Udhibiti wa uzazi

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Udhibiti wa uzazi
Mwainisho na taarifa za nje
MeSHD003267

Udhibiti wa uzazi (pia udhibiti wa uwezo wa kuzaa au kontraseptivu) ni juhudi za kuratibu uzazi kwa sababu mbalimbali. Upangaji, utoaji na utumiaji wa udhibiti wa uzazi huitwa uzazi wa mpango.[1][2]Kwa kuacha nafasi kati ya mimba na mimba, udhibiti wa uzazi unaweza kuboresha matokeo ya kuzaa kwa wanawake wazima na kuishi kwa watoto wao.[3] Katika ulimwengu unaokua mapato ya wanawake, rasilimali, uzito na elimu kwa watoto wao na afya huboreshwa kwa kupunguza idadi ya watoto.[4] Udhibiti wa uzazi huweza kuongeza mapema ukuaji wa uchumi kwa sababu ya watoto wachache wanaokutegemea, wanawake wengi kushiriki katika utendakazi, na matumizi madogo ya rasilimali haba,[4][5] ingawa idadi ya watoto ikipungua mno, baada ya muda wazalishaji wachache wanabebeshwa mzigo wa kutunza wazee wengi, inavyotokea katika nchi zilizoendelea.

Kwa kuwa suala hilo linahusu binadamu na uhai wake, linahitaji kukabiliwa kwa upana kuanzia maana ya utu, mwili, jinsia, upendo, uzazi n.k. Kumbe hapa zinazungumziwa tu mbinu au vifaa vinavyotumika pengine kuzuia au kuua mimba, yaani teknolojia katika ngono.[6] Jambo nyeti zaidi ni suala la mimba ya binadamu kuwa binadamu tayari, kiasi kwamba nchi nyingi zinaipatia haki fulanifulani, k.mf. ile ya kurithi. Kwa msingi huo, baadhi ya watu wanatetea uhai wa binadamu kuanzia mimba ilipotungwa na kulaumu baadhi ya vifaa vya udhibiti wa uzazi kuwa viuamimba na kusababisha vifo vya mamilioni.

Hali ya sasa[hariri | hariri chanzo]

Mbinu za kudhibiti uzazi zimetumika tangu kale, lakini mbinu zinazofaulu zaidi zilipatikana katika karne ya 20[7] zikichangia mabadiliko katika jamii na utamaduni ambayo wengine wanayaita mmomonyoko wa maadili ambao unachangia hata uenezi wa ukimwi na maradhi mengine. Ni kwamba kati ya vifaa hivyo, kondomu ya kike na kondomu ya kiume zinaweza pia kupunguza maambukizi ya magonjwa ya zinaa, ukiwemo ukimwi, lakini vingine vingi sivyo. Watu wanaofanya ngono wakijua mimba haitapatikana, kwa kujisikia salama upande huo pengine wanasahau hatari ya kuambukizwa maradhi hayo.[8][9] Pamoja na hayo, dini na tamaduni nyingine huchukulia mbinu hizo kuwa hazifaii kimaadili na kisiasa, na wataalamu wengine wa afya wanasisitiza madhara ya matumizi yake hasa kwa mwanamke na mazingira.

Mbinu zinazofaulu zaidi kudhibiti uzazi ni kuondoa kabisa uwezo wa kuzaa kwa kumhasi mwanamume, kwa kufunga uzazi kwa njia ya vasektomi kwa wanaume na ukataji wa neli kwa wanawake. Halafu kuna vitanzi (IUD) na vipandikizi, kontraseptivu za homoni zikiwa ni pamoja na dawa za kunywa, doa, pete ya uke, na sindano.

Mbinu nyingine zinazofaulu ni pamoja na kizuizi kama vile kondomu, daframu na sponji ya kontraseptivu na mbinu ya mafunzo ya uzazi.

Mbinu zinazofaulu kidogo zaidi ni dawa ya kuua mbegu na mbinu ya kukatiza ngono kwa mwanamume kabla hajamimina mbegu katika tumbo la uzazi.

Ufungaji uzazi, ingawa hufaulu zaidi, hauwezeshi kuurudisha tena kwa hakika; mbinu nyingine zinaweza kuurudisha, lakini mara nyingi baada ya kuziacha mwanamke anakuta utaratibu wa hedhi umeathirika.[10]

Baada ya kuzaliwa kwa mtoto, mwanamke asiyenyonyesha tu anaweza kuwa mjamzito mapema kuanzia wiki nne hadi sita. Njia zingine za kudhibiti uzazi zinaweza kuanzishwa baada ya kuzaa, ilhali zingine hungoja hadi miezi sita. Kwa wanaonyonyesha mbinu za projestini tu hupendekezwa kuliko kontraseptivu za kunywa.

Kwa waliofikisha ukomohedhi imependekezwa kuwa waendelezwe kwa mwaka mmoja baada ya hedhi ya mwisho.[11]

Udhibiti wa uzazi wa dharura unaweza kuua mimba hadi siku chache baada ya ngono.

Tofauti na mbinu za kiteknolojia, sayansi inawezesha kuzuia mimba bila madhara kwa mwanamke ikipendekeza mbinu zinazoelekeza kufanya tendo la ndoa wakati asipoweza kupata mimba. Kati ya mbinu hizo, ya kuaminika zaidi ni ile ya kupima ute wa uke iliyogunduliwa na John Billings katika miaka ya 1950 na kuboreshwa pamoja na mke wake Evelyn Billings hadi kifo chao (2007 na 2013).[12][13][14]

Wengine huchukulia kujinyima ngono kama njia ya kudhibiti uzazi kwa vijana, ila wengine wanaona mafundisho ya usafi wa moyo yatumiwapo bila vifaa yanaweza kuongeza mimba kutokana na udhaifu wa wahusika[15][16]na wanadai kuwa mafunzo ya ngono kwa undani pamoja na upatikanaji wa vifaa hupunguza idadi za mimba zisizotarajiwa katika kikundi hiki.[17][18]Ilhali aina zote za udhibiti wa uzazi zinaweza kutumiwa na vijana,[11]udhibiti wa uzazi usio wa kudumu unaotenda kazi kwa muda mrefu kama vile vipandikizi, vitanzi na pete za ukeni zina manufaa maalum kwa kupunguza idadi ya mimba za vijana bila kuzuia uzazi baadaye.[18]

