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1.
PLoS One ; 15(2): e0228678, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017797

RESUMO

INTRODUCTION: The first year after birth is an ideal time to offer contraception services, as many women have many opportunities to be in contact with the health care system. Nevertheless, a large number of postpartum women in developing countries do not use the service owing to the interplay of factors operating at various stages. Therefore, this study aimed to assess predictors of modern contraceptive use in the extended postpartum period. METHODS: A community based retrospective cross-sectional study was done among 1281 women who gave birth within 12 months preceding the survey. Kaplan-Meier plots and log rank tests were used to explore the rate of modern contraceptive use. The Weibull regression survival model with multivariate frailty was employed to identify the predictors of time to contraception. RESULTS: Of the respondents, 59.1% (95% CI: 56.8%-62.2%) had started using modern contraceptive methods within 12 months after birth. By the second month after birth, only 11.1 percent of the women surveyed started to use a contraceptive method, which increased steadily to 25.9%, 37.7%, and 59.5% at 6, 9, and 12 months, respectively. The most preferred contraceptive method was injectable (71.5%), followed by implants (21.5%). Women's education (aHR = 1.29; 95%CI: 1.02, 1.66), four or more antenatal care (aHR = 1.59; 95% CI: 1.22, 2.06), early initiation of antenatal care (aHR = 2.03; 95% CI: 1.28, 3.21), and early postnatal checkup (aHR = 1.39; 95% CI: 1.12, 1.73) were statistically significant predictors of earlier initiation of modern contraceptive methods. CONCLUSIONS: A substantial proportion of women did not use modern contraceptive methods in the first year after birth. Maternal services were found to be the sole predictors in postpartum contraceptive use. Findings suggest the importance of linking postpartum family planning along the continuum of care. The observed heterogeneity at cluster level also urges the need of disaggregating data for decision-making.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Serviços de Saúde Materna , Período Pós-Parto , Adolescente , Adulto , Anticoncepção , Estudos Transversais , Etiópia , Serviços de Planejamento Familiar/métodos , Feminino , Humanos , Estudos Retrospectivos , Adulto Jovem
2.
PLoS One ; 15(1): e0227218, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31935224

RESUMO

BACKGROUND: There has been an increase in the uptake of long-acting or permanent contraceptive methods (LAPMs) in Ethiopia. Identifying the factors associated with this change is important for designing interventions that will further accelerate the uptake. This study was done to identify components of, and factors associated with, changes in the use of LAPMs in Ethiopia. METHODS: Information about 16,336 married or in-union reproductive-age women were extracted from the 2005 and 2016 Ethiopian Demographic and Health Surveys (EDHS). Normalized weighting was used to compensate for disproportionate sampling and non-response in the survey. The two data sets were merged and analyzed using multivariate decomposition analysis. RESULT: From 2005 to 2016, the use of LAPMs increased by 12.0 percentage points. Changes in the characteristics of women (compositional factors) were responsible for nearly 7.0% of the observed difference. Most of the change (92.0%) was attributable to differences in the effects of characteristics. Age, working status, woman's occupation, concordance on the desired number of children between women and their partners, and a visit by health workers in the 12 months before the survey were all significantly associated with the change. CONCLUSION: The contribution of variation in the survey population structure was not significant for the observed change. The change in the use of LAPMs was mainly due to behavioral changes among older, educated and working women, and women visited by health workers.


Assuntos
Anticoncepção/métodos , Adolescente , Adulto , Anticoncepção/estatística & dados numéricos , Comportamento Contraceptivo/estatística & dados numéricos , Etiópia , Serviços de Planejamento Familiar/métodos , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos , Humanos , Dispositivos Intrauterinos/estatística & dados numéricos , Casamento , Pessoa de Meia-Idade , Análise Multivariada , Esterilização Reprodutiva/métodos , Esterilização Reprodutiva/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
3.
Artigo em Inglês | MEDLINE | ID: mdl-31861151

