Nuriye Ortayli - Academia.edu (original) (raw)
Papers by Nuriye Ortayli
state of world population 2012All countries should take steps to meet the family-planning needs o... more state of world population 2012All countries should take steps to meet the family-planning needs of their populations as soon as possible and should, in all cases by the year 2015, seek to provide universal access to a full range of safe and reliable family-planning methods and to related reproductive health services which are not against the law. The aim should be to assist couples and individuals to achieve their reproductive goals and give them the full opportunity to exercise the right to have children by choice.
Nutrition and Health in a Developing World, 2017
This chapter discusses the relationship between nutritional status and reproductive well-being. I... more This chapter discusses the relationship between nutritional status and reproductive well-being. It explores the role that nutrition plays during various phases of the reproductive cycle starting from the onset of puberty, to the menstrual cycle, to pregnancy. It also explores the role of nutrition in other aspects of reproductive health such as sexually transmitted infections and reproductive organ cancers. Evidence on clinical interventions involving supplementation is reviewed. Where possible the chapter examines the potential biological pathways of impact from nutrients to the outcome.
Studies in Family Planning, 2015
This systematic review evaluates the strength of the evidence that community health workers&a... more This systematic review evaluates the strength of the evidence that community health workers' (CHW) provision of family planning (FP) services in low- and middle-income countries is effective. In a search of eight databases, articles were screened by study design and outcome measure and ranked by strength of evidence. Only randomized trials, longitudinal studies with a comparison group, and pre-test/post-test studies met inclusion criteria. A total of 56 studies were included. Of those studies with relevant data, approximately 93 percent indicated that CHW FP programs effectively increased the use of modern contraception, while 83 percent reported an improvement in knowledge and attitudes concerning contraceptives. Based on these findings, strong evidence exists for promoting CHW programs to improve access to FP services. We recommend a set of best practice guidelines that researchers and program managers can use to report on CHW FP programs to facilitate the translation of research to practice across a wide range of settings.
The journal of family planning and reproductive health care / Faculty of Family Planning & Reproductive Health Care, Royal College of Obstetricians & Gynaecologists, 2001
The European Journal of Contraception and Reproductive Health Care, 2000
A progestin-only injectable contraceptive has been integrated into the method mix at a well-woman... more A progestin-only injectable contraceptive has been integrated into the method mix at a well-woman clinic in Turkey. During the period from 1st December 1996 to 1st December 1997, among 3545 new method acceptors at the clinic, 254 women decided to use the injectable, giving an initial acceptance rate of 7%. Continuation rates, however, were quite low: 43.7% at 6 months and only 18.5% at 12 months. Though all the side-effects were mentioned during the counselling sessions, side-effects such as amenorrhea and spotting might have been underestimated by the potential users of this method, which was new in the country. A more detailed counselling with a strong emphasis on frequent side-effects might lower the initial acceptance rate, but can help to increase the continuation rates.
Contraception, 2014
Many adolescents in developing countries have an unmet need for contraception, which can contribu... more Many adolescents in developing countries have an unmet need for contraception, which can contribute to poor reproductive health outcomes. Recent literature reviews have not adequately captured effective contraceptive services and interventions for adolescents in low- and middle-income countries (LMICs). This study aims to identify and evaluate the existing evidence base on contraceptive services and interventions for adolescents in LMICs that report an impact on contraceptive behavior outcomes. Structured literature review of published and unpublished papers about contraceptive services and interventions for adolescents in LMICs that report an impact on contraceptive behavior outcomes. We identify common elements used by programs that measured an impact on adolescent contraceptive behaviors and summarize outcomes from 15 studies that met inclusion criteria. Effective programs generally combined numerous program approaches and addressed both user and service provision issues. Overall...
The European Journal of Contraception and Reproductive Health Care, 2000
To make an assessment of the acceptability and cost of subdermal implants, a new method in Turkey... more To make an assessment of the acceptability and cost of subdermal implants, a new method in Turkey, in a free-choice environment. The records of women attending a university well-woman clinic in Istanbul, Turkey, were analyzed retrospectively. Among other contraceptives registered in the country, the women were offered subdermal contraceptive implants (Norplant) during counselling sessions. The women who chose implants were invited to attend for follow-up three times during the first 12 months and were advised to return annually thereafter. An estimation of cost was performed for Norplant, using the government price of the implant and the wage rates of public-sector staff. An estimation of cost was also performed for oral contraceptives. Among the 5650 women who applied to the Clinic for contraception between 1 January 1995 and 31 December 1998, 274 women decided to use implants, giving an initial acceptance rate of 5.1%. Continuation rates were 91.8%, 71.6% and 42.5% at 12 months, 24 months and 36 months, respectively. There were no pregnancies within the study period. The only demographic characteristic that was positively related to the acceptability of Norplant was younger age. The cost of contraception with Norplant was found to be lower than that for oral contraceptives. The high initial acceptance and continuation rates, combined with its high efficacy, make Norplant a valuable tool for Turkey's National Family Planning Program. Contraception with Norplant is also a cost-effective method, at least for the public sector.
