Population explosion is one of the global issues of concern. The increasing number of individuals could result in negative impact on social and economy. To overcome this problem, convenient and safe modern contraception was introduced. However, recently many researchers have conducted studies on the effectiveness of medicinal plants as contraceptive agents on human and animal models. Therefore, the studies of herbal and modern contraceptives were summarized in this review article. A total of 66 relevant articles were documented having information regarding the modern and herbal contraceptives. All contraceptives are highly effective provided they are used consistently and in the proper way. Contraception is important as it could prevent diseases and infections caused by sexual intercourse and prevent unintended pregnancy. Therefore, this review is an attempt to summarize the potential of medicinal plants as contraceptive agents and the modern contraceptive methods used as birth control in males and females.
Background and Objectives: Unmet need for contraception is the gap between women's reproductive intentions and their contraceptive behavior. This community based interventional study was carried out to determine the unmet needs for contraception, the reasons for this and to assess the impact of interventional measures on acceptance of contraception.
Subjects and Methods: This study was conducted in 52 villages in the state of Maharashtra, India, among 363 married women selected by cluster sampling. Data was collected using an interview guide. An intervention was done for the women who had an unmet need and an assessment of the change was done subsequently. Data was analyzed by using SPSS.
Results The prevalence of contraceptive usage was 59.2% and the prevalence of unmet need for contraception was 44% (160). The unmet need for spacing births was 53.8%, 38.7% for limiting births and 7.5% women were dissatisfied with the current contraceptive method. The reasons ranged from side effects to contraceptives to source of obtaining contraceptives. Age of the respondents, education and number of living children showed statistically significant association with unmet needs. Post intervention, the contraceptive prevalence rate increased significantly 85.7% and there was a significant reduction in the unmet needs for spacing and limiting births, equally there was a significant reduction of dissatisfaction with using contraception.
Conclusion: Improvement in the use of contraception and addressing the unmet need for contraception requires community involvement and ongoing, sustained efforts by health workers to ensure quality care to the beneficiaries.
In Cambodia, the growth of family planning services and socio-economic development have resulted in a spectacular rise in contraceptive prevalence rate and an equally remarkable reduction in contraceptive use differentials. With rising educational levels and increased participation in the modern labour market, Cambodian women are playing an increasingly pivotal role in household decision-making. This study used data from three rounds of Cambodia Demographic and Health Surveys to elucidate trends and patterns of contraceptive use. It then examined the determinants of contraceptive use through the use of logistic regression. The central hypothesis to be tested was whether or not women's involvement in household decision-making affected contraceptive use. Multivariate analysis showed that apart from the number of living children, women's work status and education of both men and women had a more significant impact on contraceptive use, as compared to women's power in household decision-making. More effort is needed to empower women in all aspects in order to reduce the socio-economic differentials in contraceptive use and improve their reproductive health, in line with the goal of the global agenda of the sustainable development goals (SDGs) to leave no one behind.
BACKGROUND: The increasing trend of premarital sexual experience and unintended pregnancies in Malaysia warrants sustained and serious attention. The sensitivities of sex-related issues in a Muslim-majority country create various types of barriers to sexual and reproductive health information, support and practices. This study aims to gain understanding of knowledge, attitudes and behaviours of young women in Malaysia concerning reproductive, contraception and premarital sexual practices.
METHODS: A cross-sectional study was performed, using an anonymous self-administered questionnaire carried out among 1695 female university students in a public university in Malaysia.
RESULTS: Respondents had low scores for knowledge of reproduction and pregnancy (median=4, of maximum score 10), contraceptive uses (median=6, of maximum score 16) and contraceptive availability (median=3, of maximum score 13). The majority of women surveyed do not have liberal values in relation to premarital sexual behaviour (median=37, of maximum 40); higher scores on this scale corresponded to opposing premarital sex. The multivariate analyses showed that ethnic group was the strongest correlate of knowledge and attitude scores; being of Malay Muslim ethnicity was associated significantly with lower knowledge scores and premarital sex permissiveness. Other significant correlates were year of study, maternal occupational groups, level of religious faith, dating status and urban-rural localities. Level of premarital sex permissiveness was inversely correlated with reproduction and pregnancy knowledge score, and contraceptive knowledge scores.