RESUMO

The uptake of vasectomy in many countries in sub-Saharan Africa is low. In Eswatini, a kingdom with strong patriarchal norms, the use of vasectomy is at 0.3%. This is despite great efforts to introduce vasectomy and involve men in reproductive health. This study explored the views of men about the acceptability of vasectomy and their willingness to adopt vasectomy as a family planning option. Focus group discussions were conducted with adult men recruited from health facilities located in rural, semi urban, and urban areas in two of the regions of Eswatini. A thematic approach was used to analyze the data. The acceptability of and intention to use vasectomy as a family planning option was very low. Cultural beliefs, societal norms, lack of knowledge about the procedure for vasectomy, and misconceptions influenced the acceptability of vasectomy greatly. The participants could not grasp the concept of a family planning method that is as permanent as vasectomy. However, the decisions to accept or reject vasectomy were influenced by their misconceptions and fears about vasectomy and were not based on facts. To address the need to involve men in reproductive health and improve the acceptability and adoption of vasectomy, planning should be conducted with them and informed by their understanding of their needs.


Assuntos
Serviços de Planejamento Familiar/métodos , Aceitação pelo Paciente de Cuidados de Saúde , Vasectomia/psicologia , Adulto , Tomada de Decisões , Essuatíni , Grupos Focais , Humanos , Masculino , Pesquisa Qualitativa , Saúde Reprodutiva , População Rural
4.
Plast Reconstr Surg ; 144(5): 1227-1236, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31688771

RESUMO

BACKGROUND: Plastic surgery trainees who wish to start a family face challenges. This is the first study to collect data directly from residents and fellows to understand issues surrounding childbearing and to propose solutions. METHODS: Following institutional review board approval, an anonymous survey was distributed to all current plastic surgery residents and fellows in the United States. Data regarding demographics, obstetrical complications, parental leave, breastfeeding, and use of assisted reproductive technology were collected. RESULTS: The survey was completed by 307 trainees, for a resident response rate of 27.0 percent. Mean age of the respondents was 31.7 ± 3.8 years, 58.6 percent were married, and 35.3 percent reported at least one pregnancy for themselves or for their partner. Both male (67.4 percent) and female (76.5 percent) respondents intentionally postponed having children because of career. Women were significantly more likely to report negative stigma attached to pregnancy (70.4 percent versus 51.1 percent; p = 0.003) and plan to delay childbearing until after training. Fifty-six percent of female trainees reported an obstetrical complication. Assisted reproductive technology was used by 19.6 percent of trainees. Mean maternity leave was 5.5 weeks, with 44.4 percent taking less than 6 weeks. Mean paternity leave was 1.2 weeks. Sixty-two percent of women and 51.4 percent of men reported dissatisfaction with leave. Sixty-one percent of female trainees breastfed for 6 months and 19.5 percent continued for 12 months. Lactation facilities were available near operating rooms for 29.4 percent of respondents. CONCLUSIONS: Plastic surgery training may negatively impact fertility, obstetrical health, and breastfeeding practices. The data presented in this article provide the groundwork for identifying areas of concern and potential solutions.


Assuntos
Escolha da Profissão , Educação de Pós-Graduação em Medicina/organização & administração , Serviços de Planejamento Familiar/métodos , Licença Parental/normas , Médicas/estatística & dados numéricos , Cirurgia Plástica/educação , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , Humanos , Internato e Residência/métodos , Masculino , Saúde Materna , Determinação de Necessidades de Cuidados de Saúde , Licença Parental/tendências , Gravidez , Fatores de Risco , Fatores de Tempo , Estados Unidos
5.
Matern Child Health J ; 23(12): 1679-1685, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31571133

