Characteristics of Pakistani women seeking abortion and a profile of abortion clinics.

A study of the characteristics of Pakistani women seeking abortion and a profile of abortion clinics was conducted in 32 abortion clinics in three provincial capitals of the country. All 452 women who had their pregnancies terminated between October and December 1997 were interviewed. Except for 39 women (8.6%), all study subjects were married. A majority of the women (36.6%) were aged >35 years, 61.0% had given birth to > or =5 children, and 40.2% were illiterate. The predominant reasons for abortion were "too many children" (64.4%), contraceptive failure (20.3%), premarital affairs (8.6%), medical reasons (5.4%), and extramarital affairs (1.3%). Nearly two thirds of the abortions were induced by inadequately trained persons. Only 22% of the abortion clinics met the World Health Organization (WHO) standards required for safe termination of pregnancy. At all these clinics, the procedure used to terminate the pregnancy was dilatation and curettage (D&C). Only one clinic was using manual vacuum aspiration (MVA). Induced abortion seems to be fairly common among married women of high parity, advanced age, and low educational status. Keeping in view the large number of terminations, new medical and surgical techniques of pregnancy termination should be introduced to those already providing abortion services.

Norplant: reasons for discontinuation and side-effects.

OBJECTIVE: To study the side-effects and reasons for the discontinuation of Norplant. METHODS: The study was based on the analysis of the medical records of 265 Norplant users, who obtained Norplant from two clinics of the Family Planning Association of Pakistan and who were followed for 5 years. RESULTS: The most common reason (29.4%) for the discontinuation of Norplant was menstrual disturbances, followed by medical problems (4.1%), desire for more children (3.1%) and family problems (3.1%). The major side-effects were weight gain, breast tenderness, headache and dizziness. Only 7.7% of users mentioned any change in sexual behavior and 69.6% of the complaints leading to Norplant removal developed within 6 months of insertion. CONCLUSION: The extent and nature of the side-effects experienced by Pakistani women using Norplant are similar and comparable to those reported from other countries.

Efficacy and continuation rates of Norplant in Pakistan.

A total of 265 women who had the Norplant system inserted were followed for 5 years. The present study is based on 11,435 women-months of use, describing the continuation rates and efficacy of Norplant among these women. The 5-year cumulative continuation rate was 45.7 per 100 continuing users. The continuation rates were age-dependent. The women > or = 35 years of age consistently maintained higher continuation rates at all time intervals as compared with those of younger women. During 5 years of follow-up, five women became pregnant. Three pregnancies occurred in year 2, one in year 3, and one in year 5. The 5-year cumulative pregnancy rate was 2.5 per 100 continuing users. The weight of the user did not influence the pregnancy rate. The continuation rates, as well as the pregnancy rates, are comparable to those reported from other countries in the region.

PIP: This article documents a 5-year follow-up of Norplant acceptors. The study was based on the medical records of 265 women who obtained Norplant from the Family Planning Association of Pakistan clinics in Lahore and Karachi during 1988-89 to examine the efficacy and continuation rates of Norplant in Pakistan. The studied sample participated in the introductory trial that were followed up for 5 years. Results revealed that the cumulative continuation rate during the 5-year period was 45.7 per 100 continuing users. The continuation rates were age-dependent, wherein women aged 35 years or older consistently maintained higher continuation rates at all time intervals as compared with younger women. During the 5-year follow-up, 5 women became pregnant (3 in year 2, 1 in year 3, and 1 in year 5). Furthermore, the 5-year cumulative pregnancy rate was 2.5 per 100 continuing users. The user¿s weight did not influence the pregnancy rate. Lastly, the continuation rates, as well as the pregnancy rates, were comparable to those reported from other countries in the region.

A wake-up call. NGO / Youth Fora.

PIP: The client first, informed choice, and quality of care approach to reproductive health is being applied around the world, energized by individuals, communities, and organizations. There has been unprecedented support during the Cairo+5 global review process of the centrality of youth in the process, for by 2000, approximately 1 billion people aged 15-24 years will either be in or entering their reproductive years, the largest generation ever in this age cohort. These young people face considerable reproductive health risks and poor access to information and services. In addition, 25% of children are assaulted or abused, and 20% live in poverty. The Youth Forum recommendations will help to ensure that the reproductive health and social development needs of the world's youth are properly met. However, to fully implement the International Conference on Population and Development (ICPD) program of action, donor governments need to meet their funding commitments.^ieng

Norplant: users' perspective in Pakistan.

