Prevention and Treatment of Contraceptive Failure I n Honor of Christopher Tietze Prevention and Treatment of Contraceptive Failure In Honor of Christopher Tietze Edited by Uta Landy International Women's Health Coalition New York, New York and S. S. Ratnam Department of Obstetrics and Gynecology National University of Singapore Singapore, Republic of Singapore PLENUM PRESS • NEW YORK AND LONDON Library of Congress Cataloging in Publication Data Christopher Tietze International Symposium on the Prevention and Treatment of Contra ceptive Failure (1st: 1985: Berlin, Germany) Prevention and treatment of contraceptive failure_ "Proceedings of the First Christopher Tietze International Symposium on the Preven tion and Treatment of Contraceptive Failure, sponsored by the International Women's Health Coalition, held September 21-22, 1985, in Berlin (West), Federal Republic of Ger many" - T_p_ verso_ Includes bibliographies and index. 1. Abortion - Congresses. 2. Contraception - Failures - Congresses. 3. Contraception -Failures-Prevention-Congresses. I. Landy, Uta. II. Ratnam, S. S. III. Title. [DNLM: 1. Abortion, Induced-methods-congresses. 2. Abortion, Induced-trends-congresses. 3. Contraception - methods - congresses. 4. Contraception - trends - congresses. W3 C156F 1st 1985p I WP 630 C556 1986p] RG734.C47 1985 613.9/4 86-25318 ISBN-13: 978-1-4684-5250-1 e-ISBN-13: 978-1-4684-5248-8 001: 10.1007/978-1-4684-5248-8 Proceedings of the First Christopher Tietze International Symposium on the Prevention and Treatment of Contraceptive Failure, sponsored by the International Women's Health Coalition, held September 21-22,1985, in Berlin (West), Federal Republic of Germany © 1986 Plenum Press, New York Softcover reprint of the hardcover 1s t ed ition 1986 A Division of Plenum Publishing Corporation 233 Spring Street, New York, N.Y. 10013 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher Christopher Tietze, 1908-1984 FOREWORD The International Women's Health Coalition was pleased to be the convenor and host of the first Christopher Tietze International Symposium, held in Berlin in September 1985. The papers in this volume represent a wide range of international views and experience with the prevention and treatment of contraceptive failure. We believe the issues discussed at the Tietze Symposium to be of interest and concern to women throughout the world and to those who would serve them. The Coalition intends to l1'ive broad distribution to this volume and encourages those interested in these issues to be in touch with the Coalition in New York City (see address below). We would like to thank The Ford Foundation, Stewart Mott, The David and Lucile Packard Foundation, the Population Crisis Committee, and The Uockefeller Foundation for their support of this Symposium. In particular we would like to express our appreciation to Sarah Lewit Tietze and Uta Landy for the devotion ann dedication which made this Symposium possible and a worthy memorial to Christopher Tietze. Joan B. Dunlop President International Women's Health Coalition P.o. Box 8500 New York, NY 10150 v,i PREFACE The death of Dr. Christopher Tietze was a profound scientific, political, and personal loss for the family planning community in the United Rtates and around the world. His scientific brilliance and personal magnetism connected a world community of scholars and activists. Shortly after his death, we began to think of organizing an international symposium to bring together scientists from around the world whom he had influenced and inspired, addressing Dr. Tietze's life-long con cerns--the health of women as affected by contraception and legal and illegal abortion around the world. Support for a Tietze memorial symposium came quickly and enthusiastically from individuals, organizations, find foundations. An interna tional advisory committee was established and the International Women's Health Coalition sponsored and hosted the meeting. The symposium took place on September 21 and 22, 1985, in Berlin (West), immediately following the Congress of the International Federation of Gynecology and Obstetrics (FIGO). It was an inspiring and moving testimony to Christopher Tietze and to all who are dedicated to the health and well-being of women and their families. Those who knew Dr. Tietze personally were gratified to remember him through this international gathering of colleagues, friends, and fellow scien tists; others found themselves inspired by the memories and testimonies of those he had taught, advised, or encouraged. But the meeting did not simply evoke Dr. Tietze's memory; it offered an impressive array of presentations about the health benefits of contraception and safe, legal abortion and menstrual regulation, as well as an international review of social policies and their effect on the health of women and their families. The symposium was so successful that the "Christopher Tietze International Symposia" will be continued as a forum to honor this scientist and present new work in his field. This publication includes most of the papers presented at the Symposium. They are organized according to subject: prevention of contraceptive failure, effects of illegal abortion on medical practice and public' health, medical practice after legalization of abortion, abortion technology, menstrual regulation, delivery of abortion care, maternal mortality in different countries and continents (People's Republic of China, Asia, Africa, South America, Europe, and the United States). These Proceedings begin with a memorial tribute to Dr. Tietze, followed by a worldwide review of information about access to contraception, contraceptive fail ure, and