RESUMO

OBJECTIVES: Social environmental influences on pregnancy-related practices and outcomes have been studied, yet few studies explore these influences qualitatively from the perspectives of women's personal social networks and the larger social networks that exist within their communities. This study sought to understand and describe the social environment related to pregnancy and planning for pregnancy in Harare, Zimbabwe from the perspectives of women's social networks, and its influence on pregnancy-related decisions and practices. METHODS: Semi-structured, in-depth, qualitative interviews were conducted in both Shona and English with 24 key community stakeholders (6 healthcare workers, 6 school teachers, 6 family members of females aged 14-24 years, and 6 community leaders) who lived or worked in 2 low-income, high-density communities in Harare. Data were analyzed thematically using NVivo 10 software. RESULTS: The social environment related to pregnancy and planning for pregnancy described by participants was deeply rooted in culture and cultural practices and centered on four themes: (1) pregnancy importance to the role of a woman in the community and the fulfillment of marriage, (2) pregnancy silence to prevent adverse pregnancy outcomes and adolescent and out of wedlock pregnancies, (3) patriarchal pregnancy culture, and (4) community support during pregnancy. CONCLUSIONS FOR PRACTICE: Maternal health efforts in Zimbabwe should acknowledge cultural influences on pregnancy and address pregnancy silence to improve reproductive health communication, empower women to be partners in the pregnancy decision-making process, and include women's social networks.


Assuntos
Comportamento Contraceptivo/psicologia , Serviços de Planejamento Familiar/métodos , Conhecimentos, Atitudes e Prática em Saúde , Meio Social , Rede Social , Apoio Social , Adolescente , Adulto , Cultura , Feminino , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Humanos , Entrevistas como Assunto , Gravidez , Pesquisa Qualitativa , Adulto Jovem , Zimbábue
6.
Health Qual Life Outcomes ; 17(1): 154, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615524

RESUMO

BACKGROUND: Although Jordan has made progress in meeting Family Planning (FP) needs in last decades, recently the use of FP methods has declined significantly. Women's personal experiences, knowledge, and perceptions of how a FP method might impact their quality of life (QoL) can influence FP decisions. However, a lack of comprehensive understanding of the impact of modern FP methods on women's QoL continues to exist among Jordanian couples. Therefore, this study aimed to investigate the relationship between the use of common modern FP methods and QoL among Jordanian women. METHODS: Using the WHOQOL-BREF questionnaire along with other questions, non-pregnant women of reproductive age were interviewed at their homes through face-to-face structured interviews. Women who visited the obstetrics and gynecology clinic of King Abdullah University Hospital for contraceptive advice and follow-up consultations were also included. RESULTS: A total of 548 women aged between 18 and 49 participated in the study. Based on the WHOQOL-BREF scale, the overall mean (SD) scores of the four domains were found to be average. Our findings show that women who used Intra Uterine Devices (IUDs) and women whose husbands used condoms had better QoL in the four domains (physical health, psychological health, social relationships, and environment) than those who used Oral Contraceptives (OCs). Women who used implant and injectable hormonal contraceptives had better QoL in terms of the physical health and social relationships domains. In contrast, women who had undergone permanent sterilization had lower QoL scores in all of the four domains. Further analysis revealed that women who had undergone tubal sterilization were less satisfied overall and more likely to experience side effects than women who used OCs. CONCLUSION: The choice to use contraceptives and decide freely whether and when to have children is regarded as a fundamental reproductive health right and is strongly linked to women's health and QoL. Women who use OCs and women who have undergone permanent sterilization are likely to have lower QoL than women who use IUDs or implant and injectable hormones and those whose husbands use condoms.


Assuntos
Anticoncepção/psicologia , Serviços de Planejamento Familiar/métodos , Qualidade de Vida , Adolescente , Adulto , Anticoncepção/métodos , Anticoncepção/estatística & dados numéricos , Estudos Transversais , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Jordânia , Pessoa de Meia-Idade , Gravidez , Direitos Sexuais e Reprodutivos/psicologia , Autorrelato , Saúde da Mulher , Adulto Jovem
7.
Sex Reprod Health Matters ; 27(1): 1581533, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31533565