Takribani milioni 222 ya wanawake wanaokusudia kuzuia mimba katika nchi zinazoendelea hawatumii teknolojia ya kudhibiti mimba.[19][20] Utumiaji wa vifaa vya kudhibiti uzazi katika nchi hizo umepunguza idadi ya vifo vya kina mama kwa asilimia 40 (takribani vifo 270,000 vilizuiwa mwaka 2008) na ungezuia asilimia 70 iwapo masharti yote yangetimizwa.[3][21] Kwa kuacha nafasi kati ya mimba na mimba, udhibiti wa uzazi unaweza kuboresha matokeo ya kuzaa kwa wanawake wazima na kuishi kwa watoto wao.[3] Katika ulimwengu unaokua mapato ya wanawake, rasilimali, uzito na elimu kwa watoto wao na afya huboreshwa kwa kupunguza uzazi.[4] Udhibiti wa uzazi huongeza ukuaji wa uchumi kwa sababu ya watoto wachache wanaokutegemea, wanawake wengi kushirikia katika utendakazi, na matumizi mdogo wa rasilimali haba.[4][5]

Mbinu[hariri | hariri chanzo]

Chance of pregnancy during first year of use:[7][22]
Mbinu Matumizi ya kawaida Matumizi kamili
No birth control 85% 85%
Combination pill 8% 0.3%
Progestin-only pill 13% 1.1%
Sterilization (female) 0.5% 0.5%
Sterilization (male) 0.15% 0.10%
Condom (female) 21% 5%
Condom (male) 18% 2%
Copper IUD 0.8% 0.6%
Hormone IUD 0.2% 0.2%
Patch 8% 0.3%
Vaginal ring 9% 0.3%
Depo Provera 3-6% 0.2%
Implant 0.05% 0.05%
Diaphragm and spermicide 12% 6%
Withdrawal 27% 4%
Standard days method ~12-25% ~1-9%
Billings ovulation method ~1-5% ~0-2.9%
Lactational amenorrhea method 0-7.5%[23] <2%[24]

Kufaulu kwa mbinu huelezwa kama asilimia ya wanawake wanaoshika mimba wanapoitumia njia hiyo kwa muda wa mwaka mmoja[25] na wakati mwingine kama kiwango cha kufeli cha maisha kati ya mbinu zinazofaa zaidi, kama vile, ukataji wa neli.[26]

Mbinu zinazofaulu kiteknolojia ni zile ambazo hutenda kazi kwa muda mrefu na hazihitaji ziara za kuendeleza utunzaji wa afya.[27] Ufungaji wa uzazi, homoni zinazotiwa mwilini, na vifaa vinavyotiwa ndani ya uterasi huwa na kiwango cha kufeli kwa mwaka wa kwanza chini ya asilimia 1.[27] Dawa za kontraseptivu za homoni, madoa au pete, na mbinu ya lactational amenorrhea (LAM), inapotumiwa ipasavyo pia inaweza kuwa na kiwango cha kufeli katika mwaka wa kwanza chini ya asilimia 1 (au kwa lactational amenorrhea (LAM), miezi ya sita ya kwanza).[27] Kwa kutumia, viwango vya kufeli katika mwaka wa kwanza ni vya juu, katika kiwango cha asilimia 3-9, kwa sababu ya matumizi mabaya.[27] Mbinu zingine kama vile mafunzo ya uzazi, kondomu, daframu, na spematosidi huwa na viwango vya juu zaidi vya kufeli katika mwaka wa kwanza hata kwa matumizi sahihi.[27]

Ingawa mbinu zote za teknolojia ya kudhibiti uzazi zinaweza kuathiri afya, watetezi wake wanasema hatari ni chache kuliko zile za mimba hasa wakati wa kujifungua.[27]

Baada ya kuacha au kutoa njia nyingi za kudhibiti uzazi, pamoja na kontraseptivu za kunywa, IUD, dawa za kutia mwilini na sindano, idadi ya mimba kwa miaka inayofuata ni sawa na wasiotumia udhibiti wa uzazi.[28]

Kwa walio na matatizo maalumu ya afya, mbinu za kudhibiti uzazi zinaweza kuhitaji uchunguzi zaidi.[29] Kwa kina mama wenye afya, njia nyingi za kudhibiti uzazi hazipaswi kufanyiwa uchunguzi wa tiba ikiwa ni pamoja na dawa za kudhibiti uzazi, udhibiti wa uzazi unaoweza kudungwa au kutiwa mwilini, na kondomu.[30] Hasa, uchunguzi wa pelvisi, uchunguzi wa matiti, au uchunguzi wa damu kabla ya kutumia dawa za kudhibiti uzazi hauonekani kuathiri matokeo na hivyo hauhitajiki.[31][32] Shirika la Afya Ulimwenguni katika 2009 lilichapisha kwa undani orodha ya njia ya tiba ya kubaini kufaulu kwa kila aina ya udhibiti wa uzazi.[29]

Homoni[hariri | hariri chanzo]

Kontraseptivu za homoni hutenda kazi kwa kuzuia uovuleshaji na utungaji mimba.[33] Hupatikana kwa aina tofautitofauti ikiwa ni pamoja na tembe za kunywa, dawa za kutia mwilini chini ya ngozi, sindano, madoa, IUD na Pete ya uke. Kwa sasa zinazopatikana ni za wanawake tu. Kuna aina mbili za dawa za kunywa Tembe za kontraseptivu za kunywa zilizochanganywa na tembe zilizo na projestojeni tu.[34]Zinapotumiwa wakati wa ujauzito, haziongezi hatari ya kuharibika kwa mimba wala kusababisha matatizo ya kuzaa.[32]

Kontraseptivu za homoni zilizochanganywa huhusishwa kidogo na ongezeko la vena na madonge ya damu ya ateri; hata hivyo, hatari ni kidogo kuliko inayohusishwa na mimba.[35] Kwa sababu ya hatari, hazipendekezwi kwa wanawake walio na umri wa zaidi ya miaka 35 amabao huendelea kuvuta sigara.[36] Athari kwa hamu ya kufanya ngono hutofautiana, huku kukiwa na ongezeko au kupungua kwa wachache lakini hakuna athari kwa wengi.[37] Kontraseptivu za kunywa zilizochanganywa hupunguza hatari ya saratani ya ovari na saratani ya endometriu na haibadilishi hatari ya saratani ya matiti.[38][39] Mara nyingi hubadilisha hedhi na mkakamao wa hedhi uliyo na maumivu.[32] Dozi za chini za estrojeni zinazopatikana kwenye pete ya ukeni zinaweza kupunguza hatari ya uchungu wa matiti, kichefuchefu, na maumivu ya kichwa yanayohusishwa na bidhaa zilizo na dozi ya juu ya estrojeni.[38]

