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The Pop Reporter®

Volume 4, Number 17
26 April 2004

"The Pop Reporter" (R) Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs INFO Project When you click on any link below, your Internet browser will access a Web site not connected to "The Pop Reporter." Information accessed through these links and contained in this issue of "The Pop Reporter" does not necessarily state or reflect the views of the INFO Project, Johns Hopkins University, or the US Agency for International Development. All links were verified at the date of mailing. Your computer and/or network configuration regarding Java script, cookies, and other security issues may not allow you to view certain Web sites. Consult your computer technician if you are having problems.

GUEST EDITORIAL

"Missing Strings": Is it a Medical Emergency? Best Practices and Standards in Management of Family Planning Complications

by Shalini Shah, MBBS, DCH, MPH

shali777@hotmail.com

Recently, I participated in an interesting but unfortunate medical death audit of an IUD user. The 40-year-old client had an IUD inserted without event, but her strings were missing on the third day. Pregnancy was ruled out, and an x-ray confirmed that the IUD was not expelled.

An ultrasound was requested to confirm the position of the IUD (intrauterine or translocated into the abdominal cavity). The client postponed the investigation as she had no abdominal pain or other problems. On the sixth day prior to the ultrasound, the client was examined and an attempt made to remove the IUD as had been done in other clients earlier. Records showed that several cases of “missing strings” had been managed successfully at this center using dilatation and curettage (D&C) over the previous 9 months. The client developed pain and so the procedure was abandoned, and she was referred for the ultrasound. Subsequently, she was managed for acute abdomen pain. At laparotomy there was a uterine and intestinal perforation, and the IUD was in the pouch of Douglas. The patient died on the seventh day (related not to the insertion but the management of the complication).

This led to a review of all the available resources on standards and guidelines for the management of "missing strings" and other complications in family planning practice. There is a dearth of such materials and no explicit protocols and guidelines. Practice is often divorced from existing written and researched standards. "Missing strings" is not a medical emergency except to provide alternative family planning protection to the client. But often there is an urgency to "do" something. If the IUD is identified as intrauterine, Alligator forceps is recommended for removal, but there is also mention of D&C, which is the standard practice with some clinicians. A disposable, plastic instrument, "Retrievette®", has also been successfully used, and a plastic spiral curette (Mi-Mark) has been described for retrieval. But there is no last word on the safest procedure and when it should be used.

The gold standard set by the WHO eligibility criteria has made it easy for country governments to remove some of the barriers for women to access family planning. Similarly, WHO should develop comprehensive protocols, guidelines, and standards, based on research, on the safest procedures in the management of all complications that might be met with in family planning practice. This will help countries standardize procedures based on the best practices and train practitioners in its use. Policy makers, researchers, and standard-setting task force members should make this an urgent priority agenda for action.

Protocols from current research on existing practices and guidelines on “missing strings” is as follows:

Management of "Missing Strings"

Complication or side effect
•In the event of a missing IUD string, it must be determined whether the IUD is in utero, has been expelled, or has been translocated into the abdominal cavity.
•Pregnancy must be excluded.
•If pregnancy is excluded, an x-ray can confirm whether the IUD has been expelled.
•Until the IUD is located, the patient must be advised to use a back-up barrier method of contraception.

Determine degree of risk
•A pelvic examination can be performed to determine if the strings are hidden by a fold in the vagina or are high in the cervix. The string may be teased from the endocervical canal (by inserting a cytobrush or similar device into the endocervical canal and withdrawing it slowly).
•The client can be asked to check her strings after the next period if she has no abdominal pain and the string may be found at the cervical os during the next menses.
•If the string is determined to be absent after the next menses, pelvic ultrasonography or x-ray can be used to locate the IUD.

Management
•If the IUD is in utero and the client prefers that the IUD be removed, or if the replacement time is approaching, an attempt to extract the IUD from the uterine cavity should be made after pregnancy has been excluded.
•Extraction should be performed with an Alligator forceps or a specially designed IUD removal device and must be done by a clinician trained and experienced in intrauterine instrumentation. Use of a curette (D&C) for removal of an IUD can be very dangerous. Alligator forceps is ideal for removal of the IUD and has minimal risk of perforation.
•A paracervical block may make intrauterine probing less painful.
•If the client prefers to keep the IUD in place, it can be left in place.
•Translocated intraperitoneal devices can be removed by laparoscopy or laprotomy as soon as is medically feasible.

