上海市已婚妇女初产后避孕方法的选择和转换

本文对上海市3701名已婚妇女初产后15个月内避孕方法的选择和转换进行了分析,分析结果表明：产后15个月内,95．46％的妇女采取过避孕方法。产后首次采取的避孕方法城市以避孕套（50．72％）和IUD（29．09％）为主,农村以IUD（56．65％）和避孕套（30．60％）为主,其它方法较少。首次避孕选择避孕套者,终止向IUD的转换率较高;而选用IUD者终止向其它方法的转换率较低。15个月随访时,94．54％的妇女正在使用某种避孕方法,其中60．76％的城市妇女71．07％的农村妇女正在使用IUD。多项分类Logistic回归分析结果表明不同特征的妇女对避孕方法的选择存在很大差异,城市、文化程度高的妇女倾向于选用避孕套和安全期,较少选用口服药;年龄大的妇女使用避孕套和安全期的人要多些;正在哺乳的妇女不愿用口服药;单位或计划生育部门对产后选用何种避孕方法有推荐意向的妇女使用IUD的比例较高。提示计划生育管理部门应根据妇女的不同特征耐心、细致、客观地向她们说明各种避孕方法的优点和缺点,需纠正社会上对一些避孕方法的偏见。应充分尊重妇女的避孕选择,使妇女自觉满意地实行计划生育。     

Contraception within six-month postpartum in rural Vietnam: implications on family planning and maternity services.

OBJECTIVES: This longitudinal study documents contraception practice and factors influencing contraception decision within the first six months postpartum, amongst women residing in the rural Northern Central region of Vietnam. METHODS: A sample of 463 rural women who gave birth during August-October 2002 were recruited and interviewed at one, 16 and 24 weeks postpartum. RESULTS: The proportion of contraceptive users at weeks 16 and 24 were 17% and 43% respectively. At week 24, of contraceptive users, 57% used IUD, 25% used condom, and 14% used traditional methods. Logistic regression analysis found age, sufficient knowledge on contraceptives and husband/partner opinion can significantly affect the contraception decision. CONCLUSIONS: In order to improve the situation, health authorities should be encouraged to provide counselling on postpartum contraceptive methods during ante- and postnatal care visits. Health education on family planning and breastfeeding should also involve the husband/partner group taking into account local socio-cultural features.     

Concordance between intention to use and current use of contraceptives among six-month postpartum women in Brazil: The role of unplanned pregnancy

Objectiveto examine the effect of pregnancy planning status in the concordance between intention to use and current use of contraceptives among postpartum women.Design and settinga prospective study was conducted in 12 primary health care facilities in São Paulo, Brazil, from November 2013 to September 2014.ParticipantsA total of 264 woman aged 15–44 years old completed a face-to-face interview when they were pregnant (baseline), and were interviewed by phone at 6 months postpartum.MeasurementsAt baseline, participants were questioned about the contraceptive method they would prefer to be using at 6 months postpartum. At 6 months postpartum, they answered about the contraceptive method they were currently using. Pregnancy planning status was measured using the Brazilian Portuguese London Measure of Unplanned Pregnancy. We conducted logistic regression, considering contraceptive preference-use concordance as the dependent variable and the main covariate as pregnancy planning status.FindingsOnly 28.9% of postpartum women were using the method they preferred to use when they were pregnant. The agreement between preference and contraceptive use was higher for injectables (60.9%) and lowest for IUD, as nobody who preferred it was actually using it. Women who were not sure about what method they intended to use after childbirth more frequently reported no use at six months postpartum. Multivariate logistic regression showed that postpartum women whose pregnancy was unplanned were less likely to use the contraceptive methods that they intended to use when they were pregnant [aOR=0.36; 95%CI=0.14-0.97].Conclusions and implications for practiceBrazilian women were able to access contraceptives in the postpartum period. However, there is a considerable discordance between their contraceptive intention to use and use at the sixth postpartum month. A higher unmet demand for IUD and sterilization should be highlighted. The pregnancy planning status is associated to postpartum contraceptive preference-use concordance, so interventions before pregnancy may affect postpartum contraceptive use. Women with unintended pregnancies present an important opportunity to offer additional family planning counseling.     

The introduction of postpartum intrauterine devices in the People's Republic of China

In China, which has a commitment to family planning and, in particular, to the one-child family, a postpartum IUD should be widely accepted and could have significant impact on the Chinese family planning program. This report presents the introduction of the Delta T and Delta Loop devices, with 200 immediate postpartum insertions. Fifty-two deliveries were by cesarean section. The 6-month expulsion rates were 13.3 and 17.2 for the Delta T and Delta Loop, respectively. There was one pregnancy reported. Analysis suggests that the two devices are suitable for use in the postpartum period for Chinese women.     