CONCLUSION: Reproductive health knowledge and attitudes were intricately linked to religious values and cultural norms differences surrounding sexual issues.
INTRODUCTION: Women with chronic medical conditions are at higher risk of adverse pregnancy outcomes, which may be minimized through optimal preconception care and appropriate contraceptive use. This study aimed to describe contraceptive use among women with chronic medical conditions and factors associated with its non-use.
METHODS: This study used cross-sectional data from a family planning survey among women with chronic medical conditions conducted in three health facilities in a southern state of Malaysia. A total of 450 married women in reproductive age (18-50 year) with intact uterus, and do not plan to conceive were analysed for contraceptive use. Both univariate and multivariate analysis was conducted to identify factors associated with contraceptive non-use among the study participants.
RESULTS: A total of 312 (69.3%) of the study participants did not use contraceptive. Contraceptive non-use was highest among the diabetics (71.2%), connective tissue disease patients (68.6%) and hypertensive patients (65.3%). Only 26.3% of women with heart disease did not use contraceptive. In the multivariate analysis, contraceptive non-use was significantly more common among women who received their medical treatment in the health clinics as compared to those who received treatment in the hospital (adjusted odds ratio [OR]=1.75, 95% confidence interval [CI]: 1.09, 2.79), being in older age group of 41-50 year (adjusted OR=2.31, 95% CI: 1.19, 4.48), having children (adjusted OR=4.57, 95% CI: 1.66, 12.57) and having lower education (adjusted OR=2.87, 95% CI: 1.43, 5.77).
CONCLUSION: About two-third of women with chronic medical conditions who needed contraceptive did not use them despite the higher risk of pregnancy related complications. The high unmet need warrant an effective health promotion programme to encourage the uptake of contraceptives especially targeting women of older age group, low education and those who received their medical treatment at health clinics.
Study site: Outpatient clinic, three hospitals; 8 health clinics, Malaysia
PIP: The initial results of a study conducted to develop guidelines for the clinical management of family planning acceptors with regard to return of fertility following contraceptive use, are presented. 193 parous women attending an urban family planning clinic were interviewed regarding their last pregnancy conceived after stopping a method of contraception. The average interval to pregnancy was 3.9, 2.8 and 1.8 months for ex-users of oral pills, intrauterine devices and conventional methods of contraception, respectively, with median delays to conception of 1.9, 1 and within the 1st month for the 3 categories. In comparison, 149 women who had not used any method at all took 7.3 months before becoming pregnant. Selected variables including age and parity, duration of use and problems encountered, and outcome of pregnancy are further analysed. Follow-up investigations and treatment are recommended 12 months after stopping oral pills and 6 months after removal of intrauterine device for those who have not yet conceived.
An increase in the use of health services and contraception is usually associated with a decrease in breastfeeding. This study seeks to establish the relationship between maternal use of health services and breastfeeding practice. Data was obtained from the Sarawak Population and Family Survey of 1989. The breastfeeding pattern of 1583 children born to 1047 women aged between 15-49 years in the five years preceding the study were analyzed and compared among the various groups using maternal health services and contraception. Results showed that Sarawak has a very short mean duration of about 6 months for breastfeeding. Women attending antenatal and postnatal clinics had shorter breastfeeding durations but higher initiation rates compared to those who did not. Those whose delivered by doctors and those delivering in private hospitals were least likely to breastfeed. Contraceptive use was also negatively associated with breastfeeding duration. Whilst it is commendable that the use of maternal health facilities is high in Sarawak, the inverse relationship to breastfeeding can offset its health benefits. Health policies can play a part to arrest this decline which is also related to socioeconoic development.
