Background: The provision of safe abortion services upholds the realization of justice in sexual and reproductive health. Many state-level studies in India have identified poor availability of abortion services in the public sector and negative attitudes toward abortion among health providers, as potential barriers to access. Materials and Methods: A cross-sectional study was done to document the availability and utilization of medical termination of pregnancy (MTP or abortion) services and to assess public sector health providers' attitudes towards safe abortion. It was carried out in a representative district of West Bengal, using a facility checklist and a validated attitude scale. Results: Only 11 of 42 public health facilities had both trained doctors and equipment to provide MTP services. Twelve facilities provided MTP services, of which only three urban-based secondary-level facilities provided second trimester MTPs. There were female providers in just 2 of the 12 MTP-providing facilities. Among the 64 health providers interviewed, 40% were trained to provide MTP. According to the attitude scale, 38% had a negative attitude toward the provision of safe abortion services. There was no statistically significant association between attitudes of health providers and provision of MTP. However, there appeared to be a subtle process of gatekeeping in operation, such as making MTP conditional on acceptance of contraception, requiring the husband's consent, and so on. Conclusions: The study shows the poor availability of abortion services in public sector facilities in a district of West Bengal, although all public health facilities from the primary health center level upwards are authorized to provide abortion services.
Leukaemia inhibitory factor (LIF) plays an indispensible role in embryo implantation. Aberrant LIF production is linked to implantation failure. LIF regulates multiple processes prior to and during implantation such as uterine transformation into a receptive state, decidualization, blastocyst growth and development, embryo-endometrial interaction, trophoblast invasion, and immune modulation. Due to its critical role, LIF has been a target for a nonhormonal contraception. In this review, we summarize up-to-date information on the role of LIF in implantation and its role in contraception.
INTRODUCTION: Female sexual dysfunction (FSD) is a highly prevalent sexual health problem but poorly investigated at the primary care level.
AIM: This article examines the prevalence of sexual dysfunction and its possible risk factors associated with women at high risk of FSD in a hospital-based primary practice.
METHODS: A validated Malay version of the Female Sexual Function Index (MVFSFI) was utilized to determine FSD in a cross-sectional study design, involving 163 married women, aged 18-65 years, in a tertiary hospital-based primary care clinic in Kuala Lumpur, Malaysia. Sociodemographic, marital profile, health, and lifestyle for women at high risk of FSD and those who were not at high risk were compared and their risk factors were determined.
MAIN OUTCOME MEASURES: Prevalence of FSD in Malaysian women based on the MVFSFI, and its risk factors for developing FSD.
RESULTS: Some 42 (25.8%) out of 163 women had sexual dysfunction. Prevalence of sexual dysfunction increased significantly with age. Sexual dysfunctions were detected as desire problem (39.3%), arousal problem (25.8%), lubrication problem (21.5%), orgasm problem (16.6%), satisfaction problem (21.5%) and pain problems (16.6%). Women at high risk of FSD were significantly associated with age (OR 4.1, 95% CI 1.9 to 9.0), husband's age (OR 4.3 95% C.I 1.9 to 9.3), duration of marriage (OR 3.3, 95% CI 1.6 to 6.8), medical problems (OR 8.5, 95% CI 3.3 to 21.7), menopausal status (OR 6.6, 95% CI 3.1 to 14.3), and frequency of sexual intercourse (OR 10.7, 95% CI 3.6 to 31.7). Multivariate analysis showed that medical problem (adjusted OR 4.6, 95% CI 1.6 to 14.0) and frequency of sexual intercourse (adjusted OR 7.2, 95% CI 2.1 to 24.0) were associated with increased risk of having FSD. Those who practiced contraception were less likely to have FSD.
CONCLUSION: Sexual health problems are prevalent in women attending primary care clinic where one in four women were at high risk of FSD. Thus, primary care physician should be trained and prepared to address this issue.
