High fertility among Indochinese refugees.

From 1975 to 1988, nearly 900,000 Indochinese refugees were resettled in the United States. This paper examines patterns of fertility among these refugees from Cambodia, Laos, and Vietnam who have exhibited high levels of reproduction since their arrival. Data are drawn from sample surveys in San Diego and San Francisco, CA. Fertility levels were found to exceed five children per ever-married woman, a level that is consistent with perceptions of ideal family size in the homeland. Fertility levels were significantly higher among rural second-wave refugees than in the more urban first-wave groups. One explanation for the high fertility is that couples have migrated from areas where fertility is high, and they have not yet adapted their reproductive behavior to the low fertility environment of the United States. This possibility is reinforced by a general gender preference for boys and exacerbated by the fact that, while a majority of women are aware of methods of fertility control, access is still limited by cultural and financial barriers, and the motivation to use family planning still appears to be relatively low. The data suggest that this refugee population will continue to put pressure on maternal and child health resources, and that continued residence in the United States could lead to desires to limit family size, thus increasing demand for methods of fertility control.

Family planning among Southeast Asian refugees.

PIP: Vietnamese, Cambodian, lowland Laotian, Lao Mein and Lao Hmong refugees living in Alameda, San Francisco, and Santa Clara counties, California, were interviewed to document family planning knowledge, attitudes and practices, and to identify current barriers to care. The 438 refugees were selected from those willing to participate among clinic and social service agency clients. The subjects varied widely across groups in education (Vietnamese highest to Lao Hmong lowest). Preferred family size generally followed an inverse relationship with education, from 3.2 for Vietnamese to 8.1 for Lao Hmong. Those from a rural background typically had a higher preference for boys than did urban people. Family formation was usually delayed until age 20 by most women. Knowledge of family planning methods was generally high, but variable among ethnic groups by method. Most people were more familiar with the more effective methods than they were with less effective methods. Methods commonly used in the past were female sterilization (12%), pill (31%), injectable (9%) and IUD (8%). 70% of women who were not pregnant and who did not want to be were using some method of contraception. Over half of women not already sterilized or infertile expressed willingness to use family planning. Barriers to family planning information were experienced by 70%, such as language, not knowing enough about family planning to ask questions, cost, and transportation. Fear about physical examination was not cited as a problem.^ieng

Long-term ocular manifestations in nephropathic cystinosis.

Eight nephropathic-cystinotic patients having undergone renal transplantation seven to 14 years previously were studied. Serious ocular complications were noted in four of the eight cases not previously reported. These included posterior synechiae, deposition of crystals on the anterior lens surface, and decreased visual acuity accompanied by impaired visual function, as measured by psychophysical and electrodiagnostic tests when possible.

Factors associated with birthweight: an exploration of the roles of prenatal care and length of gestation.

To assess the association with birthweight of prenatal medical care, length of gestation, and other prenatal factors, birth certificate data were studied for babies born in 1978 to mothers who were residents of Alameda or Contra Costa counties, California. Using multiple regression data analytic techniques, adequate prenatal care (defined by the number of prenatal care visits compared to length of gestation and month of start of care) was found to be associated with an increase of 197 grams in average birthweight. This effect was even greater for Black infants and infants of short length of gestation. Adding length of gestation to the equation increased significantly the proportion of the variance in birthweight accounted for. For babies of short gestation (less than or equal to 280 days), the addition of length of gestation was associated with a halving of the association of prenatal care with birthweight. The results suggest that researchers need to take into account the nonlinear relationship between length of gestation and birthweight when assessing factors that affect birthweight.

The role of a community-based satellite clinic in the perinatal care of non-English-speaking immigrants.

In the provision of health care to non-English-speaking immigrants, cultural and linguistic barriers often deter both access to and use of needed services. This is especially true of the preventive health interventions such as perinatal care and family planning that contribute significantly to reproductive health. Alternative approaches to overcoming barriers to care are being taken in an urban health department clinic serving as a satellite perinatal resource to a group of low-income Chinese-speaking immigrants. The clinic, with service linkages to San Francisco General Hospital Medical Center and the Health Department of San Francisco City and County, is an example of culturally appropriate comprehensive perinatal care. Such an institution has helped recent immigrants adapt to their new environment and learn to use health services effectively.

Microsurgical techniques of anastomosis of the fallopian tubes.

PIP: Microsurgical techniques of anastomosis of the fallopian tubes have been studied. This paper considers the present state of the art of sterilization reversal, the training and equipment required, the potential for the diffusion of knowledge concerning reversal techniques, and the implication of current research in reversibility of sterilization for the practicing gynecologist. A preoperative study should be done on any candidate for a procedure to restore patency to the fallopian tubes to rule out other possible causes of infertility. Also, preoperative counseling should include both partners. The operating microscope offers a great advantage in the repair of several types of tubal obstruction. Midsegment end-to-end anastomosis is carried out by 1st injecting a dye into the cavity to locate the area of obstruction. The area is excised using microdissection and the fallopian tube checked for patency with the dye solution. Anastomosis is accomplished by opposing the miscularis of the tube, avoiding the mucosa. 4 sutures are usually adequate for closure. Most feel that postoperative hydrotubation is of some value in monitoring tubal patency. An organized training program in a microsurgical laboratory is the prefered way for learning the techniques. Long-term results of the microsurgical techniques for tubal anastomosis are encouraging and represent an improvement over macroscopic techniques previously reported.^ieng

Maternity and perinatal services in an urban-suburban area.

The need for community-wide planning of maternity and newborn services is illustrated by a survey of services in Alameda County, California. The decline in birthrate, coupled with the persistence of a number of low volume obstetrical and newborn units, is reflected in generally underutilized and unevenly distributed services. Primary, intermediate and tertiary levels of care are represented, but not always in a logical relationship to community needs. Postgraduate training in obstetrics and gynecology and in pediatrics continues to produce increasing numbers of specialists despite declining fertility and a decline (represented by children and youth) in the total population.