Uptake of contraception during postpartum amenorrhoea: understandings and preferences of poor, urban women in Bangladesh

In urban Bangladesh, as in many other settings, an immediate postpartum family planning strategy prevails, where providers seek to promote and provide contraception at 40-45 days following birth to women regardless of their breastfeeding or menstrual status. Despite such practices, the majority of women choose to delay the initiation of contraception until menses resumes, often several months after birth. The present paper seeks to explain this discrepancy by describing poor, urban women's understandings regarding the chances of conception and the risks associated with contraceptive use in the postpartum period. Findings from in-depth interviews reveal that the majority of women perceive no personal risk of pregnancy during amenorrhoea, though most do not recognise an association between this diminished risk of conception and breastfeeding. In addition, the data illustrate that women are primarily concerned with their own and their newly born child's health and well-being in the period following childbirth, both of which are perceived to be extremely vulnerable. These perceptions, plus an understanding that modern methods of contraception are "strong" and potentially damaging to the health, mean that the majority of women are reluctant to adopt family planning methods soon after birth, particularly during postpartum amenorrhoea. The paper advocates that, since breastfeeding affords good protection against pregnancy for six to nine months following birth, efforts should be made to actively incorporate lactational amenorrhoea into postpartum family planning strategies in Bangladesh. Recommendations are also made for ways in which women may be encouraged to adopt contraception during amenorrhoea beyond the period of high natural protection. The paper highlights the importance of taking the client's perspective into consideration in attempts to improve the quality and effectiveness of family planning programmes.     

Sexuality, reproduction, and family planning in women with schizophrenia

This article reviews data about how schizophrenia affects sexuality, pregnancy, the puerperium, parenting, and family planning. Women with schizophrenia have high rates of coerced sex, sexual risk behavior, and unwanted pregnancies. High rates of obstetric complications and custody loss increase morbidity for women and their offspring. Since untreated psychosis increases these problems, the risks of withholding pharmacotherapy must be weighed against the risks of prescribing medications during pregnancy. The puerperium is a time when women are especially vulnerable to exacerbations of schizophrenia. Mothers with schizophrenia may have a reduced ability to read children's cues, and they often have weak social support networks. Their children may be more difficult to raise than other children. Parenting rehabilitation can address some of these problems. Often, women with schizophrenia who are sexually active and do not wish to become pregnant do not use contraception. Incorporating family planning measures into mental health care delivery systems may reduce unwanted pregnancies.     

The effect of COMT inhibition by tolcapone on tolerability and pharmacokinetics of different levodopa/benserazide formulations

Current practice of family planning in China is based on the population policy and strategy of the country. Comprehensive contraceptive methods are provided in family planning clinics at all levels. Among the methods used, intrauterine devices and tubal sterilization are most popular. Vasectomy is popular in some provinces. Oral pills, injectables and subdermal implants occupy a small proportion. Incidence of abortion is high due to failure of methods and unprotected intercourse. Attention is paid to the adoption of emergency contraception to prevent unwanted pregnancy. Improvement in quality of care is the key to a successful family planning program. Basic research is essential for development of new contraceptive technology.     

Time for emergency contraception with levonorgestrel alone

The World Health Organization (WHO) multicenter, randomized trial reported in this issue of "The Lancet" confirms that levonorgestrel-only (two 750-mcg doses) is significantly more effective in preventing pregnancy after unprotected intercourse than the standard Yuzpe regimen (two doses of 500 mcg levonorgestrel and 100 mcg ethinyl estradiol) and is further associated with significantly less nausea and vomiting. When initiated within 24 hours of coitus, the failure rate was only 0.4% for levonorgestrel compared with 2.0% for the combined hormonal method. A further advantage of a progestogen-only emergency contraceptive method is avoidance of contraindications in women with past proven arterial or venous thrombosis or a current attack of migraine with focal aura. Although only one pharmaceutical company (Gedeon Richter in Budapest, Hungary) currently manufactures 750 mcg of levonorgestrel in a single tablet, others are likely to follow this example given the findings of the WHO study. Strong pressure exists to increase availability of postcoital contraception through trained nurses and retail pharmacists. However, potential users will still require counseling on the importance of selecting a long-term method of contraception and a family planning provider.     

Are there sex differences in neuropsychological functions among patients with schizophrenia?