Study site: Primary Care Clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
Hysterectomy and tubal sterilisation are two commonly performed gynaecological procedures in Malaysia. Little has been published about the psychological impact on sexuality of such operations in the Far East. Many Malaysian patients believe that surgery to the pelvic organs may be detrimental to the sexual health and needs of women. There is a widespread belief that the uterus is essential for the libido and sexual wellbeing of women. It is also believed that tubal sterilisation may result in the loss of libido and thus of sexual desire for her husband. Despite counselling to dispel these misconceptions, patients frequently refuse surgical management for fear of losing their libido and sexuality. Inability to satisfy and consummate marriage is a valid reason for the partner to find another wife (Muslims in Malaysia are legally allowed to have four wives). This fear of ultimately losing the husband to another woman due to lack of libido and loss of sexuality often causes women to refuse appropriate surgery. The recent availability of the levonorgestrel intra-uterine system (IUS) in Malaysia provides a suitable medical alternative to surgery in managing some of these patients. There is good evidence to suggest the effectiveness of the levonorgestrel IUS in the treatment of menorrhagia. The use of the levonorgestrel IUS in women whose cultural beliefs/misconceptions are not amenable to counselling, may help in the psychological preservation of their libido and sexuality.
There is a high rate of unintended pregnancies in Malaysia due to low contraceptive use. Only 30% of married women use modern contraceptive methods. Emergency contraception (EC) is used within a few days of unprotected sex to prevent pregnancy. The purpose of this study was to investigate the knowledge, attitudes, and practices regarding EC pill use among Malay women. A cross sectional study was conducted among married female staff using stratified random sampling from 15 faculties in the Universiti Putra Malaysia (UPM). Data about sociodemographic factors, reproductive health, knowledge, attitudes and practices regarding EC use were gathered using validated self-administered questionnaire. The response rate was 87%. Half the 294 subjects who participated had a low knowledge, 33.0% a moderate knowledge and 17.0% a good knowledge about the EC pill. Eighty-eight percent of respondents had a positive attitude and 12.0% a negative attitude toward EC. Eleven percent of respondents had previously used EC. Unplanned and unwanted pregnancies were reported by 35.0% and 14.0% of respondents, respectively. Most respondents lacked knowledge about the indications for using EC, its mechanism of action, when it can be used and its side effects. Our findings show a need to educate women about EC.
Study site: 15 faculties in Universiti Putra Malaysia, Serdang. Selangor, Malaysia
Emergency contraceptive pills (ECP) are effective, safe and cheap, with profound global health and economic benefits. Patient education and easy access to ECP will contribute immensely to avoiding unwanted pregnancies and unsafe abortions. Issues related to morality, its perceived status as an abortifacient and harmful behaviour should it be easily available, has limited the widespread use of ECP in many countries.
This paper examines data on the sexual activities of 1,200 Malaysian adolescents aged 15-21 years based on a probability household sampled survey carried out in Kuala Lumpur in 1986. Sexual behaviours like premarital sexual intercourse, contraceptive usage and masturbation were presented. Of the 1,181 unmarried respondents, 9% (105) reported having had sexual intercourse; males were significantly more experienced compared to females. Older age groups were also found to be more sexually active than the younger ones. Among those who had experience dating (n = 521), 20% (105) have experienced sexual intercourse, 44% (228) have kissed and necked, and 35% (183) have experienced petting, while 24% (130) have had no physical intimacies. Poor use of contraception was also revealed. The most commonly used were condoms, oral contraceptives and withdrawal. With regard to masturbation, males begin this practice relatively earlier than females. Almost half of those who indulged in masturbation were worried by the act, especially the females. Implications of the findings are discussed.
Realising that family planning is not making a sufficient impact on the rural people as it is on the urban people, it was decided that it would be interesting to study the knowledge and attitude of a rural community towards family planning, The study sample consisted of 200 Malay married women - 100 acceptors and 100 non-acceptors from the Kuala Pilah District, The study commenced on 4 December 1978 and ended on 22 December 1978. A healthy climate of knowledge and attitude exists among rural Malay women. Only 2 percent nonacceptors had not heard of any method of family planning, and 99 percent acceptors, and 85 percent non-acceptors discussed family planning with their husbands. There was also enough evidence to show that birth rate does decrease as literacy rate increases. On the other hand, however, only 19 percent respondents approved of family planning practice before the first child. Also there is a dearth of information on family planning in the rural areas and not much was being done in utilising the two popular forms of mass-media - the radio and the television as a means of disseminating information on family planning. The study concludes with a recommendation that there is a need for sustained effort at improving knowledge and disseminating information, and nursing and nurturing the right attitudes towards family planning, It suggests that community leaders, women's clubs and private organisations be mobilised to participate more
fully in promoting family planning,
This is a study of 148 women seeking induced abortion by doctors. The typical woman in this study was married, with 2 or more children, Chinese, urban, 21-30 years and had completed primary education. She was motivated to defer pregnancy and to a lesser extent to limit family size by resorting to induced abortion.
