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  • Title: [Contraceptive technology from the administrator's perspective].
    Author: Caram M.
    Journal: Familia; 1984; 2(2):4-8. PubMed ID: 12178195.
    Abstract:
    Despite advances in contraceptive technology and acceptance, family planning still has numerous barriers to overcome: an ideal contraceptive is lacking and cultural and religious taboos still hamper family planning programs. Political leaders and the Catholic Church have changed their attitudes somewhat in the face of the great needs of their populations and their social reality, but women have become a decisive influence in the change of attitudes concerning family planning. Cultural barriers to acceptance of family planning include the attitude that sex for women is dirty and shameful and that their only legitimate interest in it is procreative, and the belief that birth control is exclusively a concern of women, which unfortunately has been reinforced by the fact that almost all contraceptive methods are oriented to women. The limitations and difficulties faced by family planning administrators assume new dimensions when women begin to asser their right and need for family planning and demanding that services be of high quality, freely available, safe, accessible, and reliable. A brief review of currently used methods demonstrates their strengths and weaknesses. Oral contraceptives (OCs) are easy to administer, safe, and effective, and can be administered by trained nonmedical personnel to reach large populations at relatively low cost, but their use is contraindicated for large numbers of women. IUDs are effective, require only insertion and annual follow-up, and can be inserted by trained paramedical workers, but they carry a risk of infection and septic shock in case of failure. Surgical sterilization is effective but not suited to spacing pregnancies, and its initial cost and requirements for personnel and equipment are high. Male sterilization is technically much easier to perform but lacks acceptability to men. Barrier methods have no serious side effects but require a high degree of motivation and impose onerous storage requirements in tropical countries. Their efficacy depends on correct use, so that costs of information and education are high. The real reasons why so little progress had been made in developing male methods are unclear, but it is true that men dominate family planning research and administration. Although the effect of contraceptive methods on male sexual function is a major concern, very little thought has been given to their effect on female sexual functioning. The greatest needs for family planning administrators are for a safe and approprite method for young people, and for family planning service delivery to be taken over by communities and no longer viewed as the exclusive concern of health professionals and bureaucrats. Research and other efforts should be devoted to development of improved contraceptive methods and delivery structures to overcome the obstacles that have been identified.
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