RESUMO

Birth spacing has emerged since the early 1980s as a key concept to improve maternal and child health, triggering interest in birth spacing practices in low-income countries, and drawing attention to prevailing norms in favour of long birth intervals in West Africa. In Senegal, the Wolof concept of Nef, which means having children too closely spaced in time, is morally condemned and connotes a resulting series of negative implications for family well-being. While Nef and "birth spacing" intersect in key ways, including acknowledging the health benefits of longer birth intervals, they are not translations of each other, for each is embedded in distinct broader cultural and political assumptions about social relations. Most notably, proponents of the demographic concept of birth spacing assume that the practice of using contraception after childbearing to postpone births could contribute to "empowering" women socially. In Senegal, by contrast, preventing Nef (or short birth intervals) is also viewed as strengthening family well-being by allowing women to care more fully for their family. This paper draws on policy documents and interviews to explore women's and men's understanding of Nef, and in turn critically reflect on the demographic concept of birth spacing. Our findings reinforce the relevance of the concept of birth spacing to engage with women and men around family planning services in Senegal. Accounts of the Nef taboo in Senegal also show that social norms stigmatising short birth intervals can legitimise constraints faced by women on control of their body.


Assuntos
Intervalo entre Nascimentos/etnologia , Intervalo entre Nascimentos/psicologia , Serviços de Planejamento Familiar/métodos , Aleitamento Materno , Anticoncepção/psicologia , Feminino , Humanos , Entrevistas como Assunto , Masculino , Gravidez , Senegal
8.
Reprod Health ; 16(1): 135, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488161

RESUMO

BACKGROUND: Intentions-oriented approaches to measuring pregnancy do not necessarily align with how people view and approach pregnancy. Our objective was to obtain an in-depth understanding of the notions women and men hold regarding pregnancy. METHODS: We conducted semi-structured in-depth interviews with 176 heterosexual women and men ages 18-35, in the United States. Data were analyzed using grounded theory methodology. RESULTS: Participants described notions of getting pregnant in one of three ways. One group of participants used language that solely described pregnancy as a deliberate process, either premeditated or actively avoided. Another described pregnancy as a predetermined phenomenon, due to fate or something that 'just happens.' The third group represented a blending of both notions. CONCLUSIONS: Our findings underscore the need to shift the current paradigm of deliberate intentions to one that recognizes that pregnancy can also be viewed as predetermined. These findings can be used to improve measurement, health services, and better direct public health resources.


Assuntos
Comportamento Contraceptivo/tendências , Serviços de Planejamento Familiar/métodos , Conhecimentos, Atitudes e Prática em Saúde , Intenção , Gravidez não Planejada , Comportamento Reprodutivo , Fatores Socioeconômicos , Adolescente , Adulto , Feminino , Humanos , Relações Interpessoais , Masculino , Gravidez , Pesquisa Qualitativa , Adulto Jovem
9.
Reprod Health ; 16(1): 134, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488170

RESUMO

BACKGROUND: More women are accessing modern contraceptive use in Kenya, however, contraceptive discontinuation has stagnated over the decades. Any further increase in contraceptive use will most likely be from past users, hence understanding the dynamics of discontinuation while addressing quality of family planning services offered at health facilities and communities is critical for increasing the contraceptive prevalence rate and reducing the unmet need of family planning. The paper presents a study protocol that intends to evaluate the dynamics of contraceptive use, discontinuation, and switching among women of reproductive age initiating use of a contraceptive method. METHODS: This longitudinal mixed-methods study is being conducted in Migori and Kitui counties, Kenya. A formative assessment using Interviews with adolescents, older women, heterosexual couples, health care workers, and community health volunteers explored barriers to contraceptive continuation and perspectives on discontinuation utilizing a qualitative cross sectional study design. Following the formative assessment, a client-centered intervention focusing on improving quality of family planning services, including counseling, will be implemented in 10 health facilities. A 24-month prospective cohort study among women of reproductive age initiating contraception with follow-up at 3, 6, 12, and 24 months will then be undertaken to assess the discontinuation rates, examine the dynamics of contraceptive use, discontinuation and switching, and further explore barriers and enablers for contraceptive continuation and switching among the study population. DISCUSSION: In sub-Saharan Africa, contraceptive discontinuation studies have mainly been based on survey data that is collected retrospectively. By implementing a longitudinal mixed-methods study, we gain deeper insights into the contraceptive dynamics influencing the decision to continue, discontinue, and even switch following implementation of a client-centered intervention that enhances quality of care. Additionally, the study will shed more light on the profile of women discontinuing contractive use and further explore individual and couple-level dynamics influencing decision-making on continuation and discontinuation. The findings of this study will provide information that can be used to develop and implement human-centered interventions that focus on improving quality of family planning services and consequently improved continuation rates and overall satisfaction with method. TRIAL REGISTRATION: The study is registered with the Clinical Trials Registry, NCT03973593 .