Contraception, 2014
Background: Despite being recognized as an important challenge at the 1994 International Conferen... more Background: Despite being recognized as an important challenge at the 1994 International Conference on Population and Development (ICPD), sexually transmitted ınfections (STIs) other than HIV are one of the most neglected dimensions of sexual and reproductive health. STIs, often undiagnosed and untreated, have especially harmful consequences for women and their neonates. Progress since ICPD: During the last two decades, substantial knowledge and experience have accumulated in behavior change programming during the global response to the HIV epidemic which can also be used for prevention of STIs. There has been progress in development and implementation of vaccines against certain STIs such as hepatitis B and the human papilloma virus. Development of a rapid, point-of-care test for syphilis has opened the door to control this infection. Challenges: The estimated annual incidence of non-HIV STIs has increased by nearly 50% during the period 1995-2008. The growth in STIs has been aggrevated by a combination of factors: lack of accurate, inexpensive diagnostic tests, particularly for chlamydia and gonorrhea; lack of investment to strengthen health systems that can deliver services for diagnosis and management of STIs; absence of surveillance and reporting systems in the majority of countries; political, socioeconomic and cultural barriers that limit recognition of STIs as an important public health problem; and failure to implement policies that are known to work. Recommendations: Governments, donors and the international community should give higher priority to preventing STIs and HIV; fully implementing behavior change interventions that are known to work; ensuring access of young people to information and services; investing in development of inexpensive technologies for STI diagnosis,treatment and vaccines; and strengthening STI surveillance, including of microbial resistance.
Studies in Family Planning, 2010
In 1994, at the International Conference on Population and Development (ICPD) held in Cairo, 179 ... more In 1994, at the International Conference on Population and Development (ICPD) held in Cairo, 179 countries accepted the principle that "[a]ll couples and individuals have the basic right to decide freely and responsibly the number and spacing of their children and to have the information, education and means to do so" (UNICPD 1994: Principle 8). They set the objective to "make quality family-planning services affordable, acceptable and accessible to all who need and want them" (UNICPD 1994: para 7.14). ICPD moved the decades-long debate on population growth from a perspective of fertility control and contraceptive prevalence to a focus on reproductive health and rights. Unfortunately, the years following ICPD were marked by confusion rather than by enthusiasm for achieving this goal. At its core, the international movement to improve reproductive health and access to family planning survived a period of declining interest among international donors and governments. A lack of acknowledgment and understanding of the vital role reproductive health plays in the development process accompanied the decline in interest. Moreover, the issue of sexual and reproductive health was often the subject of open hostility from political conservatives (Bernstein 2005; Blanc and Tsui 2005). As a result, sexual and reproductive health was largely absent from the first formulation of the Millennium Development Goals (MDG) framework (UN 2000). Analyses of stalled fertility levels and the lack of progress toward MDG 5 (improving maternal health) in the least-developed countries reignited interest among key actors in the field of population and development in sexual and reproductive health as a critical means of meeting health and development goals. The analyses highlighted the points that despite increases in contraceptive use overall, fertility levels are persistently high and contraceptive uptake has remained stubbornly low in many developing countries, particularly in sub-Saharan Africa (Bongaarts 2008; UNPD 2009). Thus, the goal of universal access to reproductive health was finally integrated into the MDGs at the World Summit of Leaders in 2005 (UN 2005). With five years remaining to achieve the MDGs, the time has come to assess the current status of access to reproductive health services and specifically the status of family planning as one of the core components of reproductive health. A closer look at the data for the least-developed countries of sub-Saharan Africa reveals that unmet need for family planning is particularly high. In these countries,
Social Science & Medicine, 2006
Evidence-based medicine is an important tool for improving the quality of maternity care. However... more Evidence-based medicine is an important tool for improving the quality of maternity care. However, getting providers to change their practices may not be an easy or rapid process, and other factors, in addition to knowledge of the literature, may be important. This study documents the current state of obstetric practices at three maternity hospitals in Istanbul, Turkey, and identifies attitudes, social pressures, and perceptions that, according to the theory of planned behavior, may pose challenges for adoption of evidence-based practices. Data were collected through interviews with administrators, examination of hospital statistics, provider and client interviews, and structured observations of maternity care. Practices that did not follow current guidelines included routine episiotomy, not allowing companionship during labor, use of procedures to speed up labor without indications, routine enema, restriction of mobility, restriction of oral fluids, supine position for delivery, and non-use of active management of the third stage of labor. The findings indicate that providers had negative attitudes about some recommended practices, while they had positive attitudes towards some ineffective and/ or harmful practices. We identified social pressure to comply with practices recommended by supervisors and peers, as well as the belief that limited resources affect maternity care providers, opportunities to perform evidence-based procedures. An underlying problem was the failure to involve women in decision-making regarding their own maternity care. In addition to informing providers about the evidence, it seems necessary to develop standard protocols, improve physical conditions, and implement behavior interventions that take into account provider attitudes, social pressures, and beliefs.
