Knowledge, Attitude and Practice of Contraception in Rural Kashmir

Background

Human fertility is determined by many factors such as customs, morals and habits of social groups with regard to marital obligation of life. Acceptance of family planning methods varies within and between societies and there are many factors which are responsible for such variation at community, family and individual level. Socioeconomic environment, culture and education are few of them that play a vital role. Jammu and Kashmir state in general and Kashmir valley in particular is a Muslim-dominated population with traditionally a conservative society. Apart from family customs and influence of the elders, religious background has always been behind the passive resistance, or at the best indifference towards contraception. This study makes an attempt to assess the knowledge, attitude and practice of contraception in rural Kashmir.

Objective

To assess the knowledge, attitude and practice of contraception in rural Kashmir.

Study Design

Community-based Cross-Sectional study.

Study period

December 2006 to May 2008.

Participants

1900 currently married women in the age group of 15–49 years of age.

Setting

Rural households.

Methods

1900 currently married women, aged 15–49 years, selected by multi-stage random sampling technique from three districts of Kashmir valley who were interviewed at home using a pretested oral questionnaire. The assessment of various socioeconomic and other variables made as per the available standard procedures and scales.

Analysis

Percentage, Chi square test and Bivariate analysis.

Results

Knowledge of the contraceptive methods was fairly good especially for terminal methods i.e. female sterilization (97.7 %). Main source of information on contraception was obtained from mass media (60.4 %). Contraceptive practice was significantly related to number of living children, literacy, socioeconomic status and type of family.

Conclusion

What is needed is to promote and stress contraceptive methods and their advantages using mass media approach and to explore more and more participation of private sector.     

Pille und Krebsrisiko

Background

Approximately 70–75?% of women between 18 and 50 years of age in Germany use one of many different contraceptive methods and more than half of them use combined hormonal oral contraceptives. These women demand two things from contraception: high contraceptive safety and low side effects. Thromboembolic and cardiovascular risks were recently under broad discussion in the media but the question whether hormonal contraceptives modify the risk for cancer is an important issue for many women and their doctors as well. This applies especially to women with a genetic disposition for malignant diseases.

Aim

How is cancer risk modified in women with current or recent hormonal contraceptive use? The dependency of risk on duration of use, intervals between intake and use in particularly hormone-sensitive phases of life (such as puberty) are described.

Material and methods

State of the art information is presented and discussed in view of the results of current meta-analyses, as well as national and international guidelines.

Results

Current meta-analyses showed a significant risk reduction for endometrial and ovarian cancer in combined oral contraceptive users with increased risk reduction following increased duration of use. No significant increase for risk of breast cancer was reported. No uniform data on risk modification for cancer of the cervix uteri and colon cancer in current users of hormonal contraceptives are available. This applies not only for the general population but also for carriers of breast cancer (BRCA) mutations.

Conclusion

For women without a hormone-dependent tumor or disease in the medical history, there is no contraindication for hormonal contraception due to elevated cancer risk. However, the data are not sufficient to justify their use exclusively for chemoprevention, such as for ovarian cancer in high-risk patients.     

Impact of Structured Counseling on the Selection of Hormonal Contraceptive Methods: Results of a Multi-Centric,Observational Study in India

Objective

To determine the influence of “structured contraception counseling” on Indian women’s selection of contraceptive methods.

Methods

Women (≥18 and ≤40 years) requesting contraception were enrolled at 36 sites. “Structured contraception counseling” was provided by a health care professional on the available contraceptive methods. Questionnaires on the women’s pre- and post-counseling contraceptive choice, her perceptions, and the reasons behind her post-counseling decision were filled.

Results

Significant reductions were observed in the proportion of women who were indecisive (n = 260; 31.5 % pre-counseling vs. n = 30; 3.6 %, post-counseling [P < 0.001]) and women opting for non-hormonal method (24.6 % pre-counseling vs. 6.8 % post-counseling, [P < 0.001]). Of all the women counseled (n = 825), 89.6 % (739/825) of women chose a hormonal contraceptive method. There were significant difference (P < 0.001) in the women’s choice of contraceptive in the pre- and post-counseling sessions, respectively (combined oral contraceptive: 30.8 vs. 40.7 %; vaginal ring: 1.8 vs. 14.1 %; progestogen only pills: 1.6 vs. 7.9 %; injectable-depot medroxyprogesterone acetate: 5.9 vs. 13.6 %; levonorgestrel-intrauterine system: 3.8 vs. 13.3 %).

