Obstacles to progress in family planning.

Two dip-tests, Testuria and Uricult, were studied as screening tests for bacteriuria in children. Both tests showed a very good correlation with a standard method of urine culture.Testuria is easier to read and more accurate; however, it shows more “doubtful” results. Uricult presents the advantages of showing fewer “doubtful” results, and of differentiating between gram-positive and gram-negative organisms.The use of both tests should be limited to screening for bacteriuria. Certainly they are no substitute for accepted methods of urine culture.     

Epidemiology of endometriosis in women attending family planning clinics.

OBJECTIVE--To describe the epidemiology of endometriosis in women attending family planning clinics with special reference to contraceptive methods. DESIGN--Non-randomised cohort study with follow up of subjects for up to 23 years. Disease was measured by first hospital admission rates since endometriosis can be diagnosed with accuracy only at laparotomy or laparoscopy. SETTING--17 family planning centres in England and Scotland. SUBJECTS--17,032 married white women aged 25-39 years at entry during 1968-74 who were taking oral contraceptives or using an intrauterine device or diaphragm. About 99% of the women approached agreed to participate and annual loss to follow up was about 0.3%. MAIN OUTCOME MEASURES--Diagnosis of endometriosis, age, parity, and history of contraceptive use. RESULTS--Endometriosis was significantly related to age, peaking at ages 40-44 (chi 2 for heterogeneity = 30.9, p < 0.001). Endometriosis was not linked to duration of taking oral contraceptives. Nevertheless, the risk of endometriosis was low in women currently taking oral contraceptives (relative risk 0.4; 95% confidence interval 0.2 to 0.7), but higher in women who had formerly taken them (1.8; 1.0 to 3.1 in women who had stopped 25-48 months previously) compared with women who had never taken the pill. A similar pattern was seen for use of intrauterine devices (relative risk 0.4 (0.2 to 0.7) in current users and 1.4 (0.4 to 3.2) in users 49-72 months previously compared with never users). No association was found between endometriosis and use of the diaphragm. CONCLUSIONS--Oral contraceptives seem to temporarily suppress endometriosis. Endometriosis may be diagnosed late in women using intrauterine devices as pain and bleeding occur with both.     

Fertility and family planning in Accra

A sample of 1000 currently married women aged 25-39 and living in 3 geographic areas of the Ghanaian capital were interviewed about their contraceptive knowledge and practice. Slightly over 90% of the respondents said that they had heard of ways to delay or prevent pregnancy. There was no difference between the 3 areas, but more of those aged 30-34 had heard about contraception. The chances that a respondent had heard about contraception increased with the level of education. Catholics were less likely to have heard of any contraceptive methods than Protestants. Also, women engaged in traditional informal occupations were the least likely to have heard of any contraceptive methods. Overall, education emerged as the most important differentiating factor. The pill, condom, and IUD were the best known methods. Regarding actual contraceptive practice, only 41% of the respondents were currently using some form of contraception, with about 19% using modern and 27% traditional methods. Results of contraceptive usage by user characteristics show that the majority of women in 2/3 of the areas rely on a mixture of traditional and modern methods; that the % of users (any method) increases with age up to 30-34 years, after which it decreases. The % of ever-users of any type of contraception in this study is highest for the highest education levels, at 84% for women with 2ndary and post 2ndary education. With the exception of the IUD, douche and folklore methods, better educated women have higher ever-use %s for both traditional and modern methods. While the %s of users increases with education for foam, diaphragm and withdrawal; the reverse is observed for the pill and IUD, probably due to fear of negative side effects. Overall, there are no significant variations in contraceptive use by migration status; but the % of non-users is highest among recent migrants who are also the least likely to have ever used modern methods. Fertility differentials across ethnic groups have been observed in Ghana. The Akan have the highest fertility, followed by the Ewe and Ga-Adangbe with moderate fertility, and the northern ethnic groups with the lowest fertility. The Akan also have the highest % of ever users of modern contraceptives, an inconsistency which may be explained by their recent recognition of the burdens of high fertility and their attempts to control it. Religious differences are pronounced, especially between the traditional category on the 1 hand, and Christians and Muslims on the other. Results of an analysis of variance suggests that family size is the strongest motivation for adopting modern contraception, and that it may be used for limiting rather than spacing births.