Evaluación de la capacitación clínica en anticoncepción post-parto y post-aborto: resumen / Evaluation of clinical training in contraception post-partum and post-abortion

Sus objetivos son conocer el efecto de la capacitación clínica en el mejoramiento de la calidad y la cobertura de los servicios de anticoncepción post-parto/post-aborto, estimar la contribución relativa de la capacitación al incremento de la prevelencia del uso de métodos modernos, especialmente el DIU, verificar si los proveedores que recibieron capacitación clínica están todavía trabajando en los establecimientos de salud incluídos en el Programa, examinar la calidad de la atención desde la perspectiva de la clienta, inlcuyendo la calidad de consejería

Inhalants in Peru.

In Peru, the prevalence and consequences of inhalant abuse appear to be low in the general population and high among marginalized children. Inhalant use ranks third in lifetime prevalence after alcohol and tobacco. Most of the use appears to be infrequent. Among marginalized children, that is, children working in the streets but living at home or children living in the street, the problem of inhalant abuse is a serious problem. Among children working in the streets but living at home, the lifetime prevalence rate for inhalant abuse is high, ranging from 15 to 45 percent depending on the study being cited. For children living in the streets, the use of inhalant is even more severe. As mentioned earlier in this chapter, most of these street children use inhalants on a daily basis. The lack of research on the problem of inhalant abuse is a serious impediment to development of intervention programs and strategies to address this problem in Peru. Epidemiologic and ethnographic research on the nature and extent of inhalant abuse are obvious prerequisites to targeted treatment and preventive intervention programs. The urgent need for current and valid data is underscored by the unique vulnerability of the youthful population at risk and the undisputed harm that results from chronic abuse of inhalants. Nonetheless, it is important to mention several programs that work with street children. Some, such as the Information and Education Center for the Prevention of Drug Abuse, Generation, and Centro Integracion de Menores en Abandono have shelters where street children are offered transition to a less marginal lifestyle. Teams of street educators provide the children with practical solutions and gain their confidence, as well as offer them alternative socialization experiences to help them survive the streets and avoid the often repressive and counterproductive environments typical of many institutions. Most of the children who go through these programs tend to abandon inhalant use as they mature out of street life.

[Peru: reproductive health, abortion and family planning]. / Peru: salud reproductiva, aborto y planificacion familiar.

PIP: The average number of children per woman in Peru declined from 7 to 3.5 between 1960-65 and 1990-95, but the 1991 Demographic and Health Survey indicates that ideal family size was 2.7. Significant socioeconomic and regional fertility differentials persist. Despite the desire for smaller families, 59% of reproductive-age women use no contraceptive method. The most widely used method in Peru is rhythm. Around 34% of women 15-44 years old, some 2 million women, can be considered insufficiently protected against risks of unwanted pregnancy. The 1991 survey found that 1/3 of women using contraceptive methods had experienced failure of their method, with proportions ranging from 32% for rhythm to 1.2% for IUD. Abortion is illegal in Peru, as in most of Latin America, but is known to be widespread. The recurring public debates about abortion are hampered by lack of reliable data. The Alan Guttmacher Institute (AGI) estimate for Peru was based on data from the 1991 Demographic and Health Survey, official hospital discharge statistics, and a survey of 197 professionals and nonprofessionals. The AGI study reveals that a wide variety of techniques are used to induce abortion. There are the safe, modern methods, such as vacuum aspiration or dilatation and curettage, but the most common methods include inserting a probe or catheter, sometimes pouring toxic fluids into the uterus. Women also insert metal objects into the uterus or herbal suppositories into the vagina. They jump, fall, exercise violently, and take injections. 84% of rural women and 64% of poor urban women attempt to induce the abortion themselves or seek the aid of untrained midwives. 95% of wealthier urban women are attended by health professionals. An estimated 1 in 5 illegal abortions in Peru result in hospitalization. Applying this ratio to the estimated 54,230 hospitalizations for induced abortion in 1989 results in an estimate of 271,150 induced abortions in that year, equivalent to 43% of live births.^ieng

[Infant mortality in Peru. Levels and trends, 1955-1990. Projections, 1990-2000]. / La mortalidad infantil en el Peru: niveles y tendencias 1955-1990, proyecciones 1990-2000.

