Mediating Healthy Female Citizenship in the HPV Vaccination Campaigns

Analyzing the HPV awareness and Gardasil® vaccine campaigns for the United States (US), we argue that the campaigns reflect “the new public health” model that positions individuals as neoliberal citizens responsible for managing their health and maximizing public health opportunities. The campaigns, directed primarily at girls and young women and their mothers, also mobilized neoliberal discourses of risk, choice, and self-management alongside postfeminist political rhetoric that values empowerment, freedom, choice, and rights. Postfeminist tropes were co-opted by Merck's marketing imperatives in order to produce girls and young women as an agentic, niche market of health consumers. We then foreground a low-budget counter-narrative alternative media campaign produced by young women and disseminated through YouTube. This campaign demonstrates the role of new media in producing alternative perspectives on agentic female citizenship and disrupts Merck's campaign imperatives.     

American Catholicism and the International Family Planning Movement

This paper examines the role of the American Catholic Church in the international family planning movement and discusses elements of the Catholic opposition to birth control. The paper argues that the reaction of American Catholics to government support for contraceptive services was based not only on the Church's condemnation of particular contraceptive methods, but also on a variety of other factors including class and ethnic hostility between Catholics and the promoters of family planning, jurisdictional disputes over what institutions would guide family life, the perceived threat that government support of family planning was to the authority of the Church and the Church's understanding of sex and women. The role of an American theology of political compromise and accommodation in mitigating the American Catholic Church's opposition to organized family planning is assessed.     

Continuity of women's work,breastfeeding, and fertility in Ghana in the 1980s

Much of the inconsistency that has appeared in studies of the effect of women's work on fertility in less developed countries has been attributed to the varying accessibility of employment in the modern sector. The analysis presented in this paper shows that continuity of work matters more than sector of work. It also confirms that, even in a setting of low contraceptive prevalence, increased fecundity associated with the less intense breastfeeding practices of working women do not result in shorter birth intervals. The influence of women's work on fertility control is likely to be underestimated if the effects of sporadic versus continuous work are conflated, or if fecundity differentials by work status are unmeasured.     

Contraception provision in the postpartum period: Knowledge,views and practices of midwives

BackgroundWomen are susceptible to unintended pregnancies in the first year after giving birth, particularly as consideration of contraception may be a low priority during this time. Discussing and providing contraception before women leave hospital after giving birth may prevent rapid repeat pregnancy and its associated risks. Midwives are well placed to assist with contraceptive decision-making and provision; however, this is not routinely undertaken by midwives in the Australian hospital setting and little is known regarding their views and experiences in relation to contraception.MethodsAn anonymous survey was conducted with midwives at two urban hospitals in New South Wales to better understand their contraceptive knowledge, views and practices regarding midwifery-led contraception provision in the postpartum period.FindingsThe survey was completed by 128 midwives. Most agreed that information about contraception provided in the postpartum period is valuable to women, although their knowledge about different methods was variable. The majority (88%) believed that midwives have a role in providing contraceptive information, and 79% reported currently providing contraceptive counselling. However, only 14% had received formal training in this area.ConclusionFindings demonstrate that most midwives provide some contraception information and believe this is an important part of a midwife’s role. Yet most have not undertaken formal training in contraception. Additional research is needed to explore the content and quality of midwives’ contraception discussions with women. Training midwives in contraceptive counselling would ensure women receive accurate information about available options. Upskilling midwives in contraception provision may increase postpartum uptake and reduce rapid repeat pregnancies.     

The Risk of an Unwanted Birth: The Changing Context of Contraceptive Sterilization in the U.S.

Life-table estimates indicate that one-quarter of U.S. women intend no more births by age 25, one-half by age 27, and three-quarters by age 30. The resulting long period at risk of unwanted fertility is argued to be an important underlying dimension of the revolution in attitudes to and practice of sterilization. Life-table estimates are then considered of the timing of sterilization after the last wanted birth. Almost one-quarter of all couples select sterilization within the first year after they have had the number of children they desire. Recent experience would imply that four-fifths of all couples will eventually use contraceptive sterilization. In order to examine the determinants of men's and women's sterilization, logistic regression is used with a polytomous dependent variable: sterilization of the woman, sterilization of the man, or no sterilization within four years of the last wanted birth. Covariates considered are age and parity at last wanted birth, year and duration of marriage at last wanted birth, wife's and husband's education, wife's and husband's religion, whether residence is in a central city, region, pill-use history and timing-failure histories before the last wanted birth, and unwanted birth. Large and significant effects are found for most of these variables, and these effects change in interpretable ways between early innovative behaviour and sterilization during the most recent period when it was widely accepted.     