Conclusions

Structured contraception counseling using standardized protocol and aids resulted in a significant increase in the selection of modern contraceptive methods. Post-counseling majority of women opted for hormonal methods with an increase in selection of pills and newer alternatives.     

Evaluation of Post Partum Depression in a Tertiary Hospital

Objective

To evaluate the association of different factors with postpartum depression.

Methods

A prospective study conducted in the Department of Obstetrics and Gynecology, Medical College, Kolkata. Six thousand patients, 4–7 days postpartum, were interrogated using Edinburgh Postnatal Depression Scale (EPDS). Sociodemographic factors (age, parity, literacy, socioeconomic status, marital status and family structure), history of psychiatric disorder and abuse, mode of delivery and obstetric outcome were recorded. The results were analyzed statistically using Chi-square test.

Results

Incidence of PPD was 25%. Significant association of PPD was seen with poor socioeconomic group (P < 0.05), literacy (P < 0.001), nuclear family structure (P < 0.05), single mother (P < 0.001), past history of psychiatric illness (P < 0.001), history of abuse (P < 0.05), and poor obstetric outcome (P < 0.001). Age, parity and method of delivery showed no association.

Conclusion

EPDS should be used routinely to screen for PPD among high risk cases.     

Prevalence of liver disease in pregnancy and its outcome with emphasis on obstetric cholestasis: An Indian scenario

Objective

To determine the prevalence of liver disease in pregnant Indian women and the risk of adverse pregnancy outcomes resulting from intrahepatic cholestasis.

Methods

We analyzed 5947 pregnant women, A total of 79(1.32%) patients had abnormal liver tests. 47 (0.79%) women who gave birth at Sant Parmanand Hospital from January 1997 to August 2008 had pregnancy complicated by cholestasis. Fisher’s exact 2-Tail p-value analysis was used to compare pregnancy characterstics of this group with those of the general obstetric population (n = 5300).

Results

Obstetric cholestasis started at a mean ± SD of 31 ± 4 weeks’ gestation, with pruritus as the leading symptom.. Affected pregnant women had meconium stained liquor significantly more often (40.4%) than the general obstetric population (18.86%). Intrahepatic cholestasis increased the low basic risk of preterm delivery, thereby increasing the need for neonatal care in the general population. Increased incidence of postpartum hemorrhage was also significant(29.78%) p<0.0004.

Conclusion

Intrahepatic cholestasis of pregnancy has an adverse effect on maternal and fetal prognosis, and affected pregnancies merit closer surveillance.     

Pregnancy outcomes in women greater than 45 years: a cohort control study in a multi-ethnic inner city population

Objective

To examine the pregnancy outcomes of women >45 years in a multi-ethnic population when compared to controls and to reflect on socio-demographic details of the older mothers.

Design

A retrospective cohort control study over an 8-year period in an inner city London hospital with multi-ethnic population. The influence of advanced maternal age (>45 years at time of delivery) on fetal and maternal outcomes was assessed by comparing these women to controls (aged 20–30 years) matched for ethnicity, country of origin and parity.

Results

Data from 64 cases and 64 controls were compared. Ninety percent of the index group had undergone assisted conception. Mothers >45 years had a fourfold increase in cesarean section (35/64 vs 8/64), a threefold increase in blood loss (669.2 vs 272.4 ml) (both p < 0.001) and were more likely to have preterm birth (12/64 vs 3/64) (p < 0.05). Only 5 % of the 64 women were born in the United Kingdom, 52 % were unemployed and 50 % were not fluent in English. Seventy-five percent of the study population were multiparous, 52 % of the pregnancies were unplanned and 90 % had conceived spontaneously.

Conclusion

In an inner city immigrant population, older mothers >45 years were more likely to have cesarean sections, postpartum hemorrhage and premature deliveries. Moreover, social and demographic factors suggest that late child bearing is influenced by cultural factors such as acceptance of large families and lack of contraception.     

Video Media in Clinic Waiting Areas Increases Interest in Most Effective Contraceptive Methods

Objective

To examine the utility of a patient-level information video as part of the contraception consultation visit. Specifically, to assess the impact of the video on women's contraception choice, and, further, to assess patient and provider acceptability of incorporating the video into the patient visit.