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.

     

Contraception within six-month postpartum in rural Vietnam: Implications on family planning and maternity services

Objectives?This longitudinal study documents contraception practice and factors influencing contraception decision within the first six months postpartum, amongst women residing in the rural Northern Central region of Vietnam.

Methods?A sample of 463 rural women who gave birth during August-October 2002 were recruited and interviewed at one, 16 and 24 weeks postpartum.

Results?The proportion of contraceptive users at weeks 16 and 24 were 17% and 43% respectively. At week 24, of contraceptive users, 57% used IUD, 25% used condom, and 14% used traditional methods. Logistic regression analysis found age, sufficient knowledge on contraceptives and husband/partner opinion can significantly affect the contraception decision.

Conclusions?In order to improve the situation, health authorities should be encouraged to provide counselling on postpartum contraceptive methods during ante- and postnatal care visits. Health education on family planning and breastfeeding should also involve the husband/partner group taking into account local socio-cultural features.     

Analysis of risk factors associated with uterine perforation by intrauterine devices.

OBJECTIVE: To determine the risk factors for intrauterine devices (IUDs) being displaced into the abdominal cavity. METHODS: This prospective follow-up study was conducted between 1996 and 2002, at the family planning clinic of a referral hospital. All 8343 women who had a copper T-380A IUD inserted underwent ultrasound examination after 1 year. Relative risk estimates and logistic regression analyses were performed to determine the risk factors associated with uterine perforation by intrauterine devices. RESULTS: Eighteen uterine perforations occurred during the study, giving an incidence of 2.2 per 1000 insertions. When the time elapsed after the last delivery until IUD insertion is considered, postplacental insertion and insertion after 6 months postpartum were found not to increase the risk of uterine perforation. However, IUD insertion 0-3 months postpartum increased the risk of uterine perforation (odds ratio (OR) 11.7, 95% confidence interval (CI) 2.8-49.2) as did insertions at 3-6 months postpartum (OR 13.2, CI 2.8-62). Increasing parity decreased the risk (OR 0.04, CI 0.01-0.1) and increasing number of abortions increased the risk (OR 2.1, CI 1.2-3.6). CONCLUSION: It is safer to postpone IUD insertion until 6 months after delivery.     

Determinants of Intrauterine Contraceptive Device Discontinuation Among Indian Women

Objective

To determine intrauterine contraceptive device (IUCD) discontinuation rate and its causes and related factors among women attending the OPD/family planning clinic in Mahila Chikitasalaya, SMS Medical College, Jaipur from January 2012 to December 2012.

Methods

387 women who had an intrauterine device (IUD) inserted during the last 1–5 years were interviewed during their visits to the OPD/family planning clinic. Sociodemographic characteristics for all women were described using frequency distribution. Life tables were used to describe the proportion of women who discontinued IUD at various time intervals. The main outcome measure was IUD discontinuation.

Results

The incidence of IUD discontinuation in the first year following insertion was 16.79 %. Approximately 31 % of the study sample continued using their devices after 5 years. The average duration of IUD use was 36 months. Of the 387 women, 56 % discontinued IUD use because of a desire to conceive, 27.7 % because of side effects, 15.36 % because of opposition from the woman’s family, and 1.5 % because they were sexually inactive. The most common side effects reported as the reasons for discontinuation were bleeding, infection, and pain. Discontinuation was inversely related to the age at insertion, the number of living children, and the sex of children. Previous contraceptive users were significantly less likely to discontinue IUD use.

Conclusions

The crude cumulative rate of IUD discontinuation was 16.79 % during the first year, suggesting a need to tackle the problem of discontinuation through effective educational strategies and counseling techniques. Desire to have a male child still predominates among Indian families. The average duration of IUD use in majority of the females was about 36 months (45 %), thereby fulfilling its objective of spacing between children as laid down by the WHO (2 years spacing between pregnancies). About 31 % of the women continued using IUCD even after 5 years. It is crucial to correct misconceptions and identify the lack of correct and complete information both among the providers and the acceptors, to improve the effectiveness of family planning programs.     