OBJECTIVE: Studies of sex differences in neuropsychological performance in schizophrenia report inconsistent results, due in part to methodological artifacts. The study presented here was specifically designed to examine sex differences in neuropsychological performance. It was hypothesized that schizophrenic women would exhibit fewer neuropsychological deficits than schizophrenic men and that their performance would be more similar to that of normal women than schizophrenic men's performance would be to that of normal men. METHOD: Thirty-one outpatients with DSM-III-R-defined schizophrenia were systematically sampled from an extensive service network serving a large urban catchment area for seriously mentally ill persons. Twenty-seven normal comparison subjects were matched within sex on the basis of age, parental socioeconomic status, ethnicity, and handedness. An extensive neuropsychological test battery was administered, and multivariate analysis of variance was used to test for the effects of sex and group and sex-by-group interactions. RESULTS: Male patients were significantly impaired across all functions in comparison with normal male subjects and on tests of attention, verbal memory, and executive functions in comparison with female patients. Female patients performed significantly worse than female normal comparison subjects only on tests of attention, executive functions, visual memory, and motor functions. CONCLUSIONS: The findings suggest that women with schizophrenia may be less vulnerable to particular cognitive deficits, especially those involving verbal processing, than schizophrenic men.     

Family planning practices and attitudes among former Soviet new immigrant women in Israel

One hundred young new immigrant women from the former U.S.S.R. now living in Israel answered a detailed semi-open questionnaire regarding their knowledge, attitudes and behaviors in fertility and birth control issues. A collective family planning profile of these women is largely in line with that of the urban population of Slavonic U.S.S.R., combining early marriage, early and low fertility, the latter achieved by both abortion and contraception. Most respondents and their partners tried to prevent unwanted pregnancies, usually starting from traditional methods and switching over time to modern ones. An IUD remained most popular contraceptive among parous women, while use of the pill, very rare in the U.S.S.R., has almost doubled upon migration, mostly among younger women. Still, they kept some misleading ideas on the pros and cons of traditional versus modern methods, suggesting lack of adequate information also upon migration. Like their ex-compatriots, our women preferred to solve their birth control problems without external professional involvement. Contrary to the expected, free abortion ideology was not universally advocated by our respondents, and most were fully aware of abortion limitations in Israel. While rationally condemning abortion in both moral and health terms, most respondents still use it, this gap between beliefs and practice being indicative of their readiness to adopt efficient contraception. This switch occurs faster in women actively involved with host society via work or studies. Younger women were found to be more flexible and advanced in their family planning practices than were older ones, while almost no differences were related to education and origin within the U.S.S.R. This exploratory study suggests that any investment into promotion of healthy fertility control practices among new immigrants will be cost-effective in the near future.     

Awareness of language in children who have reading difficulties: historical comparisons in a longitudinal study

The purpose of this study was to assess factors associated with the use of family planning at first sexual intercourse among young adults aged 15 to 24 in urban Ecuador. The study population consisted of 1443 young adults (494 females and 949 males) in the cities of Quito and Guayaquil, interviewed by the 1988 Ecuador Young Adult Reproductive Health Survey, who reported having experienced consensual sexual intercourse. Approximately 11% of females and 15% of males reported using contraception at first intercourse. Binary logistic regression was performed to assess jointly the effect of multiple factors on contraceptive use at first intercourse. The regression model was first run on the entire study population and then separately for males and females. In the overall population, the following variables were significantly related to using family planning at first sex: being male; being from Guayaquil; older age; father's completion of secondary school. Having lost one's virginity to a prostitute was significantly associated with non-use of family planning. Males were 3.6 times more likely than females to use family planning during their first sexual intercourse. For each year older a young adult was at first sex, his or her odds of using family planning was multiplied by a factor of 1.3. Twenty-eight per cent of males in this study experienced their first sexual intercourse with a prostitute, and these young men were highly unlikely to use family planning. A male who experienced first intercourse with his girlfriend was more than five times as likely to use contraception than a male who lost his virginity to a prostitute.     

Impact of an educational support group on family participants who take care of their schizophrenic relatives.