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepcionais/uso terapêutico , Substituição de Medicamentos/estatística & dados numéricos , Serviços de Planejamento Familiar/métodos , Adolescente , Adulto , Aconselhamento , Estudos Transversais , Feminino , Humanos , Quênia , Estudos Longitudinais , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Adulto Jovem
10.
Int J Gynaecol Obstet ; 147(3): 350-355, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31523811

RESUMO

OBJECTIVE: To assess the effects of strengthening family planning capacity on the uptake of long acting reversible contraceptive (LARC) methods at two primary health centers. METHODS: Between April 2016 and March 2017, the Society of Gynecologists and Obstetricians of Burkina Faso (SOGOB) increased the capacity of two primary health centers in Ouagadougou, Burkina Faso, to offer LARC methods by training staff and providing family planning equipment and commodities. Uptake of LARC methods was compared between the year preceding the intervention and the year during the intervention. RESULTS: Within a year, the number of new users of family planning increased 2.8-fold from 2936 new users before the intervention to 8267 during it. The rate of new users of contraception increased 1.9-fold (14.9% vs 28.1%; P<0.001) for all LARC methods, 2.4-fold for intrauterine contraceptive devices (IUCDs), and 1.7-fold for subdermal contraceptive implants. The proportion of new users of the copper IUCD younger than 25 years was higher during the intervention than before it (57.2% vs 46.9%; P=0.026). CONCLUSION: The SOGOB's family planning intervention resulted in an increase in the use of LARC methods at the two primary health centers.


Assuntos
Serviços de Planejamento Familiar/métodos , Pessoal de Saúde/educação , Contracepção Reversível de Longo Prazo/estatística & dados numéricos , Adolescente , Adulto , Burkina Faso , Feminino , Humanos , Ensaios Clínicos Controlados não Aleatórios como Assunto , Atenção Primária à Saúde/métodos , Melhoria de Qualidade
11.
Reprod Health ; 16(1): 139, 2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31500638

RESUMO

BACKGROUND: Continuing population growth could be detrimental for social and economic wellbeing. Understanding the factors that influence family planning decisions will be important for policy. This paper examines the effect of childhood mortality and women's bargaining power on family planning decisions. METHODS: Data was from the 2014 Ghana Demographic and Health Survey (DHS). A sample of 3313 women in their reproductive age were included in this study. We created variables on women's exposure to and experience of child mortality risks. Three different indicators of women's bargaining power in the household were also used. Probit models were estimated in accordance with the nature of the dependent variable. RESULTS: Results from the probit models suggest that child mortality has a positive association with higher fertility preference. Also, child mortality risks and woman's bargaining power play important roles in a woman's fertility choices in Ghana. Women with higher bargaining power were likely to prefer fewer children in the face of child mortality risks, compared to women with lower bargaining power. CONCLUSION: In addition to public sensitization campaigns on the dangers of high fertility and use of contraceptives, the findings of this study emphasize the need to focus on reducing child mortality and improving women bargaining power in developing countries.


Assuntos
Mortalidade da Criança/tendências , Serviços de Planejamento Familiar/métodos , Fertilidade , Autonomia Pessoal , Direitos da Mulher/estatística & dados numéricos , Adulto , Criança , Países em Desenvolvimento , Características da Família , Feminino , Gana , Humanos , Fatores Socioeconômicos
12.
Niger J Clin Pract ; 22(8): 1055-1062, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31417047