How menstrual shame affects birth

In Western, industrialised culture, menstruation and birth are commonly seen as unstable, pathological processes requiring medical control. Girls learn to see menstruation as shameful and secretive. Menarche is a nodal event around which girls’ beliefs and attitudes to being female are organised. The perception of menstruation as a liability has foundational implications for future female experiences, particularly birth. Other cultures have recognised menstruation and birth as spiritual phenomena, with menarche and childbirth experienced as powerful initiatory processes. My PhD research explored the links between cultural attitudes to menstruation and spirituality, and women's experiences of birth. My feminist perspective recognised the power imbalances, patriarchal controls and structural inequities that oppress women in their intimate body experiences. Menstrual shame was identified as a core patriarchal organising principle that inculcates and perpetuates male dominance and female subordination. Engendering the perception of female physiology – and thus womanhood – as inherently flawed, menstrual shame was a key factor that predisposed women to approach birth feeling fearful, disempowered and vulnerable to intervention. However, my research also unearthed a counter-cultural group of women who had transformed their relationship with both menstruation and birth. Redesignating menstruation as a spiritual phenomenon enabled these women to dismantle their menstrual shame, connect with their female spirituality and give birth fearlessly and powerfully. For others, the profound spirituality of birth transformed their understanding of menstruation. Contrary to cultural norms, both menstruation and birth can be sacred female experiences which are sources of authority and empowerment.     

Family Planning and Child Health Care: Effect of the Peruvian Programa de Salud Reproductiva y Planificación Familiar, 1996–2000

Our study estimates the effects of exposure to a family planning program which promoted surgical contraception for the first time in Peru on women's use of birth control methods and their children's health. While a broad program, the Programa de Salud Reproductiva y Planificación Familiar forced many indigenous women to undergo sterilization. We compare provinces affected by the program earlier with provinces affected later, before and after the policy. Overall, the results indicate that women in treated areas were more likely to use both temporary and permanent contraceptive methods and their children were less likely to die within their first year of life, partly due to longer breastfeeding. However, we observe heterogeneity by ethnicity. In treated provinces, nonindigenous children benefited from the policy regardless of their mothers’ choice of contraceptive method, while there were few positive impacts for indigenous children whose mothers underwent sterilization. This suggests that coercive or aggressively implemented family planning programs may not confer health benefits on children.     

An update on the pill

The discussion traces the development of the oral contraceptive (OC) pill and presents the most recent medical findings on OC and its effects. In 1959 the 1st combined OC, Enovid, was officially approved for use in the US after clinical trials in Los Angeles and Puerto Rico. By 1975, OCs were being used in the US by more than 1/3 of married women who practiced family planning and by an even higher percentage of unmarried contraceptive users. Retail pharmacy sales of OCs have declined by 40% during the 1975-79 period. The major reason given for the decline was the side effects or fear of side effects arising from OC use. Many OCs are available today because of an increasing variety of chemical combinations and the rapid increase in product names, according to "Oral Contraceptives: A Guide for Programs and Clinics," a Pathfinder Fund handbook. The authors classified OCs into 2 general groups -- combined pills and the mini-pills. OCs used in the combined preparation each contain 2 synthetic hormones -- estrogen and progestin. The combined OC is 99% effective when taken properly. The most popular belief now is that OCs act by interfering with the normal menstrual cycle. The mini-pills, which contain small doses of synthetic progestins, have a contraceptive effect by altering the cervical mucus and by altering the lining of the womb or endometrium. Absolute, strong relative, and other relative contraindications to pill use are listed. Side effects that are possibly life threatening include blood clots in the legs, pelvis (lower abdomen), lungs, heart, or brain. Women OC users over 40 have a higher risk of heart attack than younger users, and users over 40 who smoke have the highest risk of heart attack. Benign tumors of the liver, which have been found to be more common in women who use OCs, may cause rupture of the capsule of the liver, extensive bleeding, and even death. Rare tumors of the liver, hepatocelluar adenomas, are more likely to occur in long term OC users, older women, and women using high dose pills. Side effects considered serious are gallbladder disease and hypertension. Fairly minor OC side effects are listed as are noncontraceptive benefits of OC use.     

