Carnival Conniptions and Conundrums in Trinidad/Tobago:
Population Communications International is driven to “communicate” a serious conundrum. What are the “negative” results of Carnival joy’? CARNIVAL BABIES! An esteemed research team from the University of the West Indies Department of Obstetrics and Gynecology Faculty of Medical Science, Gordon Narayangh and Samuel Ramsewak, pondered the problem deeply. They discovered that babies come from “sex during Carnival!” To make matters worse, Carnivals are spreading — from Trinidad and Tobago to Malaysia to North and West Africa — Carnivals are spreading all over the world! Just think of all those “negative results!”
Something must be done about this! Narayangh and Ramsewak scratched their heads and pondered. Oh what to do? Oh what to do? Of course! Christmas would be the time to take action — and now during the Christmas/Carnival period the learned university doctors will promote “contraception and safe sex” — at the very same time that the rest of the world is celebrating the “positive results” of a very special birth (excerpts from International Dateline, Populations Communications International, January 1993, 2).
Intercountry Adoption:
The Interamerican Parliamentary Group on Population and Development reports that the demand for adoptable children rose “significantly” in the United States and Sweden during the 1970s. In fact, the demand “caught Latin America by surprise” since it lacked both “policy guidelines and legal frameworks” to deal with the situation.
U.S. data reveal the demand for Latin American children increased in the United States from 8% of the “total number of foreign children” to 30% by 1980. Research shows a similar rise in adoptions from Latin America by Sweden. Colombia, Chile, Peru, Ecuador and El Salvador were principal “’child sending countries” of Latin America at that time.
The United States was the largest “receiving country” in terms of “absolute numbers” during the 1980s while Sweden was first “in terms of adoptions per one hundred thousand population.” Asia accounted for 70.35% of foreign adoptions in the United States, Sweden and Norway, Latin America and the Caribbean for 27.3%, and “the rest of the world” for 2.34%. Presently, Latin American countries which are the “main child sending nations” are Colombia, Chile, El Salvador, Guatemala, Brazil and Mexico (Dr. Francisco Pilotti, “Intercountry Adoption: Trends, Issues and Policy Implications for the 90s,” Bulletin, Vol. 8 No. 8, Sept, 1991, Inter-American Parliamentary Group on Population and Development).
Population Conferences Planned:
Non-Governmental Organizations (NGOs) are beginning to plan for the U.N. International Conference on Population and Development (ICPD). The 5-13 Sept. 1994 conference to be held in Cairo, Egypt, will attempt to prove that “population, economic growth and sustain- able development are interlinked” and cannot be dealt with as separate issues.
David O. Poindexter, co-convenor of the New York-based NGO planning committee for the ICPD, said that committee membership was composed of 80 national and international NGOs who maintained consultative status with the U.N. Social and Economic Council. Poindexter warned, however, that membership by the smaller NGOs was not being encouraged because of the “cacophony” that “characterized the U.N. Conference on Environment and Development (UNCED)” in Brazil. “The main purpose of this committee,” he said, “is to facilitate consultation of the NGOs, the governments and the United Nations.”
The other “co-convenor” of the NGO planning committee was Guadalupe de la Vega, president of the Mexican Federation of Private Family Planning Associations (Reuter, “Upcoming Population Conferences to Deal With…”, New York, 9 November 1993).
Intrauterine Progestagen Devices:
Sixty million women world-wide are currently using intrauterine devices, according to the International Planned Parenthood Federation (IPPF). Use of the copper-releasing IUDs causes “increased menstrual blood loss and some pain.” Several studies show “an increased risk of pelvic inflammatory disease (PID) in users of IUDs,” particularly among “young nulliparous women.”
Initially, progestagen-releasing IUDs were developed “in order to reduce the risk of expulsion.” The research subsequently led to the development of “Progestasert, a device releasing 65 mg of progesterone per 24 hours from a polymer capsule.” The contraceptive efficacy of the Progestasert is “similar to that of copper-releasing IUDs.” While Progestasert reduces menstrual blood loss, “its limited duration of action necessitates replacement every l2 to 18 months.” There is also a “possible increased risk of ectopic pregnancy” (IPPF Medical Bulletin, “Intrauterine progestagen for effective contraception”).
“Progestin-Only” Oral Contraceptive:
The progestin-only oral contraceptive “is less effective in preventing unplanned pregnancy than Norplant, Depoprovera, or Progesterone releasing IUDs.” A World Health Organization study on the “vaginal ring releasing 20 mg of levonorgestrel per day” reported “3.7 unplanned pregnancies per 100 women years.” The “one year discontinuation rate,” including loss to follow up, was 50%. “Progesterone oral contraceptive users” appear to have a “higher risk than combined oral contraceptive users for ectopic pregnancies.” In the United States, the “overall percentage of ectopic pregnancies is estimated to be 0.3-3% while the rate among progesterone oral contraceptive users is 2.3-4.l %,” a proportion nearly as high as that for the “4.3% reported by IUD users.”