BACKGROUND: The practice of modern contraceptives still remains a sceptical issue in the society and dormant due to increasing objection of husbands who play a significant role in the family planning practice.
OBJECTIVES: This study was done to determine the factors affecting the ever use of modern contraceptive methods among married men visiting a healthcare clinic in Malaysia.
MATERIAL AND METHOD: A cross sectional study of 443 men aged over 18 years was conducted using convenient sampling from January 2016 till March 2016 at a primary care clinic. A self-administered questionnaire assessing sociodemographic characteristic, attitude towards family planning, spousal communication and ever used of modern contraceptive methods was used.
RESULTS: The proportion of ever used modern contraception was 48% (n=192). Multiple logistic regression revealed that spousal communication on family planning (Adjusted OR 15.8; 95% CI 7.0 - 35.6) and attitude towards marital relationship (Adjusted OR 1.1; CI 1.0 - 1.1) were significant predictors for ever used of modern contraception among married men.
CONCLUSION: The proportion of ever used modern contraception is still not high. Men who communicated with their spouse on modern contraception and perceived family planning as means to preserve their marital relationship were more likely to practice modern contraceptive method.
Study site: Klinik Kesihatan, Selangor, Malaysia
PIP: Responses to questions relating to breastfeeding in the World Fertility Surveys of South Korea, Indonesia, Nepal, Sri Lanka, Malaysia, and Bangladesh are analyzed. Of these countries, the percentage of ever-married women who had breastfed in the last closed interval was between 94-99%, except for Malaysia (81%) and average number of months breastfeeding took place was from 16.5-19.2, except for Malaysia (7.3). The infant mortality rate in these countries was 33/1000 live births for South Korea, 45/1000 for Malaysia, 51/1000 for Sri Lanka, 137/1000 for Indonesia, 150/1000 for Bangladesh, and 152/1000 for Nepal. Responses, however, might vary according to different interview situations. Assuming that the reporting errors are of similar magnitude and direction, the relationship between duration of breastfeeding and the birth interval can be studied. But it is possible that breastfeeding was prolonged due to other reasons for which conception was delayed; thus the regression of breastfeeding duration on the birth interval is not as logical as the regression of the birth interval on the breastfeeding is, especially when habitual breastfeeding can be avoided. The negative relationship between breastfeeding and infant mortality does exist, assuming that a woman breastfeeds all her children for similar durations. Some breastfeeding differentials are place of residence (less for rural areas), education (reduces duration), and religion (Christians have shorter duration than Muslims, Hindus, or Buddhists). In South Korea the mean length of breastfeeding of women aged 25-34 and 35-44 are 17.5 and 20.5, and women using contraceptives are 26% for 25-34 and 20% for 35-44. South Korea also has the highest level of breastfeeding, highest incidence of ever use of contraceptives, and a very low level of fertility. Nepal and Bangladesh have a high level of breastfeeding but since their contraceptive incidence is low, their fertility level remains high. Some areas of further research include influence of breastfeeding on infant and child mortality.
Data from the 1984 Malaysian Population and Family Survey were matched with birth registration records for 1985-87 to determine the accuracy of statements regarding desired family size that were reported in a household survey in predicting subsequent reproductive behavior. The findings of this study were that stated fertility intention provides fairly accurate forecasts of fertility behavior in the subsequent period. In other words, whether a woman has another child is predicted closely by whether she wanted an additional child. Informational, educational, and motivational activities of family planning programs would, therefore, have greater success in reducing family size if fertility intentions were taken into account.
This report examines Malaysian women's perceptions of the contraceptive effect of breastfeeding, the determinants of their perceptions, and any effect these perceptions might have on nursing duration and contraceptive use. The report also considers whether women are consciously replacing breastfeeding with modern contraceptive methods. Data from the 1976 Malaysian Family Life Survey are analyzed, and the author concludes that Malaysian women do perceive that breastfeeding has a contraceptive effect, but that this perception is not universal. Ethnicity and desire for a particular family size are the most significant determinants of this perception. Finally, Malaysian women's recognition of the contraceptive effect of nursing does not influence either the duration of their breastfeeding or their adoption of contraception. Malaysian women may not be abandoning breastfeeding to adopt contraception. More probably, breastfeeding declines and contraceptive prevalence increases with modernization.