RESUMO

Background: Turkey is the third most populous country of the European region located at the crossroads of Asia, Europe, and the Middle East. In Turkey, approximately 2 million pregnancies occur every year. Half of the pregnancies are involuntary, and five out of every 100 pregnancies end with wanted abortion. There are limitations in access to modern methods in the north of Turkey. This study was aimed to determine the factors associated with better attitudes and participation to family planning (FP) services in primary care settings from Northern Turkey. Materials and Methods: This cross-sectional study, based on primary care settings, was conducted in the Middle Black Sea Region of Turkey with 400 married men. Male attitudes and participation were measured by a questionnaire form. Chi-square testing and logistic regression analyses were applied. Results: We found that male participation was present in 302 participants (75.5%), and 363 participants (90.8%) approved the use of FP. Male participation was significantly different by age, occupation, education, marriage age, spouses' education and occupation, and attitudes towards FP. Based on multivariate analysis, male participation was significantly associated with spouses' level of education, employment status, currently using FP, and the perception of spousal communication. Conclusion: Better participation existed among participants with higher educated spouses, employed spouses, current users of FP, and the better self-perception of communication.


Assuntos
Comportamento Contraceptivo , Anticoncepção/estatística & dados numéricos , Serviços de Planejamento Familiar/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Cônjuges/psicologia , Adolescente , Adulto , Anticoncepção/psicologia , Estudos Transversais , Serviços de Planejamento Familiar/métodos , Feminino , Humanos , Masculino , Casamento , Pessoa de Meia-Idade , Gravidez , Atenção Primária à Saúde , Fatores Socioeconômicos , Cônjuges/estatística & dados numéricos , Inquéritos e Questionários , Turquia/epidemiologia
13.
Reprod Health ; 16(1): 125, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31426800

RESUMO

OBJECTIVE: Access to comprehensive and culturally appropriate reproductive life planning is essential to women's health. Although many strategies and tools exist, few are designed for longitudinal use or provide visual aids. Our objective is to present the Family Planning Quotient (FPQ) and Reproductive Life Index (RepLI) (FPQ/RepLI) tool we created to facilitate the discussion of family planning and reproductive life goals between patients and providers and to provide a summary our evaluation of the tool. This tool was developed as a response to the Centers for Disease Control and Prevention's charge of developing a tool that could help facilitate reproductive life planning by giving the patient a better understanding of their reproductive goals and trajectory. STUDY DESIGN: This cross-sectional evaluation of our tool took place with patients and providers at an urban, public hospital in Chicago. Patients spoke with a health educator about their sexual, gynecological, and obstetric history to complete the FPQ/RepLI tool. Our primary objective was to measure the proportion of women who indicated the tool was helpful and that they would use it to track their reproductive goals. MAIN OUTCOME MEASURES: Patients and providers completed an evaluation survey rating their satisfaction with the tool. Survey responses were summarized using frequencies and percentages. RESULTS: During the study, 790 patients completed the evaluation.. Most patients (n = 725, 91.9%) agreed that the tool was helpful and that they would use it to track their reproductive goals. Fifty-five (83.5%) providers agreed that there is a need for reproductive health tools in clinical practice. CONCLUSIONS: Most agreed that the tool helped the patient communicate goals, aided in educating about contraception, and facilitated the discussion and decision-making process about available contraceptives. The tool gives patients a resource for family and reproductive goal planning. Broad dissemination amongst other medical specialties beyond obstetrics and gynecology may make reproductive life planning accessible to more women.


Assuntos
Anticoncepção/métodos , Aconselhamento/métodos , Serviços de Planejamento Familiar/métodos , Conhecimentos, Atitudes e Prática em Saúde , Cuidado Pré-Concepcional/métodos , Educação Sexual , Adolescente , Adulto , Criança , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Gravidez , Saúde Reprodutiva , Estados Unidos , Saúde da Mulher , Adulto Jovem
14.
BMC Womens Health ; 19(1): 104, 2019 07 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340794