Dr. Shah is presently a free lance consultant serving in India, Bangladesh, and the US.

References:

1. Ismail H, Mansour D. The 'tail' of a missing intrauterine contraceptive device. J Fam Plann Reprod Health Care. 2002;28(2):96-7.
2. Millen A, Austin F, Bernstein GS. Analysis of 100 cases of missing IUD strings. Contraception. 1978;18(5):485-95.
3. Barsaul M, Sharma N, Sangwan K. 324 cases of misplaced IUCD--a 5-year study. Trop Doct. 2003;33(1):11-2.
4. Pap de Pesteny M, Solheim F, Akerlund M. A solution to the problem of "missing" IUD threads. Acta Obstet Gynecol Scand. 1986;65(1):89-91.
5. Planned Parenthood Federation of America, Inc. Manual of Medical Standards and Guidelines, Section IV-A-2, IUD Use; 2003.

FAMILY PLANNING/REPRODUCTIVE HEALTH RESEARCH

Gender Differences in Health Care-Seeking Behavior for Sexually Transmitted Diseases: A Population-Based Study in Nairobi, Kenya (research abstract)
This study describes the proportion seeking care, patient delay, and choice of provider among men and women with STD-related complaints in Nairobi, Kenya. Of 291 respondents reporting complaints, 20% of men versus 35% of women did not seek care, mainly because symptoms were not considered severe, symptoms had disappeared, or as a result of lack of money. Of those who sought care, women waited longer than men (41 vs. 16 days). Most men and women went to the private sector (72% and 57%, respectively), whereas the informal sector was rarely visited (13% and 16%, respectively). More women than men visited the government sector (28% vs. 15%). Because women were mostly monogamous, they did not relate their complaints to sexual intercourse, which hampered prompt care-seeking.

Organizing Work Better (report)
(You need Adobe Acrobat Reader to access this document)
This issue of Population Reports focuses on "Organizing Work Better." From the summary: "Family planning and other health care organizations in developing countries increasingly must do more with the same resources, and sometimes with fewer. Reorganizing work processes offers one common-sense way to help staff members at all levels cope with growing demands. Whether you are a clinic manager, front-line provider, program supervisor, or district-level manager, you can improve how work is organized and performed. Often, simple changes enable organizations to serve clients better, offer more satisfying work to the staff, operate more effectively, cut waste, and even reduce or recover costs."

Consistency of Self-Reported Sexual Behavior and Condom Use Among Current Sex Partners (research abstract)
The aim of this study was to determine concordance in sex partner reports of frequency of vaginal and oral intercourse and condom use. Researchers from the Universitys of California and Michigan investigated the self-reported behaviors among 112 women treated for urinary tract infection (UTI), sore throats, or receiving birth control at a student health service and compared them with those of their current sex partner. Correlation was excellent for frequencies of vaginal intercourse, cunnilingus, fellatio, and condom use, but women with UTI compared with women without UTI reported greater frequency of sexual activity than their sex partner. Researchers noted that this effect overwhelmed the modest increases in correlation associated with duration of relationship and marital status.

Attitudes of Married Individuals towards Oral Contraceptives: A Qualitative Study in Istanbul, Turkey (PubMed abstract)
Researchers from the Department of Public Health, Marmara University, Istanbul, conducted 20 focus group discussions to determine positive and negative attitudes of married Turkish women and men regarding the use of oral contraceptives (OCs). They found that most of the negative attitudes relating to OCs stemmed from concerns over side effects, particularly in the male focus groups. Factors limiting the uptake of OCs included health care professionals' behavior, lack of concern or bias, and their reluctance to prescribe. The female groups had very positive attitudes towards OCs compared to those of the male groups. The researchers conclude that beliefs and attitudes towards OCs are important factors to consider for education interventions in consumer and health care provider groups.

