bluuebunny/crossref_metadata_2025 huggingface dataset:
Cost‐effectiveness of screening and treatment for bacterial vaginosis in early pregnancy among women at low risk for preterm birth
Authors: Kekki Minnamaija , Kurki Tapio , Kotomäki Teija , Sintonen Harri , Paavonen Jorma
Published: December 2003

Background.  Bacterial vaginosis (BV) is an important risk factor for preterm birth. BV is detected in 10–30% of pregnant women and is often asymptomatic. Treatment of BV during pregnancy seems to reduce the risk of preterm delivery among high‐risk women. We performed a cost‐effectiveness analysis of screening and treatment for BV in early pregnancy among asymptomatic women at low risk for preterm delivery.

Methods.  A decision tree was built with two arms. For the screening (and treatment) arm the probabilities were derived from our earlier randomized trial on screening and treatment for BV, consisting of BV‐positive women treated with intravaginal clindamycin cream or placebo and also of BV‐negative pregnant women. The probabilities of outcomes among these women were collected from antenatal clinic records and hospital records, and for the no‐screening arm mainly from the Finnish Perinatal Statistics. The outcomes considered were preterm delivery, mode of delivery, peripartum infections and postpartum complications. The unit costs associated with these outcomes were mainly based on disease‐related groups (DRGs). No‐screening was compared with two screening programs (one with clindamycin, the other with metronidazole treatment) and subjected to sensitivity analyses.

Results.  There was no significant difference between screening and no‐screening strategies in the costs and in the rate of preterm deliveries but the screening strategy produced significantly fewer peripartum infections and postpartum complications. Sensitivity analyses suggested that the screening strategy may become cost‐saving if the rate of preterm deliveries exceeds 3%.

Conclusion.  Screening and treatment for BV in early pregnancy may not reduce costs compared to no‐screening in a population at low risk for preterm birth but would produce, at the same cost, more health benefits in terms of fewer peripartum infections and postpartum complications. However, it may be cost‐saving if the rate of preterm deliveries is higher than 3%.
Repeated random blood glucose measurements as universal screening test for gestational diabetes mellitus
Authors: Östlund Ingrid , Hanson Ulf
Published: December 2003

Background.  To determine the value of repeated random blood glucose (R‐B‐glucose) measurements alone or in combination with traditional risk factors [family history of diabetes, obesity, prior large‐for‐gestational‐age (LGA) infant or prior gestational diabetes mellitus (GDM)] to predict the outcome of the oral glucose tolerance test (OGTT).

Methods.  A prospective population‐based study was undertaken in a Swedish county. All pregnant nondiabetic women (n = 4918) visiting the maternal health care clinics over a 2‐year period were offered a 75‐g OGTT in gestational weeks 28–32. Traditional risk factors and values of repeated R‐B‐glucose measurements were registered, as well as the results of the OGTT, in terms of fasting B‐glucose and 2‐h B‐glucose.

Results.  A total of 3616 women (73.5%) had an OGTT. Of these, 1.7% had GDM, 1.3% impaired glucose tolerance (IGT) and 0.4% diabetes mellitus (DM). An R‐B‐glucose cut‐off level ≥8.0 mmol/L as the only indicator for an OGTT was optimal for detecting GDM with regard to sensitivity (47.5%) and specificity (97.0%). It has the same sensitivity for detecting GDM as using traditional risk factors, but reduces the need to carry out the OGTT from 15.8% to 3.8% of the population. Combined with prior LGA infant or prior GDM as indications for the OGTT in the present study, all women with DM and 44.7% of those with IGT will be identified. Only 7.3% of the population will have to take the OGTT.

Conclusion.  A random B‐glucose level ≥ 8.0 mmol/L prior LGA infant or prior GDM as an indicator for taking the OGTT is a simple and effective first step in a two‐step screening model for GDM.
Effect of urinary trypsin inhibitor on potassium currents: fetus modulates membrane excitability by production of UTI
Authors: Takeuchi Kinya , Fukuda Atsuo , Kanayama Naohiro
Published: December 2003

Background.  Amniotic fluid contains a significant level of urinary trypsin inhibitor (UTI). Previously, we reported that UTI inhibits calcium influx of myometrium and it is effective in preventing uterine contraction. This study examined the effects of UTI upon potassium channels, which is important for membrane excitability.

Methods.  Whole‐cell patch‐clamp recordings were performed in fibroblasts derived from human fetal skin. Potassium currents were recorded and the effects of exogenous UTI and/or cadmium determined.

Results.  Tetraethylammonium sensitive potassium currents were elicited by step or ramp stimulations at depolarized membrane potentials (over +30 mV). Administration of 1 µM UTI significantly increased these potassium currents by 16.9%. When calcium channels were blocked by the administration of cadmium, UTI increased the rest of the potassium currents by 4.8%. This indicates that UTI increased calcium‐dependent potassium currents by 94.8% but only increased voltage‐dependent potassium currents by 4.8%.