RESUMO

BACKGROUND: Achieving the unfinished agenda towards sexual and reproductive health and rights requires overcoming remaining barriers to contraceptive uptake, which can be method-specific. Women's uptake of the IUD is poor across sub-Saharan Africa. The objective of this paper is to identify the reasons for comparatively high IUD use observed in a CARE project in DRC, together with the programmatic characteristics which facilitated uptake. METHODS: Qualitative data were collected in 2015 as part of a reproductive health project in the DRC. Using purposive sampling, 15 focus group discussions took place with IUD users, users of other methods and non-users of modern contraception as well as their male partners. Eighteen in-depth interviews were conducted with health providers, project staff, community health workers and local stakeholders to capture a range of experiences. Data were analyzed using content theory approach and contextualized through a review of routine monitoring data. RESULTS: In an area with practically no previous IUD use, 38,662 new FP clients were served during the first 5 years of the project and 82% (31,569) chose long-acting or permanent methods. Over 10,000 clients chose an IUD, representing 30% of the total FP clients. Key informants expressed mainly positive views about the IUD and quality of service. Concerns related to method insertion, which some perceived as too intimate or shameful. Findings indicate that this uptake reflects effective supply chains, good provider training and supervision and multiple communication strategies including those which target men. Community engagement was enhanced by local stakeholders' participation in sensitization and quality assurance as well in analysis of data for decision-making. CONCLUSIONS: The findings of the paper showed that by involving local stakeholders in addressing structural and socio-cultural barriers to women's free access to FP, programs can positively influence quality of service and method mix as well as knowledge and attitudes surrounding FP use and thus improve the uptake of FP in general and IUDs in particular, even in conflict-affected settings. A Theory of Change for enhancing IUD provision within family planning programs is suggested.


Assuntos
Serviços de Planejamento Familiar/métodos , Serviços de Planejamento Familiar/normas , Educação em Saúde , Dispositivos Intrauterinos/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , Adulto , Comunicação , Anticoncepção , Tomada de Decisões , República Democrática do Congo , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Adulto Jovem
15.
Reprod Health ; 16(1): 105, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307474

RESUMO

BACKGROUND: Although Nepal legalised abortion in 2002, a significant number of women continue to access unsafe abortions. An estimated 60% of all abortions performed in 2014 were unsafe, with unsafe abortion continuing to be a leading contributor to maternal mortality. Despite medical abortion access being solely permitted through government accredited safe abortion services, medical abortion pills are readily available for illegal purchase at pharmacies throughout the country. METHODS: Utilising an Assets Focused Rapid Participatory Appraisal (AFRPA) research methodology, underpinned by a health information pyramid conceptual framework, this qualitative exploratory study collected data from in-depth, open-ended interviews. The study explored the medical abortion and sexual and reproductive health experiences of ten women who accessed medical abortion through an accredited safe abortion service, and ten women who accessed unsafe medical abortion through pharmacies. RESULTS: Thematic content analysis revealed emerging themes relating to decision-making processes in accessing safe or unsafe medical abortion; knowledge of safe abortion services; and SRH information access and post-abortion contraceptive counselling. Findings emphasised the interconnectivity of sexual and reproductive health and rights; reproductive coercion; education; poverty; spousal separation; and women's personal, social and economic empowerment. CONCLUSIONS: While barriers to safe abortion services persist, so will the continued demand for medical abortion provision through pharmacies. Innovated and effective harm reduction implementations combined with access and information expansion strategies offer the potential to increase access to safe medical abortion while decreasing adverse health outcomes for women.


Assuntos
Aborto Induzido/psicologia , Aborto Legal/psicologia , Serviços de Planejamento Familiar/métodos , Serviços de Planejamento Familiar/estatística & dados numéricos , Farmácias/estatística & dados numéricos , Saúde Reprodutiva/normas , Aborto Induzido/estatística & dados numéricos , Aborto Legal/estatística & dados numéricos , Adolescente , Adulto , Feminino , Acesso aos Serviços de Saúde , Humanos , Pessoa de Meia-Idade , Nepal , Gravidez , Pesquisa Qualitativa , Adulto Jovem
16.
BMJ Sex Reprod Health ; 45(3): 190-199, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31289100