The Concerns During Assisted Reproductive Technologies (CART) Scale and Pregnancy Outcomes (news article)
Related news article: Researchers: Worry Affects Female Fertility
A team at the University of California San Diego found that women who worried about either the medical aspects or the cost of their assisted reproductive technology cases were less likely to become pregnant than women who are less concerned. They studied 151 women seeking in vitro fertilization, also known as IVF, or another procedure called GIFT. The women filled out questionnaires about concerns relating to treatment side effects, surgery, anesthesia, pain recovery, finances, missing work, and having a baby. Women who worried about the medical aspects of the procedure had 20% fewer eggs retrieved and 19% fewer eggs fertilized than women who were less inclined to worry about it.

Birth of Parthenogenetic Mice That Can Develop to Adulthood (research abstract)
Related news article: Fatherless Mouse Conceived Without Sperm
Japanese researchers have demonstrated for the first time how mammals can reproduce without a male, leading to the birth of apparently healthy baby mice by mixing two sets of female genes inside an egg.

Genital Herpes in a Sexually-transmitted Infection Clinic in Singapore: A 1-year Retrospective Study (research article)
(You need Adobe Acrobat Reader to access this document)
This study describes the clinical features of genital herpes seen in a STI clinic in Singapore over a 1-year period and the characteristics of the affected population. There were 324 cases of genital herpes (259 males, 65 females). Of these, 153 (47.2%) were first-episode and 171 (52.8%) were recurrent HSV infections. More males were affected than females in a 4:1 ratio, and the peak incidence was seen in the 26- to 30-year-old age group.

FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS

Majority of World's Couples of Reproductive Age Using Contraception (press release)
Worldwide, 61% of all women of reproductive age who are married or in a consensual union are using contraception. This percentage amounts to 635 million of the more than 1 billion women aged 15-49 who are married or in union. In the more developed regions, 69% of those women use a method of contraception, while in the less developed regions 59 per cent do so. In Africa, the corresponding percentage is a low 27%, whereas in Asia and Latin America and the Caribbean the equivalent proportions are much higher, at 64% and 71%, respectively. These are some of the key findings presented in the wall chart on World Contraceptive Use 2003, issued by the United Nations Department of Economic and Social Affairs’ Population Division.

FAMILY PLANNING/REPRODUCTIVE HEALTH LAW AND POLICY

Pro-Choice March Largest in History (news article)
More than one million pro-choice activists converged in the nation's capital Sunday to protest the government's persistent effort to chip away at women's reproductive and health rights.

HIV/AIDS RESEARCH

Can Highly Active Antiretroviral Therapy Reduce the Spread of HIV?: A Study in a Township of South Africa (research abstract)
This community-based study in a township near Johannesburg, South Africa finds that the population impact of HAART on reducing sexual transmission of HIV-1 is likely to be small under current WHO guidelines. The authors write that reducing the spread of HIV-1 will depend on further strengthening conventional prevention efforts.

Declining HIV Gives Hope in Cambodia: Targeted Condom Promotion Credited for Fall in Prevalence (research summary)
(You need Adobe Acrobat Reader to access this document)
This publication by Population Services International examines the decrease in HIV prevalence in Cambodia, which the World Health Organization has attributed to the government's 100% condom use policy in commercial sex establishments and the work of NGOs supporting that policy. Condom use among brothel-based sex workers is reported to have more than doubled from 1997 to 2002, and the share of new HIV infections resulting from commercial sex has plummeted from 80%-90% to 21% in 2002. Cambodia has followed the example of Thailand, where HIV prevalence fell dramatically after the government implemented a 100% condom use policy in 1989. This certainly does not mark an end of the epidemic in Cambodia but does show that well-targeted social marketing efforts, including the strategic promotion of condoms, can have a significant impact on the epidemic.

Impact on Mortality of the AIDS Epidemic in Northern Namibia Assessed Using Parish Registers (research abstract)
HIV spread rapidly in Namibia in the 1990s and, as in most of Africa, few data exist to document the impact on mortality of AIDS. Researchers conducted this study to analyse death records from the registers of eight Evangelical Lutheran parishes in northern Namibia. They examined trends in post-neonatal and 1-4-years mortality, and the age-standardized death rates at age 20-64 years of both men and women. They found that post-neonatal mortality increased more than sixfold and 1-4-years mortality more than threefold between 1991 and 2000. By 2000, adult mortality for women was 3.5 times, and for men 2.5 times, its 1993 level. The increase in adult mortality was concentrated at ages 30-54 years for men and 25-49 years for women. The authors conclude that the pattern of mortality increase by age is consistent with the hypothesis that it is entirely due to AIDS, and they suggest that parish registers can potentially be a low-cost source of data for study of the impact of AIDS on mortality and demographic trends more generally.