Understanding U.S. fertility: findings from the National Survey of Family Growth,Cycle III

The 1st overview of findings from Cycle III of the National Survey of Family Growth, the latest of 7 such surveys of US fertility since 1955 and the 1st to cover all women of childbearing age in the conterminous US is presented. Interviews between August 1982 and February 1983 with 7969 women, representative of 54 million women aged 15-44, reveal that sterilization is now the leading contraceptive method in the US, used by 33% of all contraceptors in 1982 (22%, female sterilization; 11% male sterilization), followed by the pill (29%), condom (12%), diaphragm (8%), and IUD (7%). Linked to this is the continuing decline in unwanted births since the baby boom peak in 1957, which accounted for nearly 1/2 of the drop between 1973 and 1982 in ever-married women's children ever born, from 2.2 to 1.9/woman. However, births conceived sooner than planned increased slightly among younger married women, probably due to the large drop in pill use since 1973 and increased use of the less effective diaphragm and condom among couples still intending to have more children. Black women are now more likely than white women to use the most effective female methods: female sterilization, pill, and IUD. Only 45% of women aged 15-44 in 1982 had used a contraceptive method at 1st intercourse. 4 out of 5 women married for the 1st time between 1975 and 1982 had intercourse before marriage. However, premarital sexual activity may be leveling off among white teenagers after a steep rise since the early 1970s and declining moderately among black teenagers. 16% of 1st marriages among ever-married women aged 15-44 in 1982 had been dissoved within 5 years, mostly by divorce or separation. 59% of black women with children in 1982 had their 1st birth before marriage, compared to 11% of white mothers. The proportion of babies who were breastfed more than doubled between 1970-71 and 1980-81, from 24 to 53%.     

The Contraceptive Role of Breastfeeding

We review (1) neuro-hormonal mechanisms by which breastfeeding postpones the return of ovulation and menstruation after birth, and (2) various statistical procedures used to analyse this effect in human populations. This review reveals that the biology and the statistical procedures are incompatible. We propose a statistical approach, compatible with present knowledge of physiology, that differentiates between ovulation-inhibiting mechanisms at birth and the weakening of these inhibitions thereafter, so that it is possible to investigate the effects on these mechanisms due to breastfeeding and to other determinants such as mother's age. An empirical test with typical recall data indicates that full breastfeeding postpones ovulation longer than does supplemented breastfeeding, and that both have stronger contraceptive effects than has previously been thought.     

The Effect of Parental Education on Marital Fertility in Developing Countries

The effects of parents' education on marital fertility are analysed with data from 38 Surveys in the WFS programme, and a two-parameter model in which the age-dependent level of fertility and a duration-dependent slope of fertility are estimated. The level parameter reflects post-partum infecundity and, in some populations, contraceptive spacing of births. The slope parameter reflects parity-specific birth control. The effects of the husband's and of the wife's education are estimated, both before and after adjustment for other socio-economic factors. The schooling of the wife emerges as a more decisive influence on fertility than that of the husband, with substantial net effects even after controlling for urban-rural residence, husband's socio-economic status and wife's employment. In Latin America and the Arab states, monotonic declines in marital fertility are found, as the level of the wife's education increases. However, in many Asian and African populations, the highest fertility is observed among women with moderate exposure to schooling, because the relaxation of traditional spacing mechanisms is not matched by increased birth control. This regional diversity cannot be explained convincingly by national levels of economic development or efforts made to popularize contraception, but appears to relect ill-understood cultural factors.     