Reproductive Health Matters, 2005
Withdrawal is an ancient and prevalent form of male contraception which has largely been ignored ... more Withdrawal is an ancient and prevalent form of male contraception which has largely been ignored by family planning programme managers all over the world. The objective of this study was to understand men's perspectives on withdrawal use, both users and non-users. In-depth interviews with 62 male factory workers in western Turkey are reported, on use of withdrawal, attitudes to family planning, information on contraception, marital and sexual experience, and gender values and attitudes. Advantages reported both by users and non-users of withdrawal were being free from side effects, ease of access and having no cost. While current users said withdrawal was easy to use and practical, non-users complained about the difficulties of using withdrawal, that it was coitus-dependent, caused anxiety and decreased pleasure during sexual intercourse. Current users emphasised taking responsibility as husbands for family planning and protecting their wives from possible adverse effects of contraceptives. Withdrawal should be seen as a valuable choice in a world where increasing method choice, male participation and responsibility taking in reproductive health are all desirable. With its cited advantages withdrawal is likely to fill an important niche among current contraceptive practices and deserves more attention and support.
mulheres.org.br
... Alguns preferiam viver sozinhos, sem os parentes. Cerca de um terço dos entrevistados dissera... more ... Alguns preferiam viver sozinhos, sem os parentes. Cerca de um terço dos entrevistados disseram ten-tar ajudar as esposas ao máximo possível, limpan-do a casa, lavando a louça, arrumando a mesa e, às vezes, cozinhando. ...
Medical Teacher, 2003
This report presents an evaluation of the impact of the &... more This report presents an evaluation of the impact of the 'Training of Trainers' (TOT) courses conducted since 1997. The effects of TOT programmes were studied using a questionnaire given to the course participants immediately after and again following a minimum period of six months after completion of the course. The 85 participants included in this analysis were medical teachers from the Istanbul Faculty of Medicine, of whom 17% were instructors, 39% were associate professors and 44% full professors. Some 72% of the medical teachers stated that they were able to implement the knowledge/skills they had acquired during the TOT course in their teaching. The majority of the participants reported more feedback from students and enhancement of student-faculty interaction in their teaching experience after the course. These results appear promising and indicate that TOT courses indeed motivate the teaching staff and provide them with tools and opportunities for more effective teaching. They also appear to have a lasting impact.
International Family Planning Perspectives, 2000
International Journal of Gynecology & Obstetrics, 2001
Objecti¨e: To demonstrate the impact of preabortion counseling followed by immediate postabortal ... more Objecti¨e: To demonstrate the impact of preabortion counseling followed by immediate postabortal provision of the chosen method on postabortion contraceptive use. Methods: Three hundred and forty-two women undergoing voluntary termination of pregnancy at less than 10 weeks gestation were enrolled at the Woman and Child Health Training and Research Clinic, Medical School of Istanbul. Clinic visits and telephone surveys were performed to measure contraceptive use at 6 months following abortion. Result: Two hundred and thirty-six women either visited the clinic or responded to the telephone survey. Eighty percent of the respondents reported use of a modern contraceptive as compared to less than 40% prevalence found in the national survey. Conclusion: Preabortion counseling combined with immediate postabortal provision of contraceptives may significantly increase contraceptive use at 6 months postprocedure.
International Journal of Gynecology & Obstetrics, 1996
The aim of the study was to gather information about the pregnancies of female health workers and... more The aim of the study was to gather information about the pregnancies of female health workers and to compare them with those of another group of working women with different working conditions, namely bank workers. Methods: Using a cross-sectional comparative design, physicians (184), nurses (197) and bank-workers (192) were interviewed about their previous pregnancies and working conditions during those pregnancies. Results: The majority of physicians (70.6%) and nurses (81.2%) had night work during their pregnancies and two-thirds of them continued this work until the last month of pregnancy, even though they have a legal right not to work during the night after the 7th month of pregnancy. Health workers had shorter maternity leaves than bank workers (P c 0.001) and complained more about the negative attitudes of managers and colleagues during their pregnancy (P < 0.001). Health workers had more preterm deliveries (P < 0.05) compared with bank workers, and nurses had more low birth weight babies compared with bank workers (P < 0.05). Conclusion: There is a need for a change in the climate in hospitals in terms of the working conditions of pregnant health staff and the attitudes towards them.