Origin of AIDS: Contaminated Polio Vaccine Theory Refuted (research abstract)
Related news article: Definitive Evidence That HIV-AIDS Is Not from Oral Polio Vaccine
HIV-AIDS did not come from oral polio vaccine contaminated with chimpanzee virus, reports a research team led by a University of Arizona evolutionary biologist. Belief that polio vaccine can spread AIDS has hampered the World Health Organization's efforts to stamp out polio. In Nigeria, several states recently banned use of the vaccine. Nigeria now has the highest number of polio cases in the world. Although scientists agree that HIV comes from a chimpanzee simian immunodeficiency virus (SIV) that infected humans, when and how SIV jumped the species barrier has not been definitively determined.

HIV/AIDS NEWS

Russian AIDS Workers Wage Battle on Edge of Epidemic (feature article)
Russia reported 163 cases of HIV infection in 1994, but now an estimated 1 million have contracted the disease, according to this feature article from USA Today. Every hour in Russia, five people are infected. But thus far, there are few signs that the government of President Vladimir Putin is taking the AIDS problem seriously. President Vladimir Putin's government still does not take the epidemic seriously, according to the article. Drug treatment and AIDS prevention efforts are still virtually non-existent. However, a United Nations report in February said one Russian adult in every 100 now had the virus, giving Russia one of the highest infection rates in the world.

AIDS and India (commentary)
In this commentary, by Melinda French Gates relates her experiences on her recent trip to India.

HIV 'Gel' Tested on South African Women (news article)
Human testing of a microbicide to prevent women becoming infected by HIV has begun in South Africa and several other countries in sub-Saharan Africa. It could also prevent infected women transmitting HIV to men. In South Africa, five research institutes have collaborated in the animal testing phase, and the final phase of human testing has begun with more than than 10,000 women taking part.

St. Petersburg, Russia: Half of All Prostitutes In City Have HIV (news article)
One in every 10 HIV-positive Russians lives in St. Petersburg and almost half of prostitutes in the city are infected with HIV, the latest studies show.

China: Free AIDS Drugs Trigger Strong Side Effects (feature article)
For most HIV/AIDS sufferers in China, the free medication scheme initiated last year brought a ray of hope. Yet for others, the strong side effects triggered by the medicine eroded their enthusiasm for embracing the government's effort to combat the deadly virus.

Canada: Groups Call for More Amendments to AIDS Bill (news article)
Groups working to get drugs to countries ravaged by AIDS and other diseases say changes to proposed federal legislation don't go far enough.

Ethiopia: New Project Launched to Help HIV/AIDS-affected Families (news article)
A US$6.3 million community care campaign for families affected by the HIV/AIDS pandemic has been launched in Ethiopia. The UN World Food Programme and the government’s HIV/AIDS Prevention and Control Office jointly set up the project to support HIV/AIDS affected households, women, and children.

China Approves Traditional Medicine for AIDS Patients (news article)
Chinese authorities have for the first time approved the use of a traditional medicine to help treat patients with HIV/AIDS. The medicine, known as Tangcaopian (which means 'traditional herbal pill'), was licensed by the State Food and Drug Administration earlier this month.

South Africa: Risking HIV to Access Grant (news article)
The South African government expressed concern this week after a news report highlighted the story of a young woman who admitted she was thinking of contracting HIV in order to access a disability grant.

MATERNAL AND CHILD HEALTH RESEARCH

Urbanization, Development, and Under-five Mortality Differentials by Place of Residence in São Paulo, Brazil, 1970–1991 (research article)
This paper examines differentials in under-five mortality by place of residence for the state of São Paulo, Brazil: between urban and rural areas, and by location within urban areas, over a 21-year period (1970 and 1991).