Tembe zilizo na projestini tu, sindano na vifaa vya kuzuia mimba vinavyotiwa ndani ya uterasi havihusishwi na ongezeko la hatari ya kuganda kwa damu na vinaweza kutumiwa na wanawake waliokuwa na mgando wa damu hapo awali katika vena zao.[35][40] Kwa walio na historia ya kuganda kwa damu katika ateri, mbinu za kudhibiti uzazi zisizo na homoni au zilizo na projestini tu kando na zile za sindano zinapaswa kutumiwa.[35] Tembe zilizo na projestini tu zinaweza kuboresha dalili za hedhi na zinaweza kutumiwa na kina mama wanaonyonyesha kwa kuwa haziathiri kutengenezwa kwa maziwa.Hedhi isiofuatana inaweza kushuhudiwa kwa kutumia njia zilizo na projestini tu, huku baadhi ya wanaotumia wakiripoti kutopata hedhi.[41] Projestini, drospirenoni na desogestreli hupunguza athari za androjeni lakini huongeza hatari ya kuganda kwa damu na hivyo haifai sana.[42] Kiwango cha kufeli katika mwaka wa kwanza kwa projestini ya sindano, Depo-Provera, hakijaafikiwa huku idadi ikiwa kutoka asilimia 1[43]hadi asilimia 6.[27]

Kizuizi[hariri | hariri chanzo]

kondomu ya wanaume iliyofunguliwa.

Kontraseptivu za kizuizi ni vifaa vinavyojaribu kuzuia mimba kwa kuzuia mbegu ya kiume kuingia katika uterasi.[44] Huwa ni pamoja na kondomu ya kiume, kondomu ya kike, kofia ya seviksi, daframu, na sponji ya kontraseptivu iliyo na spemisidi.[44]

Ulimwenguni, kondomu ndiyo njia ya kawaida sana ya kudhibiti uzazi.[45]Kondomu ya kiume huvalishwa kwa uume iliyosimama na kuzuia mbegu za kiume zilizotolewa kuingia mwili wa anayefanya ngono naye.[46] Kondomu za kisasa mara nyingi hutengenezwa kwa lateksi, lakini nyingine hutengenezwa kwa nyenzo kama vile polyurethane, au matumbo ya kondoo.[46] Kondomu ya kike pia hupatikana, mara nyingi iliyotengenezwa kwa nitrile, lateksi au poliyourethani.[47] Kondomu za kiume huwa na faida kwa sababu ni bei nafuu, rahisi kutumika, na huwa na athari chache.[48] Nchini Japani takribani asilimia 80 ya wachumba wanaotumia udhibiti wa uzazi hutumia kondomu ilhali nchini Ujerumani kiwango hiki ni takribani asilimia 25,[49] na nchini Marekani ni asilimia 18.[50]

Kondomu za wanaume na daframu iliyo na spemisidi huwa na kiwango sawa cha kufeli katika mwaka wa kwanza kwa asilimia 15 na 16 mtawalia.[7] Inapotumiwa ipasavyo huwa bora zaidi ikiwa na kiwango cha kufeli katika mwaka wa kwanza kwa asilimia 2 huku daframu ikiwa na kiwango cha kufeli katika mwaka wa kwanza kwa asilimia 6.[7] Kondomu huwa na faida nyingine ya kusaidia kuzuia kuenea kwa maambukizi mengine ya ngono kama vile VVU/UKIMWI.[10]

Sponji za kontraseptivu huunganisha kizuizi na spemisidi.[27] Kama daframu, huingizwa ukeni kabla ya ngono na inapaswa kuwekwa juu ya seviksi kwa matokeo bora.[27] Kufeli katika mwaka wa kwanza hulingana na iwapo mwanamke amewahi kuzaa au la, ikiwa asilimia 24 kwa wale wamewahi kuzaa na asilimia 12 kwa wale hawajawahi kuzaa.[27] Sponji inaweza kuingizwa hadi masaa 24  kabla ya kufanya ngono na inapaswa kuachwa pale kwa angalau masaa sita baadaye.[27] Athari ya aleji[51] na athari zingine kali kama vile sindromu ya mshtuko wa sumu zimeripotiwa.[52]

Vitanzi[hariri | hariri chanzo]

Vitanzi (IUD) huwa vifaa vidogo vilivyo na umbo la 'T'-, ambavyo huwa na shaba au levonorgestrel, iliyoingizwa ndani ya uterasi.[53] Ni aina ya udhibiti wa uzazi wa muda mrefu. Kiwango cha kufeli katika mwaka wa kwanza kwa kutumia IUD ya shaba ni takribani asilimia 0.8 ilhali IUD ya levonorgestrel huwa na kiwango cha kufeli katika mwaka wa kwanza cha asilimia 0.2.[7] Kati ya aina za kudhibiti uzazi pamoja na dawa za zinazotiwa mwilini matokeo yake huwa ya kuridhisha kwa wanaotumia.[54]

Dhibitisho hukubaliana na matokeo bora na usalama kwa vijana[54] na wale ambao hawajawahi kuzaa.[55] IUD haziathiri unyonyeshaji na zinaweza kuingishwa baada ya kuzaa.[56] Zinaweza pia kutumiwa baada ya uavyaji mimba.[57] Zinapotolewa, hata baada ya kutumika kwa muda mrefu, uwezo wa kuzaa hurudi kama kawaida mara moja.[58] Ilhali IUD za shaba zinaweza kuongeza hedhi na kusababisha mikakamo iliyo na maumivu zaidi,[59] IUD za homoni zinaweza kupunguza hedhi au kutokuwepo kwa hedhi yote kwa pamoja.[56] Athari zingine zinaweza kuwa ni pamoja na kutoka( asilimia 2 had5) – na kwa nadra, kushuka kwa uterasi (chini ya asilimia 0.7).[56][60] Kuwa na mikakamo kunaweza kutibiwa kwa NSAID.[60]

Kufikia 2007, IUD ndizo aina za kudhibiti uzazi zisizo za kudumu zinazotumika sana, zikiwa na zaidi ya watu milioni 180 wanaozitumia kote ulimwenguni.[61][62] Hapo awali aina ya kifaa kinachotiwa ndani ya uterasi (Kinga ya Dalkon) kilihusishwa na ongezeko la hatari ya ugonjwa wa inflamesheni ya pelvisi; hata hivyo, hatari haihusishwi na aina za kisasa kwa wale wasio na maambukizi ya zinaa karibu na wakati wa kuingishwa.[63]

Kufunga uzazi[hariri | hariri chanzo]

