Pregnancy diagnosis and contraception.

The benefits of the early diagnosis of pregnancy such as timely initiation of prenatal care and the avoidance of prescribing hormonal contraceptives to pregnant women--are obvious. In many African settings however pregnancy testing reagents are unavailable and the diagnosis is made on the basis of history taking and physical examination. A 1990 survey of maternal child health/family planning service providers in Kenya Tanzania and Kenya revealed that only 5.7% of the 70 facilities included in the study provided pregnancy testing with a reagent. When the physical examination produces inconclusive findings clients are advised to return in 4 weeks for a 2nd examination or--if the client is unwilling to wait this long--given a 6-day course of oral contraceptives containing 50 mcg of estrogen to see if bleeding occurs. Since it is not realistic to expect that reagents will soon become accessible or affordable to clinics in Africa primary care service supervisors and trainers must ensure that personnel are skilled in non-reagent pregnancy diagnosis procedures. Provider skills can be assessed through 3 methods: role play of history taking and management of suspected pregnancy use of pelvic model for demonstration of a speculum and bimanual pelvic examination and actual observation of provider-client interactions.