Post-partum and post-abortal use of IUDs (author's transl)

The search for an IUD that could be safely inserted in the immediate postpartum period and retained as long as desired led the Population Council to undertake a 13-center study of Lippes loop insertion during the 1st 10 postpartum days. The expulsion rate of 20.5% in the 1st 3 months following insertion was considered too high, despite apparently lower risks of perforation and infection. In 1975 the International Fertility Research Program (IFRP) began a program to modify existing IUDs for immediate postpartum and postabortal insertion. Several approaches were explored using biodegradable materials to avoid expulsion, and a modified Lippes loop with catgut sutures gave good results. A case study undertaken by the IFRP attempted to evaluate too many factors with too little attention to the qualifications of participating physicians, resulting in highly variable experiences in different centers. A program recently initiated in 10 collaborating centers in Turkey promises to yield interesting results; preliminary indications are that success rates vary between institutions and depend partly on the enthusiasm of the program director. 1 Turkish center solved the difficult problem of follow-up by adding a clinic where the newborns received check-ups. In 1 month, with 100% follow-up, over 100 IUDs were inserted and only 1 of the last 50 was expelled. Many IUDs inserted postpartum are expelled because they are not placed sufficiently deeply in the uterine cavity. The IFRP believes that with appropriate training of personnel and a better tool for insertion, a high rate of retention can be achieved. Within 6 months the IFRP expects to begin clinical testing of a 2nd generation postpartum IUD with improved sutures. Despite variable success in the past, development of a satisfactory postpartum IUD would be a valuable addition to many national family planning programs.     

Hospital-based family planning program

To improve the family planning program at Temple University Hospital, the charts of 1526 service patients were analyzed in 1966. Total ward deliveries showed 855(56%) were married, while 671(44%) were single, separated, divorced or widowed. 834(55%) accepted some method of birth control. 44% of the 1526 returned for postpartum visits. It was revealed that a large number of welfare recipients accepted family planning than did those whose hospital bill was paid. Family planning services should be made an integral part of already established obstetric and gynecologic programs. The addition of indigenous personnel from the community serving the team of physicians, nurses, and social-workers will expedite the accepting of family planning information and services.     

云南省县、乡计划生育服务机构IUD放置服务的管理现状研究

目的:了解云南省县、乡计划生育服务机构IUD放置服务管理现状。方法:采用多阶段分层整群随机抽样的方法,抽取云南3个县进行横断面调查。采用情景分析法收集与IUD放置服务及其管理的相关数据及资料并进行深入分析。结果:3个县的县、乡计划生育服务机构作为农村育龄妇女最易获得服务的机构,承担了大量IUD放取工作。其管理系统运行基本正常,但3个县计划生育服务站/所IUD放置服务的管理总体尚比较粗糙,且基层计划生育服务机构间管理水平差异显著。结论:情景分析法可以对生殖健康服务及其管理提供全面、丰富和细致的信息。开展试点和研究,提高西部农村IUD放置服务的管理水平现实可行。     

Visibility of Strings After Postplacental Intracesarean Insertion of CuT380A and Cu375 Intrauterine Contraceptive Device: A Randomized Comparative Study

Objectives

To compare the incidence of visible strings after postplacental intracesarean insertion of Cu375 and CuT380A intrauterine contraceptive devices (IUD).

Methods

This was a prospective, randomized comparative study. A total of 100 women fulfilling the inclusion and exclusion criteria underwent postplacental intracesarean insertion of either Cu375 IUD or CuT380A IUD. Women were followed up at 1, 6 weeks and 3 months after IUD insertion and were questioned about IUD expulsion or removal at each visit. The cervix was inspected to visualize the IUD strings. Data were analyzed by Chi-square test.

Results

At 6-week follow-up, 97.9% women in group A versus 41.7% women in group B had strings visible at the cervical os and at 3 months 100% women in group A versus only 47.9% women in group B (p < 0.001) had visible strings of IUD.

Conclusion

Both Cu375 and CuT380A IUD are safe postpartum method of contraception but Cu375 if used for intracesarean IUD insertion increases the incidence of visible IUD strings. Hence, it avoids radiological investigations and invasive procedures at follow-up visits required to locate the IUD when strings are not visible. CTRI No. CTRI/2015/09/006221.

     

Hospital family planning service in Khartoum,Sudan

In January 1971, a family planning clinic was started in the postnatal wards of Khartoum Hospital. During the first 2 years of the program, 350 recently delivered women (9.3%) adopted family planning. 165 patients accepted the pill, 65 accepted the IUD, and 120 underwent surgical sterilization. 57% of the acceptors attended a follow-up clinic, with IUD wearers being the best represented. The percentage of acceptors, though low, is higher than at family planning clinics outside the hospital. As the postpartum clinic utilizes hospital staff already available, it is seen as an effective and economical way of providing contraception.     

Acceptance of lactational amenorrhoea for family planning after postpartum counseling.