Conclusions.  Urinary trypsin inhibitor is a physiological substance of fetal origin that modulates calcium‐dependent and voltage‐dependent potassium channels. These data suggest that UTI is capable of regulating the membrane properties of the fetal and myometrial cells in contact with amniotic fluid.
Mode of delivery in pregnancies with suspected fetal growth restriction following induction of labor with vaginal prostaglandin E2
Authors: Ben‐Haroush Avi , Yogev Yariv , Glickman Hagit , Kaplan Boris , Hod Moshe , Bar Jacob
Published: December 2003

Background.  Many fetuses below the 10th percentile for gestational age are uncompromised. We aimed to evaluate the mode of delivery and immediate neonatal outcome in pregnancies with suspected fetal growth restriction (FGR) and normal antenatal assessment following induction of labor with vaginal application of prostaglandin E2 (PGE2).

Methods.  Ninety women with suspected FGR (sonographic estimated fetal weight < 10th percentile) with normal oxytocin contraction test (OCT), biophysical profile (BPP) and reassuring fetal heart rate underwent induction of labor with vaginal application of PGE2 tablets. The findings were compared with 115 women admitted for induction of labor because of decreased fetal movement (group 2) and with 510 women with normal spontaneous onset of labor (group 3).

Results.  There were no between‐group differences in mean maternal age, gravidity, parity, nulliparity rate, number of tablets used or rate of patients receiving more than one PGE2 application. The rate of cesarean section (CS) in the study group (8.9%) was similar to the rate in groups 2 and 3 (14.8% and 9.0%, respectively). The incidence of nonreassuring fetal heart rate pattern leading to cesarean delivery was higher in the study group, but the rate of low 5‐min Apgar scores (< 7) was similar in all groups. A logistic regression model and forward likelihood analysis yielded no single significant variable associated with increased risk of cesarean delivery.

Conclusions.  In selected cases of suspected FGR with reassuring fetal heart rate and normal OCT and BPP, induction of labor with vaginal PGE2 may yield a similar immediate fetal outcome and CS rate as in uncomplicated, induced or spontaneous deliveries.
Second‐ and third‐trimester serum levels of placental proteins in preeclampsia and small‐for‐gestational age pregnancies
Authors: Bersinger Nick A. , Ødegård Rønnaug A.
Published: December 2003

Background:  Poor placentation may perpetuate preeclampsia, but the presence of a major placental pathology has been questioned in cases of preeclampsia where the newborn has an appropriate birthweight for gestational age. On the other hand, poor placentation is also observed in the absence of preeclampsia, in pregnancies with small‐for‐gestational‐age (SGA) fetuses. In late gestation, maternal serum levels of placental protein hormones are changed in both preeclampsia and SGA, but no longitudinal preonset studies are available for pregnancy‐associated plasma protein A (PAPP‐A), pregnancy‐specific β1‐glycoprotein (SP1) or human placental lactogen (HPL).

Methods:  In a nested case‐control study we compared maternal serum levels of PAPP‐A, SP1, HPL and placenta growth factor (PLGF) at 17, 25 and 33 weeks in pregnancies developing preeclampsia without fetal growth restriction (n = 28), or characterized by a growth‐retarded fetus (n = 25), with gestation‐matched controls (n = 65). The proteins were quantified using microplate enzyme immunometric assays and the serum levels at 17, 25 and 33 weeks compared between the three groups by nonparametric statistical tests.

Results:  In pregnancies with subsequent preeclampsia PAPP‐A, SP1, HPL and PLGF were reduced at 17 weeks of gestation whereas at 25 and 33 weeks only PLGF remained below the controls. In growth‐restricted pregnancies PAPP‐A, SP1 and HPL were reduced at 17 weeks, and only HPL continued to be strongly affected thereafter.

Conclusion:  The reduced serum levels of the placental proteins PAPP‐A, SP1 and HPL in the early second trimester (17 weeks) in pregnancies with subsequent preeclampsia or with fetal growth restriction involve an underlying role for the placenta in either pathology independent from the other.
Maternal risks and perinatal outcome in a Danish national cohort of 1005 twin pregnancies: the role of in vitro fertilization
Authors: Pinborg Anja , Loft Anne , Schmidt Lone , Langhoff‐Roos Jens , Andersen Anders Nyboe
Published: December 2003

Background.  Twin pregnancies constitute 25% of all in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) pregnancies. There is a lack of knowledge on maternal risks and perinatal outcome of IVF/ICSI twin pregnancies.

Methods.  National survey by questionnaire (n = 1769). The study population consisted of all IVF/ICSI twin mothers (n = 266) and the two control groups of all IVF/ICSI singleton mothers (n = 764) and non‐IVF/ICSI twin mothers (n = 739) who delivered in Denmark in 1997. The response rate was 89% among IVF twin mothers and overall 81%.

Results.  In terms of maternal risks and perinatal outcome no significant differences were observed between IVF/ICSI twin and non‐IVF/ICSI twin pregnancies after stratification for maternal age and parity. Nevertheless, IVF/ICSI twin mothers were more frequently on sick leave (OR 2.5, 95% CI 1.5–4.0) and hospitalized (OR 1.9, 95% CI 1.3–2.8) during pregnancy. Compared with IVF/ICSI singleton pregnancies, IVF/ICSI twin pregnancies were characterized by a higher incidence of preeclampsia (OR 2.4, 95% CI 1.5–4.2) and a higher frequency of sick leave (OR 6.8, 95% CI 4.4–10.5) and hospitalizations during pregnancy (OR 3.5, (95% CI 2.5–4.9); moreover, mean birthweight (p < 0.001) and gestational age (p < 0.001) were lower. No differences were observed in the incidence of pregnancy‐induced hypertension and gestational diabetes between IVF/ICSI twin and singleton pregnancies.