Contraception, 2014
*Created under the auspices of the ICPD Secretariat in its General Assembly mandated convening ro... more *Created under the auspices of the ICPD Secretariat in its General Assembly mandated convening role for the review of the ICPD Action Programme. 4 *Created under the auspices of the ICPD Secretariat in its General Assembly mandated convening role for the review of the ICPD Action Programme. law and thus leaving no option for women other than having an unwanted birth or a clandestine risky abortion. Political and policy barriers continue to hinder legal reforms to permit abortion on request and to make services accessible where countries have reformed the laws. No other issue in reproductive health divides politicians and policy makers as abortion. More recently, the organized opposition to provision of safe abortion and efforts to make its access more restrictive are presenting formidable challenges. Together, these barriers and challenges deprive women from accessing safe abortion and exposing them to unwanted births or to unsafe abortion and its devastating consequences of death and disability. This paper reviews evidence on abortions laws and policies, levels and trends in the incidence of safe and unsafe abortion and of mortality due to unsafe abortion, focusing on changes since 1994 ICPD. Key findings are highlighted before describing data and methods, abortion laws and their implementation and levels and trends in unsafe and safe abortion. This is followed by evidence on levels and trends in unsafe abortion mortality and morbidity, selected case studies of transiting from unsafe to safe abortion and preserving the legal provision of safe abortion, reproductive rights and, finally, a set of recommendations are presented in the concluding section of the paper. Key Findings 1) Globally, the annual number of induced abortions has declined from 46 million in 1995 to 44 million in 2008. This corresponds to a decline in overall abortion rate from 35 to 28 per 1000 women in reproductive age 15-44 years. 2) From 1995 to 2008, the decline in unsafe abortion globally was modest; from 15 to 14 per 1000 women of reproductive age 15-44 years while the rate for safe abortion dropped from 20 to 14 during the same period. 3) Unsafe abortion rate declined in all regions, except in Africa where it remained constant from 1990 to 2008 at a rate of 28 per 1000 women in reproductive age 15-44 years. 4) The number of deaths due to unsafe abortion has declined from 69 000 in 1990 to 47 000 in 2008; corresponding to an annual decline in unsafe abortion-related mortality ratio of 1% in Africa, compared to 4% in Asia and over 6% in Latin America. 5) The case-fatality rate of unsafe abortion has also declined globally at a rate of nearly 3% annually, but remains many times higher than for safe abortion in developed countries. 6) Nearly all unsafe abortions and related mortality occur in developing countries with sub-Saharan Africa accounting for 61% of all deaths due to unsafe abortion. The case fatality rate for Africa was 520 per 100 000 unsafe abortions in 2008. 7) Since ICPD, countries not permitting abortion on any ground have declined from 8% to 3% in 2011 and countries where abortion is permitted on request increased from 22% to 30%. During this period, the number of countries which made grounds for abortion more liberal was much higher (70) than those making the grounds for abortion more restricted (11). 8) Whether legally restricted or not, abortions continue to occur with abortion rates being higher where it is restricted than where it is permitted on request or under broad grounds. 9) Where abortion is legally highly restricted, the incidence of unsafe abortion and related mortality is high. Legal restrictions also result in major inequity in access to safe providers, as women in urban areas and those who can afford to pay can access physicians or travel abroad to procure abortion. 10) Some countries have made major progress in reducing unsafe abortion and the associated burden of mortality and morbidity with concerted efforts, including political will, legal and health system reforms and by applying innovative approaches.
Contraception, 2013
Comparative data on etonogestrel and two-rod levonorgestrel contraceptive implants are lacking. A... more Comparative data on etonogestrel and two-rod levonorgestrel contraceptive implants are lacking. A multicenter, open, parallel-group trial with random allocation of implants was performed. For every second implant user, an age-matched woman choosing an intrauterine device (IUD) (TCu380A) was admitted. Methods and data on implant/IUD insertion and 6-week follow-up are reported. A total of 2008 women were randomized to an implant, and 974 women were enrolled in the IUD group. Results from 997 etonogestrel implant users, 997 levonorgestrel implant users and 971 IUD users were analyzed. In the etonogestrel and levonorgestrel groups, respectively, mean insertion durations were 51 (SD 50.2) s and 88 (SD 60.8) s; complication rates at insertion were 0.8% and 0.2%; and at follow-up, 27.2% and 26.7% of women, respectively, had signs or symptoms at the insertion site. At follow-up within 6 weeks after insertion, all implants were in situ, while 2.1% of IUDs were expelled. Performance of etonogestrel and levonorgestrel implants at insertion and within the first 6 weeks is similar. Short-term (6 weeks) continuation rates appear higher for implants than TCu380A.
state of world population 2012All countries should take steps to meet the family-planning needs o... more state of world population 2012All countries should take steps to meet the family-planning needs of their populations as soon as possible and should, in all cases by the year 2015, seek to provide universal access to a full range of safe and reliable family-planning methods and to related reproductive health services which are not against the law. The aim should be to assist couples and individuals to achieve their reproductive goals and give them the full opportunity to exercise the right to have children by choice.