Ufungaji uzazi kwa upasuaji hupatikana kwa njia ya kufunga uzazi kwa wanawake na vasektomi kwa wanaume.[7] Hakuna athari kuu za muda mrefu, na kufunga uzazi hupunguza hatari ya saratani ya ovari.[7] uwezekano wa athari za muda mfupi zinazotokana na vasektomi huwa chini ya mara ishirini na tano kuliko ufungaji uzazi wa mwanamke.[7][64] Baada ya vasektomi kunaweza kuwa na uvimbe na maumivu ya korodani ambayo kwa kawaida huisha baada ya wiki moja au mbili.[65] Kwa kufunga uzazi wa mwanamke athari hutokea kwa asilimia 1 hadi 2 za taratibu kukiwa na athari kali kwa kawaida zinazosababishwa na ganzi.[66] Kati ya mbinu hizi hakuna inayokinga dhidi ya maambukizi ya zinaa.[7]

Wanawake wengine hujuta baadaye: takribani asilimia 5 ya walio na umri wa zaidi ya 30, na takribani asilimia 20 walio na umri wa chini ya 30 .[7] Wanaume huwa na uwezekano mdogo wa kujuta kwa sababu ya ufungaji uzazi (<asilimia5); huku walio na umri mdogo, walio na watoto wachanga au bila, na ndoa zinazoyumbayumba zikiongeza hatari.[67] Katika uchunguzi mmoja wa watu waliowahi kuwa na watoto, asilimia 9 walisema kuwa hawangepata watoto tena iwapo wangefunga uzazi tena.[68]

Ingawaje ufungaji uzazi huchukuliwa kuwa utaratibu wa kudumu,[69] inawezekana kujaribu kurejesha uzazi kwa kuunganisha tena neli ya falopia au kupindua vasektomi ili kutoa vasa diferentia. Hamu ya wanawake kutaka kurejesha huhusishwa mara nyingi na kubadilisha kwa mwanamume.[69] Viwango vya kufaulu kupata mimba baada ya kurejesha uzazi huwa kati ya asilimia 31 hadi 88, huku athari ikiwa ni pamoja na ongezeko la hatari ya mimba bandia.[69] Idadi ya wanaume ambao huomba kurejesha ni kati ya asilimia 2 na 6.[70] Kiwango cha mwanaume kufaulu kupata mtoto mwingine baada ya kurejesha ni kati ya asilimia 38 na 84; huku kiwango cha kufaulu kikiwa chini kulingana na muda kati ya utaratibu wa kwanza na kurejesha.[70] Kutolewa kwa mbegu za kiume kukifuatiwa na utungisho katika vitro pia kunaweza kuwa njia nyingine.[71]

Mbinu za kitabia[hariri | hariri chanzo]

Mbinu za kitabia ni pamoja na kufanya ngono kwa kuzuia mbegu kuingia katika njia ya uzazi ya mwanamke, wakati wowote au wakati kuna uwezekano wa kuwepo kwa kijiyai.[72] Inapotumiwa ipasavyo kiwango cha kufeli katika mwaka wa kwanza kinaweza kuwa takribani asilimia 3.4, hata hivyo, isipotumiwa ipasavyo viwango vya kufeli mwaka wa kwanza vinaweza kuwa takribani asilimia 85.[73]

Mafundisho ya uzazi[hariri | hariri chanzo]

Mbinu ya mafundisho ya uzazi huhusisha ubainishaji wa siku za kushika mimba katika kipindi cha hedhi na kuepuka ngono siku hizo.[72] Mbinu hizo ni pamoja na kuchunguza halijoto, ute wa uke, au siku ya hedhi.[72] Huwa na kiwango cha kufeli katika mwaka wa kwanza kwa kati ya asilimia 1 na 5; viwango vya kufeli katika mwaka wa kwanza baada ya matumizi bora hulingana na mfumo uliotumiwa na huwa asilimia 0 hadi 2.9.[12] Thibitisho linalozingatiwa na makadirio haya, hata hivyo, ni hafifu kwa kuwa watu wengi wanaojaribu kuzitumia huacha mapema.[72] Ulimwenguni, hutumiwa na takribani asilimia 3.6 ya wachumba.[74]

Iwapo itazingatia pia halijoto na ishara zingine kuu, njia hii huitwa symptothermal. Viwango vya mimba zisizotarajiwa vimeripotiwa kati ya asilimia 1 na 20 kwa wanaotumia symptothermal.[75]

Kukatiza ngono[hariri | hariri chanzo]

Mbinu ya kukatiza ngono, ni shughuli ya kukatiza kufanya ngono ("kuvuta nje") kabla ya kumwaga mbegu za kiume.[76] Hatari kuu ya kukatiza ngono ni kuwa mwanaume anaweza kutotoa kwa usahihi au kwa wakati unaofaa.[76] Viwango vya kufeli katika mwaka wa kwanza huwa kati ya asilimia 4 inapotumiwa ipasavyo hadi asilimia 27 isipotumiwa ipasavyo.[29] Haichukuliwi kuwa udhibiti wa uzazi na baadhi ya weledi wa afya.[27]

Kuna dhibitisho ndogo kuhusu idadi ya mbegu za kiume katika kiowevu kabla ya kumwaga.[77] Ilhali baadhi ya uchunguzi haukupata mbegu,[77] jaribio moja liligundua kuwepo kwa mbegu kwa watu 10 kutoka kwa 27 ya waliojitolea.[78] Mbinu ya kukatiza ngono hutumiwa na takribani wachumba asilimia 3.[74]

Kujinyima ngono[hariri | hariri chanzo]

Ingawa makundi mengine hukubaliana na kujinyima ngono, hii humaanisha kuepuka shughuli zote za ngono, katika muktadha wa kudhibiti uzazi neno hili humaanisha kujinyima ngono inayohusisha ukeni.[79] Kujinyima ngono hufaulu kwa asilimia 100 katika kuzuia mimba; hata hivyo, si kila anayekusudia hujinyima shughuli zote za ngono, na katika idadi nyingi za watu huwa na hatari nyingi za mimba kutokana na ngono isiyokubaliwa.[80][81]

