clinical contraceptive services, like other clinical services, should be included in measures to prevent iatrogenic infections. Both clinical and community-based programs need to incorporate into guidelines for counseling some realistic assessment, and discussion, of clients' exposure to STDs, including HIV. Latex condoms and nonoxnynol-9 reduce the risk of STD transmission as well as unwanted pregnancy. As we argue in Chapter 3, family planning clinics providing insertion of IUDs should be able to supply standardized case management of symptomatic infections (using the World Health Organization algorithms) and selected screening efforts.

Information, Education, and Communication

The diffusion of information about modern contraception throughout the world in the last three decades has been a remarkable achievement. In 13 of the 22 countries where DHS surveys were conducted in 1990-1993, more than 90 percent of women said they had heard of one or more modern contraceptive methods. In all countries except Nigeria, more than one-half of the women had heard of one or more modern methods (Curtis and Neitzel, 1996). In every country except 4 of the 11 sub-Saharan African countries, more than one-half of the women had heard of the contraceptive pill, the best-known method worldwide. These survey questions have sometimes been criticized on the grounds that respondents claim knowledge out of politeness or so as not to appear ignorant (e.g., by Bongaarts and Bruce, 1995), but even without prompting, the majority of women in all but five countries could name at least one modern contraceptive method (Curtis and Neitzel, 1996). Men are even more likely than women to know at least one contraceptive method: in 15 countries where men were interviewed in DHS surveys, more than one-half of the men reported that they had heard of at least one modern contraceptive method (Ezeh, Seroussi, and Raggers, 1996).

Of course, knowledge that an option exists is not enough. Informed choice and effective use of contraceptives require basic knowledge of how a method works, what noncontraceptive effects it might have, and how to use it. There is evidence both from standardized survey questions and from more intensive interviews and observations that many women and men do not know such things, even in countries where family planning programs are well established. For example, in the DHS in Egypt in 1992, women who reported using the contraceptive pill were asked to show their packet of pills. Interviewers inspected the packets for evidence that the pills had been taken out of sequence, and they asked the women whether they had missed days and what they would do if they did miss a day. Thirty-seven percent of the women had missed taking at least one

The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement