New WHO family planning guidelines

New WHO family planning guidelines

reactions at first, with warnings that abortion rates in the Netherlands, now among the lowest in Europe, will rise sharply, and that women in the low...

185KB Sizes 1 Downloads 144 Views

reactions at first, with warnings that abortion rates in the Netherlands, now among the lowest in Europe, will rise sharply, and that women in the lowest-income groups will once again have to be on their husbands. Later, however, younger feminists were telling their older colleagues that there were matters far more serious than "Dfl 8 per month" . : warranting attention. The pill became eligible for health insurance refund in 1971 when the Health : Insurance Act was amended in favour of the pill and homoeopathic and other alternative medicines. In 1983 the Health : Insurance Board attempted, unsuccessfully, to reduce the pharmaceutical burden of ’. the social insurance system by removing the pill from the insurance package. Whether the current, politically controversial, proposal will be adopted this time will depend very much on Els BorstEilers’ presentation of her arguments.


Marjanke Spanjer

bearing children; corresponding figure data)

: like Livingstone, you’ve got is how Paul Livingstone That good. a distant relative of the Armstrong, famous doctor, feels. And, as indicated at the World Health Assembly earlier this month, his message on preventing teenage pregnancy is at long last getting across. During the 1973 ceremonies marking the centenary of David Livingstone’s death, the year before Armstrong retired as a management-control consultant, it was suggested to him that efforts to improve the health of disadvantaged peoples, and not only in Africa, would be an appropriate tribute to Dr Livingstone’s memory. Since then he has become a familiar figure at successive WHAs: quieta name

spoken, patient, still straight-backed, and seemingly tireless despite his 82 years. He has remained steady on course in seeking to convince both the medical profession and the general public of the known hazards and damage of teenage pregnancy. According to WHO’s annual World Health Report, the first issue of which was produced this year, "Maternal mortality rates at ages 15-19 are double the



20-24, and those

at ages

10-14 five times higher in some countries". The latest surveys in Africa, it adds, "found that in 14 countries at least half the women married before the age of 18". In Niger nearly half the female population is married by 15, two out of five having one child by the time they are 17.



China, through family


trol, has succeeded in having parents mostly between the ages of 23-26 (women) and 26-29 (men). Japan leads the world with


only 16%

of women under


except in rare circumstances, combined oral contraceptives prescribed An expert group brought together last should contain no more than 50 µg week by WHO’s Division of Family oestrogen. Older, inadequately studied Health to update family planning guidemonthly injectables, still widely used in lines concluded that there are only a few v Latin America, also need to be replaced situations, such as the first six weeks after by the newer preparations Cyclofem delivery for breast feeding women, or (25 mg medroxyprogesterone acetate + 5 current thromboembolic disease, acute mg osetradiol cypionate) and Mesigyna myocardial infarction, or stroke, where the (50 mg norethisterone oenanthate + 5 mg disadvantages of monthly injectable conoestradiol valerate). traceptives outweigh the advantages. The The plan is to circulate the final report group also concluded that there are few of the meeting by the end of this year. In restrictions for the use of steroids or the real world, national guidelines often intrauterine contraceptive devices for lag behind expert opinion. For example, emergency contraception, other than the last year’s review broadened eligibility routine eligibility criteria applied to these criteria for the use of combined oral devices. In addition, the group accepted contraceptives to include diabetics withthat there are no medical reasons to out vascular disease or those over 35 who restrict an individual’s eligibility for volunsmoke less than 20 cigarettes a day, yet tary sterilisation, although selected cases more conservative guidelines remain in should be referred to a more advanced place. setting, or have the operation postponed to deal with temporary illness.: Malcolm Potts



discussing the phasing out of older : methods, the consensus of the group was In

family planning


age 25

Preventing teenage With to do


for the USA is 43% (1993

More than a decade ago, Livingstone Armstrong convinced the Charing Cross and Westminster Medical School, London, UK, of the validity of his cause, for which he has produced, at his own expense, demonstration kits with lifesize plastic pelvises for ages 16, 19, and 23.

Some recognition of his endeavours came in 1985, when the WHA approved a resolution "urging" governments to "promote the delay in child-bearing until both prospective parents, but especially the mother, have reached maturity in adulthood" and, in addition, "ensure that their populations are aware of the need for both parents to be fully grown, adequately nourished and disease-free before conception". For many governments, this seemed like whistling into the wind, in view of the social, economic ("hands to help on the land"), and religious ("what, contraception"?) circumstances of their

The resolution would have joined the : : many others in limbo had it not been for : Livingstone Armstrongs’ determination, backed up

by judicious,

if strictly


: donations of his pelvis demonstration kits, : including one to refugee camps along the : Thai-Cambodia border. But, at this : month’s WHA, delegations showed more : genuine interest than has hitherto been

: : : : : : : : : :

: :

the case, with Tanzania, Uganda, Kenya, Zimbabwe, and Zambia asking for kits. Mounting interest is reflected, too, in the correspondence that Livingstone Armstrong now receives, such as the letter from Dr R G Whitehead, director of the Dunn Nutrition Centre, Cambridge, UK. On visiting Gambia, he found that a pelvis kit was being used in training sessions for traditional birth attendants. The kit also featured in instructing village elders-all men-invited for some of the training meetings. Moreover, the letter added, there was a suggestion that a similar kit be developed for schools.



Fight for sex equality on prescription charges in UK

Retired Persons over 50, with some financial aid from Help the Aged. Richardson’s lawyers argue that the UK government is in breach of European directive 79/07, which binds all member states to equal treatment for men and women in all matters of social security. The oral hearing was held last week and the European Court’s advocate-general is scheduled to give an opinion on July 13. The Court’s decision is expected in the autumn. CESPA estimates that the annual increase in drugs bill will be 25-40 million; the government makes it L50 million.

The National Health Service could face a its drugs bill if the government loses a test case now under consideration by the European Court of Justice in Luxembourg to give men aged 60-65 free prescriptions. Pensioners in the UK are entitled to free prescriptions, but the state pension age for men is 65, whereas that for women is 60. : The case has been brought by Richardson, a patient with asthma, and is : funded jointly by the Campaign for Equal . State Pension Ages and the Association of

huge increase in



Vivien Choo