E-mail Update, 2 October 2002, 3(1).
More than 100,000 U.S. women have chosen Mifeprex for their non-surgical abortion. Press release, Danco Laboratories, 24 September 2002.
Difficulty in measuring views of service users in quality of care evaluations
Assessing the opinions of health service users plays an increasingly important part in quality evaluations, but how best to measure this? A study in South Africa analysed findings from 14 focus group discussions (FGDs) and 337 exit interviews to obtain users' views on the same set of primary health care providers. In the absence of explicit and universal standards, users evaluated providers against their own experience in other health care services. Responses were thus highly context-specific. The FGDs provided a different and generally more negative picture of providers than the exit interviews, suggesting that where and how views are elicited has a bearing on results obtained. The FGDs appeared to encourage dramatic representations of what was, on observation, banal everyday reality. Both methods defied superficial reading and had limitations in establishing people's true opinions. User opinion must be seen as a social phenomenon, dynamic, bound to particular contexts and difficult to capture in single assessments, regardless of how well designed. [1]
Schneider H, Palmer N. Getting to the truth? Researching user views of primary health care. Health Policy and Planning 2002; 17(1):32–41.
Artificial pelvis educates all
The use of a pelvic simulator to train medical and non-medical staff in pelvic examinations and IUD insertion helps them to gain both confidence and skill in the procedures, prior to carrying them out on women. The simulator has also been successful in health education for women, improving their understanding of female physiology and gynaecological procedures and reducing their concerns. [1]
Geyoushi B, Apte K, Stones RW. Simulators for intimate examination training in the developing world. Journal of Family Planning and Reproductive Health Care 2003;29:34–35.
Breastfeeding breaks the rules
A mother was forbidden to breastfeed in Hong Kong's central library because it broke a “no food or drink” rule. [1] In Australia, a member of parliament who was breastfeeding in the chamber of the Victoria state legislature was ejected for bringing in an “unelected member”. [2]
Metro (UK). 25 October 2002.
Guardian (UK). 27 February 2003.
Figure 1 Street fair, Mexico City, 2001