PIP: The infant mortality rate of 55/1000 estimated for Peru on the basis of the 1991-92 Demographic and Family Health Survey is significantly lower than the official projection of 82/1000. Two demographers with the National Population Council conducted an exhaustive analysis of census and survey information for the period 1972-92 in order to evaluate the infant mortality estimates. They paid particular attention to the quality of data in surveys over the past decade, concluding that, in accordance with the trends demonstrated in all available sources, a continuing infant mortality decline amounting to 17% every 5 years could be expected. They affirmed that the 1993 infant mortality rate was 56/1000 and estimated that it would drop to 46/1000 during 1996-2000. They suggested that results for the 1990s should be verified when definitive results of the 1993 national census become available. Despite declines, Peru's infant mortality rate is still the third highest in Latin America. The decline may be attributed to fertility decline, increased educational attainment of women, massive vaccination campaigns, and urbanization, which apparently overcame the negative effects of poverty and deteriorating living conditions. Infant mortality and other demographic data needed to orient health policies and programs should not continue to be based on externally funded surveys whose timing is beyond the control of national officials.^ieng

[Fertility transition in Peru]. / La transicion de la fecundidad en Peru.

PIP: Data from national censuses and sample surveys are the basis for this examintion of differential fertility and the fertility transition in Peru. Changes in the level and structure of fertility in the 3 major geographic regions are compared, and the role of contraceptive usage and nuptiality changes in the fertility decline are analyzed. Peru's total fertility rate was estimated at 6.85 in 1965 and has since declined to 6.56 in 1965-70, 6.00 in 1970-75, 5.30 in 1975-80, 4.65 in 1980-85, and 4.00 in 1985-90. The fertility decline varied in intensity and timing in the geographic regions. A clear fertility decline began among upper and middle income groups in the principal cities in the 1960s, spreading gradually to the urban low income sectors. Not until the late 1970s did the fertility decline spread to the rest of the population, coinciding with the years of severe economic crisis. The urban total fertility rate declined from 6 to 3.77 during 1961-86, but rural fertility increased through 1972 to 8.12, before declining slightly to 7.62 in 1981 and more markedly to 6.65 in 1986. Sociocultural and economic differences between Peru's natural regions are appreciable, and account for the contrasts in fertility trends. The greatest changes occurred in metropolitan Lima, which already had relatively low fertility in 1961. Its total fertility rate declined 44% from 5.6 in 1961 to 3.13 in 1986. Fertility declined by slightly under 40% in the rest of the coast, by almost 25% in the jungle, and by scarcely 14% in the sierra. The total fertility rates in 1961 and 1986, respectively, were 6.38 and 4.13 on the coast, 6.64 and 6.45 in the highlands, and 7.92 and 5.97 in the lowlands. The fertility decline, especially in the lower classes, was a response initially to the process of cultural modernization which in slightly over 2 decades saw a profound transformation of Peru from a rural, Andean, illiterate, and agrarian society to an urban, coastal, literate, and commercial society. From 1972 on, the fertility decline spread in the rural sectors and was intensified as a response to the profound economic crisis experienced in Peru from 1975 to the present. Increased contraceptive usage was apparently the most important cause of Peru's fertility decline. Overall prevalence increased from 31% in 1977-78 to 46% in 1986, and use of modern methods by women in union doubled in the same years. Regional fertility differences are correlated strongly to contraceptive prevalence and especially to prevalence of modern methods. The 3 most recent national fertility surveys and a series of more limited surveys suggest that women have an increasingly strong desire to control their fertility. The greatest barriers to use of modern contraception are fears of health effects and lack of knowledge.^ieng

Seminar on adult mortality and orphanhood in the past: five Latin American cases.

This report concerns a seminar on adult mortality and orphanhood in the past in Latin America that was held in San Jose, Costa Rica, December 12-14, 1984. The first part describes five historical studies presented at the seminar concerning Mexico, Chile, Peru, Brazil, and Argentina. "The second part of this article is an explanation of the calculation involved in a life table derived from information on the incidence of orphanhood according to the age of newly married couples on their marriage."