Watafiti mbalimbali wanasema elimu ya kujinyima ngono haipunguzi mimba za vijana,[9][82] ambazo huwa nyingi kwa wanaopewa elimu ya kujinyima ngono, ikilinganishwa na wale wanaopewa elimu ya ngono. [83][82] Baadhi ya mamlaka hupendekeza kuwa wanaojinyima ngono wawe na mbinu nyingine za kutumia (kama vile kondomu au tembe za kontraseptivu za dharura).[84] Ngono isiyo ya kuingiliana na ngono ya mdomo bila ngono ya ukeni pia wakati mwingine hutumiwa, ingawa baada ya ashiki kupata nguvu, pengine ni vigumu kujizuia katika kuishia katika tendo la ndoa.[85] Ingawa kwa kawaida huzuia mimba, ujauzito bado unaweza kupatikana kwa ngono ya katikati ya miguu na mbinu nyingine za ngono ambapo uume huwa karibu na ukeni (kusugua viungo vya uzazi, na kutoka kwa uume kutoka kwa ngono ya unyeo) ambapo mbegu ya kiume yanaweza kumwagika karibu na ukeni halafu yanaweza kupitia viowevu vinavyolainisha uke.[86][87]

Unyonyeshaji[hariri | hariri chanzo]

Mbinu ya amenorea ya unyonyeshaji huhusisha matumizi ya utasa asili wa baada ya kuzaa wa mwanamke na unaweza kuendelezwa kwa kunyonyesha.[88] Hii kwa kawaida huhitaji kutokuwepo kwa damu ya hedhi, kunyonyesha tu mtoto mchanga, na mtoto aliye chini ya miezi sita.[24] Shrika la Afya Ulimwenguni hueleza kuwa iwapo kunyonyesha ndio njia ya pekee ya mtoto kupata chakula, kiwango cha kufeli katika miezi sita ya kwanza baada ya kuzaa ni asilimia 2.[89] Majaribio yametambua viwango vya kufeli kuwa kati ya asilimia 0 hadi 7.5.[23] Viwango vya kufeli huongezeka hadi asilimia 4-7 katika mwaka moja na asilimia 13 katika miaka miwili.[90] Kulisha watoto, kubembeleza badala ya kutunza, matumizi ya mpira wa watoto, na kulisha chakula kigumu vyote huongeza kiwango chake cha kufeli. [91] Kwa wale wanaonyonyesha, takribani asilimia 10 hupata hedhi kabla ya miezi tatu na asilimia 20 kabla ya miezi sita.[90] Kwa wanaonyonyesha, uwezo wa kuzaa unaweza kurudi wiki nne baada ya kuzaa.[90]

Dharura[hariri | hariri chanzo]

Mbinu za udhibiti wa uzazi wa dharura ni dawa (tembe za asubuhi) au vifaa vinavyotumika baada ya ngono kwa matarajio ya kuua mimba.[92] Hutenda kazi kwa kuzuia uovulesheni au utungaji mimba.[93] Baadhi ya njia hupatikana, ikiwa ni pamoja na dozi ya juu ya tembe za kudhibiti uzazi, levonorgestrel, mifepristone, ulipristal na IUD.[94] tembe za levonorgestrel hupunguza uwezekano wa mimba kwa asilimia 70 (kiwango cha mimba asilimia 2.2) inapotumiwa kati ya siku 3  baada ya ngono bila kinga au kufeli kwa kondomu.[92]Ulipristal hupunguza uwezekano wa mimba kwa asilimia 85 (kiwango cha mimba hadi asilimia 1.4) hadi siku 5  na inaweza kuwa bora kuliko levonorgestrel.[95][94][92] Mifepristone pia huwa bora zaidi kuliko levonorgestrel ilhali IUD za shaba ndizo njia bora zaidi.[94] IUD zinaweza kutiwa siku 5  baada ya ngono na kuzuia takribani asilimia 99 ya mimba (kiwango cha mimba cha asilimia 0.1 hadi 0.2).[93][96] Hii huzifanya kuwa aina mbinu bora zaidi wa kudhibiti uzazi kwa dharura.[97]

Kupeana tembe za asubuhi kwa kina mama mapema haiathiri kiwango cha maambukizi ya ngono, matumizi ya kondomu, viwango cha mimba, au tabia hatari ya ngono.[98][99] Mbinu zote huwa na athari chache.[94]

Kinga mbili[hariri | hariri chanzo]

Kinga mbili ni matumizi ya mbinu zinazozuia maambukizi ya zinaa na mimba.[100] Hii inaweza kuwa kwa kodomu pekee au pamoja na mbinu nyingine ya kudhibiti uzazi au kwa kuepuka ngono ya kuingiliana.[101][102] Iwapo mimba ni hoja kuu kutumia njia zote mbili kwa wakati mmoja kunakubalika,[101] na aina zote mbili zimependekezwa kwa wale wanaotumia dawa isiyo na chunusiisotretinoini, kwa sababu ya hatari kuu ya matatizo ya uzazi itumiwapo wakati wa ujauzito.[103]

Athari[hariri | hariri chanzo]

Afya[hariri | hariri chanzo]

maternal mortality rate map
Maternal mortality rate as of 2010[104]

Matumizi ya kontraseptivu katika nchi zinazoendelea umekadiriwa kupunguza idadi ya vifo vya kina mama kwa asilimia 40 (takribani vifo 270,000 vilizuiliwa mwaka 2008) na ungepunguza asilimia 70 ya vifo iwapo matakwa yote ya udhibiti wa uzazi yangetimizwa.[21][3] Faida hizi hupatikana kwa kupunguza idadi ya mimba zisizotarajiwa ambazo husababisha uavyaji mimba usiokuwa salama na kwa kuzuia mimba kwa walio na hatari kuu.[3]

Udhibiti wa uzazi huboresha kuishi kwa mtoto katika ulimwengu unaokua kwa kuacha nafasi kubwa kati ya mimba.[3] Katika idadi hii ya watu matokeo huwa mabaya zaidi mama anaposhika mimba kati ya miezi kumi na nane ya baada ya kujifungua.[3][105] Kuchelewesha mimba baada ya kuharibika kwa mimba hata hivyo hakuonekani kupunguza hatari na wanawake hushauriwa kujaribu kushika mimba katika hali hii wakati wowote wanapokuwa tayari.[105]

Mimba za utotoni, yaani za wasichana wadogo, huwa katika hatari kuu ya matokeo mabaya pamoja na kuzaa kabla ya wakati, kuzaa mtoto aliye na uzito wa chini na kifo cha mtoto.[17] Nchini Marekani asilimia 82 ya mimba kwa walio kati ya miaka 15 na 19 ni zile zisizopangwa.[60] Mafundisho ya ngono kwa kina na utumiaji wa kontraseptivu huwa bora katika idadi ya mimba katika kikundi hiki cha umri.[106]

Faida[hariri | hariri chanzo]

fertility rate map
Countries by fertility rate as of 2012.
     7–8      6–7      5–6      4–5
     3–4      2–3 Children      1–2 Children      0–1 Children

