Adolescent sexual and reproductive health: the challenge for society

Within almost all countries of the world there is a growing concern about the sexual and reproductive health of adolescents. This concern has resulted from either a real or a perceived increase in adolescent sexual activity, coupled with high rates of unplanned pregnancies, early childbearing and the transmission of sexually transmitted infections, including HIV. Although many adults have difficulties in accepting young people as sexual beings, there is now a growing consensus that young people need more information and services to help them ensure their sexual and reproductive health. Many of the programmes designed to make sexual and reproductive health information and services available to young people have used 'top down' approaches, based on adult-led risk and lifestyle orientation. In such programmes, young people are often looked upon negatively, in terms of their problems, rather than positively, in terms of their potential and capabilities. This article argues that a focus on the negative aspects of adolescent sexual and reproductive health means that young people are seen as collections of discrete problems. Furthermore, such approaches tend to view all young people as one homogeneous group when in reality adolescents are an enormously diverse group, not only in terms of age and gender, but also in terms of ability and beliefs. Such approaches therefore fail to address the vulnerabilities of particular young people and fail to contextualize sexual health within a wider framework of young people's lives. A challenge for the next century is to move away from focusing on risks, towards embracing needs and rights, and to involve young people in identifying issues and developing solutions.

Women and reproductive health in a graying world

Gender differences in longevity suggest that the health problems in both developed and developing countries will largely be the problems of older women. As life expectancy increases, the important causes of death and ill health change. Older women's health issues and reproductive health needs are different from those of younger women. Biological susceptibility to various conditions also differs between the sexes. Monitoring of differences in incidence can better direct preventive efforts and contribute to improving the quality of life for aging women worldwide.

A new model for collaboration--making emergency contraceptives available in developing countries

Private/public-sector collaboration in contraceptive research and development offers a fresh opportunity to consider a holistic approach to making emergency contraception (EC) available in developing countries. Emergency contraception has been available since the 1970s but has remained under-utilized. Emergency contraception may be used by women who want to prevent a pregnancy and therefore has a specific use, in a specific situation. This paper highlights the distinct and reciprocal advantages of a collaborative approach between the Consortium for Emergency Contraception (the public sector) and a pharmaceutical company (the private sector), to the introduction of EC in developing countries. The importance of cultivating a public/private-sector collaborative approach, which serves the interests of both parties concerned, in order to foster progress in this important initiative, is highlighted.

Family planning perspectives at the beginning of the next century

Looking back over the past 40 years or so, family planning has indeed been the success story of development; it has made an extraordinary difference to the lives of tens of millions of women. Globally speaking, the unmet needs for family planning and reproductive health still exist. Meeting these challenges would require better and improved methods of contraception, addressing issues such as sexually transmitted infections, unsafe abortions, cultural, religious, legal and political barriers. Better utilization of communication channels and investment in 'human capital'--informing people, opening a dialogue to reach consensus for action, are crucial. Finally, changes at policy and administrative level, including improvements in financial and human resource management, and making family planning and reproductive health programs sustainable will be important as we move into the 21st century.

Reproductive health: an international perspective

The twentieth century began with approximately 1.6 billion human beings in the world and, with an increase of 96 million people per year, will end with over 6 billion people. Unless this trend is directly confronted by the world governments and their citizens, there will be nearly 8 billion by 2025 and over 11 billion by 2050. Thus, reproductive health is and will remain an issue of critical importance for all countries to realize and study. Part of this trend is because of the many pregnancies which occur in adolescents around the world. A number of issues have developed this century contributing to the many pregnant teenagers. For example, India has one of the world's largest populations of teenagers--over 23 million, representing over 26% of the total in the world. Effective methods for contraception and sexually transmitted diseases prevention are available, but not to all sexually active humans. However, many barriers to effective contraception exist around the globe. This article discusses some of them and also reviews use of contraceptive methods in various countries. These include oral contraceptives, emergency contraceptives, injectable and implantable contraceptives, intrauterine devices, barrier contraceptives and others. Reproductive health remains a critical, universal issue for all humans in the world. We all must examine the many pitfalls to controlling the world's populations, including lack of sex education, limited access to effective contraceptives, and others. We cannot afford to let the population continue unchecked. Effective strategies are needed at this time; otherwise, the population will continue to run out of control, negatively damaging the world for the coming generations. There is need to leave a positive, and not negative legacy for the next generation.

Expanding access to emergency contraception in developing countries

Emergency contraception has been called the best-kept contraceptive secret. Previous research shows that several regimens of postcoital contraception offer safe and effective ways for women to avoid pregnancy. Yet the methods are typically unavailable to women in developing countries. In this article, the authors review the main methods of emergency contraception and describe experience with them to date. The prevalence and urgency of the need for making these methods available to women in developing countries are assessed. The necessary elements for creating such access are described. In several developing countries, conditions for introducing the methods may be more favorable than in industrialized countries. These advantages are reviewed. Finally, the authors describe the challenges anticipated for broadening the availability of postcoital methods in the developing world. They conclude with a brief series of recommendations for policymakers.

Contraception by the end of the 20th century--the role of the voluntary organizations

The formation and activities of several voluntary organizations (non-governmental organizations or NGOs) are described. They were formed in response to the social needs arising from the vast population changes in the last century. Many of them have undertaken active roles in the introduction or improvement of various forms of contraception. They have an urgent need for more funds in order to pursue their activities. Even a small diversion of money from other uses would permit the development of several new, safe and effective contraceptive methods acceptable to men and women in all countries of the world.