Using a stress-coping framework, we designed a six-session educational support group offering family caretakers information about schizophrenia, training in problem-solving skills for managing patient behavior, and greater access to social support and community resources. Subjects were recruited through local community mental health centers; 24 subjects participated in one of five identically structured caretakers' groups and another 24 subjects served as matched controls. Results of the multivariate analysis of covariance indicated a significant difference between the experimental and control caretakers following the intervention. Caretakers of the educational support group reported significantly reduced anxiety and personal distress and significantly more active coping behaviors (increased use of community resources and better management of home life with their schizophrenic family member). However, no changes were reported in the frequency of their negative feelings toward their mentally ill family member or in their generalized sense of self-efficacy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A reconsideration of the Kety and associates study of genetic factors in the transmission of schizophrenia

The author reviews a study by Kety and associates that reported a significantly greater prevalence of schizophrenic spectrum disorders among the biological relatives of schizophrenic adoptees than among those of nonschizophrenic adoptees. The principal statistical analysis of the Kety study used an incorrect sample size (306 rather than 66) and failed to weight each index and control case (family) equally. This violation of the independence assumption would allow a few families to disproportionately influence the outcome. The author argues that proper statistical analysis applied separately to available categories indicates that significant differences between the index and control groups occurred mainly in the half-sibling category; this result violates the principle that genetic effects increase with greater consanguinity. She concludes that Kety and associates' study raises more questions than it answers regarding the role of genetic factors in schizophrenia.     

Risk factors for homelessness among schizophrenic men: a case-control study

OBJECTIVES: To identify risk factors for homelessness among the severely mentally ill, we conducted a case-control study of 100 indigent schizophrenic men meeting criteria for literal homelessness and 100 such men with no homeless history. METHODS: Subjects were recruited from shelter, clinic, and inpatient psychiatric programs in Upper Manhattan. Clinical interviewers employed standardized research instruments to probe three domains of risk factors: severity of mental illness, family background, and prior mental health service use. RESULTS: Homeless subjects showed significantly higher levels of positive symptoms, higher rates of a concurrent diagnosis of drug abuse, and higher rates of antisocial personality disorder. Homeless subjects experienced greater disorganization in family settings from birth to 18 years and less adequate current family support. Fewer homeless subjects than subjects in the never-homeless comparison group had a long-term therapist. These differences remained when demographic variables were adjusted statistically. CONCLUSIONS: Homeless schizophrenic men differed from their domiciled counterparts in all three domains we investigated; family background, nature of illness, and service use history. Findings are discussed in relation to policy and programs for the severely mentally ill.     

Contraception for the under 16s: better safe than sorry

This study concerns the opinions of family planning clinic clients on the availability of contraception for adolescents under 16 years of age. The 1978 British statistics indicated that 1300 babies were born to girls under 16, while in France 3000 babies were born. A 1965 study by Schofield of sexual attitudes and behavior of 15-19 year olds in Britain found that experienced girls were as sexually active as experienced boys. He also found that 54% of sexually experienced boys never used a contraceptive and 65% of experienced girls did not insist on contraceptive use. Furthermore, sex education was found to be in heavy demand by adolescents, but that the demand was not being met. This and other studies suggest that adolescent children behave sexually although there is a marked reluctance to admit to it. The questionnaire study of opinions involved 60 British subjects ranging from 15-58 years of age. The mean age was 27, and age at marriage ranged from 16-36 years. The age at leaving home ranged from 13-32 years. Information was gathered on the onset of sexual activity, contraceptive habits, an evaluation of sexuality, and views on abortion, and premarital sexual intercourse. The results indicate that: 1) age at 1st intercourse ranged from 13-28 years with a mean age of 18, 2) age at 1st marriage was at a mean of 21 years, but at this age a drop in frequency of 1st intercourse occurred, 3) 14 of the 60 had not had premarital intercourse, 4) 60% of all subjects used contraception at the time of 1st intercourse, with 31.5% between 20-30 years of age using contraception, 5) the most careful contraceptive users were those who became sexually active over the age of 21, 6) 40.5% considered their sex life to be very important while 53.4% felt it was fairly important, 7) 48.9% considered their sex life to be completely fulfilling and 48.9% felt it to be satisfactory, 8) 49% favored premarital intercourse, 41.9% favored it if it was right for the girl, while 3% felt it was acceptible if the couple was engaged, and 5.4% were totally against it, 9) 62% felt abortion was the right of every woman and 31.1% felt it was acceptible if the physical or mental well being of the mother was at risk, 10) 40.9% agreed with the British Medical Association policy on teenage contraception which advises doctors to encourage under 16's to tell their parents, but if they refuse, the doctor can still prescribe the pill, 11) 22.7% wanted contraception unconditionally available, 18.2% felt it should be dependent on parental knowledge, and 17% said it should not be available, 12) there was a trend for opinions to become less liberal as age increased, and 13) young girls appear to be less conscientious in using contraception than older women.     

