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.     

Evidence-based family planning: the paradigm for the third millennium

Evidence-based medicine applies clinical epidemiology to the care of the individual patient. In contrast, autocratic or authoritarian medicine rests largely on expert opinion and clinical tradition. The need for evidence-based medicine in family planning practice is acute, as counselling for intrauterine devices and tubal sterilization attests. Two international evidence-based guidelines in family planning, both published in 1996, represent a major advance in clinical practice. In addition, the Cochrane Collaboration, a global effort to identify and synthesize randomized controlled trials in medicine, now includes topics on fertility regulation. Evidence-based clinical guidelines and Cochrane systematic reviews are valuable tools for family planning practice. The use of evidence-based medicine will improve clinical care today, and, more importantly, in the millennium which is just beginning.     

Slaughtering sacred cows: Six institutional obstacles to advances in family planning

Abstract

In order to capitalise on new opportunities to advance contraceptive and reproductive health choices globally, organisations working in these fields will need to overcome six institutional obstacles. These are: (i) committee management; (ii) over-medicalisation; (iii) fear of risk and controversy; (iv) conferences, meetings, and symposia; (v) obsession with coordination; and (vi) fear of sex. The reproductive health community will require energy, innovative approaches, and a sharp focus on service delivery to address these hurdles that will otherwise slow down and misdirect programmatic momentum.

Chinese Abstract

摘 要 为了抓住新的机会促进全球生殖与避孕的健康选择, 在此领域工作的机构将需要克服六个体制性问题。分别为：(i) 委员会管理;(ii) 过度医疗化; (iii) 惧怕风险与争论;(iv) 讨论,会议与座谈;及(vi)对性的恐惧。生殖医学界需要活力而创新的态度并密切关注可解决这些障碍的方式,否则会阻碍和误导程序化势头。     

Client participation and provider communication in family planning counselling and the sample study from Turkey

Background?The family planning program in Turkey was established in 1965 to curb the rapid increase in population growth. The last Demographic and Health Survey showed that about 64 % of married women in Turkey used contraception.

Objectives?This study examines of behaviour of family planning clients and provider in Eskisehir/Turkey, to see whether they can achieve this ideal parnership.

Methods?Consultation between 83 physicians, 222 nurses and 324 clients requesting family planning methods were audiotaped and analysed for physicians and nurses communication style. Data were collected from 3 hospital and 14 small health units that give services in Eskisehir. The audiotaped consultations were coded using an adaptation of the RIAS which has been used extensively in both developed and developing countries and in statistical analysing χ² and t test were utilized.

Results and conclusion?The single strongest factor was providers giving biomedical and technical information. The qualitative analysis of audiotapes found that most of clients' questions concern contraceptive side effects and symptoms. The next category social talk, consisted largely of greetings. Most of the providers (87.6 %) are women. The results show that providers dominate most counselling session and clients rarely take on active role.     

Community mobilization and service strengthening to increase awareness and use of postabortion care and family planning in Kenya

Objective

To evaluate whether a community engagement and service-strengthening intervention raised awareness of family planning (FP) and early pregnancy bleeding (EPB), and increased FP and postabortion care (PAC) use.

Methods

The intervention was carried out in 3 communities in Kenya over 18 months; 3 additional communities served as the comparison group. A pre–post, contemporaneously controlled, quasi-experimental evaluation was conducted independently from the intervention.

Results

Baseline characteristics were similar. Awareness of FP methods increased (P ≤ 0.001) in the intervention group. The incidence of reported EPB (before 5 months of pregnancy) in the comparison group was 13.3% at baseline and 6.0% at endline (P = 0.02); 79% at baseline and 100% at endline sought care (P > 0.05). In the intervention group, recognition and reporting of EPB increased from 9.8% to 13.1% (P > 0.05); 65% sought PAC at baseline and 80% at endline (P = 0.11). The relative increase in EPB reports after the intervention was over 3 times greater in the intervention group (P ≤ 0.01).

Conclusion

The intervention raised FP and EPB awareness but not FP and PAC services use. As fewer comparison group respondents reported experiencing EPB, the PAC impact of the intervention is unclear. Mechanisms to improve EPB reporting are needed to avoid this reporting bias.     

Misoprostol versus cervagem for the induction of labour to terminate pregnancy in the second and third trimester: a systematic review

AIMS: to compare the benefits and harms of misoprostol to induce labour in the second and third trimester of pregnancy with cervagem. METHODS: MEDLINE was searched using the terms abortion, induced; abortifacient agents; pregnancy, second trimester; pregnancy, third trimester; misoprostol; cervagem; and gemeprost to identify randomised controlled trials in which misoprostol was compared with cervagem, for induction of labour to terminate pregnancy in the second or third trimester. Outcomes included vaginal birth not achieved within 24h; induction to delivery interval; analgesia requirements; blood loss; blood transfusion; surgical evacuation of the uterus; maternal death or serious maternal morbidity; side effects. RESULTS: Six randomised trials were included. Five compared vaginal misoprostol with cervagem [el Refaey H, Hinshaw K, Templeton A. The abortifacient effect of misoprostol in the second trimester: a randomized comparison with gemeprost in patients pre-treated with mifepristone (RU486). Hum Reprod 1993;8(10):1744-6; Ho PC, Chan YF, Lau W. Misoprostol is as effective as gemeprost in termination of second trimester pregnancy when combined with mifepristone: a randomised comparative trial. Contraception 1996;53(5):281-3; Nuutila M, Toivonen J, Ylikorkala O, Halmesmaki E. A comparison between two doses of intravaginal misoprostol and gemeprost for induction of second trimester abortion. Obstetr Gynecol 1997;90(6):896-900; Wong KS, Ngai CS, Wong AY, Tang LC, Ho PC. Vaginal misoprostol compared with vaginal gemeprost in termination of pregnancy: a randomized controlled trial. Contraception 1998;58(4):207-10; Dickinson JE, Godfrey M, Evans SF. Efficacy of intravaginal misoprostol in second trimester termination of pregnancy: a randomized controlled trial. J Mater Fetal Med 1999;7(3):115-9], and one oral misoprostol with gemeprost [Bartley J, Baird DT. A randomised study of misoprostol and gemeprost in combination with mifepristone for induction of abortion in the second trimester of pregnancy. Br J Obstetr Gynaecol 2002;109(11):1290-4]. Vaginal misoprostol compared with cervagem was associated with reduced narcotic analgesia (3 studies, 169 women, RR 0.64 95% CI 0.49-0.84), and surgical evacuation of the uterus (5 studies, 319 women, RR 0.71 95% CI 0.53-0.95). No other statistically significant differences were observed for other outcomes with reported data. In the single trial comparing oral misoprostol with gemeprost, reported outcomes were similar. CONCLUSIONS: Vaginal misoprostol for the termination of second and third trimester of pregnancy appears as effective as cervagem, but information about maternal safety is limited.     

Prophylactic use of olanzapine and quetiapine from pregnancy to the postpartum period in women with bipolar disorder: a case series

The management of bipolar disorder in pregnant and postpartum women is one of the most difficult issues in clinical practice. Data on the efficacy of mood stabilizers, except lithium and antipsychotics, in the maintenance treatment of bipolar disorders during pregnancy and postpartum period are very limited. This report presents results of prophylaxis with olanzapine and quetiapine with regard to affective episodes in pregnancy to the postpartum period.