Nutrition and Health in a Developing World, 2017
This chapter discusses the relationship between nutritional status and reproductive well-being. I... more This chapter discusses the relationship between nutritional status and reproductive well-being. It explores the role that nutrition plays during various phases of the reproductive cycle starting from the onset of puberty, to the menstrual cycle, to pregnancy. It also explores the role of nutrition in other aspects of reproductive health such as sexually transmitted infections and reproductive organ cancers. Evidence on clinical interventions involving supplementation is reviewed. Where possible the chapter examines the potential biological pathways of impact from nutrients to the outcome.
Studies in Family Planning, 2015
This systematic review evaluates the strength of the evidence that community health workers&a... more This systematic review evaluates the strength of the evidence that community health workers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (CHW) provision of family planning (FP) services in low- and middle-income countries is effective. In a search of eight databases, articles were screened by study design and outcome measure and ranked by strength of evidence. Only randomized trials, longitudinal studies with a comparison group, and pre-test/post-test studies met inclusion criteria. A total of 56 studies were included. Of those studies with relevant data, approximately 93 percent indicated that CHW FP programs effectively increased the use of modern contraception, while 83 percent reported an improvement in knowledge and attitudes concerning contraceptives. Based on these findings, strong evidence exists for promoting CHW programs to improve access to FP services. We recommend a set of best practice guidelines that researchers and program managers can use to report on CHW FP programs to facilitate the translation of research to practice across a wide range of settings.
The journal of family planning and reproductive health care / Faculty of Family Planning & Reproductive Health Care, Royal College of Obstetricians & Gynaecologists, 2001
The European Journal of Contraception and Reproductive Health Care, 2000
A progestin-only injectable contraceptive has been integrated into the method mix at a well-woman... more A progestin-only injectable contraceptive has been integrated into the method mix at a well-woman clinic in Turkey. During the period from 1st December 1996 to 1st December 1997, among 3545 new method acceptors at the clinic, 254 women decided to use the injectable, giving an initial acceptance rate of 7%. Continuation rates, however, were quite low: 43.7% at 6 months and only 18.5% at 12 months. Though all the side-effects were mentioned during the counselling sessions, side-effects such as amenorrhea and spotting might have been underestimated by the potential users of this method, which was new in the country. A more detailed counselling with a strong emphasis on frequent side-effects might lower the initial acceptance rate, but can help to increase the continuation rates.
Contraception, 2014
Many adolescents in developing countries have an unmet need for contraception, which can contribu... more Many adolescents in developing countries have an unmet need for contraception, which can contribute to poor reproductive health outcomes. Recent literature reviews have not adequately captured effective contraceptive services and interventions for adolescents in low- and middle-income countries (LMICs). This study aims to identify and evaluate the existing evidence base on contraceptive services and interventions for adolescents in LMICs that report an impact on contraceptive behavior outcomes. Structured literature review of published and unpublished papers about contraceptive services and interventions for adolescents in LMICs that report an impact on contraceptive behavior outcomes. We identify common elements used by programs that measured an impact on adolescent contraceptive behaviors and summarize outcomes from 15 studies that met inclusion criteria. Effective programs generally combined numerous program approaches and addressed both user and service provision issues. Overall...
The European Journal of Contraception and Reproductive Health Care, 2000
To make an assessment of the acceptability and cost of subdermal implants, a new method in Turkey... more To make an assessment of the acceptability and cost of subdermal implants, a new method in Turkey, in a free-choice environment. The records of women attending a university well-woman clinic in Istanbul, Turkey, were analyzed retrospectively. Among other contraceptives registered in the country, the women were offered subdermal contraceptive implants (Norplant) during counselling sessions. The women who chose implants were invited to attend for follow-up three times during the first 12 months and were advised to return annually thereafter. An estimation of cost was performed for Norplant, using the government price of the implant and the wage rates of public-sector staff. An estimation of cost was also performed for oral contraceptives. Among the 5650 women who applied to the Clinic for contraception between 1 January 1995 and 31 December 1998, 274 women decided to use implants, giving an initial acceptance rate of 5.1%. Continuation rates were 91.8%, 71.6% and 42.5% at 12 months, 24 months and 36 months, respectively. There were no pregnancies within the study period. The only demographic characteristic that was positively related to the acceptability of Norplant was younger age. The cost of contraception with Norplant was found to be lower than that for oral contraceptives. The high initial acceptance and continuation rates, combined with its high efficacy, make Norplant a valuable tool for Turkey's National Family Planning Program. Contraception with Norplant is also a cost-effective method, at least for the public sector.