Findings on the demographic and sexual health characteristics associated with the experience of a crisis pregnancy are important to inform the public health policy of a country, including Ireland. Studies from other jurisdictions have suggested that certain demographic groups are at risk for unintended pregnancies and the disparity between the groups has been growing in recent years. Ireland is a country which experienced much economic and societal change in the first decade of the 21(st) century; changes which are likely to have affected demographic variables pertaining to sexual health. The current study had two aims: to investigate changes in the socioeconomic characteristics associated with crisis pregnancies over a seven year period [2003 to 2010], and to investigate the recent [2010] socioeconomic risk factors associated with crisis pregnancies in Ireland.
OBJECTIVE: Teenage abortions predispose women to adverse pregnancy outcomes in subsequent pregnancies such as anemia, stillbirths, preterm deliveries and low birth weight babies. We aim to profile the women presenting for abortions in our institution and determine risk factors for late presentation for abortions.
STUDY DESIGN: In this retrospective cohort study, all women who underwent an abortion at the National University Hospital, Singapore, from 2005 to 2009 were recruited. Data was obtained from a prepared questionnaire during the mandatory pre-abortion counseling sessions. Profiles of women aged <20 years were compared with those ≥ 20 years old using Chi-square test if the assumptions for Chi-square test were met; otherwise, Fisher's exact test was carried out. Logistic regression was used to investigate the risk factors for second trimester termination of pregnancy.
RESULTS: 2109 women presented for induced abortions, of which 1998 had single abortion throughout the course of the study. The mean age of women with single abortion was 29.1 years (sd 7). In the group of women with single abortion, 182 (9.1%) were teenage abortions. In contrast to women ≥ 20 years of age, pregnant teenagers were more likely not to have used any contraception (51.1% vs. 25.2%) and more likely to present late for abortions (39.6% vs. 15.9%). Other risk factors for late presentation for abortions include Malay ethnicity, singlehood, nulliparity and lack of prior usage of contraception.
CONCLUSION: Teenagers are more likely to have no prior contraceptive usage and to present late for abortions. Lack of proper sexual education and awareness of contraceptive measures may have a major contributory factor to such a trend in teenage abortions. Recommendations have been made in order to curb this societal problem.
PIP:
Fertility trends and prospects for east and southeast Asian countries including cities in China, Taiwan, the Republic of Korea, Thailand, Indonesia, Malaysia, the Philippines, Myanmar, and Viet Nam are described. Additional discussion focuses on family planning methods, marriage patterns, fertility prospects, theories of fertility change, and policy implications for the labor supply, labor migrants, increased female participation in the labor force (LFP), human resource development, and social policy measures. Figures provide graphic descriptions of total fertility rates (TFRS) for 12 countries/areas for selected years between 1960-90, TFR for selected Chinese cities between 1955-90, the % of currently married women 15-44 years using contraception by main method for selected years and for 10 countries, actual and projected TFR and annual growth rates between 1990-2020 for Korea and Indonesia. It is noted that the 1st southeast Asian country to experience a revolution in reproductive behavior was Japan with below replacement level fertility by 1960. This was accomplished by massive postponement in age at marriage and rapid reduction in marital fertility. Fertility was controlled primarily through abortion. Thereafter every southeast Asian country experienced fertility declines. Hong Kong, Penang, Shanghai, Singapore, and Taipei and declining fertility before the major thrust of family planning (FP). Chinese fertility declines were reflected in the 1970s to the early 1980s and paralleled the longer, later, fewer campaign and policy which set ambitious targets which were strictly enforced at all levels of administration. Korea and Taiwan's declines were a result of individual decision making to restrict fertility which was encouraged by private and government programs to provide FP information and subsidized services. The context was social and economic change. Indonesia's almost replacement level fertility was achieved dramatically through the 1970s and 1980s by institutional change in ideas about families and schooling and material welfare, changes in the structure of governance, and changes in state ideology. Thailand's decline began in the 1960s and is attributed to social change, change in cultural setting, demand, and FP efforts. Modest declines characterize Malaysia and the Philippines, which have been surpassed by Myanmar and Viet Nam. The policy implications are that there are shortages in labor supply which can be remedied with labor migration, pronatalist policy, more capital intensive industries, and preparation for a changing economy.
