Journal Articles

Long-Acting and Permanent Contraception: An International Development, Service Delivery Perspective
Recent scientific findings about long-acting and permanent methods of contraception underscore their safety, effectiveness, and wide eligibility for individuals who desire them. This has led to new guidance from the World Health Organization to inform national policies, guidelines, and standards for service delivery. Although developing countries have made much progress in expanding the availability and use of family planning services, the need for effective contraception in general (and long-acting and permanent methods in particular) is large and growing because the largest age cohorts of people in human history are entering their reproductive years. More than half a billion people will use contraception in developing countries (excluding China) by 2015, an increase of 200 million over levels of use in 2000. The health, development, and equity rationales that historically have underpinned and energized the international family planning effort remain valid and relevant today. Despite the other compelling challenges faced by the international health community, the need to make family planning services more widely available is pressing and should remain a priority.
Journal of Midwifery & Women's Health Volume 52, Issue 4, July-August 2007, pages 361-367  Special Issue - Global Perspectives on Women's Health: Policy and Practice

The changing position of IUDs in reproductive health in developing countries: opportunities and challenges
The shared goals of contraceptive development and service delivery efforts are to help individuals and couples achieve their fertility intentions in a healthy, affordable, and timely manner. Some would believe that now that contraceptive use has reached 60% in developing countries, there is little need for further investment in product research and development or family planning service delivery for developing countries. The expected growth (40%) in the demand for contraception by 2025 and the prevailing levels of unmet need for contraception (17%) in developing countries suggest that continued efforts to ensure that health systems and donors support family planning services are necessary. The IUD has the potential for enhancing women's health and the ability to both space and limit births at an affordable cost. Organizations involved in product research and development can join with service delivery partners to make new products more accessible to individuals in developing countries.
Contraception Volume 75, Issue 6, Supplement 1, June 2007 pages S35 - S40.

Factors Affecting Vasectomy Acceptability in Tanzania
Calls for increased inclusion of men in matters of reproductive health emphasize the need for research into vasectomy acceptability and decision making. Vasectomy is a safe, simple, and effective method of contraception, but is underused worldwide. Focus group discussions and in-depth interviews were conducted with potential and actual sterilization clients and their partners in the Kigoma Region of Tanzania. Content analysis was used to search for emergent themes related to vasectomy decision making. Six themes emerged as overarching factors contributing to the vasectomy decision-making process: economics, spousal influence, religion, provider reputation and availability, uncertainty about the future, and poor vasectomy knowledge and understanding. There was substantial communication between partners regarding the vasectomy decision, and wives had a strong influence on the outcome; however, men and women agreed that husbands would resist vasectomy if wives initially raised the topic. Vasectomy acceptance is limited by the scarcity of skilled vasectomy providers and by the fact that men and women hold many of the same misunderstandings about vasectomy, including a fear of decreased sexual performance as a result of the procedure. Spousal discussions are important in the decision to get a vasectomy, but these discussions should be initiated by the male partner. Programs need to educate men about contraceptive options, including vasectomies. Detailed, culturally relevant knowledge of the barriers and facilitators individuals experience during their decision-making process will enable vasectomy promotion programs to more successfully target appropriate populations.
International Family Planning Perspectives Volume 33, Number 1, March 2007 pages 13-21.

Vasectomy surgical techniques in South and Southeast Asia
Simple ligation of the vas with suture material and excision of a small vas segment is believed to be the most common vasectomy occlusion technique performed in low-resource settings. Ligation and excision is associated with a risk of occlusion and contraceptive failure which can be reduced by performing fascial interposition along with ligation and excision. Combining fascial interposition with intraluminal thermal cautery could be even more effective. The objective of this study was to determine the surgical vasectomy techniques currently used in five Asian countries and to evaluate the facilitating and limiting factors to introduction and assessment of fascial interposition and thermal cautery in these countries.
BMC Urology Volume 5, Number 10, May 2005