Katika nchi zinazokua, udhibiti wa uzazi hukusudia ongezeko la uchumi kwa sababu ya kuwepo kwa watoto wachache wategemezi na hivyo mama hushiriki katika utendakazi.[4] Mapato ya wanawake, rasilimali, uzito wa mwili, na kielelezo cha mwili na usomaji wa watoto vinaweza vikaongezeka kukiwa na udhibiti wa uzazi.[4] Upangaji uzazi wa kisasa ni njia bora zaidi kwa afya.[107] Kwa kila dola inayotumiwa, Umoja wa Kimataifa hukadiria kuwa karibu dola mbili hadi sita huwekezwa.[108] Huwekezaji huu huhusiana na uzuiaji wa mimba zisizopangwa na upunguzaji wa maradhi ya kuambukizana.[107] Ilhali mbinu zote zinaleta manufaa ya kifedha, matumizi ya IUD za shaba zilisaida katika uwekezaji.[107] Kufikia mwaka 2012 gharama yote ya matitabu ya ujauzito, kuzaa na utunzaji wa mtoto mchanga nchini Marekani ni takribani dola 21,000 kwa kuzaa kupitia uke na dola 31,000 kupitia upasuaji.[109] Katika nchi nyingi gharama huwa chini ya nusu.[109] Kwa mtoto aliyezaliwa mwaka 2011, familia ya kawaida nchini Marekani hutumia dola 235,000 kwa zaidi ya miaka 17 kumlea.[110]

Uenezi[hariri | hariri chanzo]

prevalence of modern birth control map
Asilimia ya wanawake wanaotumia teknolojia katika kupanga uzazi (mwaka 2010).
     6%      12%      18%      24%      30%      36%
     42%      48%      54%      60%      66%      72%
     78%      84%      86%      no data

Kote ulimwenguni, kufikia mwaka 2009, karibu asilimia 60 ya waliokuwa wameolewa na kupata watoto walitumia udhibiti wa uzazi.[62] Namna ambavyo mbinu mbalimbali hutiwa hutofautiana katika nchi.[62]

Mbinu ya kawaida katika nchi zilizoendelea ni kondomu na dawa ya kumeza, ilhali barani Afrika ni dawa ya kumeza na kule Amerika Kusini na Asia ni ufungaji wa uzazi.[62]

Katika nchi zinazoendelea, asilimia 35 ya udhibiti wa uzazi ni kupitia ufungaji wa uzazi wa kike, asilimia 30 ni kupitia IUD, asilimia 12 ni kupitia dawa ya kumeza, asilimia 11 ni kupitia kondomu, na asimia 4 ni kupitia ufungaji uzazi wa kiume.[62]

Wakati inatumika mara chache kwa nchi zilizoendelea kuliko zile zinazoendelea, kufikia mwaka 2007 wanawake zaidi ya milioni 180, walikuwa wakitumia IUD [61]

Uepukanaji wa ngono wakati wa kuwa na uwezo wa kupata mimba unatumiwa na wanawake wanaoendelea kuzaa karibu asilimia 3.6, na kutumika sana kwa asilimia 20 kule Amerika Kusini.[111]

Kufikia mwaka 2005, asilimia 12 ya wachumba walikuwa wanatumia mbinu ya kiume ya kuzuia mimba (mojawapo KATI ya kondomu au utoaji wa mrija wa mbegu), hali nyingi zikiwa katika nchi zilizoendelea.[112] Matumizi ya kudhibiti uzazi kwa kutumia njia ya wanaume imepungua kati ya mwaka wa 1985 na 2009.[62]

Matumizi ya dawa za kuzuia mimba kwa wanawake Kusini mwa Jangwa la Sahara yameongezeka kutoka karibu asilimia 5 mwaka 1991 hadi karibu asilimia 30 mwaka 2006.[113]

Kufika mwaka 2012, asilimia 57 ya wanaoendelea kuzaa wanataka kuepukana na ujauzito (milioni 867 kati ya 1520 [114] Hata hivyo wanawake karibu milioni 222 hawakuweza kupata udhibiti wa kuzaa, milioni 53 wakiwa Kusini mwa Jangwa la Sahara na milioni 97 wakiwa Asia.[114] Hii inasababisha milioni 54 ya mimba zisizopangwa na vifo 80,000 hivi vya kina mama kila mwaka.[62] Baadhi ya sababu za wanawake kutokuwa na huduma ya udhibiti ni sababu za kidini na kisiasa,[7] ilhali umaskini huchangia pia.[115]

Kwa sababu ya sheria za utoaji mimba Kusini mwa Jangwa la Sahara, wengi hutafuta watoaji mimba wasiokuwa na kibali kwa mimba zisizopangwa, inayosababisha karibu asimilia 2-4 ya utoaji mimba unaoitwa si salama kila mwaka.[115]

Historia[hariri | hariri chanzo]

ancient coin depicting silphium
Ancient silver coin from Cyrene depicting a stalk of silphium

Ebers Papyrus ya Misri kutoka 1550  na Kahun Papyrus kutoka 1850 KK zina maelezo kuhusu udhibiti wa kuzaa, matumizi ya asali, matawi na nyuzi za pamba ya acacia zinazowekwa ukeni ili zizuie mbegu ya kiume.[116][117] Michoro ya zamani ya Misri yanaonyesha matumizi ya kondomu.[49]

Hali ya kutoa kiungo cha kiume wakati wa tendo la ndoa (kwa Kilatini coitus interruptus), inasimuliwa na Kitabu cha Mwanzo kama njia ya kudhibiti uzazi wakati Onan "hutoa mbegu za kiume" (kumwaga) chini ili asimpatie mtoto bibi ya kakaye aliyekufa, Tamar.[116]

Inaaminika kuwa hapo zamani nchini Ugirikisilphium ilitumiwa kudhibiti uzazi, kwa sababu ya kudumu na ubora wake, ulivunwa hadi ukaisha.[118]

Katika Ulaya ya leo, juhudi za kutoa mimba unachukuliwa kama uovu na Kanisa Katoliki.[116] Inaaminika kuwa wanawake hadi leo bado hutumia baadhi ya mbinu za kudhibiti uzazi kama vile coitus interruptus na kuingiza mizizi ya lily na rue katika ukeni (na, zaidi ya hayo, uuaji wa mtoto mchanga baada ya kuzaliwa).[119]

Casanova (1725-1798), wakati wa kuchipuka upya kwa Italia alielezea jinsi ya kutumia ngozi ya kondoo kuzuia ujauzito; hata hivyo, upatikanaji wa kondomu haikutokea hadi karne ya 20.[116]