Contraception, 2014
Background: Despite being recognized as an important challenge at the 1994 International Conferen... more Background: Despite being recognized as an important challenge at the 1994 International Conference on Population and Development (ICPD), sexually transmitted ınfections (STIs) other than HIV are one of the most neglected dimensions of sexual and reproductive health. STIs, often undiagnosed and untreated, have especially harmful consequences for women and their neonates. Progress since ICPD: During the last two decades, substantial knowledge and experience have accumulated in behavior change programming during the global response to the HIV epidemic which can also be used for prevention of STIs. There has been progress in development and implementation of vaccines against certain STIs such as hepatitis B and the human papilloma virus. Development of a rapid, point-of-care test for syphilis has opened the door to control this infection. Challenges: The estimated annual incidence of non-HIV STIs has increased by nearly 50% during the period 1995-2008. The growth in STIs has been aggrevated by a combination of factors: lack of accurate, inexpensive diagnostic tests, particularly for chlamydia and gonorrhea; lack of investment to strengthen health systems that can deliver services for diagnosis and management of STIs; absence of surveillance and reporting systems in the majority of countries; political, socioeconomic and cultural barriers that limit recognition of STIs as an important public health problem; and failure to implement policies that are known to work. Recommendations: Governments, donors and the international community should give higher priority to preventing STIs and HIV; fully implementing behavior change interventions that are known to work; ensuring access of young people to information and services; investing in development of inexpensive technologies for STI diagnosis,treatment and vaccines; and strengthening STI surveillance, including of microbial resistance.
Studies in Family Planning, 2010
In 1994, at the International Conference on Population and Development (ICPD) held in Cairo, 179 ... more In 1994, at the International Conference on Population and Development (ICPD) held in Cairo, 179 countries accepted the principle that "[a]ll couples and individuals have the basic right to decide freely and responsibly the number and spacing of their children and to have the information, education and means to do so" (UNICPD 1994: Principle 8). They set the objective to "make quality family-planning services affordable, acceptable and accessible to all who need and want them" (UNICPD 1994: para 7.14). ICPD moved the decades-long debate on population growth from a perspective of fertility control and contraceptive prevalence to a focus on reproductive health and rights. Unfortunately, the years following ICPD were marked by confusion rather than by enthusiasm for achieving this goal. At its core, the international movement to improve reproductive health and access to family planning survived a period of declining interest among international donors and governments. A lack of acknowledgment and understanding of the vital role reproductive health plays in the development process accompanied the decline in interest. Moreover, the issue of sexual and reproductive health was often the subject of open hostility from political conservatives (Bernstein 2005; Blanc and Tsui 2005). As a result, sexual and reproductive health was largely absent from the first formulation of the Millennium Development Goals (MDG) framework (UN 2000). Analyses of stalled fertility levels and the lack of progress toward MDG 5 (improving maternal health) in the least-developed countries reignited interest among key actors in the field of population and development in sexual and reproductive health as a critical means of meeting health and development goals. The analyses highlighted the points that despite increases in contraceptive use overall, fertility levels are persistently high and contraceptive uptake has remained stubbornly low in many developing countries, particularly in sub-Saharan Africa (Bongaarts 2008; UNPD 2009). Thus, the goal of universal access to reproductive health was finally integrated into the MDGs at the World Summit of Leaders in 2005 (UN 2005). With five years remaining to achieve the MDGs, the time has come to assess the current status of access to reproductive health services and specifically the status of family planning as one of the core components of reproductive health. A closer look at the data for the least-developed countries of sub-Saharan Africa reveals that unmet need for family planning is particularly high. In these countries,
Social Science & Medicine, 2006
Evidence-based medicine is an important tool for improving the quality of maternity care. However... more Evidence-based medicine is an important tool for improving the quality of maternity care. However, getting providers to change their practices may not be an easy or rapid process, and other factors, in addition to knowledge of the literature, may be important. This study documents the current state of obstetric practices at three maternity hospitals in Istanbul, Turkey, and identifies attitudes, social pressures, and perceptions that, according to the theory of planned behavior, may pose challenges for adoption of evidence-based practices. Data were collected through interviews with administrators, examination of hospital statistics, provider and client interviews, and structured observations of maternity care. Practices that did not follow current guidelines included routine episiotomy, not allowing companionship during labor, use of procedures to speed up labor without indications, routine enema, restriction of mobility, restriction of oral fluids, supine position for delivery, and non-use of active management of the third stage of labor. The findings indicate that providers had negative attitudes about some recommended practices, while they had positive attitudes towards some ineffective and/ or harmful practices. We identified social pressure to comply with practices recommended by supervisors and peers, as well as the belief that limited resources affect maternity care providers, opportunities to perform evidence-based procedures. An underlying problem was the failure to involve women in decision-making regarding their own maternity care. In addition to informing providers about the evidence, it seems necessary to develop standard protocols, improve physical conditions, and implement behavior interventions that take into account provider attitudes, social pressures, and beliefs.