Conclusion.  Although this population study indicates that maternal risks in IVF/ICSI twin pregnancies are comparable with non‐IVF/ICSI twin pregnancies, the IVF/ICSI twin mothers were more likely to be on sick leave or hospitalized during pregnancy. Furthermore, maternal risks were higher and obstetric outcome poorer in IVF/ICSI twin vs. IVF/ICSI singleton pregnancies.
The influence of body mass index on the prevalence of complications after vaginal and abdominal hysterectomy
Authors: Rasmussen Kjeld Leisgaard , Neumann Gudrun , Ljungström Britt , Hansen Villy , Lauszus Finn Friis
Published: December 2003

Aim of study.  To investigate the association between obesity and peri‐ or postoperative complications after hysterectomy for nonmalignant bleeding disorders.

Material and methods.  Data from 444 vaginal hysterectomies and 503 abdominal hysterectomies indicated by benign bleeding disorders were drawn from a regional database. Data on peri‐ or postoperative complications and postoperative stay were related to preoperative body mass index (BMI).

Results.  Obesity was related to longer operation time for vaginal as well as abdominal hysterectomy and to large perioperative blood loss for vaginal hysterectomy only. No association was found between BMI and serious complications such as ileus, infection or hematomas except for a higher prevalence of wound hematoma after abdominal hysterectomy in underweight and normal weight patients. Neither was any association found between BMI and use of blood transfusion, reoperation or prolonged postoperative stay.

Conclusion.  Vaginal and abdominal hysterectomy have a significant risk of complications, but obese patients did not experience an increased risk of serious morbidity compared to normal weight women. Obesity per se is not a contraindication of vaginal or abdominal hysterectomy in otherwise healthy women.
Norepinephrine, adrenocorticotropin, cortisol and beta‐endorphin in women suffering from fear of labor: responses to the cold pressor test during and after pregnancy
Authors: Saisto Terhi , Kaaja Risto , Helske Satu , Ylikorkala Olavi , Halmesmäki Erja
Published: December 2003

Background.  Women suffering from fear of labor have reduced pain tolerance during a cold pressor test (CPT) during and after pregnancy.

Methods.  We compared levels of norepinephrine, adrenocorticotropin (ACTH), cortisol and beta‐endorphin before and during the CPT up to 60 min in 20 normotensive women with and 20 without fear of labor at 37.4 ± 0.2 (mean ± SE) gestational weeks and at 41.9 ± 1.6 weeks after delivery.

Results.  Baseline levels of norepinephrine in the pregnant fear group (1.63 ± 0.18 nmol/L) were higher (p = 0.068) than in controls (1.38 ± 0.14 nmol/L) but after delivery they were lower in the fear group (1.75 ± 0.31 nmol/L vs. 2.31 ± 0.26 nmol/L, p = 0.064). ACTH, cortisol and beta‐endorphin did not differ between pregnant and nonpregnant groups. The CPT caused a 28.4% smaller response in norepinephrine in the pregnant fearful women than in controls, whereas the responses of ACTH and beta‐endorphin were similar between groups during and after pregnancy. The CPT caused no significant response in cortisol. Pregnant fearful women had higher diastolic blood pressure (85.6 ± 4.5 mmHg, mean ± SE) than the controls (74.9 ± 3.4 mmHg, p = 0.065).

Conclusions.  Women with fear of labor were characterized by changes in norepinephrine but not in ACTH, cortisol or beta‐endorphin before and during the CPT, indicating a normal pituitary–adrenal axis function.
Inhibitory effects of SR 49059 on oxytocin‐and vasopressin‐induced uterine contractions in non‐pregnant women
Authors: Steinwall Margareta , Bossmar Thomas , Gaud Christine , Åkerlund MatS
Published: December 2003

Background.  Compounds that block uterine oxytocin and vasopressin V1a receptors have a therapeutic potential in preterm labor and primary dysmenorrhoea. The orally active vasopressin V1a receptor antagonist, SR49059, inhibits the effect of vasopressin on human uterine activity in vivo, but the influence on the response to oxytocin is unknown.

Methods.  In a placebo‐controlled, double‐blind, parallel‐group, four‐dose comparison, the inhibitory effect of SR 49059 on oxytocin‐ and vasopressin‐induced uterine contractions in humans was investigated. Sixteen healthy female subjects, who had previously undergone sterilization with tubal ligation, participated in intrauterine pressure recordings at one of the first 3 days of bleeding of two menstrual cycles. Intravenous bolus injections of 10 pmol/kg body weight of vasopressin (Period 1) and of 50 pmol/kg body weight of oxytocin (Period 2) were given 1 h before and 1 , 2 and 4 h after oral administration of 0  (placebo), 25 , 75  or 200 mg of SR 49059. The area between the recording curve and zero level of intrauterine pressure (AUC) was calculated. Vital signs as well as urine and plasma safety parameters were measured. The plasma concentrations of oxytocin, vasopressin and the study drug were also estimated.

Results.  The plasma concentrations of SR 49059 appeared to be dose related, with mean maximal values of 62.0, 163.7 and 468.0 ng/ml in the 25, 75 and 200 mg dose groups, respectively, in Period 1 with vasopressin and 34.4, 116.7 and 418.0 ng/mL, respectively, in Period 2 with oxytocin. Tmax was observed at about 1 h. The cumulative AUC over 50 min after vasopressin injection per se was significantly higher than that after oxytocin in spite of a five times lower dose and lower plasma concentrations. Pretreatment by SR 49059 caused a dose‐related reduction in AUCs for vasopressin, whereas no such effect was seen for oxytocin. With vasopressin as an agonist, a lower diastolic blood pressure was observed in all SR 49059 treatment groups, but not with oxytocin.

Conclusions.  The much higher potency of vasopressin compared with oxytocin on uterine activity in non‐pregnant women at menstruation was confirmed. SR 49059 dose‐dependently inhibits vasopressin‐induced contractions, whereas such an effect was not seen with the present doses of SR 49059 and oxytocin. A marked reduction by SR 49059 of diastolic blood pressure after vasopressin injection was observed, indicating an inhibition by this compound of vascular vasopressin receptors.
Dietary supplementation with l‐arginine or placebo in women with pre‐eclampsia
Authors: Staff Anne Cathrine , Berge Lillian , Haugen Guttorm , Lorentzen Bjorg , Mikkelsen Bente , Henriksen Tore
Published: December 2003

Background.  To investigate the effect of dietary intake of the NO‐donor l‐arginine on the diastolic blood pressure in women with pre‐eclampsia.

Methods.  A randomized double‐blind study was designed to compare the effect of l‐arginine and placebo in pre‐eclamptic women with gestational length ranging from 28+0 to 36+0 weeks. The women received orally 12 g of l‐arginine or placebo daily for up to 5 days. The primary end‐point was to identify a difference in diastolic blood pressure alteration between the two groups after 2 days of intervention. Secondary end‐points included the interval from study start to delivery, the proportion of women delivered after 2, 5 or 10 days from treatment start and mean birth weight.

Results.  There was no statistically significant alteration in diastolic blood pressure in the l‐arginine group compared with the placebo group after 2 days of treatment (p = 0.4). No differences in the proportions of women delivered by day 2, 5 or 10 after study start, in the mean interval from study start to delivery, or in mean birth weight percentile were observed between the two groups.

Conclusions.  Oral l‐arginine supplementation did not reduce mean diastolic blood pressure after 2 days of treatment compared with placebo in pre‐eclamptic patients with gestational length varying from 28 to 36 weeks. Whether l‐arginine treatment could be clinically beneficial for the mother or the fetus if started earlier in the disease process than for the women in our study remains to be seen.
Radiotherapy at a young age reduces uterine volume of childhood cancer survivors
Authors: Larsen Elisabeth C. , Schmiegelow Kjeld , Rechnitzer Catherine , Loft Anne , Müller Jørn , Nyboe Andersen Anders
Published: December 2003

Background.  In contrast to chemotherapy, previous irradiation of the uterus carries an increased risk of an adverse pregnancy outcome. Conflicting results exist as regards the ability of the uterus to increase in volume following radiotherapy‐induced damage. We measured uterine volume in a cohort of childhood cancer survivors, and assessed uterine response to a high‐dose estrogen replacement regimen.

Methods.  Uterine volume was assessed by transvaginal sonography in 100 childhood cancer survivors. Three patients with ovarian failure and severely reduced uterine volume following abdominal or pelvic irradiation were treated with percutaneous estradiol 150 µg/24 h for three cycles, and transvaginal uterine sonography was repeated monthly.

Results.  Uterine volume was significantly reduced in nulliparous patients who had received direct uterine irradiation (n = 13; median 13 mL, range 1–52 mL) compared with nulliparous patients who had received chemotherapy only (n = 37; 47 mL, 22–88), radiotherapy above the diaphragm (n = 17; 40 mL, 24–61), or radiotherapy below the diaphragm not directly involving the uterus (n = 13; 34 mL, 8–77) (p < 0.02 in all comparisons). Among nulliparous patients a significant correlation was found between age at direct uterine irradiation and uterine volume (r = 0.78, p = 0.002). No significant improvement in uterine volume, endometrial thickness or uterine artery blood flow was observed in three hypogonadal patients in response to high‐dose estrogen replacement therapy.

Conclusions.  Our results indicate that cytotoxic treatment in childhood does not affect adult uterine size. In contrast, uterine irradiation at a young age reduces adult uterine volume. The radiotherapy‐induced damage is probably irreversible.
The Kola Birth Registry and perinatal mortality in Mončegorsk, Russia
Authors: Vaktskjold Arild , Talykova Ljudmila , Chashchin Valerij , Nieboer Evert , Odland Jon Øyvind
Published: December 2003

Background. A population‐based birth registry has been set up for the Arctic town of Mončegorsk in north‐western Russia. In this investigation, the quality and the content of the registry are assessed and the perinatal mortality (PM) rates in the period 1973–97 estimated.

Material and method. Enrollment in the Kola Birth Registry (KBR) involved the retrospective inclusion of all births with at least 28 weeks of gestation in Mončegorsk in the period 1973–97. The data in the registry were assessed for data entry errors, completeness of data and population coverage. The annual PM rates were estimated for live‐ and stillborns with at least 28 weeks of gestation.