Reassessment of plasma angiotensins measurement: effects of protease inhibitors and sample handling procedures

Characterization of C- and N-terminal forms of angiotensin (Ang) peptides mandated assessment of methods to determine plasma levels. 125I-Ang I, 125I-Ang II, and 125I-Ang(1-7) were added to blood samples in the presence of protease inhibitors. Ethylenediaminetetraacetic acid (EDTA) inhibited the conversion of 125I-Ang I to 125I-Ang II. o-Phenanthroline and EDTA (EDTA + o-Ph) did not eliminate [des-Asp1] fragments or 125I-Ang(1-7). The combination of EDTA + o-Ph and pepstatin A or 4-(chloromercuri) benzoic acid (PCMB) significantly reduced 125I-Ang(1-7) generation. Only PCMB plus EDTA + o-Ph eliminated [des-Asp1] fragments. Authentic plasma values of Ang peptides require the correct choice of protease inhibitors.

Women's reproductive health--challenges for the 1990s

Health policy makers, program planners and donor agencies have paid little attention to issues surrounding women's reproductive health. This paper will look at reproductive health issues surrounding pregnancy and childbirth, the accessibility and safety of contraception, and reproductive tract infections. The gross social injustice caused by high maternal mortality can no longer be ignored. Nor can we ignore the much larger numbers of women who suffer life-long health impairment resulting directly from the health hazards associated with pregnancy and childbirth. The challenge is to reduce maternal mortality by at least 50% by the year 2000. If these challenges are not faced, the 1990s may very well be remembered as the decade that saw the largest numbers of women dying in childbirth and pregnancy. The 1990s will see the addition of some 300 million couples to the reproductive age group. These couples will need access to good sexual health care, including safe and effective contraception, and prevention of reproductive tract infections and sexually transmitted disease. The biomedical consequences of reproductive tract infections are, among others, fetal wastage, low birth weight, carcinoma of the cervix, infertility and ectopic pregnancy. In addition to these consequences, there are the psychological, social and economic costs of these diseases. Some suggestions for meeting these challenges are put forward. These include building on existing programs and expanding available resources to help women to attain health, dignity, and their basic human rights.

Problems of adolescent sex

Four issues concerning adolescent sexuality are reviewed--the counselling needs of teenagers, the risks of Sexually Transmitted Diseases, the controversy over contraception for adolescents, and the consequences of pregnancy in adolescence--in terms of their effect on the adolescent as an individual, and on the community of which he/she belongs. The need for services specifically designed for adolescents is stressed, demonstrating that many of the "problems" of adolescent sex can be successfully addressed through comprehensively planned and executed programmes.

Sterilization-associated deaths: a global survey

Except for data from several geographically limited studies, little is known globally about the number and causes of death associated with surgical sterilization. To identify clinical characteristics and problems leading to deaths related to the procedures, the International Planned Parenthood Federation ( IPPF ) and the Centers for Disease Control (CDC) in the United States collaborated in a global mail survey of 4642 physicians. Usable responses were received from 1298 physicians (28%) in 80 countries. Fifty-five sterilization-associated deaths which occurred from January 1, 1980 to June 30, 1982 were reported. The most frequently reported causes of death were infection, anesthetic complications, and hemorrhage. There were some regional differences in the relative frequencies of these causes. Most cases did not involve surgical accident. The characteristics most frequently associated with the reported fatal procedures were: interval sterilizations, minilaparotomy incision, tubal ligation and general anesthesia. Most deaths were attributable to the surgical sterilization procedure.

Oral contraceptive during lactation: a global survey of physician practice

The use of combined estrogen-progestogen oral contraceptives (EP-OC) by lactating women has been associated with suppression of lactation. To determine the extent to which physicians prescribe combined EP-OC for lactating women, the International Planned Parenthood Federation (IPPF) and the United States Centers for Disease Control (CDC) collaborated in a global mail survey of 3697 physicians affiliated with Family Planning Associations (FPA) in 72 countries. Usable responses were received from 831 physicians (22%) in 65 countries. The percent of clinicians who provide EP-OC to lactating women was higher in developing regions (63% or more) than in developed regions (40% or less). Patient preference was rated important more often than any other factor in the decision to prescribe EP-OC for lactating women. The percentage of clinicians who reported complaints of decreased milk production from women using EP-OC was higher (32% or more) in developing regions where breast milk is often essential to infant nutrition.

Contraception and the etiology of pelvic inflammatory disease: new perspectives

The dramatic increase in use of contraception worldwide makes it imperative to understand the effects of contraceptives on the health of women using them. In this article, we review the literature on the relationships of modern nonsurgical contraception with pelvic inflammatory disease. Subsequently, we identify areas where further research is needed to better define the risks and benefits of these contraceptive methods in various settings. From our review, two new conclusions emerge. First, our reanalysis of published data on the risk of PID associated with intrauterine device (IUD) use compared with no contraceptive use shows, with one exception, less risk than the previous comparisons to all non-IUD use. Second, and probably most importantly, the studies, when taken together, strongly imply that oral contraceptives have a protective effect against PID. Only one study of 11 is equivocal on this point.

Family spacing and limitation. Applying family planning in rural communities

In most parts of the world, family planning services for the rural communities remain a neglected subject; many problems and shortcomings are encountered especially in the developing countries. Some of these problems may have simple remedies; others need much more complex solutions. With a good overall family planning programme, changes at both local and central level can be made within a country to encourage birth spacing and birth limitation methods, and to make them more easily accessible to the great majority of the rural populations.