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Some clinicians and ethicists in the first group object to the combined OCP based on good indirect evidence that it could cause the death of an early embryo.4 Others in this group broaden their moral opposition to include the primary effect of the OCP: direct suppression of fertility for procreative (family-planning) purposes. For the latter, moral objection to the OCP would continue even if it were proven that it was not an abortifacient. 5

Family planning (FP) program contributed to Egypt’s progress in reducing infant and maternal mortality and the total fertility and population growth rates. The Arab spring has brought to the forefront long-held aspirations, which can only be fulfilled by a clear shift to a rights-based and person-centered family planning approach and away from an imposed top-down program with targets for family size and fertility rate. The essence of a rights-based approach to FP is interacting with people as individuals with rights to control ones lives, not as a target of a particular program. The FP program also needs to determine and mitigate the factors that make it difficult for the poor, young, and marginalized groups to exercise rights to receive the services needed. The authors of this report examined the challenges facing Egypt’s FP program through a human rights lens, exploring whether individuals and couples are able to exercise their rights to financial and physical access to good quali...

Recent evaluations of large scale social interventions have used randomized control trial (RCT) designs that require the identification of comparable areas before the intervention is initiated so that some areas can be randomized to receive the intervention, while others serve as controls. An RCT begins with a baseline survey to collect data before the program is implemented and then a follow-up survey is conducted after the program has run long enough to have an impact. RCT are not only technically, programmatically, and financially difficult, but also delineating between treatment and control groups can be politically challenging. RCT also require lag times that are long enough (3-5 years) to ensure that impact can be validly measured. The remaining part of the report discusses the technical aspects of design and analyses for RCT of nutrition interventions and for the plausibility and the adequacy investigations. It presents technical information for evaluating nutritional interve...

Background Over 100 million women worldwide are using oral contraceptives pills (OCP) and mood changes were being as the primary reason for OCP discontinuation. The purpose of this study was to determine the prevalence and predicting factors of mood changes in oral contraceptive pills users. Methods This was a cross-sectional study of 500 women aged 15–49 years old using low dose (LD) pills attending family planning centers in Ahwaz, Iran. Data were collected via face-to-face interviews using a structured questionnaire including items on demographic, self-efficacy and mood change. Both univarate and multiple logistic regression analyses were performed to assess the relationship between reported mood change and the independent variables. Results In all 406 women reported that they did experience OCP side effects. Of these, 37.7% of women (n =153) reported mood changes due to OCP use. The results of multiple logistic regression revealed that place of living (OR = 2.57, 95% CI = 1.06-6...

To compare bleeding patterns between a 21/7-day triphasic norgestimate/ethinyl estradiol (E2) 25-microgram oral contraceptive pill (OCP) and a 24/4-day drospirenone/ethinyl E2 20-microgram OCP. In a three-cycle, open-label, multicenter study, healthy, sexually active women were assigned randomly to a 21/7-day (norgestimate/ethinyl E2) or 24/4-day (drospirenone/ethinyl E2) OCP regimen. Randomization was stratified to assure a balanced distribution between regimens for "fresh starts" and "switchers." Bleeding data were collected daily using an interactive voice-response system. Bleeding was defined according to the 2007 U.S. Food and Drug Administration's Reproductive Health Drug Advisory Committee-endorsed criteria. Across the three cycles, the 21/7-day OCP group (n=165) reported fewer unscheduled bleeding days than did the 24/4-day OCP group (n=167) (mean 4.6 compared with 6.1 days, P=.003). Women using the 21/7-day OCP had significantly fewer episodes of unscheduled bleeding than did those using the 24/4-day OCP (mean 1.47 compared with 2.01, P=.001). Moreover, women using the 21/7-day OCP had a significantly lower absence of scheduled bleeding at each cycle (P<.001). Both regimens were well-tolerated. A 21-day norgestimate/ethinyl E2 25-microgram regimen results in less unscheduled bleeding and more scheduled bleeding than does a 24-day drospirenone/ethinyl E2 20-microgram regimen. ClinicalTrials.gov, www.ClinicalTrials.gov, NCT00745901. I.

What factors must be weighed when deciding whether to promote local manufacturing of pharmaceuticals in developing countries? Andreas Seiter's note summarizes pros, cons and key issues. Pharmaceuticals are essential in every health care system. The objective of pharmaceutical policy is to make sure that there is a reliable supply of good quality medicines at affordable prices. Local manufacturing is sometimes offered as a potential solution to the access problem. Supporters of this concept suggest that local production in a developing country should result in a cheaper final product. Skeptics argue that small manufacturing units don't achieve economies of scale, and that higher unit costs outweigh potential advantages such as lower transportation costs.