Reproductive Health Matters, 2005
Withdrawal is an ancient and prevalent form of male contraception which has largely been ignored ... more Withdrawal is an ancient and prevalent form of male contraception which has largely been ignored by family planning programme managers all over the world. The objective of this study was to understand men's perspectives on withdrawal use, both users and non-users. In-depth interviews with 62 male factory workers in western Turkey are reported, on use of withdrawal, attitudes to family planning, information on contraception, marital and sexual experience, and gender values and attitudes. Advantages reported both by users and non-users of withdrawal were being free from side effects, ease of access and having no cost. While current users said withdrawal was easy to use and practical, non-users complained about the difficulties of using withdrawal, that it was coitus-dependent, caused anxiety and decreased pleasure during sexual intercourse. Current users emphasised taking responsibility as husbands for family planning and protecting their wives from possible adverse effects of contraceptives. Withdrawal should be seen as a valuable choice in a world where increasing method choice, male participation and responsibility taking in reproductive health are all desirable. With its cited advantages withdrawal is likely to fill an important niche among current contraceptive practices and deserves more attention and support.
mulheres.org.br
... Alguns preferiam viver sozinhos, sem os parentes. Cerca de um terço dos entrevistados dissera... more ... Alguns preferiam viver sozinhos, sem os parentes. Cerca de um terço dos entrevistados disseram ten-tar ajudar as esposas ao máximo possível, limpan-do a casa, lavando a louça, arrumando a mesa e, às vezes, cozinhando. ...
Medical Teacher, 2003
This report presents an evaluation of the impact of the &amp;amp;amp;amp;amp;amp;amp;amp;... more This report presents an evaluation of the impact of the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;Training of Trainers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (TOT) courses conducted since 1997. The effects of TOT programmes were studied using a questionnaire given to the course participants immediately after and again following a minimum period of six months after completion of the course. The 85 participants included in this analysis were medical teachers from the Istanbul Faculty of Medicine, of whom 17% were instructors, 39% were associate professors and 44% full professors. Some 72% of the medical teachers stated that they were able to implement the knowledge/skills they had acquired during the TOT course in their teaching. The majority of the participants reported more feedback from students and enhancement of student-faculty interaction in their teaching experience after the course. These results appear promising and indicate that TOT courses indeed motivate the teaching staff and provide them with tools and opportunities for more effective teaching. They also appear to have a lasting impact.
International Family Planning Perspectives, 2000
International Journal of Gynecology & Obstetrics, 2001
Objecti¨e: To demonstrate the impact of preabortion counseling followed by immediate postabortal ... more Objecti¨e: To demonstrate the impact of preabortion counseling followed by immediate postabortal provision of the chosen method on postabortion contraceptive use. Methods: Three hundred and forty-two women undergoing voluntary termination of pregnancy at less than 10 weeks gestation were enrolled at the Woman and Child Health Training and Research Clinic, Medical School of Istanbul. Clinic visits and telephone surveys were performed to measure contraceptive use at 6 months following abortion. Result: Two hundred and thirty-six women either visited the clinic or responded to the telephone survey. Eighty percent of the respondents reported use of a modern contraceptive as compared to less than 40% prevalence found in the national survey. Conclusion: Preabortion counseling combined with immediate postabortal provision of contraceptives may significantly increase contraceptive use at 6 months postprocedure.
International Journal of Gynecology & Obstetrics, 1996
The aim of the study was to gather information about the pregnancies of female health workers and... more The aim of the study was to gather information about the pregnancies of female health workers and to compare them with those of another group of working women with different working conditions, namely bank workers. Methods: Using a cross-sectional comparative design, physicians (184), nurses (197) and bank-workers (192) were interviewed about their previous pregnancies and working conditions during those pregnancies. Results: The majority of physicians (70.6%) and nurses (81.2%) had night work during their pregnancies and two-thirds of them continued this work until the last month of pregnancy, even though they have a legal right not to work during the night after the 7th month of pregnancy. Health workers had shorter maternity leaves than bank workers (P c 0.001) and complained more about the negative attitudes of managers and colleagues during their pregnancy (P < 0.001). Health workers had more preterm deliveries (P < 0.05) compared with bank workers, and nurses had more low birth weight babies compared with bank workers (P < 0.05). Conclusion: There is a need for a change in the climate in hospitals in terms of the working conditions of pregnant health staff and the attitudes towards them.