PIP: The population explosion has been abating since the 2nd half of the 1960s. The birth rate of the 3rd World dropped from 45/1000 during 1950-55 to 31/1000 during 1985-90. From the 1st half of the 1960s to the 1st half of the 1980s the total fertility of such countries dropped from 6.1 to 4.2 children/woman. In Taiwan, Singapore, Hong Kong, South Korea, and Malaysia living standards improved as a result of industrialization, and fertility decreased significantly. In Sri Lanka, China, North Vietnam, and Thailand the drop of fertility is explained by cultural and religious factors. In 1982 about 78% of the population of developing countries lived in 39 states that followed an official policy aimed at reducing the population. Another 16% lived in countries supporting the concept of a desired family size. However, World Bank data showed that in the mid-1980s in 27 developing countries no state family planning (FP) programs existed. India adopted an official FP program in 1952, Pakistan followed suit in 1960, South Korea in 1961, and China in 1962. In Latin America a split policy manifested itself: in Brazil birth control was rejected, only Colombia had a FP policy. In 1986 the governments of 68 of 131 developing countries representing 3.1 billion people considered the number of children per woman too high. 31 of these countries followed concrete population control policies. On the other hand, in 1986 24 countries of Africa with 40% of the continent's population took no measures to influence population growth. In Latin America and the Caribbean 18 of 33 countries were idle, except for Mexico that had a massive state FP program. These programs also improve maternal and child health with birth spacing of at least 2 years, and the prevention of pregnancies of too young women or those over 40. The evaluation of rapidly spreading FP programs in the 1970s was carried out by the World Fertility Survey in 41 countries. The impact of FP programs was more substantial than socioeconomic factors. Contraceptive use increased in Mexico from 13% in 1973 to 41% in 1978 among women of fertile age. According to 1984 and 1988 UN data modern methods of contraception were used by 70% of women in China, 60-65% in Southeast Asia, Costa Rica, and Puerto Rico. In contrast, less than 5% used them in most countries of Africa, 15-20% in West Asia, 25-30% in South Asia, and 40% in Latin America. The pill was the most popular method. From the early 1980s in South and East Asia 1/5 of women got sterilized after attaining the desired family size. Less than 10% of women used IUDs in developing countries. FP programs have benefited from higher education levels and economic incentives and sanctions and exemplified in Singapore, China, South Korea, Thailand, and Taiwan.
PIP:
In the Philippines the number of children per woman is envisioned to be 2 by the year 2000 to reach simple replacement level. The crude birth rate had dropped from 43.6% in 1960 to 32.3% during 1980-85 corresponding to 4.2 children/woman. However, the corresponding rates for Thailand and Malaysia were 28% and 32.1%, respectively. The total fertility rate (TFR) was still a high 4.7% in 1988. In 1980 TFR was 3 in Manila, but 3/4 of the provinces still had TFR of 5-6.8 in 1985. Yet the World Fertility Survey of 1970 indicated that the total married fertility rate had decreased from 9.6 in 1970 to 9.1 in 1977. Married women had an average of 4.5 children in 1968 and still 4 children in 1983. Only 1/2 of married women aged 15-45 used contraception. In 1983, only 26.2% of all fertile married women used effective contraception. 63% of Moslim women, 70% of Catholics and Protestants, and 83% of members of the Church of Christ advocate modern contraceptives. From 1967 the National Population Outreach Program of the state sent out family planning advisers to unserviced areas. In 1983 only 37% of married women knew about such a service within their locality, and in 1988 a World Bank investigation showed that 67% could not afford contraceptives. The education, employment, income, urbanization of the household as well as medical care of women and children strongly influenced reproduction. The lifting of living standards and improvement of the condition of women is a central tenet of Philippine family planning policy. A multiple regression analysis of the World Fertility Survey proved that professional women tended to have smaller family size, however, most women worked out of economic necessity not because of avocation. The higher the urban family income, the lower marital fertility; but the reverse is true in rural areas where traditionally large families have had more income, and children have provided future material security. In 1983 1/3 of women with children over 18 received regular financial remittances from them. Thus, appropriate family planning program evaluation has to be concerned with the relationships of fertility and rural areas, the economic development of the community, and the physical access to a family planning clinic.