Mwaka 1909, Richard Richter alitengeneza kifaa cha kuweka ndani ya uterasi kutokana na uzi nyororo ya utumbo, ambacho kilitengenezwa zaidi na kuuza nchini Ujerumani na Ernst Gräfenberg mwishoni mwa miaka ya 1920.[120]

Mnamo 1916 Margaret Sanger alifungua kituo cha kwanza cha kudhibiti uzazi nchini Marekani iliyosababisha akamatwe.[116]Mwanamke huyo alikuwa pia mtetezi wa ubaguzi wa rangi na kulenga kupunguza Wanegro na wengineo[121][122][note 1] Hii ilifuatiwa na kituo cha kwanza barani Ulaya mwaka 1921, kilichofunguliwa na Marie Stopes.[116]

Gregory Pincus na John Rock kwa msaada wa Planned Parenthood Federation of America walitengeneza vidonge vya dawa vya kudhibiti uzazi miaka ya 1950 iliyoanza kuuzwa kwa umma miaka ya 1960.[123]

Dawa za kutoa mimba zilianza kutumika badala ya utoaji mimba kwa njia ya upasuaji kwa kuwepo kwa prostaglandin analog na kuwepo kwa mifepristone miaka ya 1980.[124]

Jamii na utamaduni[hariri | hariri chanzo]

Hali ya sheria[hariri | hariri chanzo]

Baadhi ya maafikiano kuhusu Haki za Kibinadamu yanadai serikali zitoe huduma na maelezo ya upangaji uzazi. Hii ilijumuisha mahitaji ya kutengeneza mpango wa kitaifa wa kupanga uzazi, kuondoa sheria zinazozuia huduma ya kupanga uzazi, kuhakikisha kuna aina mbalimbali za mbinu salama na bora za kupanga uzazi, kuhakikisha kuna wahudumu wa afya waliohitimu na vifaa vya afya kwa bei nafuu, na kubuni utaratibu wa kukagua mpango zilizoidhinishwa. Serikali ikikosa kutekeleza inaweza kulaumiwa kwa kuvunja sheria za kimataifa.[125]

Miungano ya Kimataifa yalizindua kikundi cha Every Woman Every Child kinachoshughulikia taratibu za kina mama za kupata dawa za kuzuia mimba. Shughuli hii inalenga kuongeza wanawake wanaotumia mbinu mpya za kuzuia mimba kwa milioni 120 katika nchi zilizo maskini kufikia mwaka 2020. Vile vile, wanataka kuruhusu hata wasichana wadogo wajitafutie dawa za kuzuia mimba bila ruhusa ya wazazi.[126]

Mtazamo wa kidini[hariri | hariri chanzo]

Dini zinatofautiana sana kuhusu maadili ya udhibiti wa uzazi.[127]

Kanisa Katoliki hukubali tu uzazi wa mpango kwa njia za kisayansi bila teknolojia,[128] ingawa waumini wengi katika nchi zilizoendelea hukubali na kutumia mbinu nyingine.[129][130][131]

Miongoni mwa Waprotestanti kuna mitazamo tofauti kutoka wale wasiokubali hadi wanaokubali mbinu zote za kudhibiti uzazi.[132]

Mtazamo wa Uyahudi hutoka kwa madhehebu kali ya Waorthodoksi wa Kiyahudi hadi kwa Wayahudi wa mageuzi[133]

Katika Uislamu dawa za kupanga uzazi zinakubalika ikiwa hazidhuru afya, ingawa matumizi yake hukataliwa na wengine.[134] Kurani haitoi maelezo yoyote kuhusiana na uadilifu wa kupanga uzazi, lakini zina maelezo yanyohimiza watoto. Mtume Muhammad huripotiwa kuwa "alioa na kuzaa".[135]

Wahindu wanaweza kutumia upangaji uzazi wa kawaida na wa kisasa.[136]

Mtazamo wa kawaida wa wafuasi wa Buddha ni kuwa uzuiaji wa mimba unakubalika, lakini utoaji baada ya kutungwa mimba haikubaliki.[137]

Siku ya Ulimwengu ya kupanga uzazi[hariri | hariri chanzo]

Tarehe 26 Septemba ni Siku ya Ulimwengu ya kupanga uzazi, iliyotengwa kwa uhamasishaji na uboreshaji wa elimu kuhusu afya ya kuzaa na ngono, ikiwa na lengo la dunia ambayo mimba inahitajika.[138] Inasaidiwa na kikundi cha Serikali na Mashirika ya kimataifa yasiyo ya kiserikali, ikijumuisha baraza la Asian Pacific Council kuhusu Uzuiaji mimba, Centro Latinamericano Salud y Mujer, European Society of Contraception and Reproductive Health, German Foundation for World Population, International Federation of Pediatric and Adolescent Gynecology, International Planned Parenthood Federation, Marie Stopes International, Population Services International, Population Council, United States Agency for International Development (USAID), na Women Deliver.[138]

Dhana zisizo sahihi[hariri | hariri chanzo]

Kuna idadi kadhaa ya matatizo ya kawaida kulingana na ngono na ujauzito.[139] Usafishaji baada ya kufanya ngono si mbinu mwafaka wa kupanga uzazi.[140] Vile vile, huhusishwa na baadhi ya matatizo ya kiafya na kwa hivyo haipendekezwi.[141] Wanawake wanaweza kuwa wajawazito mara ya kwanza anaposhiriki ngono[142] na katika hali yoyote ya ngono.[143] Kuna uwezekano, ingawa si rahisi, kuwa mjamzito wakati wa hedhi.[144]

Utafiti[hariri | hariri chanzo]

Wanawake[hariri | hariri chanzo]

Uboreshaji wa upangaji uzazi kwa mbinu zinazoendelea zinahitajika, kwa sababu karibu nusu ya wanaopata mimba kwa bahati mbaya wanatumia upangaji uzazi wakati huo.[27] Baadhi ya mbinu tofauti tofauti za uzuiaji mimba zinachunguzwa, ikijumuisha pamoja kondomu bora ya wanawake, daftramu, doa lililo na projesteroni pekee, na pete ya ukeni iliyo na projesteroni refu.[145] Pete ya ukeni huwa bora kwa miezi 3 au 4 na inapatikana katika baadhi ya maeneo duniani.[145] Kuna mbinu kadha za kutekeleza uangamizaji wa vimelea kwa kuchunguza seviksi. Moja inahusisha uwekaji wa quinacrine ndani ya uterasi inayosababisha kovu na kutoweza kupata mimba. Ingawa utaratibu huo ni rahisi na haihitaji upasuaji, kuna wasiwasi kuhusu madhara ya muda mrefu.[146] Bidhaa nyingine ya, polidocanol, inayofanya kazi sawa inachunguzwa.[145] Kifaa kinachoitwa Essure, inayopanuka na kufunga inapowekwa ndani ya fallopio, ilikubaliwa Marekani mwaka wa 2002.[146]

