Table Of ContentPrevention 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