abortion. The closing presentation takes a global look at the future of women's health. I want to thank the Advisory Board--Sudesh Bahl Dhall from Inelia, Pouru Bhiwandiwala, George Brown, Allan Rosenfield, Jeannie Rosoff, and Phillip Stub blefield from the United States; Mahmoud Fathallah from Egypt; Evert Ketting from the Netherlands; Fred Sai from Ghana; Benjamin Viel from Chile, and my coeditor, S. S. Ratnam, from Singapore for their invaluable support and guidance. The co-sponsorship of the Population Council, the Alan Guttmacher Institute, IX Columbia University's Department of Obstetrics and Gynecology, Assiut Univer sity's Faculty of Medicine, the International Federation of Obstetrics and Gyne cology (FIGO), the World Health Organization, and the International Planned Par enthood Federation greatly contributed to the success of this meeting, as did the grants of several foundations and individual donors. My personal friendship and professional admiration for Chris Tietze and his wife, Sarah, who provided encouragement, support, and invaluable help and sugges tions during the planning and organization of this memc..ial symposium, have made my work in preparing the meeting and this publication a source of immense satis faction. To have known Christopher Tietze and to honor him with this publication is a great privilege. Uta Landy, Ph.D. Program Director Christopher Tietze International Symposium x CONTENTS Opening Remarks ••.•••••...........••...•..•••...•••••.........••..... xv S. S. Ratnam Memorial Tribute to Dr. Christopher Tietze 1 H. Lehfeldt GLOBAL REVIEWS Availability and Accessibility of Contraception: A Worldwide Public f-lealth Problem ..••••••.••••.••••.••••••••••••••.••••••.••••.•• 5 F. T. Sai Induced Abortion--A World Review 17 S. K. Henshaw PREVENTION OF C'ONTRACEPTIVE FAILURE Prevention of Contraceptive Failure--An Overview 21 P.Senanayake The Permanent Contributions of Christopher Tietze: Methods and Models........................................................ 27 I. Sivin Interception • . • • • • • • • • • • . . . • . • • • • • • • • . • • • • . . • • • • . . • • . . . . • . . . . • • • . • • • • • . 3 J J. Lippes Prevention of Contraceptive Failures with Hormonal Implants 39 A. Faundes Factors Contributing to Use-Effectiveness. • • • • • • • • • • . • • • • • • • . • • • • • • • • . . • • 45 J. D. Forrest ILLEGAL ABORTION: EFFECTS ON MEDICAL PR ACTICE AND PUBLIC HEALTH Illegal Abortion and Effect on Medical Practice and Public Health-- Nigeria........................................................ 53 O. A. Ladipo Utilization of Induced Abortion in F'orea 61 Sung-bong Hong XI Induced Abortion in Latin America: Impact on Health .•••.•. • • • • • • • . . • • • • • • • 67 B. Viel MEDICAL PRACTICE AFTER LEGALIZATION OF ABORTION Training and Delivery of Abortion in India .••••••. • • • • • • • • • • . • • • • . • • . • • . • • • 73 S. Bahl Dhall Legal Abortions in Socialist Countries of Eastern Europe: An Epidemiological Review. • • • . • • • • • • . • • • • • • • • • • • • • • • • • • • . • • • . • • • . • • 79 K. H. Mehlan Medical Experience with Abortion after Legalization in Western Europe ••.•••••••••••••••••..••••••.•••••••••••••••.••••••••••• 83 E. Ketting The Effects of Legislation of Abortion on Maternal and Perinatal Outcome....................................................... 89 K. Singh, o. Viegas, S. S. Ratnam Medical Practice after Legalization of Abortion: The Chinese Experience • • • • • • • • . . • • • • • • • • • . • • • • • • • • • • • • • . • • • . . • • • • . . • • • • • • . • 99 Yan Ren-Ying Medical Practice after Legalization of Abortion: Bangladesh . . . . . • • • • . . . . . • •• 111 H. H. Akhter ABORTION TECHNOLOGY Some Lessons from the United States Experience with Legal Abortion •••...•.. 119 P. G. Stubblefield Evolution of Second Trimester Abortion Techniques ••••••..••.••••.••.•.•.•• 125 W. M. Hern Training Physicians in Elective Abortion Technique in the United States .•...••.••..••••••••.••.•••••••••••••••••••.••••••••••••• 133 P. D. Darney Reducing the Risks of Pregnancy Termination •••••.•••••••••••••••.••••.••• 141 M. S. Rurnhill MENSTRUAL REGULATION: DELIVERY AND TRAINING Problem of Septic Abortion in Bangladesh and the Need for Menstrual Regulation • • • • • • • • • • • • • • • • • • . . • • • • • • • • • • • • • • . • • • • • • . • • • • . • • • • •• 149 S. F. Begum, K. .J alil Menstrual Regulation Service Delivery •••••••••.••.•.••••••••••.••.•••••.• 157 S. M. Kabir The Karman Syringe in Family Practice: Techniques, Safety, and Usage •••••••••••••••••••••••.••••••.••.•••••.•••.••.••••••.••• 163 K. Pannikar Traini.ng in Menstrual Regulation: The Philippine Experience ••••••••••••••••• 169 L. A. Alfonso xii DELIVERY OF ABORTION CARE IN HOSPITAL, CLINIC, OR PRIVATE SETTING: SAFETY, rOST, AND AcrESS Delivery of Abortion Care in the United States ••••••••••••••••••••••••••••• 175 J. D. Forrest Delivery of Abortion Care in Western Europe ••••••••••••••.•••.•••.••••••• 181 E. Ketting Induced Abortion Services in Asia .••.••.•.•.••..••.••••••••••••••••••.••• 187 R. P. Soonawala Counseling and Abortion Care ••..••••••••••••••••••••••••••••••••••••••. 191 U. Landy Contraception after Pregnancy Termination ••••.•••••••.••.••••••••.•••••• 197 A. Rosenfield MATERNAL MOFTALITY The Magnitude of Maternal Mortality: Definitions and Methocls of Measurement. . . • • • . • • • • • • • • • • . • • • . • . . • • • . • • • • • • • . • • • • • . • • • • • • •• 201 R. W. Rochat THE FUTURE OF WOMEN'S HEALTH Future Policies and Practices to Promote Women's Health .••••••••••.••..••• 215 L. Mehra INDEX •.•••••••••••••••••.•.•••..••.•••••••••••••••••.••••••••••••••. 233 xiii