[Surgical contraception on mentally retarded women]. / La esterilizacion quirurgica en mujeres con retardo mental

PIP: Mentally retarded (MR) women present a difficult dilemma in medicine because of the vulnerability of this population to unscrupulous people, and their ability to conceive. Sterilization remains the only contraceptive methods that can prevent pregnancy among these women without the additional complications found in temporary methods. There are 3 categories of people who should be included in any discussion of this type: 1) MR with IQ's of 55=70; who have reached the 4th grade; who can get married and lead a semi-normal life within society. This group should not be considered for sterilization; 2) MR with IQ's of 40-55; these can generally adapt themselves to society; however, it's possible that the process of the "normalization" is too great an effort which could aggravate the burdens of pregnancy and childbearing; sterilization is recommended for this group; 3) MR with IQ's under 40; this group is severely retarded, requiring supervision; they are incapable of taking care of themselves, especially their personal hygiene, and require sterilization. 24-26.4% of children will be retarded when 1 parent is retarded, and 44-47% when both parents are retarded. In cases where sterilization is recommended: 1) it must be determined that the patient cannot demonstrate voluntary informed consent and that coercion was not used; 2) that the patient cannot raise a child; 3) that the patient is at risk of getting pregnant; 4) it must be proven, through a multi-disciplinary committee that there are no other alternatives in the cases; 5) the legal consent of the patient's guardians must be obtained; 6) in cases where there aren't any legal guardians, the institution or legal authority must follow all legal procedures before the Colombian Institute for Family Welfare according to Articles 599 and 600 of the National Health Code. (Author's modified).^ieng

[Impact of family planning on maternal-child health. The future of humanity depends on our children]. / Impacto de la planificacion familiar en la salud materno-infantil. El futuro de la humanidad depende de nuestros hijos.

PIP: Better hygiene, nutrition, housing, health care and education are needed to prevent some of the estimated 15 million deaths in children under 5 and 500,000 maternal deaths that occur each year in the developing countries. The World Fertility Surveys and other studies beginning in the 1970s in Africa, Asia, the Middle East, and Latin America demonstrated the direct relationship between family planning and maternal and child mortality and morbidity. A child born in a high mortality country of Asia or Africa has a 20 times greater risk of dying before age 5 than a child in the US, Japan, or Sweden. Methods for reducing this mortality are known, including spacing of pregnancies, limiting family size, and avoiding pregnancy at unfavorable ages. During 1986, approximately 2 million children under 5 died from causes associated with rapid procreation and short birth intervals. It is estimated that 1 in 5 of these deaths would have been avoided if the interval between births had been longer. The high mortality rate is partly due to maternal exhaustion; mothers have insufficient time to recuperate between births, especially if they practice prolonged breast feeding, are undernourished, or engage in arduous physical labor. Inability to give high quality care to several children at a time may be another factor. From the 3rd birth on, women run 4 times greater risks of abortion or fetal death than in the 1st or 2nd pregnancy. The proportion of low birth weight babies increases significantly after the 4th child, explaining their vulnerability to health problems or death. Large family size may also prejudice the nutritional status of children. Infant mortality in the entire world in mothers under 20 is estimated at 126/1000 live births. The 1st child of an adolescent mother has an 80% greater probability of death than the 2nd or 3rd child of a mother aged 25-34 years. Lack of access to contraception and lack of motivation to use it are factors preventing tremendous infant mortality gains in the developing world. Only about 6000 of the estimated half million maternal deaths each year occur in developed countries. The indirect causes of maternal mortality are related to the unfavorable status of women reflected in poverty, illiteracy, lack of access to health care, and procreation patterns. The World Fertility Surveys indicate that 200,000 maternal deaths would be avoided each year if women not wanting more children had access to contraception. Contraceptive use would also prevent most of the estimated 100,000-200,000 maternal deaths from complications of abortion each year. The 4 basic elements of a maternal health program are primary care, prenatal care, attendance at delivery by trained personnel, and rapid access to emergency medical care.^ieng

[Impact of family planning on maternal-child health]. / Impacto de la planificacion familiar en la salud materno-infantil.

PIP: An estimated 15 million children under 5 die each year, most of them in developing countries. Some 1/2 million women die of causes related to pregnancy, leaving at least 1 million children orphaned. The World Fertility Surveys of the 1970s demonstrated the direct relationship between family planning and maternal-child health. Between 1985-2000, some 2 billion children are expected to be born, 87% of them in developing countries. Some 240 million will die before 5 years. The main causes of death in small children are acute diarrheal disease, respiratory infections, transmissible diseases preventable with vaccination, malaria, malnutrition, and high fertility. 3 aspects of reproduction have significant effects on child survival: spacing, parity, and maternal age. In 1986, approximately 2 million children under 5 died because of risks associated with rapid procreation, and it is estimated that 1/5 of all child deaths could have been prevented with longer birth intervals. Maternal exhaustion and the inability to give adequate care to several small children at once are believed to be the main causes. The problem of abortion or fetal death increases significantly beginning at the 3rd birth, and the proportion of low birth weight babies increases at the 4th birth. The risk of malnutrition increases in large families with limited resources. The safest ages for childbearing are 20-34 years; the worldwide infant mortality rate for mothers under 20 is about 126/1000. Adolescent mothers are at increased risk of problems in the pregnancy and delivery. Family planning can reduce risks related to spacing, family size, and maternal age, and also risk of congenital defects that increase for older mothers. According to the World Health Organization, each year there are some 500,000 maternal deaths, only 6000 of which occur in developed countries. Immediate causes of maternal death in developing countries include hemorrhage, sepsis, eclampsia, dystocic delivery, and induced abortion, but the underlying causes are related to the poor situation of the woman: poverty, illiteracy, lack of adequate prenatal health care, and childbearing at extreme ages. Estimates based on the World Fertility Survey suggest that if all women stating they wanted no more children used contraception, 30% of maternal deaths would be avoided. It is estimated that some 15 million women undergo induced abortions each year, with 100,000-200,000 resulting deaths.^ieng