The higher incidence of ectopic pregnancies with progesterone is thought to be due to “changes in tubal motility, secretions, and ciliary activity which may decrease the rate of transport of the blastocyst in the fallopian tube.” “Progesterone is also the hormone which causes cell mitosis in the breast; whereas estrogen causes mitosis in the uterus. There may well be an incidence of increased breast cancer under these circumstances” (Natural Family Planning Diocesan Activity Report Supplement, “The progestin only oral contraceptive – its place in postpartum contraception,” I.C. Chi et al, Advances in Contraception, 8:95- 103, 1992).
Survivors of Extreme Prematurity:
“Survivors of premature birth between 24 and 29 completed weeks of gestation were studied at 8 years of age. Sixty one percent survived; 27% of these were available for study: 70% of the children were not disabled; 13% had mild disability; 2% moderate; and 4% severe. While survival decreased with decreasing gestation, the disability among the survivors did not increase. Assessment of the same children at approximately 2 years of age had been unduly pessimistic especially “for those born earlier than 26 weeks of gestation. [In view of these studies, assessment at birth should not be overly concerned with long term neurologic outcome when making clinical decisions.” Ed., ACOG Current Journal Review ] (W.H. Kiche et al, “Survivors of Extreme Prematurity – Outcome at 8 Years of Age, Obstet. and Gynaecol . 31: 337-339, 1991 cited in ACOG Current Journal Review 5:37, 1992).
Use of Depoprovera:
A questionnaire about the use of medroxyprogesterone acetate (DMPA) use by adolescent health care providers was circulated at the 1991 Meeting of the Society for Adolescent Medicine. Thirty three percent of 160 American and Canadian physicians responded. Two thirds of these had prescribed depoprovera as a form of birth control. Nearly half had prescribed it to more than 10 young women. Female physicians were more likely than males to have prescribed the drug, and pediatricians more likely than gynecologists. The strongest indication was mental retardation. [Note: since the majority of recipients were mentally retarded, prevention of pregnancy was considered of higher priority than protecting them from rape. Ed., Contraception ] (F. Isart et al, “Use of Injectable Progestin, medroxyprogesterone acetate, in Adolescent Health Care,” Contraception 46:41-48, July 1992.)
Effect of Norplant on Carbohydrate Metabolism:
“Norplant users’ carbohydrate metabolism was measured with an oral glucose tolerance test before and after removal of the device. While the glucose tolerance curve increased slightly during the use of the device, (35.1 min mmol vs. 26.l min mmol) this was not statistically different. However, the areas of insulin under the curve, while not great, were significant. The mechanisms which delay return of insulin metabolism to normal after removal of Norplant are still under discussion, but change in liver structure and function and increase in insulin antagonistic hormones, such as growth hormone, cortisol, and glucagon, and increase in peripheral resistance to insulin have been postulated.
“The authors postulate that slower return of insulin level after Norplant removal may be due to persistence of the stimulus to the pancreas from previously elevated glucose levels even after the discontinuation of Norplant. While these changes are mild in normal women, offering of the device to women at risk for diabetes mellitus could be problematic. Currently women are not screened for diabetes before insertion” (J .C. Konje et al, “Carbohydrate Metabolism Before and After Norplant Removal,” Contraception 46:6l-69, July 1992).
&Ldquo;Save the Children” ‘Integrated’ Programs:
“Save the Children” (STC) gives demonstration sessions in 10 villages of northern Gambia to local women’s groups. The sessions integrate health and nutrition information with family planning. “All pregnancies are followed, birth weights recorded and family planning information given,” including breast feeding, “both for the child’s health and as a natural ‘brake’ on fertility.” No comment was made on whether the use of contraceptives with breastfeeding is encouraged as is the case with other population controllers.
In the Egyptian governorate of El-Minya, STC has “expanded” a program begun by the “Ministry of Social Affairs,” in which local women, euphemistically called “raidaat” (pioneers) “provide villagers with services” which integrate family planning with literacy training.
STC assists the government of Tuvalu, in the South Pacific, in a “primary health care plan that ranks family planning as first priority.” An STC family planning manual has been sent to all households. Training workshops “have produced capable male and female outreach workers.”
In Honduras, STC instructs mothers in “health and family planning” during “growth-monitoring sessions” for their children, and in meetings with “traditional birth attendants by trained STC.
In Bangladesh, “family planning is an important ingredient in extensive health and rural development projects.” “Male and female community members” are trained to “extend home counseling and provide referrals to local clinics.”
In Nepal, “Save the Children” brags that “more than twice the national family planning acceptance rate occurs in the areas where we work.” In the United States STC inner-city youth leadership training and counseling incorporate discussions on family planning and parenting (Save the Children Reports , 1992).