Contraception, 2014
*Created under the auspices of the ICPD Secretariat in its General Assembly mandated convening ro... more *Created under the auspices of the ICPD Secretariat in its General Assembly mandated convening role for the review of the ICPD Action Programme. 4 *Created under the auspices of the ICPD Secretariat in its General Assembly mandated convening role for the review of the ICPD Action Programme. law and thus leaving no option for women other than having an unwanted birth or a clandestine risky abortion. Political and policy barriers continue to hinder legal reforms to permit abortion on request and to make services accessible where countries have reformed the laws. No other issue in reproductive health divides politicians and policy makers as abortion. More recently, the organized opposition to provision of safe abortion and efforts to make its access more restrictive are presenting formidable challenges. Together, these barriers and challenges deprive women from accessing safe abortion and exposing them to unwanted births or to unsafe abortion and its devastating consequences of death and disability. This paper reviews evidence on abortions laws and policies, levels and trends in the incidence of safe and unsafe abortion and of mortality due to unsafe abortion, focusing on changes since 1994 ICPD. Key findings are highlighted before describing data and methods, abortion laws and their implementation and levels and trends in unsafe and safe abortion. This is followed by evidence on levels and trends in unsafe abortion mortality and morbidity, selected case studies of transiting from unsafe to safe abortion and preserving the legal provision of safe abortion, reproductive rights and, finally, a set of recommendations are presented in the concluding section of the paper. Key Findings 1) Globally, the annual number of induced abortions has declined from 46 million in 1995 to 44 million in 2008. This corresponds to a decline in overall abortion rate from 35 to 28 per 1000 women in reproductive age 15-44 years. 2) From 1995 to 2008, the decline in unsafe abortion globally was modest; from 15 to 14 per 1000 women of reproductive age 15-44 years while the rate for safe abortion dropped from 20 to 14 during the same period. 3) Unsafe abortion rate declined in all regions, except in Africa where it remained constant from 1990 to 2008 at a rate of 28 per 1000 women in reproductive age 15-44 years. 4) The number of deaths due to unsafe abortion has declined from 69 000 in 1990 to 47 000 in 2008; corresponding to an annual decline in unsafe abortion-related mortality ratio of 1% in Africa, compared to 4% in Asia and over 6% in Latin America. 5) The case-fatality rate of unsafe abortion has also declined globally at a rate of nearly 3% annually, but remains many times higher than for safe abortion in developed countries. 6) Nearly all unsafe abortions and related mortality occur in developing countries with sub-Saharan Africa accounting for 61% of all deaths due to unsafe abortion. The case fatality rate for Africa was 520 per 100 000 unsafe abortions in 2008. 7) Since ICPD, countries not permitting abortion on any ground have declined from 8% to 3% in 2011 and countries where abortion is permitted on request increased from 22% to 30%. During this period, the number of countries which made grounds for abortion more liberal was much higher (70) than those making the grounds for abortion more restricted (11). 8) Whether legally restricted or not, abortions continue to occur with abortion rates being higher where it is restricted than where it is permitted on request or under broad grounds. 9) Where abortion is legally highly restricted, the incidence of unsafe abortion and related mortality is high. Legal restrictions also result in major inequity in access to safe providers, as women in urban areas and those who can afford to pay can access physicians or travel abroad to procure abortion. 10) Some countries have made major progress in reducing unsafe abortion and the associated burden of mortality and morbidity with concerted efforts, including political will, legal and health system reforms and by applying innovative approaches.
Contraception, 2013
Comparative data on etonogestrel and two-rod levonorgestrel contraceptive implants are lacking. A... more Comparative data on etonogestrel and two-rod levonorgestrel contraceptive implants are lacking. A multicenter, open, parallel-group trial with random allocation of implants was performed. For every second implant user, an age-matched woman choosing an intrauterine device (IUD) (TCu380A) was admitted. Methods and data on implant/IUD insertion and 6-week follow-up are reported. A total of 2008 women were randomized to an implant, and 974 women were enrolled in the IUD group. Results from 997 etonogestrel implant users, 997 levonorgestrel implant users and 971 IUD users were analyzed. In the etonogestrel and levonorgestrel groups, respectively, mean insertion durations were 51 (SD 50.2) s and 88 (SD 60.8) s; complication rates at insertion were 0.8% and 0.2%; and at follow-up, 27.2% and 26.7% of women, respectively, had signs or symptoms at the insertion site. At follow-up within 6 weeks after insertion, all implants were in situ, while 2.1% of IUDs were expelled. Performance of etonogestrel and levonorgestrel implants at insertion and within the first 6 weeks is similar. Short-term (6 weeks) continuation rates appear higher for implants than TCu380A.