Research on Reproductive Health at WHO: Pushing the Frontiers of Knowledge, Biennial Report

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So far, women have stopped participating in the study, and have switched groups from female to male and 10 from male to female condoms. Participants will be followed up for a maximum of 12 months. A study is planned among sex workers in Johannesburg, South Africa, to determine whether female condoms prevent exposure to sexually transmitted pathogens as effectively as male condoms. The women will take self-collected vaginal swabs before and after intercourse, and used condoms will be assessed for the presence of STI organisms in the ejaculate.

A pilot project to assess the practicality and acceptability of the trial protocol started in and the experience will be used to design and implement the main phase of the project. Microbicidal gels or creams that can be applied in the vagina are new products that have the potential to protect both the woman and her partner against STIs, including HIV.

HRP has just completed a three-centre trial of the safety and acceptability of one such product, cellulose sulfate gel. All infants will receive one dose of nevirapine within 72 hours of birth. All mothers will be counselled on infant feeding choices. Those opting not to breastfeed will receive free formula milk; those choosing to breastfeed will be advised to stop after 6 months.

The primary objectives of this part of the study are to assess the rates of AIDS-free maternal survival and HIV-free child survival, and to assess the acceptability and safety of ARV drugs. These women will be aswith that of swabs collected by a clinician. The efficacy and safety of in the vagina are new products that have the overall aim of optimizing the use of antiretroviral the two regimens will be compared.

Some and postpartum periods, both to prevent MTCT Five sites have been identified for the study products also have contraceptive effects. In col- and to preserve the health of the mother. The study is sulfate gel. The trial was conducted in Kampala followed for two years after childbirth. A total of women were enrolled; half ment, i. The women of zidovudine, lamivudine and nevirapine. Transient emergence of resistant HIV strains in both groups generally found the product easy Those who do not require treatment, or who has been reported following use of short-course to use, and no serious adverse events were have contraindications to the triple regimen prophylaxis in MTCT prevention, particularly reported.

Almost all the women said that, if the ,will be offered a short-course regimen for with single-dose nevirapine. However, it is not product was proven to work, they would buy it or MTCT prevention, comprising zidovudine known whether this has any impact on the effirecommend it to others. To assess this possibility, HRP genital symptoms or colposcopy findings.

Thus, has developed a protocol for an observational cellulose sulfate appears to be as safe and well study of women receiving ARV therapy, who had tolerated as K-Y Jelly. Further studies of the HRP is collaborating with previously been exposed to low-dose nevirapine effectiveness of the product in preventing HIV researchers from France and the compared with women with no prior antiretrovitransmission and pregnancy are planned. USA to conduct a multicentre ral expsoure. Due to financial constraints HRP is study in several African unable to support research in this area and the Reducing mother-to-child study will be implemented by the US Centers for countries, with the overall Disease Control and Prevention, with WHO beaim of optimizing the use of transmission of HIV ing represented in the study working group.

The study will be nested within a study looking at the effect of administration of misoprostol before surgical abortion on the incidence of complications. The nested study will involve 11 sites and approximately women. By December , recruitment had started at ten sites, and enrolment at all 11 sites is expected to be completed in WHO defines unsafe abortion as a procedure for terminating an unintended pregnancy, either by persons lacking the necessary skills or in an environment lacking the minimal medical standards, or both.

HRP has continued to document the magnitude of the problem of unsafe abortion and its related mortality. Furthermore, study teams often play a crucial role in improving the quality of care, introducing improved techniques and developing guidelines for services.

Incidence of unsafe abortion HRP maintains a database on unsafe abortion and periodically produces updated estimates of numbers of unsafe abortions and related mortality. The most recent estimates, using information for the year , suggest that some 19 million Analysis of the available data on abortion by age shows that two-thirds of unsafe abortions are performed on women aged between 15 and 30 years.

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Where maternal mortality is generally low, a small number of unsafe abortion-related deaths may account for a substantial percentage of maternal deaths, e. The age pattern of unsafe abortion differs considerably between regions Fig. Knowledge of age patterns is essential to a better understanding of the local situation and to tailoring interventions to prevent unsafe abortion. Unsafe abortion and contraception Since contraception and abortion are two means of regulating fertility, it seems self-evident that increased use of contraception will lead to a decrease in induced abortion.

However, in some countries rising levels of contraceptive prevalence have been accompanied by a rise Analysis of the available data on abortion by in the number of abortions. To try to shed some age shows that two-thirds of unsafe abortions light on this apparently contradictory situation, are performed on women aged between 15 and HRP supported a review of existing evidence on the relationship between abortion and contraceptive use.

Careful analysis showed that, where fertility is relatively constant, increased contraceptive use is, indeed, associated with a fall in the incidence of abortion. However, where fertility is falling rapidly, both abortion and contraceptive use may rise in parallel initially, most probably because contraception alone is not sufficient to meet the demand for fertility regulation.

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However, in the long run, increased use of modern contraceptives leads to a decline in the incidence of induced abortion. Abortion in a legally restricted context HRP is supporting studies to determine the incidence of abortion in particular circumstances.

The study suggests a rate of 40 abortions per women of reproductive age in the Colombo District. A study in the country is documenting the incidence of abortion and investigating pathways to abortion, using interviews with women of reproductive age and focus group discussions. The results of the study are expected at the end of Even when safe, vacuum aspiration is an invasive procedure and many women prefer to avoid surgery. Medical, or drug-induced, abortion appears to offer an attractive alternative.

Since the s, HRP has supported numerous studies aimed at finding the optimum drug combination for medical termination of pregnancy. Clinical trials A number of clinical trials have recently been completed, or are still under way, to identify how far the doses of the drugs used for medical abortion can be reduced without affecting their efficacy, and to determine the best modes of In , HRP conducted a systematic review of administration.

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Misoprostol is currently ers in hygienic conditions. In many countries Table 4. The results of this relatively small trial were encouraging, and demonstrated a need for larger trials to test the effectiveness of sublingual administration and eventually to test a lower dose. A total of women were recruited, with a mean menstrual delay of 4. Retrospective serum analysis showed that of the women were actually pregnant at the time of admission. Among the pregnant women, This rather high pregnancy rate is of concern, and further work is needed to assess this regimen.

The target is to include a total of women; the clinical phase is expected to be completed by the end of In the first study, over women requesting legal termination of early pregnancy in 11 centres were given three doses of 0. The second study involved women requesting legal termination during the second trimester. These women were given 0.

The results of these studies of misoprostol-alone regimens will be available by the end of Mid-level providers and surgical abortion A trial is under way in South Africa and Viet Nam to investigate the safety of surgical abortions performed by medically trained and government-certified mid-level providers e. The study sample com- A trial is under way in South Africa and Viet Nam to investigate the safety of surgical abortions performed by medically trained and governmentcertified mid-level providers e.

In Viet Nam, women have already completed follow-up. Comparative results from the two countries are expected by the end of Most complications during surgical termination of pregnancy occur during dilatation of the cervix. A large randomized trial is investigating the benefits and disadvantages of misoprostol when administered vaginally three hours prior to vacuum aspiration. The study is also comparing the rates of immediate and late complications between groups given misoprostol and a placebo.

The clinical phase of this trial is expected to be completed by the end of New York, United Nations, ; paragraph The document provides a comprehensive overview of the many actions that can be taken to ensure access to good-quality abortion services as allowed by law.

It covers the public health challenge of safe abortion services, clinical care for women undergoing abortion, putting services in place, and legal and policy considerations. The document has been widely distributed to governments, professional associations, United Nations and other partner agencies, public health and research institutions, and nongovernmental organizations.