RESUMO

BACKGROUND: Many women find it difficult to choose and initiate a contraceptive method at the time of an abortion. There is a gap between regular clinical practice and existing evidence on motivational and person-centred counselling, as well as on use of long-acting reversible contraception (LARC). This study aims to describe and evaluate a Quality Improvement Collaborative (QIC) designed to enhance contraceptive services, with regard to changes in healthcare professionals' (HCPs') counselling in clinical practice, and in women's subsequent choice of, and access to, contraception. METHODS: Three multiprofessional teams working in abortion services from three hospitals in Sweden, and two women contributing with user experience, participated in a QIC during the period March-November 2017. Using a case study design, we collected and analysed both quantitative and qualitative data. RESULTS: Teams agreed on QIC goals, including that ≥50% of women would start LARC within 30 days post-abortion, and tested multiple evidence-based changes, aided by the two women's feedback. During the QIC, participating HCPs reported that they gained new knowledge and developed skills in contraceptive counselling at the time of an abortion. The teams welcomed the development of a performance feedback system regarding women's post-abortion contraception. While the majority of women counselled during the QIC chose LARC, only 20%-40% received it within 30 days post-abortion. CONCLUSION: The QIC, incorporating user feedback, helped HCPs to develop capability in providing contraceptive services at the time of an abortion. Timely access to LARC remains a challenge in the present setting.


Assuntos
Aborto Induzido/psicologia , Comportamento Contraceptivo/estatística & dados numéricos , Aconselhamento/métodos , Contracepção Reversível de Longo Prazo/normas , Adulto , Aconselhamento/normas , Aconselhamento/estatística & dados numéricos , Serviços de Planejamento Familiar/métodos , Serviços de Planejamento Familiar/tendências , Feminino , Humanos , Contracepção Reversível de Longo Prazo/psicologia , Contracepção Reversível de Longo Prazo/estatística & dados numéricos , Gravidez , Pesquisa Qualitativa , Melhoria de Qualidade/tendências , Inquéritos e Questionários , Suécia
18.
Pan Afr Med J ; 33: 17, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31312333

RESUMO

Introduction: family planning programmes have helped in increasing the prevalence of contraceptive use and reducing total fertility rate in developing countries from six to three births per woman. However, its uptake is lower in the rural areas compared to urban areas. This study seeks to elucidate the effect of community mobilisation on awareness, approval and use of family planning among women of reproductive age in the rural areas of Ebonyi state, Nigeria. Methods: we conducted a quasi-experimental study among women aged 15 to 49 years in two rural communities in Ebonyi state. Using simple random method, we recruited 484 women for the study. We used pre-tested interviewer-administered questionnaire to collect information from the participants. Community awareness and distribution of information, education and communication materials were carried out within one month. We estimated the effect of the intervention on the level of awareness, approval and uptake of family planning methods. Results: level of awareness increased by 19% (p<0.001) while uptake of family planning increased by 16.7% (p<0.001) in the intervention group. The approval rate was higher in the intervention group compared to the control group (p=0.008). The most commonly used method of family planning was the natural method in intervention and control arms. Conclusion: although uptake of family planning increased significantly in the study population, the rate is generally low. Given the critical role of the community in family planning programmes, community mobilisation may be deployed to increase uptake of family planning in similar rural communities.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/estatística & dados numéricos , Serviços de Planejamento Familiar/métodos , Conhecimentos, Atitudes e Prática em Saúde , População Rural/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Nigéria , Educação Sexual/métodos , Inquéritos e Questionários , Adulto Jovem
19.
BMC Res Notes ; 12(1): 433, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31319878

RESUMO

OBJECTIVES: To identify the determinants of long-acting contraceptive utilization among married women of reproductive age in Aneded district, northwestern Ethiopia. Unmatched case control study was conducted from May 1, 2018 to June 30, 2018. One hundred forty-five households with married reproductive age women who have used long-acting family planning for more than a year (cases) and 290 households with married reproductive age women who have never used long-acting family planning (controls) were selected by systematic random sampling in each kebele (the smallest administrative units of Ethiopia). RESULT: In this study, 145 cases and 290 controls participated. Independent positive predictors of utilization of long-acting family planning among married women reproductive age were: primary education level [AOR = 6.99, 95% CI 3.7-13.7], first discussion with providers [AOR = 2.64, 95% CI 1.6-4.5], told what to do if they experience the side effect [AOR = 3.2, 95% CI 1.7-5.9], know the source of long-acting family planning methods [AOR = 3.4, 95% CI 2.01-5.82] and discussion with health professionals [AOR = 2.07, 95% CI 1.2-3.5]. