Sexually transmitted infections: progress and challenges since the 1994 International Conference on Population and Development (ICPD)

AbstractBackgroundDespite 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 ICPDDuring 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.ChallengesThe 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.RecommendationsGovernments, 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

The effectiveness of preabortion contraception counseling

Objective: 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 modem 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. (C) 2001 International Federation of Gynecology and Obstetrics. All rights reserved

Is the diaphragm a viable option for women in Turkey?

Context: In Turkey where contraceptive prevalence is about 65%, a large number of couples rely on withdrawal and the IUD. Although the country has had a national family planning program for 35 years, the diaphragm has not been introduced as a contraceptive option. Methods: Diaphragms were offered to women as a contraceptive option during counseling sessions at four family planning clinic sites in western Turkey:two public-sector clinics (one in Capa, Istanbul, the other in Irmir) and two private-sector clinics tone in lncirli, Istanbul, the other in Denizli). Women who chose the diaphragm were interviewed at enrollment and were invited for follow-up visits with a physician at two weeks and at any time thereafter Demographic information was also collected from an additional 740 women who chose another contraceptive method and focus-group discussions were conducted with diaphragm users and their partners, with users of other methods and with service providers. Results: Overall, 166 women selected the diaphragm, and 161 enrolled in the study initial acceptance rates were higher at the two private clinics (14% and 6%) than at the public clinics (3% and 1%). At the public-sector clinics, diaphragm users were better educated and more likely to be professionally employed than were women who selected other contraceptive methods. In Capa, 42% of women who chose the diaphragm were university graduates, compared with 7% of those who chose another method. Despite differences between the two private clinics in clients' educational levels, no such differences existed between diaphragm accepters and users of alternative methods at each site. Among women who chose the diaphragm, 47% said they had sex four times or more per week compared with 29% of those using another contraceptive. More than half of the women who selected the diaphragm (59%) cited safety and freedom from side effects as the reason for their choice of contraceptive. A similar percentage of clients who used other methods (58%) cited effectiveness. Fifty percent of diaphragm users had discontinued by six months, and 66% had done so by 12 months. Conclusion: A small proportion of clients in both private- and public-sector clinics were interested in using the diaphragm and found it acceptable. In less-developed countries the diaphragm may be a viable contraceptive option when providers are able to provide adequate information and support

Challenges for the adoption of evidence-based maternity care in Turkey

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.Evidence-based practice Theory of planned behavior Maternity care Turkey