OBJECTIVE: To determine the impact of postpartum counseling on the acceptance of lactational amenorrhoea method (LAM) for family planning. METHODS: In a prospective cross-sectional study 1490 postpartum women were included. Women who accepted or refused LAM for family planning were identified by means of a written survey. Twelve socio-demographic and clinical variables were included as predictors in a logistic regression analysis, the acceptance or refusal of LAM was the dependent variable; an Alpha level was set at 0.05. RESULTS: There were 807 (54.2%) women who accepted LAM as a contraceptive method; 683 (45.8%) refused it. Main reasons for accepting LAM were: conviction following counseling (54.4%) and use of LAM initially before switching to another contraceptive modality (18.3%). Main reasons for LAM refusal were: belief that the method was unsafe (62.2%) and fear of some undesirable effect on health (15.8%). In the logistic regression analysis the variables occupation outside the home (P = 0.01) and previous knowledge of LAM (P < 0.001) emerged as predictors of LAM acceptance. CONCLUSIONS: Postpartum counseling of LAM had a very positive impact on its acceptance. Although it is recommended that information about LAM be given antenatally, in some settings postpartum counseling could improve its acceptance rate.     

Increasing postpartum family planning uptake through group antenatal care: a longitudinal prospective cohort design

Background

Despite significant improvements, postpartum family planning uptake remains low for women in sub-Saharan Africa. Transmitting family planning education in a comprehensible way during antenatal care (ANC) has the potential for long-term positive impact on contraceptive use. We followed women for one-year postpartum to examine the uptake and continuation of family planning following enrollment in group versus individual ANC.

Methods

A longitudinal, prospective cohort design was used. Two hundred forty women were assigned to group ANC (n?=?120) or standard, individual care (n?=?120) at their first ANC visit. Principal outcome measures included intent to use family planning immediately postpartum and use of a modern family planning method at one-year postpartum. Additionally, data were collected on intended and actual length of exclusive breastfeeding at one-year postpartum. Pearson chi-square tests were used to test for statistically significant differences between group and individual ANC groups. Odds ratios and adjusted odds ratios were calculated using logistic regression.

Results

Women who participated in group ANC were more likely to use modern and non-modern contraception than those in individual care (59.1% vs. 19%, p?<?.001). This relationship improved when controlled for intention, age, religion, gravida, and education (AOR?=?6.690, 95% CI: 2.724, 16,420). Women who participated in group ANC had higher odds of using a modern family planning method than those in individual care (AOR?=?8.063, p?<?.001). Those who participated in group ANC were more likely to exclusively breastfeed for more than 6?months than those in individual care (75.5% vs. 50%, p?<?.001). This relationship remained statistically significant when adjusted for age, religion, gravida, and education (AOR?=?3.796, 95% CI: 1.558, 9.247).

Conclusions

Group ANC has the potential to be an effective model for improving the uptake and continuation of post-partum family planning up to one-year. Antenatal care presents a unique opportunity to influence the adoption of postpartum family planning. This is the first study to examine the impact of group ANC on family planning intent and use in a low-resource setting. Group ANC holds the potential to increase postpartum family planning uptake and long-term continuation.

Trial registration

Not applicable. No health related outcomes reported.

     

The use of family planning methods in an administrative district of Istanbul.

In Turkey, the first population and family planning law was accepted by the government in 1965, and this law was revised in 1982. This study was carried out to evaluate the family planning methods of women who applied to rural health centers of Kü?ük?ekmece and were willing to use the health-care service and consultancy about birth control methods. The data of the study were gathered by means of an appropriate inquiry form and face-to-face interview with the women willing to use the family planning service between September 1998 and June 1999 at the health-care centers of Kü?ük?ekmece of Istanbul. There were 699 women participants in the study. The last pregnancy of 27.2% (n = 175) of the women had been undesired; 86.8% of all the women who participated in the study declared that they did not desire any more children, but only 81.3% (n = 568) out of these were using a method to protect from pregnancy. The most frequently known (84.8%) and used (45.9%) method of the participants was an intrauterine device (IUD), and 80.8% of the women using an IUD wanted to continue using that method. A total of 223 women (39.3%) using any method protecting from pregnancy became pregnant. Approximately half (57.8%) of those occurred during the use of withdrawal. According to the findings of this study, the level of knowledge about family planning and the consequent behavior of the women within the fertile age group are better than the average of Turkey, but still not satisfactory.     

Postpartum contraceptive needs in northern Haiti

Objective

To assess the knowledge of, attitudes toward, and practices regarding postpartum contraception among healthcare providers and postpartum women in northern Haiti.