Five hundred and eighteen Norplant acceptors (260 ever-users and 258 current users) were interviewed to assess their perceptions about Norplant. The mean age of the acceptors was 32.6+/-5.7 years (mean +/- SD). The mean parity was 4.3 and many of the users (40.2%) were illiterate. The most common reason to choose Norplant was its long duration of action (70.1%) followed by doctor's advice (10.4%) and use by other women (10.1%). Norplant was recommended by family planning workers in 35.3% cases, doctors in 29.2% cases and friends in 17.4% cases. Advertisement did not play any role in the women's choice of Norplant. In 77.3% cases, the decision to use Norplant was a joint decision. Only 15% of the users had fears/anxieties before insertion. Most of these women (44%) were concerned about possible ill-effects of Norplant on their health rather than efficacy. The social acceptance of Norplant was very high (76%) and more than half of the users (52.5%) were satisfied with the method. Among current users, 83.9% wanted to continue Norplant for 5 years. Only 39 users (15.1%) intended to discontinue. The main reason for discontinuation was menstrual disturbance (69.2%), followed by weight gain (12.7%). The study suggests that long duration of effective action and high social acceptance are likely to make Norplant a popular method among Pakistani women.

The movement continues. IPPF.

PIP: In her speech initiating the Kato Award in honor of Mme. Shidzue Kato, Dr. Attiya Inayatullah, president of the International Planned Parenthood Federation (IPPF) noted that Kato is one of the great women who served as a "founding mother" of the IPPF. The Kato award also highlights the IPPF's appreciation for the sustained strategic support received from the Japanese people and government. Through the momentum of grassroots family planning associations (FPAs), the IPPF has grown from eight FPAs in 1952 to 60 in 1974 and 160 today. That the conceptual work of population planners has also grown can be seen by examining the themes of the world population conferences. In 1974, the idea that development is the best contraceptive was considered novel. By 1984, planners were discussing the interrelationship between population, economic development, and quality of life. Then the 1994 International Conference on Population and Development produced a Program of Action that shifted attention from demographic, target-driven goals to democratic, client-centered goals emphasizing women's needs. The Program of Action's chapter on gender equality, equity, and the empowerment of women is considered the strongest international statement on women's status. Another advance seen in 1994 was recognition of the need for partnerships between governments and the private sector. Inayatullah called upon the 160 IPPF FPAs to actively pursue such a partnership.^ieng

Inayatullah takes Vision 2000 forward. IPPF.

PIP: Dr. Attiya Inayatullah is the newly appointed president of the International Planned Parenthood Federation (IPPF). She expresses her hopes that Japan people through its national and local government institutions and the Diet will continue to support IPPF objectives. Inayatullah commends the positive and consistent role played by the Japanese parliamentarians and recognizes the excellent work of the Municipal Coordinating Committee for Overseas Bicycle Assistance. Japan is of particular importance to the IPPF because it is actively helping the global process of democratization. Inayatullah discusses the IPPF's commitment to women, women and HIV/AIDS, empowering women, and the role of nongovernmental organizations.^ieng

Use of Norplant in Pakistan: two years experience.

The acceptability and efficacy of norplant (levonorgestrel sub- dermal implants) was assessed over a period of two years among 445 married women aged 19 to 45 years. Twenty women were lost to follow-up while the remaining 425 were regularly followed-up. At the end of two years, 388 women were still continuing with norplant (91.2%). During this period, there was only one pregnancy (0.26%). There was no significant change in mean systolic or diastolic blood pressure. However, there was a significant increase (P < 0.001) in mean weight and decrease (P < 0.001) in the mean duration of menstrual cycle. Thirty-seven women (8.7%) got the implant removed. The major reason for removal (67.6%) was menstrual disturbances. Nine acceptors (18.59%) developed side effects, which were related to the type of symptoms often associated with steroid contraception. These findings are similar to those reported from other countries. The high efficacy (99.74%) and acceptability (continuation rate of 91.29%) as well as long acting (5 years) nature of norplant suggest that this method of contraception can safely be promoted in Pakistan.