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.
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.
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.
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.
Pre-pregnancy care (PPC) is a set of interventions used to identify and reduce women’s risks during reproductive age, especially women with chronic illnesses to achieve a healthy pregnancy. It includes optimisation of care, advice on appropriate contraception, and lifestyle modification. Our project aims to increase the PPC registration percentage of women with diabetes and hypertension from 53% to 100%, hence increasing their chances of receiving appropriate PPC intervention.
Both the cards of diabetic and hypertensive clients were reviewed using the PPC assessment form where the percentages of registered clients, completeness of registration, and aspects of interventions were calculated. We developed a new standardised guideline with a refined registration process into our routine Non-Communicable Disease (NCD) Clinic. The new PPC guideline implementation was reassessed every three months for two cycles by our district PPC team.
Post-intervention, the percentages of diabetes and hypertension clients registered with PPC has increased to 79.2%. Furthermore, proper registration helped to increase the percentages of PPC intervention from 86.6% to 95.3%. The implementation analysis showed that the completeness of five registration components had increased significantly from 1.4% to 16.8%. All elements under optimisation of care showed a positive changed, from 65.1% to 85.6% for optimisation of treatment, 48% to 52.6% for contraception advice, and 30.2% to 44% for lifestyle modifications.
We conclude based on the findings of this study that a well-structured PPC guideline with a few modifications that enhanced the process efficiency was able to increase the PPC registration percentages of eligible women with diabetes and hypertension and in turn, increase their chances of getting appropriate intervention. Continuous assessment and periodic PPC courses for healthcare workers are essential to ensure the sustainability of the implementation.
A 49-year old patient presented with symptoms of adrenal suppression following an attempt to
withdraw Depo-Provera or Depot Medroxyprogesterone Acetate (DMPA) injection. She had
been receiving DMPA injections for the past 16 years for contraception. She was initially
prescribed DMPA by her gynaecologist but later on began obtaining the medication directly
from a private pharmacy without prior consultation from her gynaecologist. Clinically, she had
been experiencing significant weight gain and appeared cushingoid. Blood investigations
confirmed partial adrenal suppression with presence of an adrenal incidentaloma. This case
reports a known side effect of DMPA but occurring at a much lower dose than previously
described. It also highlights the need to increase the awareness of the insidious side effect of
DMPA and to avoid unsupervised use of the drug.
Epilepsy is the most common neurological disorder in pregnancy. The effects of epilepsy include congenital abnormalities which are increased 2-3 fold. The babies born suffer from haemorrhagic disease of newborn. Preconception management and folic acid supplementation is important in optimizing outcome. With close monitoring and proper management, more than 90% of mothers have no complications throughout their pregnancy. Hormonal contraception dosage need to be increased due to the enzyme inducing nature of the anti epileptics drugs.
Providing sexual and reproductive health (SRH) services to migrant workers is key to fulfilling sustainable developmental goals. This study aims to explore key informants' views on the provision of SRH services for migrant women in Malaysia, exploring the provision of SRH education, contraception, abortion, antenatal and delivery, as well as the management of gender-based violence. In-depth interviews of 44 stakeholders were conducted from July 2018 to July 2019. Data were thematically analysed. Migrant workers that fall pregnant are unable to work legally and are subject to deportation. Despite this, we found that insufficient SRH information and contraceptive access are provided, as these are seen to encourage promiscuity. Pregnancy, rather than sexually transmitted infection prevention, is a core concern among migrant women, the latter of which is not adequately addressed by private providers. Abortions are often seen as the only option for pregnant migrants. Unsafe abortions occur which are linked to financial constraints and cultural disapproval, despite surgical abortions being legal in Malaysia. Pregnant migrants often delay care-seeking, and this may explain poor obstetric outcomes. Although health facilities for gender-based violence are available, non-citizen women face additional barriers in terms of discrimination and scrutiny by authorities. Migrant women face extremely limited options for SRH services in Malaysia and these should be expanded.
Levonorgestrel (LNG) is a well-known safe and efficacious emergency contraception (EC). However, ectopic pregnancy following the failure of LNG-only EC has been reported. The exact incidence of ectopic pregnancy has been hindered by lack of data due to the fact that LNG-only EC is accessible at pharmacies without a prescription. We describe a case of ectopic pregnancy in an 18 year-old single woman who took LNG-only EC within 48 hours of unprotected sexual intercourse. She presented to the emergency department at 8 weeks period of amenorrhoea with an acute abdomen and hypovolaemic shock. Laparotomy confirmed a ruptured right tubal pregnancy and salpingectomy was performed. The patient was discharged well after 2 days. We aim to highlight this potential adverse effect and to discuss the plausible causality of ectopic pregnancy following administration of LNG-only EC.
One hundred and twenty-four women from a semi-urban area who came for consultation for unplanned pregnancy during an eight month period are analysed. It is found that women with a high risk of unplanned pregnancy are mostly housewives, aged between 20 and 34, who have given birth to one or three children, the last of whom is usually below one or two years old. They belong to the lower socio-economic class and are lowly-educated. Most of them have not completed their families. Although most of them have either used or heard of contraceptives begore, the majority were not using any contraceptive at the time of consultation or were using an ineffective method. Their reasons for non-use or default are identified, many of which are related to the pill. Proper motivation of would-be contraceptive receptors and regular follow-up of acceptors by general practitioners or Family Planning Clinic Staff who are knwoledgable in all available methods of contraception are offered as a solutionto the problem of high rate of defaulting and consequent high rate of unplanned pregnancies.