From lineage to conjugality: the social context of fertility decisions among the Pare of northern Tanzania

This paper is a case study of the linkages between selected characteristics of the social organization in a particular ethnic group and reproductive values and behavior. Specifically, it examines factors that might be responsible for the acceptance of contraception and an expressed desire for a relatively small number of children among the Pare of Northern Tanzania. It is hypothesized that with the increasing shift towards wage labor and diminishing dependence on land and lineage relations, there is a growing reliance on the conjugal bond and the development of a partnership marriage in which husbands and wives perceive their interests as mutual. This facilitates communication, particularly about family planning. Research methodology consisted of a two-pronged approach and combined an intensive ethnographic study of the households in the Ugwengo District of the Pare mountains with individual surveys administered to a sample of 512 women and in-depth interviews conducted with 20 women regarding the value of children and contraceptive and birth histories.     

Contraceptive practice after clinic discontinuation

A follow-up study was conducted of clients who stopped attending 4 family planning clinics in Washington County, Oregon, a predominantly white, middle-class suburban community. Clients had enrolled in the program between 1971-74, and dropped out by April 1975. 29% of the women (746) who were overdue for a return visit by more than 3 months (i.e. inactive clients) were contacted by phone and mail. No significant social or demographic differences were found between active and inactive clients or between dropouts who were contacted and those who were not. 71% of all program enrollees dropped out by the end of 3 years. However, 90% of the sample were either using contraception or not at risk of an unwanted pregnancy for a variety of reasons. The remaining 10% were either unprotected or already pregnant with an unplanned pregnancy (2%). The women at risk and not using contraception were more likely to be young, poorly educated, single, and recent enrollees in the family planning program. No other social or economic differences affected the comparison of the 2 groups. Most users continued to use the same method of contraception they had used before. However, a significantly smaller proportion of women were using the pill, a slightly larger proportion were using IUD and 6% more clients were sterilized. The most common reasons for leaving the program were the decision to use a private physician and relocation. Among women at risk, the most common reason was worry about the contraceptive method, especially the pill. New sources of care included private physicians (71%, but 1/3 of these women were disatisfied with their doctors' care or fees), public health clinic not part of the family planning program (21%) and drugstores. A very few women reported no alternate source of care.     

The risk for psychiatric disorders in relatives of schizophrenic and control probands: a comparison of three independent studies

BACKGROUND: Although replication is the heart of science, psychiatric geneticists rarely have the opportunity to replicate findings, especially more than once. METHODS: This article reviews results from three independent family studies of schizophrenia on which one of us conducted diagnostic reviews: the Danish Adoption Study (DAS), the Iowa 500 non-500 family study (IFS), and the Roscommon Family Study (RFS). We utilized DSM-III or DSM-III-R criteria and meta-analysis techniques. RESULTS: The odds ratios (OR) in personally interviewed, first degree biological relatives of schizophrenic and matched control probands for schizophrenia, other non-affective psychoses (ONAP), schizotypal personality disorder (SPD), unipolar affective illness (UPAI), bipolar affective illness (BPAI), and anxiety disorders were homogeneous across studies. For alcoholism, ORs were significantly heterogeneous. Schizophrenia, SPD and ONAP strongly aggregated in relatives of schizophrenic probands with decreasing common OR estimates of 16.2, 5.0 and 4.0, respectively. The common OR for anxiety disorders was 1.1, indicating no familial co-aggregation. For UPAI and BPAI, the common ORs exceeded unity (1.3 and 1.9, respectively), although only the former was statistically significant. CONCLUSIONS: Schizophrenia strongly aggregates in families and shares familial factors with SPD and ONAP but not anxiety disorders. The familial factors of aetiological importance for schizophrenia and affective illness may be weakly related. With the exception of alcoholism, the patterns of psychiatric disorders in relatives of schizophrenic and control probands in these three studies were sufficiently similar that, despite their methodological differences, they can probably be viewed as replications of one another.     

