Mifepristone-misoprostol medical abortion: home administration of misoprostol in Guadeloupe.

Mifepristone-misoprostol medical abortion promises to revolutionize reproductive health-care. Several simplifications of the standard three clinic visit regimen may be possible, however. Particularly in developing countries, access to the method can be greatly increased by eliminating the longest clinic visit. Indeed, shortly after mifepristone's introduction in Guadeloupe, a semi-developed Caribbean territory administered by France, in 1991, two of the authors conducted a small prospective study of a one treatment-visit regimen. The study regimen was subsequently adopted as the standard of care for medical abortion on the island. Women (n = 92) with amenorrhea of < or = 49 days received 600 mg mifepristone under clinical supervision and were given 400 micrograms oral misoprostol for home administration 2 days later, returning 2 weeks later for follow-up. The success rate (95.4%) is comparable to rates found when both drugs are administered in the clinic and to rates from a similar study conducted recently in the United States. Adverse events were also comparable to protocols requiring in-clinic administration of misoprostol. Protocol adherence appeared to be excellent and loss to follow-up was rare. We suggest that home administration of misoprostol can be safe and effective in most nonindustrialized settings.

PIP: This paper presents a prospective study of home administration and a one-treatment-visit regimen of mifepristone-misoprostol for medical abortion in Guadeloupe. The administration of this contraceptive method usually requires a standard 3-clinic visit regimen, which would sometimes lead to discontinuation of the abortion process. The study consisted of 92 medical abortion cases conducted over a 13-month period. The intervention involved a 1-day treatment visit with patients receiving 600 mg of mifepristone and instructions on ingesting 2 tablets (400 mcg) of misoprostol orally after 2 days and another 200 mcg misoprostol if bleeding had not occurred within 6-12 hours. A follow-up was conducted among these women after 10-15 days of initial clinic visit and contraceptive administration. The total success rate was 95.4% in comparison with those who received a 3-clinic visit regimen and the statistical result of a study conducted in the US. Several adverse effects have been associated with the administration of abortive methods, which include bleeding (19.6% in mifepristone users and 68.2% in misoprostol users) and vomiting. Strict monitoring of mifepristone and misoprostol distribution and patient follow-up was ensured by French legislators. The authors conclude that home administration of misoprostol must be made available to women in developing countries.

[International migration and development: the new paradigms]. / Migrations internationales et developpement: les nouveaux paradigmes.

"In the present context of economic crisis which prevails in most receiving countries, two paradigms dominate the approach of international migration issues: ¿control', as a means to contain them, and ¿development', as a means to suppress the need to migrate.... The author [stresses] the need for research aimed at a better understanding of why consequences of international migration and refugee movements can be positive in certain cases, and negative in others, and more generally [emphasizes] the need for research on the relationships between international migration and development." (SUMMARY IN ENG AND SPA)

The Guadeloupean perinatal mortality audit: process, results, and implications.

In 1983, we implemented an ongoing perinatal mortality audit in Guadeloupe to identify factors underlying the current level of poor perinatal outcome and to stimulate increased provider motivation. The audit was part of an active research approach to document the specific nature of the perceived perinatal health problem, to modify provider behavior through the use of this acquired information, and, ultimately, to decrease avoidable perinatal deaths. We investigated all 320 perinatal deaths in Guadeloupe during 1984 and 1985. Nearly one-half of the perinatal deaths reviewed were determined to be related to maternal high blood pressure, maternal/fetal infection, and preterm delivery. Slightly more than one-half of the perinatal deaths were considered to be avoidable. Over the course of the audit, perinatal mortality rates exhibited a marked decline. The findings of this study support claims that perinatal audits with confidential inquiries may help effect change in perinatal health status in a population; the findings also call attention to the potential benefits of incorporating motivational incentives into these activities.