Study site: private general practice clinic, Perak, Malaysia
Reproductive health is "a state of complete, mental and social well-being in all matters relating to the reproductive system and to its functions and processes. Implicit in this is the right of men and women to be informed and to have access to safe, effective and affordable and acceptable methods of family planning of their choice, as well as other methods of their choice for regulation of fertility, which are not against the law, and the right of access to health-care services that enable women to go safely through pregnancy and childbirth." The survey on Health Problems of Migrant Workers included a section on Women's Health covering aspects of reproductive health. This was based on concerns over reproductive health needs of migrant women workers, particularly since the large majority are in the reproductive age-group, and the utilisation of government healthcare facilities. The latter has implications for the potential burden on public healthcare services in terms of resources and costs. Specifically, the Women's Health section included questions on pregnancy, place of delivery of last baby (born in Malaysia), postnatal care related to this delivery, and mode of payment. For those currently pregnant, questions were asked of sources of antenatal care, postnatal care and respective modes of payment for thsoe services. This section also included questions on current contraceptive practices, source of supplies, and mode of payment for contraceptive methods.
INTRODUCTION An intrauterine contraceptive device (IUCD) is a common contraception method used for family planning. IUCD erosion into adjacent organs is a rare but serious complication of IUCD use. CASE PRESENTATION A 41-year-old female presented to us with a leaking left ectopic pregnancy. Emergency laparotomy and left salpingectomy were performed. A copper ICUD was found intraperitoneally and part of it had completely eroded into the sigmoid colon. Sigmoid colotomy was performed and the IUCD was removed successfully. Further history revealed that the patient had her IUCD inserted 12 years previously but was forgotten. The patient was discharged well after 4 days of admission. DISCUSSION Erosion of an IUCD into the colon is uncommon and may be asymptomatic or present with bowel perforation and obstruction. There should be a high index of suspicion for pregnancy occurring among women post-IUCD insertion. A misplaced IUCD can cause chronic inflammation of the fallopian tube, which may alter tubal functionality and increase the risk of ectopic pregnancy. Family planning is commonly done in primary health care. Primary care education and counselling are essential to improve awareness of fertile women to prevent similar complications. Periodic examination of IUCD string either by users or primary health-care practitioners is crucial. Ultrasound can be advocated if there are difficulties with the insertion. An abdominal radiograph is useful and should be performed in the case of missing IUCDs.
Friend™ feminine wipes, disinfectant impregnanted fibre Nssues meant for the maintenance of female hygiene, was evaluated for its effect on sperm viability in-vitro and found to be spermicidal. These feminine wipes are therefore not recommended for use at coitus in couples who are planning
pregnancies. Although the wipes were found to have spermicidal properties they are not recommended for the purpose of contraception
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.
Family planning has been cited as essential to the achievement of Millennium Development Goals (MDG). Family planning has a direct impact on women's health and consequence of each pregnancy. The use of modern contraception among Asian women is less than global average. In Asia a majority of unintended pregnancies are due to using traditional contraceptive or no methods which lead to induced unsafe abortion. Cultural attitudes, lack of knowledge of methods and reproduction, socio demographic factors, and health service barriers are the main obstacles to modern contraceptive practice among Asian women. Culturally sensitive family planning program, reforming health system, and reproductive health education through mass media to create awareness of the benefits of planned parenthood are effective strategies to improve modern contraceptive practice among Asian women.
The continuing decline in fertility despite a contraction in contraceptive use in Peninsular Malaysia since the mid-1980s has triggered considerable interest in the reasons behind this phenomenon, such as increase in abortion, sterility, and out-of-wedlock pregnancy. Fertility decline has been attributed to rapid socioeconomic development, which can only influence fertility through the intermediate variables. Application of vital statistics, population census, and survey data of Peninsular Malaysia on Bongaarts's model vindicates that marriage postponement and contraceptive use are the 2 most important proximate determinants of fertility, but the effects are not uniform across the ethnic groups. For instance, the predicted total fertility rate for Chinese and Malays are 2.9 and 1.6, respectively, compared with the observed level of 3.0 and 1.9. Postpartum infecundability and abortion also play a part in explaining ethnic fertility differentials. The fertility inhibiting effects of these proximate determinants have significant implications on reproductive health and future population growth.
Using data from Pakistan, India, Malaysia, Thailand, and the Philippines, we explore how gender context influences (1) husband-wife concordance in the demand for children and (2) the impact of each spouse's fertility preferences on contraceptive use. We also explore whether the husband's pronatalism can explain the wife's unmet need for contraception. The results suggest that gender context has little net effect on couples' concordance, but influences the relative weight of husbands' and wives' preferences in determining contraceptive use. Analysis of women's unmet need for contraception suggests that the husbands' pronatalism contributes to wives' unmet need, but only to a relatively small degree, especially in settings where unmet need is high. This is the case because the proportion of couples with differing fertility goals is small in most communities.