Reducing Maternal Mortality in Mozambique: Challenges, Failures, Successes and Lessons Learned (research abstract)
This paper describes different approaches to make emergency obstetric care accessible to women in Mozambique. The authors present four projects: (1) José Macamo and (2) Mavalane Hospitals in Maputo city, (3) Manhiça District in Maputo Province and (4) Sofala Province.

Experience from Bangladesh: Implementing Emergency Obstetric Care as Part of the Reproductive Health Agenda (research abstract)
This paper describes the activities of the Ministry of Health and Family Welfare of the Government of Bangladesh and UNFPA to introduce emergency obstetric care services into the reproductive health care agenda.

Crossing the River: Health of Mothers and Children in Rural Cambodia (research abstract)
This article describes the health situation of mothers and children living in rural areas of Cambodia through both quantitative data and narratives. It portrays their health-seeking behavior and examines factors prohibiting people from getting medical help and discusses ways to improve accessibility.

Beyond Bellagio: Addressing the Challenge of Sustainable Child Health in Developing Countries (research abstract)
The author argues that, in order to make a meaningful contribution to maternal and child health and survival, a multi-pronged approach is needed that not only focuses on the proximal determinants of child health but also some of the underlying factors governing the status of women in society and expenditures on health and development.

Breastfeeding and Maternal HIV-1 Disease Progression and Mortality (research abstract)
This study examined the association between breastfeeding and disease progression among HIV-infected women in Dar es Salaam, Tanzania. The researchers found that neither breastfeeding status nor the duration of exclusive or partial breastfeeding was associated with HIV-1 disease progression, represented by death or development of a low CD4 cell count, anemia or excessive weight loss, in multivariate analyses. From their findings they conclude that there is insufficient evidence to support the hypothesis that breastfeeding is detrimental to the health of HIV-infected women.

MATERNAL AND CHILD HEALTH NEWS

Pakistan: Need for Skilled Birth Attendants Imperative (feature article)
The need for skilled birth attendants in Pakistan, where about 60 women are reported to die daily because of pregnancy-related complications, is absolutely imperative and needs to be linked and backed up by emergency obstetrics care and services at health facilities, according to a United Nations Population Fund official.

One in Five Canadian Babies Delivered by C-section, an All-time High (news article)
Canada's caesarean section rate has reached an all-time high, with one in five babies born using the surgical method in 2001-2002, according to a new report. The report released last week by the Canadian Institute for Health Information found C-sections accounted for 22.5% of in-hospital deliveries during that period.

Nigeria: Government Urged to Reduce Child Mortality Rate (news article)
The federal government has been urged to intensify action on its commitment to improving the health of Nigerian children through immunization, better nutrition, and malaria control if it intends to win the current war against high mortality rates among children under 5 years of age.

Angola: Few Pregnant Women Access Medical Services (feature article)
Despite the fact that Angola has one of the world's highest infant and maternal mortality rates, few pregnant women are accessing the available medical services. The maternal mortality rate in Angola is 1,000 deaths per 100,000 births, while the mortality rate for infants reaches 250 per 1,000 births. Only Sierra Leone and Nigeria have infant mortality rates worse than Angola's.

MEN'S HEALTH NEWS

Impotence Still Taboo Subject with British Men (news article)
Fourteen percent of British men who suffer from impotence have suicidal thoughts and many wait years before seeking help, according to a survey of 1,000 men in Britain. Fourteen percent of men with the problem said it affected their family life, and 6% reported it had caused a break up in a relationship.

Viagra Gives Sperm a Boost (news article)
Related research abstract: Effect of Acute In Vivo Sildenafil Citrate and In Vitro 8-bromo-cGMP Treatments on Semen Parameters and Sperm Function
Viagra enhances a man's chances of becoming a father in more ways than one. The anti-impotence drug increases the motility of sperm and boosts its ability to bind to an egg.

POPULATION RESEARCH

World Population Policies 2003 (report)
Related press release: United Nations Issues "World Population Policies 2003"
This publication provides an overview of population policies for every country as of 2003, and at mid-decade for the 1970s, 1980s and 1990s —- that is, at the time of the United Nations international population conferences at Bucharest, Mexico City, and Cairo. The study includes information on national population policies in relation to population growth, population age structure, fertility, mortality, spatial distribution and international migration. In order to provide the proper background, key demographic indicators are also presented for each country.