PIP:
This paper presents data on contraceptive prevalence from 26 national sample surveys conducted in the Asian and Pacific region during the 1966-84 period. The basic data presented are: contraceptive prevalence rates, cross-classified by age where possible; the percentage of couples using each contraceptive method, also cross-classified by age where possible. To facilitate comparison between countries and across time, the data are presented in a standardized form, both numerically and graphically. Contraceptive prevalence rates range from 1-85% (the highest and lowest ever reported). In the Asian and Pacific region as a whole, the prevalence rate was around 40%, which was about the same level as in the Latin American region. In Africa the prevalence rate was around 12%, and in developed countries around 70%. In the late 1960s, prevalence rates in the Asian and Pacific region were less than 20%. By the early 1980s, contraception had spread throughout all parts of society so that the rates in many countries were over 50%, and in some over 60%. Most of the countries with high prevalence rates were in East and Southeast Asia, and most of those with low prevalence in South Asia. Displayed graphically with the age of wife (from 15-49 years) on the x axis, contraceptive prevalence rates appear as an inverted U, low at both ends of the age range and high in the middle. Curves skewed to the left generally have stronger effects on fertility than those skewed to the right. This is due to the fact that most births occur among younger couples and contraception used by younger couples prevents more births than contraception used by older couples. The curves of countries relying primarily on sterilization are generally skewed to the right. The data show a wide variation in the mix of contraceptives used in each country. The use of various contraceptives by age is similar throughout the region. Young couples generally use oral contraceptives (OCs), those in the middle of the reproductive ages the IUD, and those near the end of the childbearing ages sterilization. Rhythm and withdrawal methods appear to be preferred both by couples in the youngest and oldest age groups. Contraceptive needs change as couples progress through the life cycle. Consequently, family planning programs must work to provide a broad mix of contraceptives. The tables show that Thailand and the Republic of Korea, 2 countries which are thought to have excellent family planning programs, have provided well-balanced mixes of contraceptives. Other countries in the region have depended on only 1 or 2 methods.
PIP: Organizational and content features of various national family planning programs are reviewed. The Thai program is cited as an example of a family planning program organized on a massive unipurpose compaign basis. The Korean and Taiwan programs have utilized special field workers while upgrading the general health care network. 3 major problems with family planning programs are: 1) the lack of experience with such programs; 2) lack of commitment at the highest political levels; and 3) medical conservatism. Utilization of all available contraceptive methods instead of reliance on 1 method would improve most programs. Nursing and auxiliary personnel could be trained to take over the work of physicians in family planning programs. This is already being done with IUD insertion and pill prescription in several programs. The postpartum tubal ligation approach has proven effective and should be extended. There is a place in all national programs for both the private and the commercial sectors. Incentives for clinics, personnel, and acceptors might spread family planning more rapidly.
A study of knowledge, attitude and practice was carried out among sixty nine married Orang Asli women in the district of Kuaia Langat. The study showed that oniy a smail proportion of the women were using family planning methods. About half of the study women were stiil uncertain with regards to their attitude towards family planning. The findings aiso showed that there was no diversity of the methods with oral contraceptive being the major choice. Majority of the husbands had indeed positive feeling towards family planning. The women also considered breastfeeding as a major method of contraception.
PIP: A knowledge-attitude-practice (KAP) study of 69 married Orang Asli women from Kuala Langat district, Malaysia is reported. The Orang Asli comprise 2744 people in 412 households served by rural health services and a few private practitioners. The median age of the sample was 16.3 years, of whom 18.8% were married before age 15. 47.8% knew of family planning methods. 53.6% of the women said that they and their husbands approved of family planning, 2.9% disapproved, and the rest were undecided. Only 30.4% had discussed family planning with their husbands. 21.7% stated that they would use contraception, either the pill or sterilization, after their family was completed.