Client preferences and acceptability for medical abortion and MVA as early pregnancy termination method in Northwest Ethiopia

Objectives

Women aged 40-44 years in 2005 ought to have been subjected to much more influence on attitudes and knowledge on contraceptive methods during their fertile period than women who were in the same age span in 1975 when the abortion laws were introduced.

Material

From official statistics, the rates of induced abortion and birth rates in women aged 40-44 years were collected for Sweden, Denmark, Norway and Finland for each five-year during the period 1975-2005.

Results

With the exception of Sweden all other studied Scandinavian countries have lowered their abortion rates since 1975 (p < 0.001) and reduced the proportion of induced abortions in relation to birth rate (p < 0.001). In 2005 these countries also had lower rates of induced abortion than Sweden in the age group 40-44 years (p < 0.001).

Conclusion

There is a significant change in rates of induced abortion in women aged 40-44 years in Finland, Norway, Denmark, and at status quo in Sweden. 40-44 years in Finland, Norway, Denmark, and at status quo in Sweden. This indicates that family planning programs works well in the Nordic countries. The differences found may be assumed to possible diverging focus on attitudes or ethical considerations.     

Intended postpartum contraceptive use among pregnant and puerperal women at a university teaching hospital

Objective

To assess the intention to use postpartum contraceptives and factors influencing use.

Method

A total of 423 consecutive consenting women attending the pregnancy and puerperal clinics at a university teaching hospital were interviewed using structured questionnaire.

Results

The prevalence of previous contraceptive use was 35.5%. Fifty-four percent of the respondents intended to use contraceptives after delivery, though 3% were yet to decide. Condoms (38.3%) followed by intrauterine contraceptive device (IUCD) 11.5%, were the most preferred choice of postpartum contraceptives. However, spermicide (0.4%) was the least preferred. Advanced age and high parity significantly predicted intention to use postpartum contraceptives (P = 0.02 and 0.01, respectively). Also high level of respondent’s education and family planning counseling by doctors and nurses increased the intention to use postpartum contraceptives (P = 0.03 and 0.01, respectively).

Conclusion

Family planning counseling and education play a vital role in increasing the use of contraceptives in the postpartum period.     

Role of second trimester maternal serum markers as predictor of preeclampsia

Objectives

To evaluate the variations and potential clinical use of second trimester serum markers as predictor of preeclampsia.

Methods

In a prospective study β HCG, α feto protein and inhibin A levels were estimated in 50 antenatal women in the second trimester (12–24 weeks) by ELISA technique. Results were noted in terms of development of preeclampsia, mean serum levels of all three markers, mode of delivery and fetal outcome.

Resuflts

Out of 50 women, 10 developed preeclampsia (20%). A significant rise of mean serum β HCG level (16130.2 MIU/ml, >2.5 MoM,p <0.001), mean serum AFP level (161.7 ng/ml, >2.5 MoM, P<0.001) and mean inhibin-A level (1248.49 pg/ml, >2.0 MoM, P<0.001) was present in those who developed preeclampsia. Out of 10 preeclamptic women one had IUD, four fetuses were growth retarded, two babies were born before term and six were low birth weight babies, whereas out of 40 normotensive women only five had IUGR, three preterm delivery and 32 delivered at term without and complication.

Conclusions

A significant positive correlation between second trimester serum markers and development of preeclampsia was observed (p<0.001). Thus with the second trimester serum marker study, prediction of preeclampsia is possible at incipient stage and its adverse pregnancy outcome can be minimized.     

Sexual life impact evaluation of different hormonal contraceptives on the basis of their methods of administration

Purpose

The aim of this study is to evaluate and compare sexual satisfaction with the use of three types of hormonal contraceptives.

Methods

We have evaluated the sexological profile of 23 patients, treated with a subdermal hormonal contraceptive containing 68 mg etonogestrel. We have compared this profile to that of other two groups of previously studied patients: one consisting of 26 women treated with a vaginal ring releasing 120 µg/day of etonogestrel and 15 µg/day of ethinylestradiol (EE) and one consisting of 25 women treated with an oral contraceptive containing 20 µg of EE and 150 µg of desogestrel. A further group of 25 women, not in treatment with any type of hormonal contraceptive, has been studied as control group. The Interviewer Rating of Sexual Function (IRSF) has been completed by the patients at the beginning of the study and after cycles of 3 and 6 months of contraceptive usage.

Results

All three types of hormonal contraceptives have increased positive indicators of patients’ sexual life (sexual interest and fantasies, of orgasm number and intensity and satisfaction) and decreased negative ones (anxiousness, discomfort).

