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.     

Actual use of the lactational amenorrhoea method.

OBJECTIVE: The lactational amenorrhoea method (LAM) is an effective contraceptive option in developing countries. Post-partum, of the women who accept to apply LAM, many never do. Our aim was to determine the actual use of LAM. METHODS: A group of 326 post-partum women who accepted LAM use were recruited. After 6 months, they were asked if they actually had applied the method or not. In a logistic regression analysis, nine socio-demographic and clinical variables were studied as predictors of actual LAM use. An alpha level was set at 0.05. RESULTS: Overall, of the 326 women, only 61 (18.7%) actually applied LAM. The mean duration of LAM use was 4.3 +/- 0.2 months. The main reason for not applying LAM was that women thought the method was ineffective (66.0%). The variable time of menses resumption emerged as a predictor of LAM use (p = 0.001). CONCLUSIONS: Despite post-partum acceptance, most women did not actually apply LAM. In our setting as well as in other developing countries, regular contacts with a health care provider could improve LAM use.     

Natural family planning: postpartum period

The length of the postpartum anovulatory period was studied in 200 mothers by means of endometrial biopsy, basal body temperature, vaginal cytology, and cervical mucus. The occurrence of the first ovulation and the first bleeding after childbirth are analyzed in relation to the type of nursing. The characteristics of 408 postpartum menstrual cycles are studied, by means of the same methodology. The shortest anovulatory period for nonnursing mothers was 36 days; for partial nursing mothers, 40 days; and for full nursing mothers, 70 days. The first postpartum bleeding appeared to be preceded by ovulation in 41% of the full nursing mothers, 75% of partial nursing mothers, and 91% of nonnursing mothers. Postpartum cycles were significantly longer and showed a luteal phase significantly shorter than control cycles, especially when the mother was fully nursing.     

Effect of postpartum counseling on postpartum contraceptive use

Objective The aim of this study was to evaluate the effect of postpartum counseling on postpartum contraceptive use. Methods One hundred and forty-three women who delivered between 1 January 2004 and 31 September 2004 and counseled about postpartum contraception were included in the study. The participants were interviewed by telephone. Age, gravidity, parity, and mode of delivery of the participants were recorded. Their method of contraception before pregnancy, their decision on the contraceptive method after counseling and the method actually used were asked. Results Just after postpartum counseling, 47 women (32.9%) decided to use the intrauterine device (IUD), 23 (16.1%) condoms, 16 (11.2%) progestin injections, 7 (4.9%) oral contraceptives, and 7 (4.9%) coitus interruptus for contraception. Thirty-six women (25.2%) did not decide on any method of use. At the time of the telephone interview the actual method used was learned. Fifty-one women (35.7%) were using coitus interruptus, 45 women (31.5%) condoms, and 14 (9.8%) the IUD. Sixteen women (11.2%) were reported as not using any methods. Conclusion In spite of postpartum counseling, a high majority of the women appeared to use traditional and less effective contraceptive methods.     

The postpartum approach to family planning. Experiences in Thailand, from 1966 to 1971

Since 1966, 4 large Bangkok hospitals and since 1969, 11 rural Thailand hospitals have operated a postpartum program with a total of 99,434 women accepting family planning services within 3 months of delivery or abortion, the majority accepting the IUD or female sterilization before hospital discharge. There were more than 48,000 immediate postpartum acceptors of the IUD which may be the largest series of cases yet reported. Acceptors had a mean age of 28 years, median 3.2 living children and most accepted to limit family size. "First method" continuation rates were high: 79% at 12 months, 65% at 24 months, and 47% at 48 months. Success was due to emphasis on motivation during antenatal and postpartum period. It was recommended that family planning become a routine part of postpartum care. This program should be modified to reach women delivering at home in the rural areas.     

Natural family planning.