Results. The KBR contains detailed information about the newborn, delivery, pregnancy and mother for 21 214 births by women from Mončegorsk, covering at least 96% of all the births by the population in the period studied. No records were missing data for gender and birth date of the newborn, and more than 99.9% of the records contained data about gestational age and birthweight. Data concerning the mothers' employment were missing in 0.4% of the records. The annual PM rate fell from more than 20 to less than 10 deaths per 1000 births during this period.

Conclusion. The KBR provides an extensive data source useful for case‐control and register‐based prospective studies, and constitutes the first such compilation in Russia. The homogeneity of the population in Mončegorsk makes it advantageous for epidemiological investigations. The PM rate in Mončegorsk was lower than the overall rate in Russia.
Obstetric outcomes after cervical ripening by multiple doses of vaginal prostaglandin E2
Authors: Chan Louis Yik‐Si , Fu Lucille , Leung Tse Ngong , Wong Shell Fean , Lau Tze Kin
Published: December 2003

Aim.  The study was designed to investigate the delivery outcome in women who required vaginal prostaglandin E2 for cervical priming prior to labor induction.

Materials and methods.  This retrospective cohort study included all singleton term deliveries that required labor induction over a 3‐year period. Incidence and indications of obstetric interventions were compared among women who required different doses of vaginal prostaglandin E2 for cervical priming and who had induction by amniotomy and oxytocin infusion.

Results.  Of 706 deliveries, 411 had favorable Bishop's scores and no vaginal prostaglandin E2 for cervical priming was required (group A); 268 required one or two doses of vaginal prostaglandin E2 for cervical priming (group B); and 27 required three or more doses (group C). The incidence of cesarean section was significantly higher in group C (48.1%) than in group A (19.0%) and group B (16.4%). The difference remained statistically significant when primiparous and multiparous women were analyzed separately. The risk of obstetric intervention was particularly high in primiparous women in group C (58.8% required emergency cesarean section and 23.5% had instrumental delivery). There was an increased frequency of all major indications for cesarean section in group C.

Conclusion.  The risk of emergency cesarean section was higher in women who required more than two doses of vaginal prostaglandin E2 for cervical priming compared to induction by one or two doses of vaginal prostaglandin E2 or by amniotomy and oxytocin infusion. These women should be informed regarding the high risk of intrapartum cesarean section, and the option of alternative methods of induction or elective cesarean section should be made available.
Management of postmenopausal bleeding in Sweden: a need for increased use of hydrosonography and hysteroscopy
Authors: Epstein Elisabeth
Published: December 2003

Background.  The objective was to determine how postmenopausal bleeding (PMB) is managed in Sweden today, and to relate the findings to a new evidence‐based algorithm for the management of PMB.

Methods.  A questionnaire regarding the role of ultrasound and the use of different endometrial biopsy methods in the management of PMB was sent to all 61 gynecologic departments in Sweden.

Results.  Fifty‐nine of the 61 departments (97%) satisfactorily answered the questionnaire. Ultrasound was either always (n = 54, 92%) or most commonly (n = 5, 8%) used in the diagnostic work‐up of PMB. In women with endometrial thickness ≤4 mm, 18 of the departments (31%) routinely sampled the endometrium; 12 (15%) followed the women with ultrasound; three (5%) did both sampling and follow‐up with ultrasound; and the remaining 29 (49%) used expectant management (i.e. no biopsy or routine follow‐up). In women with endometrium ≥5 mm, hydrosonography was performed routinely in two departments (3%), occasionally in 37 departments (63%), and never in 20 departments (34%). In women with endometrium ≥5 mm, endometrial biopsy was obtained routinely by Endorette®/Pipelle® in 39 departments (66%), while in 26 departments (44%) operative hysteroscopy was never performed.

Conclusion.  More than one‐third of the gynecologic departments in Sweden never perform hydrosonography to rule out focal lesions or operative hysteroscopy for the removal of such lesions. Hydrosonography and hysteroscopy have a central role in the new guidelines for the management of PMB. Therefore, a need exists to broaden the use of hydrosonography and hysteroscopy.
Expanding Contraceptive Choice: Findings from Brazil
Authors: Díaz Margarita , Simmons Ruth , Díaz Juan , Gonzalez Carlos , Yolanda Makuch Maria , Bossemeyer Debora
Published: December 2003

This article presents findings from a participatory action research project in a municipality in southern Brazil that models a new and holistic approach to broadening women's contraceptive choices. The project encourages a collaborative process between researchers, community members, and public health managers to diagnose service‐delivery problems, to design and implement interventions, and to evaluate their effectiveness. Findings from the baseline evaluation revealed major constraints in availability of and access to family planning and reproductive health services for women, as well as severe deficiencies in quality of care. Interventions designed to address these weaknesses, bound by the limited resources of the public sector, focused on training, restructuring of providers' roles and service‐delivery patterns, the management process, the creation of a referral center, and the introduction of injectables, vasectomy services, and a program for adolescents. Evaluation results show the project's considerable impact in broadening reproductive options, although not all issues, especially those related to sustainability, have been resolved.
Creating Linkages Between Incomplete Abortion Treatment and Family Planning Services in Kenya
Authors: Solo Julie , Billings Deborah L. , Aloo‐Obunga Colette , Ominde Achola , Makumi Margaret
Published: December 2003

Postabortion care has received increasing emphasis as an important intervention to address part of the problem of unsafe abortion. Although a good deal of attention has been paid to improving emergency treatment of abortion complications, the other elements of postabortion care, including providing postabortion family planning services, have received less attention and are rarely found in health‐care settings around the world. This report describes a study that was conducted in Kenya to test three different models of ways to provide postabortion family planning. The study shows that these new services are both feasible and acceptable to providers and patients, and also shows how effective they can be. Whereas only 7 percent of women received family planning counseling according to the baseline survey, this proportion increased to 68 percent in the postintervention period. In addition, 70 percent of women who decided to begin using contraceptives received a method, compared with only 3 percent at baseline. The provision of postabortion family planning counseling and methods on the gynecological ward by ward staff was found to be the preferred and most effective model.
The Impact of Family Planning Service Provision on Contraceptive‐use Dynamics in Morocco
Authors: Steele Fiona , Curtis Siân L. , Choe Minja
Published: December 2003

This article uses linked data from the 1995 Morocco DHS calendar and the 1992 Morocco DHS service‐availability module to study the effect of service environment on contraceptive discontinuation, switching, and adoption of a modern method following a birth. The 1995 Morocco DHS also collected information on the source of supply for each episode of use of a modern method recorded in the calendar, allowing study of the association between the source of supply and discontinuation and switching rates. Multilevel event‐history models are used to evaluate the impact of individual‐level sociodemographic characteristics and community‐level indicators of family planning service provision. The findings show that the presence of a nearby public health center is associated with higher modern‐method adoption after a birth and lower method‐failure rates; the presence of a pharmacy is associated with lower discontinuation due to side effects or health concerns. The degree of method‐choice potential has a positive impact on both the rate of switching from the pill to another modern method and on modern‐method adoption after a birth.
Coitus‐dependent Family Planning Methods: Observations from Bangladesh
Authors: Gray Alan , Chowdhury Jamil H. , Caldwell Bruce , Al‐Sabir Ahmed
Published: December 2003

Some coitus‐dependent methods of family planning, such as withdrawal, periodic abstinence, and the condom, require male involvement for their use, and using these methods in combination has proved to be sensible. An investigation of why male and female respondents in a survey conducted in Bangladesh often gave conflicting answers about which methods they were currently using, particularly about “traditional” methods and condoms, showed that inconsistency in their reports arose because these methods are used in combination to such an extent that they are difficult to distinguish. In order to obtain reliable responses about these methods, a survey approach different from the long‐established one is required.
Women's Fears and Men's Anxieties: The Impact of Family Planning on Gender Relations in Northern Ghana
Authors: Bawah Ayaga Agula , Akweongo Patricia , Simmons Ruth , Phillips James F.
Published: December 2003

The Navrongo experiment, a family planning and health project in northern Ghana, has demonstrated that an appropriately designed, community‐based family planning program can produce a change in contraceptive practice that had been considered unattainable in such a setting. Simultaneously, however, evidence suggests that newly introduced family planning services and contraceptive availability can activate tension in gender relations. In this society, where payment ofbridewealth signifies a woman's requirement to bear children, there are deeply ingrained expectations about women's reproductive obligations. Physical abuse and reprisals from the extended family pose substantial threats to women; men are anxious that women who practice contraception might be unfaithful. Data from focus‐group discussions with men and women are examined in this report and highlight the strains on gender relations resulting from contraceptive use. The measures taken to address this problem and methods of minimizing the risk of adverse social consequences are discussed.
Assessing the Prevalence and Determinants of Unwanted Pregnancy and Induced Abortion in Nigeria
Authors: Okonofua Friday E. , Odimegwu Clifford , Ajabor Helen , Daru Patrick H. , Johnson Agnes
Published: December 2003

This study was conducted to determine the prevalence and sociodemographic determinants of unwanted pregnancy and induced abortion in the Jos and Ife local government areas of Nigeria. A total of 1,516 randomly selected women aged 15–45 responded to a pretested structured questionnaire designed to elicit information concerning previous unwanted pregnancies and induced abortions in a value‐free manner. Nearly 20 percent of the women reported having had an unwanted pregnancy. Of these, 58 percent reported that they had successfully terminated the pregnancies; 32 percent continued the pregnancies; and nearly 9 percent stated that they had attempted termination but failed. Overall, the prevalence of self‐reports of induced abortion was 11 percent. The results reveal that information can be obtained on abortion in areas with restrictive abortion policies if an indirect interviewing approach is used.
The Changing Nature of Adolescence in the Kassena‐Nankana District of Northern Ghana
Authors: Mensch Barbara S. , Bagah Daniel , Clark Wesley H. , Binka Fred
Published: December 2003