Conclusions

Subdermal contraception is slower than both intravaginal and oral hormonal contraceptives in giving these effects, but is more effective after a cycle of 6 months of usage.     

A study of obstetric cholestasis

Objective(s)

To study the epidemiology and outcome of pregnancy complicated by obstetric cholestasis (OC).

Methods(s)

Retrospective case control study of 45 women with OC at a tertiary private hospital from November 2003 to November 2006. Statistical analysis was performed using the z test when appropriate. A p value <0.05 was considered statistically significant.

Results

The incidence of OC was 8.2%. The most common symptom was generalized pruritus which appeared after 28 weeks in 73.3% cases. The cesarean section rate was 93.3%. A higher incidence of meconium staining in amniotic fluid at delivery (17.1% vs 1.1%, p<0.005) and preterm premature rupture of membranes (8.9% vs 1.1%, p<0.01) was noted without an increase in preterm delivery rate (24.4% vs 15.6%, not significant). There was no statistically significant difference in the following parameter — pathological cardiotocography, 1–5 minute Apgar score <7, intrauterine growth restriction, neonatal intensive care admission or perinatal mortality. There was no case of postpartum hemorrhage.

Conclusion

The incidence of OC is high in the Indian population. Perinatal outcome is good in actively managed women, although at the cost of a high intervention rate.     

Sublingual versus vaginal misoprostol for cervical ripening before hysteroscopy: a randomized clinical trial

Purpose

To evaluate the efficacy of two routes of misoprostol (sublingual and vaginal) for cervical ripening before hysteroscopy.

Methods

One hundred and ten perimenopausal women who were referred to a tertiary hospital for surgical hysteroscopy enrolled in this double-blind randomized clinical trial. They were divided into two groups to receive 400 mg misoprostol either sublingually or vaginally 6 h before hysteroscopy. The duration of dilatation, Hegar number inserted into the cervix without resistance, and hysteroscopic and drug complications were recorded for all cases.

Results

Forty-nine women in sublingual and 51 in vaginal group participated in the study. Dilatation time was significantly lower in sublingual group (P < 0.001). Median Hegar number passed into the cervix without resistance was 5 in sublingual versus 4 in vaginal group (P = 0.002). Cramp followed by vomiting and diarrhea were the most common side effects of misoprostol in the sublingual group, while cramp followed by vomiting was the most frequent side effect in the vaginal group. Diarrhea was not reported in the vaginal group (P = 0.008).

Conclusion

Sublingual route of misoprostol could be considered as an effective medication before surgical hysteroscopy in perimenopausal women.     

Infecciones vaginales y lesiones celulares cervicales (III). Características de la sexualidad

Objective

To study the characteristics of sexuality in a series of patients: 399 with vaginal infections and 32 with cervical cell lesions, diagnosed by cervicovaginal cytology during a 1-year period.

Material and methods

We performed personal interviews to inquire about the presence or absence of sexual intercourse and the reasons, sexual desire, arousal, orgasm, dyspareunia, vaginal dryness, the frequency of coitus, contraceptive methods, anal coitus and simultaneous multiple sexual partners. The 399 patients were compared with a control group of 252 women without vaginal infections or cervical lesions.

Results

The group with infections and lesions were younger, with a mean age of 34 years, and there were more nulligravidas (33.25%), p < 0.001. A total of 60.23% used no contraceptive method. The most commonly used methods were the pill in 14.31% and the condom in 12.23%. Seventy patients (16.27%) were not having intercourse due to lack of a sexual partner. The frequency of coitus was once a week in 20%.The characteristics of sexuality were as follows: 45.15% had no sexual desire, 32.5% experienced no arousal, 21.94% had no orgasm, and 43.88% had dyspareunia. These percentages were higher than in the control group (p < 0.001). Anal intercourse was practiced by 15.83% and 2.5% had simultaneous multiple sexual partners.The following significant differences were found according to infection types: absence of sexual desire was greater in bacterial vaginosis (p < 0.05), lack of arousal was greater in Gardnerella vaginalis (p < 0.01), and dyspareunia was greater in Candidas (p < 0.001), bacterial vaginosis (p < 0.001), in women with a history of human papilloma virus (HPV) (p < 0.01) and in Trichomonas vaginalis (p < 0.05). Anal intercourse was more frequent in women with HPV (p < 0.01) and those with cervical lesions (p < 0.05).