PIP: While Malaysia's National Family Planning Board is primarily responsible for family planning activities, several organizations and ministries, both governmental and voluntary, participate in various service programs. Current population policy attempts to go beyond family planning. Population education, treatment of infertility, and cancer screening are offered as well as family planning, to make the program more useful to greater numbers of people. The government also wishes to improve the status of women thereby giving them alternative choices of lifestyle. Rural women are reached through the Ministry of Agriculture's community development program. While the National Family Planning Board receives only 0.12% of the national budget, this figure is not expected to increase. Tables giving vital rates show that population fell below the 30 per 1000 mark for the first time in 1977. A higher rate of fertility decline has taken place between 1967 - 1977 than occurred from 1957 - 1967. Current demographic objectives are to reduce crude birthrate to 28.2 per 1000 by 1980. This goal would require 817,963 new acceptors. While the pill accounts for 80% of acceptor's choice, the proportion using condoms has increased from 1.4% during 1969 - 1970 to 11.4% in 1979. Despite reported side effects with the pill and the illegality of induced abortions, virtually all acceptors are well satisfied with the program in its current form.
The estimation of fecundability from survey data is plagued by methodological problems such as misreporting of dates of birth and marriage and the occurrence of premarital exposure to the risk of conception. Nevertheless, estimates of fecundability from World Fertility Survey data for women married in recent years appear to be plausible for most of the surveys analyzed here and are quite consistent with estimates reported in earlier studies. The estimates presented in this article are all derived from the first interval, the interval between marriage or consensual union and the first live birth conception.
PIP: The estimation of fecundability from survey data is plagued by methodological problems such as misreporting of dates of birth and marriage and the occurrence of premarital exposure to the risk of conception. The availability of data collected with a standard interview schedule from over 40 countries in the World Fertility Survey (WFS) is an invaluable resource for assessing the potential utility of measures of fecundability derived from single-round surveys as well as for comparing estimates across countries and regions of the world. In this article, data are used from 5 WFSs in Latin America (Colombia, Costa Rica, Panama, Mexico and Paraguay) and 3 in Asia (Korea, Malaysia and Sri Lanka) to determine the general usefulness of single-round survey data for the estimation of fecundability from survey data, given the limited information on contraceptive use available from many surveys and the data quality problems associated with reports of dates of marriage and dates of birth. Explored in the process are several different procedures for estimation and variations in estimates of fecundability by country, time period, and women's age. For most of this analysis, the median waiting time to conception in the absence of contraception is used as a measure of fecundability. All of the estimates presented are derived from the 1st birth interval. The estimates are based on data collected in both the birth and the marriage histories in the WFS individual interviews. The 8 surveys chosen for this analysis are characterized by relatively complete reporting of dates of birth and marriage. The primary conclusion of this exercise is that reasonable estimates of fecundability can be derived from WFS data only if one is careful to avoid numerous methodological pitfalls. The most plausible estimates appear to be for women married in the period from about 2 to 10 years before the survey. The average waiting times to 1st conception range from about 4 to 7 months; the corresponding monthly probabilities of conception lie between 0.17 and 0.26. The effect of age at marriage on fecundability is most apparent for ages below 16; differences between women married at ages 16-17 and at ages 18 and above are more modest. Suggestions for improvement of the estimation of fecundability by including a number of questions in survey questionnaires are presented.
Recent research has shown that children born before and after short birth intervals run a considerably greater risk of dying in infancy or childhood than do others. This report investigates which women have short interbirth intervals, under what circumstances, and for what reasons. The analysis uses data from the Malaysian Family Life Survey to examine influences on the two main behaviors--breastfeeding and contraceptive use--that affect birth interval length, and assesses the the impact of these same variables on the probability of having a birth interval of less than 15 months. The analysis shows that many of the independent variables affect breastfeeding and contraceptive use in opposite directions, with no significant net effect on the likelihood of a short interval. For example, a woman's education is negatively related to the probability that she breastfeeds, positively related to the probability that she uses contraceptives, and has no significant effect on the likelihood that the interpregnancy interval is less than 15 months. Having a family planning clinic nearby is associated with less breastfeeding, offsetting whatever positive effects family planning clinics have on contraceptive use in terms of the percentage of birth intervals that are so short as to be detrimental to infant and child health. Hence, factors that increase contraceptive use do not necessarily reduce the incidence of short interbirth intervals, because they are also associated with reduced breastfeeding. We simulate the proportion of intervals that would be short for alternative combinations of breastfeeding and contraceptive use in the population and show that over the period covered by the data (1961-75), breastfeeding had a considerably greater effect on preventing short interbirth intervals than did contraceptive use.