ROUND-UP Service Delivery

ROUND-UP Service Delivery

Round-Up One birth in 80 in Europe is from assisted conception OUGHLY one child in 80 (1.3 per cent) in is a test-tube baby, according to fertility ...

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One birth in 80 in Europe is from assisted conception OUGHLY

one child in 80 (1.3 per cent) in is a test-tube baby, according to fertility specialists from around Europe, as reported at the annual conference of the European Society of Human Reproduction and Embryology in Bologna, Italy. This includes either in vitro fertilisation (IVF) or ICSI, where a single sperm is injected into the egg. There are more than 200,000 treatment cycles a year carried out in Europe, just 22 years after the first successful IVF birth. France leads with 45,000, while there are 34,000 in Britain and 28,000 in Germany annually. Access is an important issue; in France, the state will pay for four attempts at IVF, Britain will only fund one or two attempts, and there are usually long waiting lists forcing many to turn to private treatment. In terms of success rates, the rate of fertilised eggs returned to the womb which result in a live birth is 27.5 per cent in Britain and 25.6 per cent in France. Some were critical of countries with higher rates, such as Spain at 45.5 per cent or the Czech Republic at 38.9 per cent. This is achieved through returning a large number of embryos to the womb each time, resulting in high rates of multiple births, which most specialists agree lead to additional risks of complications.’

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1. Boseley S, 2000. One birth in 80 from a test tube. Guardian (UK). 28 June.

Women in USA oppose religious control over reproductive health services national survey of 1,000 women in the USA

IL ound that a majority believed religion should

not place limits on the reproductive health care that religious facilities provide. As most Catholic hospitals take government money, most women (85 per cent) felt that they should not be allowed to bar certain procedures because of religious beliefs. Some 74 per cent would oppose the merger of a Catholic and a non-Catholic hospital

if this meant that women would be denied reproductive health services as a result. Most felt that hospitals should provide emergency contraception for women who have been raped (78 per cent) and that insurance policies should cover birth control pills (83 per cent). The findings of this survey highlight the fact that current Catholic health care policy, which aims to restrict reproductive health care, goes against what the majority of US women want.l 1. National survey finds women oppose religious control of reproductive health services. Catholics for a Free Choice. News release. 25 April 2000.

Compromising reproductive health at Catholic hospitals in the USA HERE

was heated debate at the American Association (AMA) annual conference over legislation regarding reproductive health services and Catholic hospitals. The legislation proposed by the California Medical Association would have required hospitals that childbirth-related services also to provide provide contraception and other reproductive health services. However, a revised compromise resolution stated that hospitals should continue to maintain ‘access to pregnancy prevention services’ should they be purchased by a Catholic hospital, but that doctors and hospitals should not be forced to go against their personal moral principles. The CMA had made the proposal in response to the increasing number of nonreligious hospitals merging with Catholic firms, which has resulted in reduced access to reproductive health services. The head of the Archdiocese of Chicago addressed the delegate’s committee in what is thought to be the first time that a church leader had so actively lobbied the AMA on internal policy.’

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1. Bishop lobbies AMA over services in Catholic hospitals. In Catholic Circles: An International News Roundup. 2000; 5(3):5.




Abstinence-only sex education for adolescent boys in Texas, USA ROJECT

Alpha was an abstinence-based sex conducted with high schools boys in Houston, USA which aimed to teach adolescent boys about sexual responsibility. The project emphasised community participation and ownership, with church groups, parents, school faculty and other community representatives forming a committee to design and deliver the programme. Of a convenience sample of 200 high school boys, half participated in the programme, which included ten 50-minute sessions featuring role model stories with various themes. The programme was evaluated after three months with a pre-test-post-test control group design. There were significant improvements in students’ knowledge, self-efficacy, beliefs and social norms. Effects on perceived risk and intentions to have sex were insignificant. Although the authors note significant differences between the treatment and the control group, for example in terms of ethnicity, they do not discuss if and how this was factored into the analysis. They also discuss the difficulty of conducting a programme on sex education in the conservative southern USA. Even this programme, which promoted sexual abstinence and did not mention alternative methods of avoiding pregnancy or measure actual behaviours, met with resistance from some community 1eaders.l An editorial explains that publication of this study is not an endorsement of abstinence-based sex education, but that the study serves as a reminder that abstinence is the only message for adolescents that is acceptable to adults in many parts of the world.’

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1. Peters RJ, Kelder S, Ross M et al, 2000. Project Alpha: a culturally appropriate approach to adolescent male sex education. Venereology. 13(2):57-62. 2. Sex education in conservative settings: culturally

appropriate or culturally imposed? (Editorial). Venereology.