Conclusions

Women with vaginal infections and cervical cell lesions were younger, with fewer pregnancies despite low use of contraception, had low coital frequency and more dyspareunia. These women practiced anal coitus and more frequently had simultaneous multiple sexual partners.Individuals are responsible for their sexuality and sexual health. Concern for sexually-transmitted diseases, HIV and cervical cancer should be universal.     

Tubal Sterilization in Women Under 30: Case Series and Ethical Implications

Objective

According to the SOGC Contraception Consensus, it is recommended that permanent contraception be offered to women regardless of age or parity. Many women who desire sterilization at a young age experience barriers from physicians who decline to facilitate the request.

Low Acceptability of Certain Contraceptive Methods among Young Women

Study Objective

To examine what predicts low personal acceptability of 4 different contraceptive methods among young women.

Italian Adolescents and Emergency Contraception: A Focus Group Study

Study Objective

Using a qualitative method, the purpose of this study was to: (1) obtain information directly from the adolescents on their attitudes and knowledge regarding emergency contraception; and (2) investigate the presence of differences between male and female participants' attitudes and knowledge.

Acceptance of Contraceptive Methods Among Postpartum Women in a Tertiary Care Center

Background

In India, a large proportion of women with an unmet need for contraception are within their first year after childbirth. Therefore, concentrating efforts to educate postpartum women on the importance of attending contraceptive clinics could have a proportionally bigger impact on increasing postpartum contraception usage.

Methods

Hundred and seventy-eight (178) women were followed up to determine the proportion of postpartum women who attended the family planning clinics for contraceptive counseling. The reason for non-attendance, choice and effectiveness of contraceptive method selected was determined.

Results

Out of 178 postpartum women who were followed up, only 12 (6.8 %) attended the contraceptive clinic. IUD, POPs and Inj-DMPA are the preferred contraceptive methods selected by postpartum women. Hundred percent of the postpartum women who attended contraceptive selected a contraceptive method as compared to only 44 % of the postpartum women who did not attend a contraceptive clinic. Only 29.2 % of these postpartum women selected highly effective contraceptive methods as compared to 83.3 % by the postpartum women who attended family planning clinics. The common reasons cited for not attending contraceptive clinic was found to be time constraint (43.9 %) followed by ‘stay far away’ (39 %), followed by ‘already have information’ (9.7 %).

Conclusions

Family planning service that is scheduled to be delivered at the 6-week postpartum is rarely attended. The common reason cited by postpartum women for poor attendance in these family planning clinics was time constraint.

     

Contraceptive Methods: Needs, Options and Utilization

Objectives

Background-Contraception is the intentional prevention of conception through the use of various devices, sexual practices, chemicals, drugs or surgical procedures. An effective contraception allows a physical relationship without fear of an unwanted pregnancy and ensures freedom to have children when desired. The aim is to achieve contraception in maximum comfort and privacy, with minimum cost and side effects. Some methods, like male and female condoms, also provide twin advantage of protection from sexually transmitted diseases. The burden of unsafe abortion lies primarily in developing countries. Here, contraceptive prevalence is measured among currently married women of reproductive age, and levels have not yet reached those that exist in developed countries.

Conclusion

In countries like India, there is a dire need for contraceptive methods to be more women friendly, accessible and provide adequate privacy. Providers also need to be sensitive to special needs of adolescents as they are at a critically vulnerable segment.     

Study on emergency contraception with Cu T 200 B and 0.75 mg Levonorgestrel (2 doses) using cafeteria approach

Objectives

To study the need for emergency contraception (EC) and evaluate the efficacy and side effects of Cu T 200 B and Levonorgestrel (LNG).

Material and Methods

A 2-years study was conducted at Kasturba Hospital, Delhi, India.

Results

A total of 68 subjects were enrolled. Of them, 16 (23.53%) chose Cu T and 52 (76.47%) chose LNG as emergency contraceptives. LNG was given to subjects who came within 72 hours of unprotected intercourse and Cu T was given to those who came after 72 hours but within 120 hours of unprotected intercourse. Reasons for EC were: no contraception used (50%), problems with barrier method (42.65%), problems with IUD (7.35%). Side effects were minimal with LNG (5.77% subjects complained of nausea). Among Cu T users 12.5% subjects complained of irregular bleeding and 18.75% had low abdominal pain.

Conclusions

Both LNG and Cu T 200 B are safe and effective methods of EC with low side effects.