Uptake of contraception during postpartum amenorrhoea: understandings and preferences of poor, urban women in Bangladesh.

In urban Bangladesh, as in many other settings, an immediate postpartum family planning strategy prevails, where providers seek to promote and provide contraception at 40-45 days following birth to women regardless of their breastfeeding or menstrual status. Despite such practices, the majority of women choose to delay the initiation of contraception until menses resumes, often several months after birth. The present paper seeks to explain this discrepancy by describing poor, urban women's understandings regarding the chances of conception and the risks associated with contraceptive use in the postpartum period. Findings from in-depth interviews reveal that the majority of women perceive no personal risk of pregnancy during amenorrhoea, though most do not recognise an association between this diminished risk of conception and breastfeeding. In addition, the data illustrate that women are primarily concerned with their own and their newly born child's health and well-being in the period following childbirth, both of which are perceived to be extremely vulnerable. These perceptions, plus an understanding that modern methods of contraception are "strong" and potentially damaging to the health, mean that the majority of women are reluctant to adopt family planning methods soon after birth, particularly during postpartum amenorrhoea. The paper advocates that, since breastfeeding affords good protection against pregnancy for six to nine months following birth, efforts should be made to actively incorporate lactational amenorrhoea into postpartum family planning strategies in Bangladesh. Recommendations are also made for ways in which women may be encouraged to adopt contraception during amenorrhoea beyond the period of high natural protection. The paper highlights the importance of taking the client's perspective into consideration in attempts to improve the quality and effectiveness of family planning programmes.

Postpartum contraceptive use in Bangladesh: understanding users' perspectives.

Qualitative and quantitative data are used to explore postpartum contraceptive use in two populations in Bangladesh. Findings from in-depth interviews with contraceptive users illustrate that women are primarily concerned with their own and their newborn child's health and well-being in the period following childbirth. In addition, women are aware of a diminished risk of pregnancy during the period of postpartum amenorrhea. These perceptions, plus a belief that modern methods of contraception are "strong" and potentially damaging to health, mean that the majority of women are reluctant to adopt family planning methods soon after birth, despite a desire to avoid closely spaced pregnancies. Supplementation of the child's diet is also shown to be an important factor determining the timing of postpartum contraceptive initiation. The findings suggest that current policies promoting contraception to women in the immediate postpartum period are inappropriate for many Bangladeshi women.

PIP: This study examined female contraceptive users' understandings, preferences, and behaviors during the postpartum period in Bangladesh. Qualitative and quantitative data focused on the vulnerability of mother and child, the risk of conception, breast feeding's protection against pregnancy, modern method use, postpartum use, and use during breast feeding. Two cohorts were used to examine the relationship between the timing of contraceptive use and resumption of menses, contraceptive use during postpartum amenorrhea, delays in adoption, and contraceptive use during breast feeding. Data were obtained from a range of qualitative data sources in the rural Matlab maternal health and family planning treatment area and in a Dhaka slum study area of the Urban Health Extension Project. Quantitative data were obtained from the Record Keeping System of Matlab and the Urban Surveillance System among a 2-year cohort of 5483 women who had given birth in Matlab in 1990-91. Findings indicate that family planning services should be integrated within maternal and child health care for women in the postpartum period. After childbirth, women are preoccupied with their and their child's health. This preoccupation influences women's priorities and behavior. Bangladeshi women seldom begin contraception soon after birth. Most breast feed for an extended period. The current policy that promotes contraception immediately after birth is inappropriate. Postpartum strategies should incorporate lactational amenorrhea and teach women about breast feeding's impact on fertility. Providers should be sensitive to women's fears and concerns.

Scabies in urban Bangladesh.

As a part of a larger project on hygiene education and diarrhoeal diseases we followed 766 children less than 6 years of age from October 1984 to September 1985 in Dhaka, Bangladesh. The aims were to estimate the annual risk of infestation with scabies in children, to describe its involvement of other family members, and to determine some of the familial and individual risk factors for apparent infestation by scabies. During this period 589 (77%) children appeared to have been infected with scabies, and 125 (16%) children were infested for more than 6 months. Of the factors examined, direct and indirect indicators of decreased wealth and incorrect hygiene practices correlated with higher rates of apparent infestation, although scabies rates remained high at all socioeconomic levels.

A reassessment of leptin's role in triggering the onset of puberty in the rat and mouse.

Leptin is an adipocyte-derived hormone that has been implicated to serve as a metabolic signal to the reproductive axis. The role of leptin in pubertal maturation, however, has been a much-debated topic. We have previously reported that leptin serves as a permissive signal to the onset of puberty in the female rat. In an attempt to further understand the mechanics of leptin during pubertal maturation in rodent species, we had three experimental objectives: first, to describe the temporal relationship of leptin with development in the male and female rat; second, to seek evidence for an increase in responsiveness of the neuroendocrine axis to leptin by assessing for possible changes in leptin receptor expression during pubertal developmental in the female rat; and, third, to reevaluate the possible role of leptin as a permissive signal to the onset of puberty in the mouse. We found that serum leptin levels remain relatively constant during the prepubertal and postpubertal stages of both sexes. In addition, we could not detect any significant developmental changes in leptin receptor gene expression in the hypothalamus of the female rat. Lastly, we corroborated our findings in the female rat that leptin reversed the delay in pubertal maturation secondary to food restriction but did not advance the onset of puberty in female mice. Together, these results suggest that leptin is not a metabolic trigger for the onset of puberty in the rodent; instead, leptin is one of several permissive factors, whose presence may be necessary but alone is not sufficient to initiate sexual maturation in these species.