The Contraceptive Confidence Idea: An Empirical Investigation

In this paper the hypothesis that ‘contraceptive confidence’ promotes accelerated childbearing is presented and examined. Methodological difficulties in investigating the question empirically are discussed. Because of the absence of a direct measure, a proxy indicator of ‘contraceptive confidence’ is used in multivariate analyses of maternity history data. These give results consistent with the existence of a contraceptive confidence effect. Evidence is also presented (a) of shorter second birth intervals among women who were in higher status occupations before marriage and (b) of an inverse association between educational qualifications and length of intervals after the first. These findings are construed as supporting the basic thesis regarding contraceptive confidence. The contraceptive confidence idea is discussed in the context of related work on an acceleration effect associated with women's labour-force participation. Several difficulties in interpreting the findings are considered and some implications are discussed.     

Sexual activity and weekly contraceptive use among young adult women in Michigan

Past studies on the influence of sexual activity on contraceptive behaviours are inconclusive, relying heavily on cross-sectional data. We used a population-based longitudinal sample of young women in Michigan to evaluate weekly associations between sexual activity and contraceptive use at three levels of measurement: comparing between women, among individual women’s partnerships, and from week to week within partnerships. We used multinomial logistic regression accounting for correlations within partnerships and women. Relative to use of least effective methods, weekly sexual activity was significantly associated with increased use of condoms, pills, and highly effective methods. For pills and highly effective methods, partnership-, woman-, and week-level effects were similar. For condoms, there was no significant woman-level effect. Evidence of immediate effects of sexual activity on contraceptive use highlights the importance of longitudinal data. These dynamics may be diluted or missed altogether when relying on cross-sectional data approaches that compare groups of individuals.     

Indicators of contraceptive policy for nations at three levels of development

The study is concerned with examining variations in contraceptive policies among 74 nations of the world. Employing quantitative data collected by the United Nations, the national policies for three types of contraceptive devices (birth control pills, condoms and IUDs) were examined for nations at three levels of development. The policies for the three items were found to be highly intercorrelated. Given this fact, a restrictiveness index related to the commercial sale of the three types of contraceptive was constructed. A set of independent variables was then related to this restrictive index employing multivariate analysis. The results differed appreciably for the developed and non-developed nations. For the developed nations restrictiveness was significantly related to the fertility rate and the number of physicians in the society, whereas for the developing nations it was significantly related to the infant mortality rate in the society.     

Motivations for the use of birth control: Evidence from West Africa

A conventional assumption in the family planning literature is that birth control in developing countries is first adopted by high parity women who wish to cease childbearing. The empirical support for this belief has mainly been drawn from interview surveys on the motivations for, and the timing of, the inception of birth control among married women in areas where there is no cultural precedent for birth spacing by traditional means. This study, on the other hand, is based on data drawn from an area sample of 6,606 women, married or single, aged 15–59, in Ibadan, Nigeria, where there is a tradition for the practice of abstinence after a birth for the purpose of birth spacing. The Nigerian pattern revealed in the data presented here is indeed distinctive in many respects: (a) although premarital sex is prevalent, levels of premarital contraception are high; and (b) within marriage, spacing is the most prominent motivation for contraceptive practice, more important than the limitation of family size.     

Dynamics of contraceptive use and breastfeeding during the post-partum period in Peru and Indonesia

This paper examines the interaction between contraceptive use and breastfeeding in relation to resumption of intercourse and duration of amenorrhea post-partum. We used data from the month-by-month calendar of reproductive events from Demographic and Health Surveys (DHS) in Peru and Indonesia. The analyses show that breastfeeding women were less likely than non-breastfeeding women to have resumed sexual intercourse in the early months post-partum in both countries. In Peru, but not in Indonesia, breastfeeding women had a significantly lower odds than non-breastfeeding women of adopting contraception. Although the likelihood of contraceptive adoption was highest in the month women resumed menstruation in both countries, about ten per cent of subsequent pregnancies occurred to women before they resumed menses. These results emphasize the importance of integrating breastfeeding counselling and family planning services in programmes serving post-partum women, as a means of enabling those who wish to space their next birth to avoid exposure to the risk of a pregnancy that may precede the return of menses.     

Birth control techniques in China

This article describes the major birth control techniques in use in China, based on data from a contraceptive prevalence study conducted in September, 1982. 118 million of the 170 million married women of child bearing age use birth control. IUD insertion accounts for 50.2% of birth control methods used, tubal ligation accounts for 25.4%, vas deferens ligation 10.0% oral contraceptives (OCs) 8.2%, and condoms 2.0%. A table of clinical data on 9 China made IUDs reveals that pregnancy rates range from 0 (V Cu-300 model) to 5.83% (mixed ring model). A method of IUD insertion immediately after delivery has been researched and adopted, using a silastic Delta IUD with barium added to reduce the high postpartum expulsion rate. fixing the IUD by sutures during Cesarean section has also been developed. Electronmicroscopic studies of the endometrium of women who have used a stainless steel IUD for more than 20 years showes no tendency towards malignancy, nor negative effects on the endocrine functions of the ovaries. 28 million Chinese women have accepted sterilization as of June, 1982. Local anesthesia and the use of acupuncture have reduced complications due to general anesthesia seen previously. Sterilization by means of chemically induced adhesion of Fallopian tube tissue has also been performed successfully; however, this method makes later anastomosis difficult, and is not suitable for young women with only 1 child. Fallopian tube occlusion by means of a silver clip has been performed in 1,128 cases, with a pregnancy rate of only .85%. 10.62 million men have accepted sterilization. While most of the procedures are val ligations, 300,000 men have been sterilized by direct injection of an adhesive agent throuh the skin of the scrotum. No increase in auto immune or vascular disease has been found. 3 low-dose OCs, used since 1969, have proven to be reliable and freer of side effects than higher-dose compounds. In addition, longterm OCs containing quinestrol have been used since 1969 with a success rate of 98.3% women-year. These pills are taken 1x monthly. R and D priority will be given be given to monthly injectable contraceptives; megestrol and norethindrone are the compounds most preferable. In trials so far, the effective rate has been 99.9% with mild side effects. Gossypol, a male contraceptive, has shown an antifertility effect in 99% of 8000 cases studied; however, hypokalemia and irreversibility of spermatogenesis were reported in some cases. Vacuum suction is the most common method for abortion, but Radix Trichosanthis and lilac daphne terpine, traditional abortifacients, anre acceptable for 1st trimester abortions. Prostaglandins are also used.     

Microcredit,Family Planning Programs,and Contraceptive Behavior: Evidence From a Field Experiment in Ethiopia

The impact of community-based family planning programs and access to credit on contraceptive use, fertility, and family size preferences has not been established conclusively in the literature. We provide additional evidence on the possible effect of such programs by describing the results of a randomized field experiment whose main purpose was to increase the use of contraceptive methods in rural areas of Ethiopia. In the experiment, administrative areas were randomly allocated to one of three intervention groups or to a fourth control group. In the first intervention group, both credit and family planning services were provided and the credit officers also provided information on family planning. Only credit or family planning services, but not both, were provided in the other two intervention groups, while areas in the control group received neither type of service. Using pre- and post-intervention surveys, we find that neither type of program, combined or in isolation, led to an increase in contraceptive use that is significantly greater than that observed in the control group. We conjecture that the lack of impact has much to do with the mismatch between women’s preferred contraceptive method (injectibles) and the contraceptives provided by community-based agents (pills and condoms).     

The trends of contraceptives of people in Shanghai since early 1980s

Shanghai has had the lowest fertility rate in China for many years. Shanghai had a negative rate of natural growth during 1990-95. During 1980-93, fertility dropped continuously. In 1982, contraceptive use among married women included 29.47% using IUDs, 29.33% using oral pills, 23.44% using female sterilization, and 10.48% using condoms. Contraceptive prevalence declined slightly from 98.6% in 1982 to 92.29% in 1993. By 1993, method use changed. Oral pill and female sterilization use declined to 8.04% and 7.22%, respectively, among married women of reproductive age. IUD use increased dramatically to 72.2% in 1993. Condom use declined to 8.83% of total users. Despite reduced contraceptive prevalence, the birth rate declined from 18.51/1000 population in 1982 to 6.50/1000 population in 1993. The proportion of women accepting the one-child certificate increased from 53.32% of all married women of reproductive age in 1984 to 70.13% in 1993. The shift use of contraceptive methods means reliance on long-term reversible methods.