PIP: In 1983, the authors implemented an ongoing perinatal mortality audit in Guadeloupe to identify factors underlying the current level of poor perinatal outcome and to stimulate increased provider motivation. The audit was part of an active research approach to document the specific nature of the perceived perinatal health problem, to modify provider behavior through the use of this acquired information, and, ultimately, to decrease avoidable perinatal deaths. The authors investigated all 320 perinatal deaths in Guadeloupe during 1984-85. Nearly 1/2 of all perinatal deaths reviewed were determined to be related to maternal high blood pressure, maternal/fetal infection, and preterm delivery. Slightly more than 1/2 of the perinatal mortality rates exhibited a marked decline. The findings of this study support claims that perinatal audits with confidential inquiries may help effect change in perinatal health status in a population; the findings also call attention to the potential benefits of incorporating motivational incentives into these activities.

Anamnestic pregnancy risk assessment.

Based on data obtained from the 1984-1985 Guadeloupean Perinatal Audit, a pregnancy risk scoring system was developed using maternal demographic, socioeconomic, obstetric history and risk characteristics recorded at the first prenatal visit. Various combinations of risk factors were identified for four distinct pregnancy outcomes (perinatal mortality, low birth weight, preterm delivery and intra-uterine growth retardation). The findings emphasize the importance of developing risk assessments for discrete pregnancy outcomes within specific populations.

[An example of research and actions related to perinatal mortality in Guadeloupe. Factors and profiles of sociodemographic risk]. / Un exemple de recherche-action sur la mortalité périnatale en Guadeloupe. II. Facteurs et profils de risque socio-démographiques.

Perinatal risk factors in Guadeloupe (French West Indies) have been analysed from a community-based case-control survey. Two hundred and sixty four perinatal deaths were involved along with 605 controls. Principal component factor analysis of individual risk characteristics was used to identify risk group profiles. These risk profiles were: "single women of low socio-economical status" (17% of the variability), "traditional Caribbean housewives" (14%), "single adolescents" (7%), and "immigrant women" (10%). Only the three first were significantly associated with a poor outcome for the current pregnancy. This approach may be fruitful in planning for public health interventions to prevent perinatal risk. Also, risk profile concepts may be well-accepted by physicians and care providers, in routine practice, for screening of individual at-risk patients.

Are Latin American and Caribbean men irresponsible with regard to family planning? An inaccurate view of Caribbean men.

PIP: The views of the president of the Caribbean Family Planning Affiliation reflect a different perspective on men's involvement in couple decision making about family size and contraceptive use. Reference is made to several Caribbean surveys that show that men are genuinely concerned about the status of women. Under 20% of men expressed the attitude of male superiority to women. The majority of men aged 15-24 years desired 2-3 children as the appropriate family size. About 50% of the men agreed that both men and women should share decision making about the use of contraceptives. The other 50% supported either the male or the female making family size decisions. It is argued that male irresponsibility is not related to the attitude of male superiority and of women's domain in the home raising children. The ability to secure regular employment enables parents to care for their children. The research findings suggest that young men do hold positive attitudes about equality of the sexes and family matters. It is argued that the labeling of Latin American men as irresponsible does not accomplish very much.^ieng

[An example of the effect of research on perinatal mortality in Guadeloupe (1984-1985). I. Objectives and methodology]. / Un exemple de recherche-action sur la mortalité périnatale en Guadeloupe (1984-1985). I. Objectifs et méthodologie.

Research with a view to action being taken was carried out in Guadeloupe in 1984 and 1985 to try to find out the causes of the high level of perinatal mortality which persists on the island before suggesting to the public health authorities what action to take. All the cases of perinatal mortality (above 500 g in weight) were looked at and analysed carefully according to a protocol that had been prepared. The events preceding the perinatal death were described and also the antenatal and intranatal as well as immediate post-natal care given to the children. A control case was studied for each case that had been registered and the same questionnaire was filled in. The present work shows the methodology used to carry out the enquiry and how it was organized with the collaboration of all the actors in the public health department as well as the doctors and the health authorities authorities.