Religion and family planning.

Religion is embedded in the culture of all societies. It influences matters of morality, ideology and decision making, which concern every human being at some point in their life. Although the different religions often lack a united view on matters such contraception and abortion, there is sometimes some dogmatic overlap when general religious principles are subject to the influence of local customs. Immigration and population flow add further complexities to societal views on reproductive issues. For example, present day Europe has recently faced a dramatic increase in refugee influx, which raises questions about the health care of immigrants and the effects of cultural and religious differences on reproductive health. Religious beliefs on family planning in, for example, Christianity, Judaism, Islam and Hinduism have grown from different backgrounds and perspectives. Understanding these differences may result in more culturally competent delivery of care by health care providers. This paper presents the teachings of the most widespread religions in Europe with regard to contraception and reproduction.

The role of Advanced Nurse Practitioners in the availability of abortion services.

Despite the legalisation of abortion in many countries worldwide, access to abortion is often restricted in many ways. Lack of availability of trained and willing physicians, inadequate and poor infrastructure as well as affordability are issues that are still contributing to poor access to abortion for many women living in countries that have legalised abortion. Improving access to early abortion despite the declining number of doctors willing to provide abortions is being addressed in some countries by expanding the role of advanced nurse-midwife practitioners in this field. There is good evidence to suggest that the outcome of first-trimester abortions performed by suitably trained non-medical practitioners is comparable in terms of safety and efficacy to abortions performed by doctors. These mid-level practitioners also have a key role in providing post-abortion care and contraception to women. We need to address outdated laws and regulations as well as political challenges that restrict both the ability of advanced nurse-midwife practitioners to provide abortion care and the opportunities to train them appropriately.

Experience of IUD/IUS insertions and clinical performance in nulliparous women--a pilot study.

OBJECTIVES: To assess experience of insertion and use, by nulliparous women, of intrauterine devices (IUDs) and intrauterine systems (IUSs) and the feasibility of a large comparative study. METHODS: Prospective pilot study of women attending for interval insertion of IUD/IUS or emergency IUD. Problems and experience of the procedure were noted. At three months and one year continuation rates, satisfaction levels and problems were recorded. Case notes were reviewed for non-responders. RESULTS: Between May and October 2005, 117 nulliparous women were recruited. Nine had an IUS inserted, and 104 an IUD. Despite a reasonable level of pain at insertion most women gave broadly positive descriptions of the procedure. At one year, 65 women were known to still have their original device. Fifteen had it removed; in six women it was expelled. The satisfaction score was high. There were no pregnancies or perforations. CONCLUSIONS: Insertion of IUD/IUS was well tolerated by the majority. Continuation and satisfaction rates were high. The IUD/IUS should be offered to nulliparous women as part of the full contraceptive menu. The ease of recruitment in this pilot study suggests that a larger study is feasible.

Assessment of workload: intrauterine device/intrauterine system provision.

The Faculty of Family Planning and Reproductive Health Care (FFPRHC) has recently published Service Standards for Workload in Contraception, which state that a minimum of 20 minutes should be made available for intrauterine device/hormonal system (IUD/IUS) provision. This document acknowledges that there is currently little formal evidence relating to assessment of time taken for providing various contraceptive methods. The Abacus Clinics in Liverpool, UK provide an average of 1,300 IUD/IUS fittings in a year. We monitored the time taken for IUD/IUS provision over a 4-week period. Our study revealed that the average time taken for all types of IUD/IUS provision is significantly more than the minimum recommended by the FFPRHC.