Contraceptive eligibility checklists for community-based services OMMUNITY-BASED programmes use checkto determine eligibility for use of combined oral contraceptives and the injectable

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Depo Provera, but these checklists can quickly become outdated as information about safety changes. In 1996 WHO updated the existing checklists, which are based on eligibility criteria. This article describes the participatory, consensus-building process that was used in modifying the checklists. Field testing highlighted the importance of being careful when translating guidelines into other languages. It was also found that there was a need for training in the use of the new checklists that focused on how they differ from the previous ones. The importance of providing a checklist guide to further clarify any issues was also stressed.l 1 Stang A, Schwingl P, Rivera R, 2000. New

contraceptive eligibility checklists for provision of combined oral contraceptive and depotmedroxyprogesterone acetate in community-based programmes. Bulletin of World Health Organization. 78(8):1015-23.

Combined hormonal contraceptive patch new combined

hormonal contraceptive patch (containing norgestimate and ethinyl oestradiol) may be available within a few years in the USA. Women would put a new patch on the arm, upper chest, abdomen or buttocks each week. Delivery of hormones in this manner is said to cause less nausea and vomiting than oral and injectable hormonal methods since the hormones do not pass through the digestive tract1

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1. Rosen J, de Silva S, Johnston B et al, 2000. Contraceptive patch moves closer to market. Washington Population Update: News and Analysis of U.S. and International Population Assistance. Population Action Internatiohal.

Reducing maternal and infant mortality in Northern Liberia ITTEN by a midwife working with the NGO Emergency Relief International (Merlin) in Northern Liberia, this article describes the challenges and successes of working to reduce maternal and infant mortality in politically unstable regions. Merlin’s activities included providing support and supervision for

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traditional midwives at the village level, supporting a therapeutic feeding centre, 10 primary health centres and clinics and two hospitals, capacity building with the country health team and improving health information systems, family planning services and disease control. Unfortunately, the area continues to experience violence and unpredictable incidents, such as having several staff (including the author) taken hostage. Though they were returned safely, many NGOs lost assets and programme activities ceased. The author argues that this relief work is still justifiable, in spite of the constraints and dangers. It is necessary to balance the benefits of interventions against the risks, but the health needs of a population in an unstable area are as great, if not greater, than in times of stability.’ 1. Nam S, 2000. Reducing maternal and infant mortality in Northern Liberia - is there hope? Journal oflnternational 13(2):6-7.


of Midwives.

Poor performance of screening and syndromic approaches to identifying gonorrhoea and chlamydia in women ONORRHOEA





6 almost half of the 333 million new cases of curable sexually transmitted infections (STIs) that occur annually, with incidences of 62 and 89 million, respectively. The highest rates of these infections occur in sub-Saharan Africa, South and South East Asia and Latin American and the Caribbean, often in places where there are ina’dequate resources and infrastructure for standard laboratory diagnosis. In order to address this situation, inexpensive and accessible tools that use symptoms, signs, and/or risk factors have been developed to identify and treat STIs without the need for laboratory diagnosis. These have been used and evaluated in many different settings, including antenatal, family planning and maternal-child health clinics, STD clinics and among women sex workers. This review of 32 studies presents a meta-analysis of the effectiveness of using risk factors, symptoms and signs, simple laboratory tests, algorithms and risk scoring. The authors conclude that these tools are not effective mechanisms for identifying or managing gonorrhoea and chlamydia in

Health Matters, Vol. 8, No, 25, May 2000

either low or high prevalence settings, as they generally have poor sensitivity and high falsepositive rates. There is an urgent need to develop and evaluate other simple and inexpensive approaches that more effectively identify these infections1 1. Sloan NL, Winikoff B, Haberland N et al, 2000.

Screening and syndromic approaches to identify gonorrhea and chlamydial infection among women. Studies in Family Planning. 31(1):55-68.

Improving quality and reducing in post-abortion care in Peru


VERY year in Latin America about 800,000 treated in hospitals for are complications due to unsafe abortions. Postcare (PAC) services are often abortion characterised by low quality and high costs. In order to address this, an operations research study was conducted at the Carrion Hospital in Lima, Peru. A baseline survey identified multiple including inadequate linkages to problems, family planning services and inefficient care leading to an average hospital stay of over 33 hours. The intervention phase included training in post-abortion family planning and manual vacuum aspiration (MVA), changes in clinical and counselling protocols, delivery of family services and planning information and reorganisation of PAC from an inpatient to an outpatient service. PAC services improved dramatically, including an increase in the use of MVA from nil to 89 per cent of appropriate cases and an increase in the proportion of women receiving family planning information from 18 to 78 per cent. There were significant cost savings to the hospital, from US$ll9 for sharp curettage in hospitalised patients in the baseline to US$45 for patients treated with MVA as outpatients. Based on this information, the hospital director lowered the fees charged to patients by half. Three years after completion of the study, high quality services continue at the hospital.’

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1. de Bruyn M, Huapaya V, Benson J, 2000. Improving

quality and reducing costs in postabortion care: no contradiction at all! Dialogue. Vo14, No 1. Ipas.