POPULATION NEWS

Population of Turkmenistan Continuing to Grow (news article)
Turkmenistan's population increased 6% to 6.367 million as of April 1, 2004. The population of Turkmenistan grew by 68,200 in the first quarter of this year, according to a quarterly report of the National Statistics and Information Institute Turkmenmillikhasabat.

Russia's Economic Growth Led to Baby Boom (news article)
Since 1999, the birth rate has been on the rise in Russia. Experts attribute this growth to economic recovery and the increase of real incomes of the population. According to data of the State Statistics Committee, last year the birth rate increased by 6.1% on 2002 to 1,359,800 babies, or 76,700 more than in the previous year. Today there are 10.4 newborns per thousand of the population.

Australia: Majority of Couples Shun Parenthood (news article)
Childless couples will become the average Australian family in 17 years, a national statistics report predicts. The change is being driven by the ageing of the population and the decision by more couples not to have children.

Disease Epidemics 'Likely' (news article)
A growing global population and unprecedented international travel have put humankind at risk of uncontrollable outbreaks of potentially hundreds of new diseases, a virus expert has warned.

Canadian Birth Rate At All Time Low (news article)
Canada’ birth rate fell its lowest level since 1921 two years ago. That’s an all-time low. In 2002 Canadian women gave birth to 328,802 babies, down 1.5% from the year before. It was also the eleventh decline in 12 years. The decline is also reflected in a drop in Canadian women's fertility rate as measured by Statistics Canada.

WOMEN'S HEALTH RESEARCH

Drug Use, Sexual Behaviours and Practices among Female Sex Workers in Hanoi, Viet Nam: A Qualitative Study (research abstract)
The authors examined the causes of a rapid increase of HIV infection among female sex workers (FSWs) in Hanoi, Viet Nam. Thirty-seven FSWs in different districts were recruited for in-depth interviews and group discussions about drug use and sexual behavior. The FSWs reported higher condom use with irregular clients, although use was still low with regular clients and their love mates. The authors found that drug use is common, and many FSWs inject, especially street-based FSWs. Drug-injecting street-based FSWs are the highest risk sex worker group for HIV infection, and potentially serve as a major bridge through their clients to the general population.

Cervical Cancer as a Priority for Prevention in Different World Regions: An Evaluation Using Years of Life Lost (research abstract)
Related news article: Cervical Cancer Still Cutting Many Lives Short
Researchers found that, on a global basis, cancer of the cervix is responsible for about 2% of the total (weighted) years of life lost (YLL), fewer than for other causes of mortality in young and middle-aged women (25-64 years old). However, it is the most important cause of YLL in Latin America and the Caribbean. It also makes the largest contribution to YLL from cancer in the populous regions of SubSaharan Africa and South-Central Asia where the actual risk of loss of life from this cause is higher, although overshadowed by noncancer deaths (from AIDS, TB, and maternal conditions). The researchers write that the fact that most of the loss of life is preventable, and that simple technologies have been developed that make this practicable, means that cervical cancer has an even higher profile from the perspective of resource allocation in low income settings.

Staging Reproductive Aging: A Comparison of Proposed Bleeding Criteria for the Menopausal Transition (research abstract)
In this study, researchers evaluated five proposed bleeding criteria or markers for the onset of early menopausal transition and four criteria for the onset of the late transition.

Prevalence and 3-Year Incidence of Abuse Among Postmenopausal Women (research abstract)
Related news article: Older Women Abused As Often As Younger Ones: Study
Women in their 50s and beyond report physical and verbal abuse at a rate similar to that of younger women, this large US study shows. At the outset, the study of nearly 92,000 women ages 50 to 79 found that 10,200 had been abused some time in the past year. Three years later, more than 2,400 more women reported abuse. Overall, 11% of women reported some form of abuse at the study's start, with 89% of them saying they'd been subjected to verbal abuse alone.

WOMEN'S HEALTH NEWS

Married as Children, Women With Obstetric Fistulas Have No Future (feature article)
This feature article from Population Reference Bureau relates how devastating obstetric fistula can be by providing data and personal stories from women with the condition and those working to prevent and treat the problem worldwide.