Methods

Six focus groups were conducted with postpartum patients and 3 were conducted with maternity service providers; a structured questionnaire was then administered to postpartum patients.

Results

In total, 282 postpartum women were included in the present study: 249 in the survey and 33 in focus groups. Although 97.9% of women expressed a desire for family-planning counseling before discharge from the postpartum ward, only 6.0% of women received such counseling. Most women wanted to space or limit their pregnancies; 79.8% of women, including those with only 1 child, wanted to choose a contraceptive method before discharge. Providers expressed concern for the volume of induced abortions and maternal deaths within the hospital, which many felt could be averted by improving postpartum family planning. However, there was no postpartum contraceptive counseling or method provision in the present setting, and no providers had experience in initiating methods immediately postpartum.

Conclusion

Efforts to integrate family planning into postpartum care services could help to reduce the unmet need for family planning, and help patients and providers reach their goals.     

Study in Turkey leads to integration of abortion and family planning services

The efficiency and effectiveness of public sector abortion services in Istanbul as well as their suitability in regulating the fertility of women were assessed in two hospitals in Turkey. The Social Security Hospital performed the surgical procedure of dilatation and curettage with little follow-up, while a Ministry of Health hospital offered the simpler procedure of manual vacuum aspiration with follow-up. In this latter case, the abortion service was part of the family planning unit of the hospital. 3% of the women were younger than 20 years old, most were married with an average of 2.5 living children, and almost half had already had at least one abortion. 11% of the women used the modern IUD and oral pill contraceptive methods. 75%, however, depended upon withdrawal for protection against unwanted pregnancies; method failure was the main reason for unwanted pregnancies. The study found abortion services to be an indispensable part of fertility regulation, especially given the high dependence upon withdrawal for contraception. The comparatively low costs of the Ministry of Health hospital services were incentive for women to seek its services, while women felt that private sector options were not as good. Study findings played a role in the integration of the family planning clinic and the abortion clinic at the Social Security Hospital into one service at the same location, with all women receiving post-abortion counseling on contraceptive use. All cases are required to return for follow-up fifteen days after the intervention. Client satisfaction along with the improvement in service quality mean that the changes may be extended to other hospitals once their longer-term effectiveness has been confirmed.     

The Ontario Mother and Infant Survey: breastfeeding outcomes.

A cross-sectional survey of postpartum women following discharge from five hospitals in Ontario, Canada, examined breatfeeding patterns and risk factors for early discontinuation. Consenting mothers completed self-administered questionnaires prior to discharge (n = 1250) and telephone interviews at 4 weeks postdischarge (n = 875). Breastfeeding initiation rates for women completing the interview varied from 82% to 96% across the sites. Continuation rates rapidly declined, with 13% to 24% of women who had initiated breastfeeding switching to formula by 4 weeks postpartum. Perceived inadequate milk supply, difficulty with breastfeeding techniques, and sore nipples were the main reasons reported. Risk factors for breastfeeding cessation included not completing high school; intention to breastfeed less than 4 months; not anticipating the use of a "mom's group" or "drop-in center"; one or more maternal visits to a family physician; length of postpartum stay greater than 48 hours; unmet need for care or help with breastfeeding; and received advice, information, or support about formula feeding.     

上海市流动人口孕产妇平产分娩点医院避孕服务状况调查

目的:了解流动人口孕产妇平产分娩点计划生育和避孕咨询服务现状及医务人员的产后避孕知识。方法:通过结构式问卷,对2004年上海市卫生局设立的10家流动人口孕产妇平产分娩点医疗机构进行机构设置及避孕服务调查,对机构中涉及到计划生育/避孕咨询服务的医务人员进行产后避孕知识调查。结果:10家外来人口分娩点医院中,仅有3家医院设有独立的计划生育门诊,8家医院设有计划生育咨询室,所有的二级医院均设有计划生育病床,平均提供10.5种避孕方法的咨询,可以操作落实的避孕服务项目平均为7.1种。343名调查对象中,279人(80.8%)曾为孕妇或产后妇女提供过避孕咨询服务;109人(31.8%)曾参加过计划生育/避孕咨询方面的培训。产后避孕知识得分最高为82分,中位得分为34分;多因素分析显示,调整其他可能的影响因素后,培训是影响医务人员产后避孕知识最重要的因素。结论:大部分流动人口孕产妇平产分娩点机构的计划生育设置和避孕方法咨询服务能够达到管理文件要求。但仍需加强计划生育门诊的硬件建设和针对性地加强医务人员产后避孕知识的再培训,更新知识结构。