Month of birth and schizophrenia in Taiwan: effect of gender, family history and age at onset

Schizophrenic patients have been shown to have a moderate excess of winter births in the areas where seasonal variations in weather are large. In this report, we examined the seasonality of schizophrenic births in Taiwan, which has a subtropical climate. Using nationwide hospitalization data (2429 male and 1320 female schizophrenic patients), we applied the life table method to compare the risk of schizophrenia among 12 cohorts of month-of-birth for males and females, respectively. Differences among the risks of the 12 cohorts were tested using the logrank test. The samples were further stratified by family history and age at onset. There was a significant association between the risk of being admitted as a schizophrenic and month of birth for both males and females. The cohorts born in November and January had the highest risks. After stratification, the association was significant only for non-familial, male, and early onset schizophrenic patients. The results indicate that seasonally varying factors might increase the risk of schizophrenia, especially in those without a family history of the disease. Men are more vulnerable to such factors than women, and the schizophrenics resulting from such insults tend to be early onset.     

Signal detection in vigilance tasks and behavioral attributes among offspring of schizophrenic mothers and among hyperactive children.

24 children of schizophrenic mothers, 20 children of mothers with nonpsychotic psychiatric disorders falling outside the schizophrenia spectrum, and 14 hyperactive children were examined relative to groups of individually matched comparison children and to a representatively stratified group of 67 normal children. Ss were 9–16 yrs of age. Children of schizophrenic mothers showed lower mean perceptual sensitivity (PS) than matched and stratified normal children and included an excessive number of extremely poor scorers. Neither children of mothers with nonpsychotic disorders outside the schizophrenia spectrum nor hyperactive children displayed a significant deficit in PS. Hyperactive children scored lower on a beta response criterion factor across vigilance tasks and were rated as higher on an Emotionality factor and lower on a Fearful Inhibition factor than their normal peers. The perceptual sensitivity deficit among children of schizophrenic mothers was found across motivational feedback conditions and was evident throughout the vigilance period. (3? p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors underlying unmet need for family planning in the Philippines

The prevalence of unmet need for family planning is a primary justification for family planning programs, but the causes of unmet need have not been much explored. This article investigates four explanations for unmet need: (1) as an artifact of inaccurate measurement of fertility preferences and contraceptive practice; (2) as a reflection of weakly held fertility preferences; (3) as a result of women's perceiving themselves to be at low risk of conceiving; (4) as due to excessive costs of contraception. The explanations are examined using quantitative and qualitative data collected in 1993 from currently married women and their husbands in two provinces in the Philippines. The results indicate that the preference-behavior discrepancy commonly termed "unmet need" is not an artifact of survey measurement. The most important factors accounting for this discrepancy are the strength of women's reproductive preferences, husbands' fertility preferences, and the perceived detrimental side effects of contraception. Inaccessible family planning services appear to carry little weight in this setting. Modification of services to make them more attentive to other obstacles to contraceptive use would improve their effectiveness in reducing unmet need.     

Basic assessment series: the adult pulmonary system

OBJECTIVE: The study was conducted to evaluate the spread of the minor physical anomalies (MPAs) in patients with schizophrenia and normal subjects, and the relevance of MPAs to sex, age of onset of the disease, birth order, and season of birth. METHODS: Forty two inpatients satisfying the DSM-IV criteria for schizophrenia and 36 normal controls were evaluated for MPAs using the Waldrop scale. Subjects with schizophreniform, schizoaffective and schizotypal personality disorders were excluded from the sample to prevent these from possible confounding of the results. RESULTS: The schizophrenic patients showed significantly more anomalies than the controls. In both male and female patients, there was a higher incidence of anomalies in the region of the head. Significantly higher scores for minor physical anomalies were associated with later position in the birth order. Gender differences were without statistical significance. No relationship was found between minor physical anomalies and age of onset of the disease and birth season. CONCLUSION: The results are consistent with the theory of disturbed craniofacial development in at least one subpopulation of schizophrenic patients and indicate the origins of the disturbance in the early embryonal period. The higher incidence of anomalies in the region of head reflects the complex processes in the morphogenesis of mouth, ears and eyes.     

Premarital sexual guilt.

Predictors of premarital sexual guilt at both first and current sexual intercourse were obtained for 355 13–20 yr old sexually active single women attending 10 birth control centers. Guilt was assessed as an episodic emotion rather than as a personality disposition. Results show that the best model for predicting guilt at first intercourse contained the variables of planning for first intercourse and self-esteem, and explained 18% of the variance. 26% of the variance in current sexual guilt was explained by the variables of number of sexual experiences, personal attitude toward premarital intercourse, planning for first intercourse, and self-esteem. (French abstract) (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)