This study reports the results of a primarily qualitative investigation of adolescent reproductive behavior in the Kassena‐Nankana District, an isolated rural area in northern Ghana, where traditional patterns of marriage, family formation, and social organization persist. The study is based on in‐depth interviews and focus‐group discussions with adolescents, parents, chiefs, traditional leaders, youth leaders, and health workers, supplemented by quantitative data from the 1996 wave of a panel survey of women of reproductive age conducted by the Navrongo Health Research Centre. The social environment that adolescent boys and girls in the Kassena‐Nankana District encounter and its links to reproductive behavior are described. The principal question is whether even in this remote rural area, the social environment has been altered in ways that have undermined traditional sexual and reproductive patterns. The survey data indicate a considerable increase in girls' education and the beginning of a decline in the incidence of early marriage. The qualitative data suggest that social institutions, systems, and practices such as female circumcision that previously structured the lives ofadokscent boys and girls have eroded, leading to an apparent increase in premarital sexual activity.
A Study of Field‐based Methods for Diagnosing Reproductive Tract Infections in Rural Yunnan Province, China
Authors: Kaufman Joan , Liqin Yan , Tongyin Wang , Faulkner Anne
Published: December 2003

Reproductive tract infections are a significant cause of poor health among rural Chinese women. This study assesses the accuracy of simple, field‐based methods of diagnosing five reproductive tract infections (trichomonas, Candida, bacterial vaginosis, gonorrhea, and chlamydia) in two rural Chinese counties, using “gold standard” laboratory diagnosis as the reference. Self‐reported symptoms and clinical examination proved inadequate for making accurate diagnoses, because many infected women show no symptoms or are infected with two or more conditions. The use of simple tests such as KOH staining, wet mount, Gram's stain, and pH of discharge greatly improved diagnostic accuracy, especially for Candida and trichomonas, the two most common infections. Promoting the use of such diagnostic approaches by rural Chinese medical and family planning health providers would reduce the prevalence and severity of these preventable and easily treated infections.
The Impact of the Family Planning Supply Environment on Contraceptive Intentions and Use in Morocco
Authors: Magnani Robert J. , Hotchkiss David R. , Florence Curtis S. , Shafer Leigh Anne
Published: December 2003

Although the extent to which organized family planning programs influence reproductive preferences remains a subject of debate, most observers would grant that such programs play a key role in helping individuals to realize their contraceptive and reproductive intentions. However, few prior studies have quantified the magnitude of this facilitating or enabling effect of family planning services, given existing demand for contraception. This study takes advantage of panel survey data and linked information on the supply environment for family planning services in Morocco in order to bridge this research gap. In the analysis, contraceptive use during the 1992–95 period is related to contraceptive intentions in 1992; individual‐, household‐, and community‐level determinants of contraceptive behavior; and family planning supply factors. Estimation procedures are used that control for unobserved joint determinants of contraceptive intentions and use. Evidence of a significant enabling or facilitating role of family planning services is found, and the results also suggest that family planning program factors influence contraceptive intentions in important ways.
Integrated Maternal and Infant Health Care in the Postpartum Period in a Poor Neighborhood in Santiago, Chile
Authors: Alvarado Reynaldo , Zepeda Ana , Rivero Soledad , Rico Nieves , López Susana , Díaz Soledad
Published: December 2003

An integrated postpartum health‐care program was established by the Consultorio San Luis de Huechuraba (CSLH), a nongovernmental organization in a neighborhood of extreme poverty in Santiago, Chile. The main components were education, maternal and infant health care, support for the mothers, and active participation of women from the community served. The program was evaluated through indicators of contraceptive use, breastfeeding performance, infant growth and health, and a qualitative assessment of women's satisfaction. Controls were women of similar characteristics attending the nearby public clinic. Acceptability of contraceptive methods was similar but contraceptive options differed between clinics. The total number of pregnancies and of respondents lost to follow‐up was significantly higher for the public clinic than for the CSLH. Breastfeeding duration was significantly longer and infant growth and health were found to be significantly better at the CSLH than at the public clinic. Women valued being treated with respect, receiving education and support, and being offered timesaving services and wider contraceptive choices at the CSLH. This study demonstrates that such interventions are possible for poor communities, providing significant advantages for women and children.
Maternal Mortality Among the Kassena‐Nankana of Northern Ghana
Authors: Ngom Pierre , Akweongo Patricia , Adongo Philip , Bawah Ayaga Agula , Binka Fred
Published: December 2003

This report presents key findings from a maternal mortality study conducted in the Kassena‐Nankana District of northern Ghana in 1997–98. Sibling history data collected in the course of this survey are analyzed together with longitudinal data from the Navrongo Demographic Surveillance System (NDSS). A comparison between mortality data from these two sources indicates that obtaining reasonably accurate estimates of age‐specific death rates is possible by using the sisterhood method. Direct and indirect estimates from the maternal mortality study and the NDSS suggest a decline in the maternal mortality ratio for the Kassena‐Nankana District from 800 to 600 maternal deaths per 100,000 live births over the past 14 years.
Explaining Trends in Teenage Childbearing in Sweden
Authors: Santow Gigi , Bracher Michael
Published: December 2003

The teenage fertility rate fell precipitately in Sweden after 1966 and is now one of the lowest in Europe. This decline can be seen in the context of major reforms enacted in 1975 whereby the school sex‐education curriculum was revised, contraceptive services were improved, and abortion was provided free and on demand. By means of microsimulation, the possible roles of contraception and induced abortion in causing teenage fertility to fall are examined. Before 1975, the decline appears to have been caused primarily by an increase in the number of induced abortions. After that date, however, an increase in the use of highly efficient methods of contraception led to a decline in the pregnancy rate in such a way that, even though the proportion of teenagers who sought abortion increased, the abortion rate declined. Parallels are drawn with the experience of other European countries, and contrasts with that of the United States, where no such developments have occurred, are noted.
The Effects of Family Planning Workers' Contact on Fertility Preferences: Evidence from Bangladesh
Authors: Arends‐Kuenning Mary , Hossain Mian Bazle , Barkat‐e‐Khuda
Published: December 2003