Wanaume[hariri | hariri chanzo]

Mbinu za kiume za kudhibit uzazi zinajumuisha kondomu, ukataji na utoaji wa mrija.[147] Wanaume kati ya asilimia 25 na 75 wanaoweza kuzalisha hutumia homoni za kudhibiti uzazi ikiwa wanaweza kupata.[147][112] Idadi ya mbinu za homoni na zisizo za homoni zinafanyiwa majaribio,[112] na kuna baadhi ya utafiti unaochunguza uwekezano wa chanjo ya kontraseptivu.[148] Mbinu ya upasuaji wa kugeuza inayochunguzwa ni reversible inhibition of sperm under guidance (RISUG) inayojumuisha huiingizaji wa polymer gel, styrene maleic anhydride kwa dimethyl sulfoxide, katika vas deferens. Ukidungwa sindano na sodium bicarbonate hutoa dawa na hurudisha uwezo wa kuzaa tena. Nyingine ni intravas device inayohusisha uwekaji wa urethane ndani ya vas deferens ili izuie. Mchanganyiko wa androgen na progestin huleta matumaini, kwa selective androgen receptor modulator.[112]Ultrasound na mbinu za kupasha moto makende zimefanyiwa uchunguzi wa kwanza.[149]

Wanyama[hariri | hariri chanzo]

Upakaji, unayojumuisha utoaji wa baadhi ya sehemu za viungo vya uzazi,[150] ni mbinu inayofanywa mara nyingi kwa wanyama.

Hifadhi za wanyama huhitaji taratibu hizi kama mkataba wa kuchukua.[151]

Udhibiti wa uzazi huchukuliwa kama njia mbadala ya kupunguza idadi ya wanyama wa mwituni.[152]

Chanjo za kontraseptivu zimepatikana kuwa na ubora kwa idadi fulani ya wanyama.[153][154]

Tazama pia[hariri | hariri chanzo]

Marejeo[hariri | hariri chanzo]

  1. ↑ (June 2012 (online)) Oxford English Dictionary. Oxford University Press. 
  2. ↑ World Health Organization (WHO). Family planning. Health topics. World Health Organization (WHO).
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Cleland, J; Conde-Agudelo, A; Peterson, H; Ross, J; Tsui, A (2012 Jul 14). "Contraception and health.". Lancet 380 (9837): 149-56. PMID 22784533 .
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 Canning, D.; Schultz, T. P. (2012). "The economic consequences of reproductive health and family planning". The Lancet 380 (9837): 165–171. doi:10.1016/S0140-6736(12)60827-7 . PMID 22784535 . http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60827-7/fulltext. Retrieved 2013-11-28.
  5. ↑ 5.0 5.1 Van Braeckel, D.; Temmerman, M.; Roelens, K.; Degomme, O. (2012). "Slowing population growth for wellbeing and development". The Lancet 380 (9837): 84–85. doi:10.1016/S0140-6736(12)60902-7 . PMID 22784542 . http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60902-7/fulltext. Retrieved 2013-11-28.
  6. ↑ Definition of Birth control. MedicineNet. Jalada kutoka ya awali juu ya 2012-08-06. Iliwekwa mnamo 9 August 2012.
  7. ↑ 7.00 7.01 7.02 7.03 7.04 7.05 7.06 7.07 7.08 7.09 7.10 Hurt, K. Joseph, et al.(eds.); Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland (2012-03-28). The Johns Hopkins manual of gynecology and obstetrics., 4th, Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 232. ISBN 978-1-60547-433-5. 
  8. ↑ Taliaferro, L. A.; Sieving, R.; Brady, S. S.; Bearinger, L. H. (2011). "We have the evidence to enhance adolescent sexual and reproductive health--do we have the will?". Adolescent medicine: state of the art reviews 22 (3): 521–543, xii. PMID 22423463 .
  9. ↑ 9.0 9.1 Chin, H. B.; Sipe, T. A.; Elder, R.; Mercer, S. L.; Chattopadhyay, S. K.; Jacob, V.; Wethington, H. R.; Kirby, D. et al. (2012). "The Effectiveness of Group-Based Comprehensive Risk-Reduction and Abstinence Education Interventions to Prevent or Reduce the Risk of Adolescent Pregnancy, Human Immunodeficiency Virus, and Sexually Transmitted Infections". American Journal of Preventive Medicine 42 (3): 272–294. doi:10.1016/j.amepre.2011.11.006 . PMID 22341164 . http://www.ajpmonline.org/article/S0749-3797(11)00906-8/abstract. Retrieved 2013-11-28.
  10. ↑ 10.0 10.1 (2011) Family planning : a global handbook for providers : evidence-based guidance developed through worldwide collaboration., Rev. and Updated ed., Geneva, Switzerland: WHO and Center for Communication Programs. ISBN 978-0-9788563-7-3. 
  11. ↑ 11.0 11.1 (2011) Family planning : a global handbook for providers : evidence-based guidance developed through worldwide collaboration., Rev. and Updated ed., Geneva, Switzerland: WHO and Center for Communication Programs, 260-300. ISBN 978-0-9788563-7-3. 
  12. ↑ 12.0 12.1 Trials of the Billings Ovulation Method Archived 5 Novemba 2005 at the Wayback Machine. The Billings Method, Dr. Evelyn Billings & Ann Westmore, 2000, p. 215.
  13. ↑ Ovarian Activity and Fertility and the Billings Ovulation Method Archived 26 Desemba 2005 at the Wayback Machine.: Dr. James B. Brown, 2000.
  14. ↑ Teaching the Billings Ovulation Method, Dr E. L. Billings AM, MB BS, DCH (London), 2001.
  15. ↑ DiCenso A, Guyatt G, Willan A, Griffith L (June 2002). "Interventions to reduce unintended pregnancies among adolescents: systematic review of randomised controlled trials". BMJ 324 (7351): 1426. PMC 115855 . PMID 12065267 .
  16. ↑ Duffy, K.; Lynch, D. A.; Santinelli, J. (2008). "Government Support for Abstinence-Only-Until-Marriage Education". Clinical Pharmacology & Therapeutics 84 (6): 746–748. doi:10.1038/clpt.2008.188 . PMID 18923389 . http://www.nature.com/clpt/journal/v84/n6/full/clpt2008188a.html.
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