Special Rapporteur on Violence Against Women Warns of Threats to Gains on Women's Human Rights (press release)
The Special Rapporteur on violence against women has addressed the Commission on Human Rights, warning against alarming trends toward political conservatism and backlash which threatened the gains made thus far in the global women's human rights agenda.

Study Finds Promise in Fertility Remedy (news article)
A small US university study suggests a nutritional supplement marketed as "Fertility Blend" may help some women conceive. The supplement was tested on 30 volunteers who had been unable to become pregnant. Half took Fertility Blend three times a day, while the other half were given a placebo. Five of the women taking the supplement became pregnant within 5 months, and four gave birth to healthy babies. None of the women in the placebo group conceived.

Uzbekistan: Focus on Domestic Violence (feature article)
This feature article describes the efforts of those working in government and NGOs in Uzbekistan to help victims of domestic violence.

Turkmenistan: International Gender Conference Underway (news article)
A two-day conference on the protection of rights of women and children kicked off last Friday in the Turkmen capital, Ashgabat, organised by the International Organization for Migration, UNICEF, and the Ministry of Justice of Turkmenistan.

Biotech Firm Joins Quest for Female Viagra (news article)
A small healthcare company thinks it can succeed where the makers of Viagra have failed -- by curing women with low sex drives. The search for a treatment for female sexual dysfunction, abandoned by the world's biggest drug company, Pfizer, 2 months ago, is showing positive results at the labs of Futura Medical, according to the company. The sexual healthcare specialist, based in southern England, has begun pilot testing its FLD500 ointment, though on just four women, giving each various doses, along with placebos.

YOUTH HEALTH RESEARCH

Preventing HIV/AIDS among Adolescents through Integrated Communication Programming (report)
(You need Adobe Acrobat Reader to access this document)
This manual focuses on HIV prevention through integrated communication programming that blends advocacy, behavior change communication, and education interventions.

Prevalence of Sexually Transmitted Infections and Mental Health Needs of Female Child and Adolescent Survivors of Rape and Sexual Assault Attending a Specialist Clinic (research abstract)
Researchers used a retrospective review of case notes of 98 females aged 16 or less, who attended a specialist clinic over a 5 year period (1996–2000). They found that the overall prevalence of STIs was 26%. The overall prevalence of vaginal candidiasis was 17% and bacterial vaginosis 13%. More than one third of the study population gave a history of previous sexual, physical, or other abuse.

YOUTH HEALTH NEWS

Launch of "Code of Conduct" for Travel Industry to Protect Children from Sex Tourism (press release)
Related news article: Code Seeks to Protect Children from Sex Tourism
UNICEF joined the World Tourism Organization and the international advocacy group ECPAT (End Child Prostitution, Child Pornography and the Trafficking of Children for Sexual Purposes) in launching a "Code of Conduct" for the North American travel industry. The code is designed to protect children from commercial sexual exploitation.

China: Students Find Sex Education Inadequate (feature article)
Once taboo, sex education courses have been added to the curriculum of 200 of Beijing's 567 high schools since 1989, according to Song Yuzhen, director of the Moral Education Department of Beijing Education Commission. But not all students find the course attractive.

Sierra Leone: Looking At the Future: Who Will Save Africa's Orphans? (feature article)
This feature article, from allafrica.com, focuses on the efforts of one foundation--the Matthew 6 Foundation--to make a difference in the lives of children orphaned by the AIDS epidemic.

Alongside Abstinence, Give Youngsters Something to Do: AIDS Campaigners (news article)
A Kenyan anti-AIDS organization has welcomed a new US initiative prompting abstinence as the best means to combat the epidemic in East Africa and the Caribbean, but it says the measure should be accompanied by funding to help younger people find something constructive to do.

Madagascar: Concern Over Rising Child Trafficking (news article)
Malagasy authorities have voiced their concern over the increase of child trafficking on the Indian Ocean island following the recent arrest of eight men accused of running an illegal adoption ring. During a raid last week on a house in the capital, Antananarivo, police found 11 babies between the ages of three weeks and nine months in the process of being sent abroad.

Togo: Child Prostitution Goes Unchecked in Togo (feature article)
This feature article addresses the problem of child prostitution in Togo.

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