Should family planning programs put more effort into persuading couples to want smaller families or into helping women achieve their reproductive goals? Indeed, can family planning programs affect fertility preferences? Longitudinal data from Bangladesh collected from 1982 to 1993 show that women's desired family sizes have declined dramatically. This study examines how the decline in desired family size is related to visits from family planning workers for three intervals: 1982–85, 1985–90, and 1990–93. By use of logistic‐regression analysis, the number of rounds during which women received visits from family planning workers is found to have no statistically significant effect on the probability that women altered their preference from wanting more children at the beginning of an interval to wanting no more at the end of the interval.
Effects of an Entertainment‐education Radio Soap Opera on Family Planning Behavior in Tanzania
Authors: Rogers Everett M. , Vaughan Peter W. , Swalehe Ramadhan M.A. , Rao Nagesh , Svenkerud Peer , Sood Suruchi
Published: December 2003

An entertainment‐education radio soap opera introduced in Tanzania in 1993 was evaluated by means of afield experimental design in which the radio program was broadcast by seven mainland stations of Radio Tanzania. An eighth station broadcast alternative programming from 1993 to 1995, its listenership serving as a comparison area in which contemporaneous changes in family planning adoption were measured. The soap opera was subsequently broadcast nationwide from 1995 to 1997. Data about the effects of the radio soap opera were gathered in five annual surveys of about 2,750 households in the comparison and the treatment areas and from a sample of new family planning adopters in 79 health clinics. The soap opera had strong behavioral effects on family planning adoption; it increased listeners' self‐efficacy regarding family planning adoption and influenced listeners to talk with their spouses and peers about contraception.
Do Parents Prefer Sons in North Korea?
Authors: Goodkind Daniel
Published: December 2003

Son preference in South Korea is stronger than anywhere else in the world, yet little is known about such preference in North Korea. Simple indicators of son preference in North Korea are constructed from its 1993 population census and a 1998 survey of child nutrition (conducted in the wake of the recent famine). These indicators include sex ratio at birth, sex ratios of infant and child mortality, and sex ratios of child malnutrition. North Koreans do not evince prenatal discrimination against daughters, a finding that may indicate a lack of prenatal sex‐testing technologies. Neither is evidence found of excess female mortality or malnutrition in the postnatal period, during which discrimination requires no special technology. The discrepancy in son preference across the Korean peninsula seems due largely to the socialist agenda pursued in the north following political partition after World War II. An important aspect of that agenda challenged the ancient Confucian ideology presumed to underlie son preference. Apparently, this challenge was more successful in North Korea than in other Asian societies instituting similar political changes, because son preference was not eliminated in China or in Vietnam.
Female Genital Cutting Practices in Burkina Faso and Mali and Their Negative Health Outcomes
Authors: Jones Heidi , Diop Nafissatou , Askew Ian , Kaboré Inoussa
Published: December 2003

Observations of the types of female genital cutting and possible associated gynecological and delivery complications were undertaken in 21 clinics in rural Burkina Faso and in four rural and four urban clinics in Mali. Women who came to the clinics for services that included a pelvic exam were included in the study, and trained clinic staff observed the presence and type of cut and any associated complications. Ninety‐three percent of the women in the Burkina Faso clinics and 94 percent of the women in the Mali clinics had undergone genital cutting. In Burkina Faso, type 1 (clitoridectomy) was the most prevalent (56 percent), whereas in Mali the more severe type 2 cut (excision) was the most prevalent (74 percent); 5 percent of both samples had undergone type 3 cutting (infibulation). Logistic regression analyses show significant positive relationships between the severity of genital cutting and the probability that a woman would have gynecological and obstetric complications.
A Qualitative Study of Clandestine Contraceptive Use in Urban Mali
Authors: Castle Sarah , Konaté Mamadou Kani , Ulin Priscilla R. , Martin Sarah
Published: December 2003

This prospective study uses qualitative methods to examine the social and economic impact of family planningon women's lives in the district of Bamako, Mali. Fifty‐five first‐time users of contraceptives were interviewed in October 1996. Of particular interest is the high proportion (17/55) of those who had hidden their use of a birth‐control method from their husbands. Substantial collusion is found to have occurred between sisters‐in‐law in assisting each other to gain and hide methods of family planning and to keep their use secret from their spouses and older marital relatives. The main reason for discontinuation among the clandestine users was menstrual disruption, which they feared would make their husbands aware of their contraceptive use. By the end of the study, women were aware that their use of contraceptives had increased their mobility and available time, enabling them to enhance the quantity and efficiency of their work activities. Contraception, therefore, appears to be a valuable resource, permitting women to improve their economic and social status. In settings where clandestine use is prevalent, at least in the short term involving men in family planning programs may not always be beneficial, nor may considering the couple as the unit of intervention and analysis always be appropriate. In the long term, however, the underlying causes of men's objections to contraceptive use need to be addressed so as to facilitate communication and joint decisionmaking about family planning