NFP (natural family planning) has replaced the term of rhythm method in the last decade as a designation for those methods of fertility regulation based on periodic abstinence. A graph presents the symptoms observable during the menstrual cycle and the ways in which these symptoms coincide with the fertile and infertile periods within the cycle. NFP counseling aims at teaching couples how to recognize the beginning and end of the fertile period within the menstrual cycle. Each of the following types of NFP are discussed and explained in detail: 1) calendar or calculation method; 2) temperature method; 3) symptothermal methods; and 4) cervical mucus methods. All of these involve detection of the time of ovulation combined with abstinence during the fertile period of the cycle. The symptoms to recognize are taught with each method. Findings from 5 retrospective and 12 prospective studies on the effectiveness of NFP are tabulated. Current research and suggested areas for future research in the field of NFP are mentioned. In the last 20 years, NFP has been popularized through more popular-oriented educational programs. Governments have taken over funding of some NFP programs. Now that NFP effectiveness has been well established, motivation and counseling will be the most important elements in NFP education in the future.     

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.     

Outreach and integration programs to promote family planning in the extended postpartum period

Background

WHO recommends birth spacing to improve the health of the mother and child. One strategy to facilitate birth spacing is to improve the use of family planning during the first year postpartum.

Objectives

To determine from the literature the effectiveness of postpartum family-planning programs and to identify research gaps.

Search strategy

PubMed and the Cochrane Central Register of Controlled Trials were systematically searched for articles published between database inception and March 2013. Abstracts of conference presentations, dissertations, and unpublished studies were also considered.

Selection criteria

Published studies with birth spacing or contraceptive use outcomes were included.

Data collection and analysis

Standard abstract forms and the US Preventive Services Task Force grading system were used to summarize and assess the quality of the evidence.

Main results

Thirty-four studies were included. Prenatal care, home visitation programs, and educational interventions were associated with improved family-planning outcomes, but should be further studied in low-resource settings. Mother–infant care integration, multidisciplinary interventions, and cash transfer/microfinance interventions need further investigation.

Conclusions

Programmatic interventions may improve birth spacing and contraceptive uptake. Larger well-designed studies in international settings are needed to determine the most effective ways to deliver family-planning interventions.     

Urban minority women's perceptions of and preferences for postpartum contraceptive counseling

Introduction: Focused antenatal contraceptive counseling about postpartum contraception may reduce the risk of contraceptive nonuse and misuse, although the optimal timing, content, and communication style of such counseling remain controversial. This study used an in‐depth, qualitative approach in a population of young, postpartum, urban, minority group women in order to examine women's perspectives toward the optimal provision of comprehensive contraceptive counseling. Methods: Brief surveys and semistructured interviews were conducted with 30 consenting postpartum women. In‐person, one‐on‐one interviews were then reviewed for themes, by using an iterative process. Qualitative analysis techniques identifying emergent themes were applied to interview data. Results: In this cohort of African American (63%) and Hispanic (37%) women (median age 26 y), 73% had unplanned pregnancies. Women preferred frequent, short sessions of provider‐initiated comprehensive contraceptive counseling throughout the antepartum period with reinforcement of decisions during the postpartum period. Participants valued patient‐centered counseling that was inclusive of all appropriate methods and personalized to individual needs. Discussion: We recommend that frequent, provider‐initiated, multiple‐modality discussions of appropriate postpartum contraceptive options should take place throughout pregnancy in an open, individualized manner. Further work should address the long‐term effects of improved patient‐centered antenatal contraceptive counseling on rates of unintended pregnancy.     

Preconception counseling improves folate status of women planning pregnancy.

OBJECTIVE: To assess whether counseling women planning pregnancy to start or continue folic acid supplementation improves folate status. METHODS: Women and their partners reported folic acid supplement intake in a preconceptional health questionnaire, and the women were categorized as reported "users" or "nonusers" of supplements before counseling. The use of periconceptional folic acid was addressed at a subsequent preconceptional consultation. Differences between reported supplement users and nonusers before counseling as well as between assumed users and nonusers of folic acid (with precounseling red cell and serum folate levels above and below 590 nmol/L and 20 nmol/L, respectively) were analyzed. RESULTS: A total of 111 (66%) of 168 eligible women participated. Estimated mean red cell folate levels of women who reported no use of folic acid supplements before counseling increased significantly after 4 months from 540 nmol/L to 680 nmol/L. Red cell folate levels of women who reported taking supplements (44%) remained stable up to 1 year after counseling. Women with low precounseling folate levels showed a highly significant mean increase in red cell folate from 475 nmol/L to 689 nmol/L 4 months after counseling. CONCLUSION: Addressing periconceptional folic acid use at a preconceptional consultation improves folate status among women planning to conceive.     

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.     

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.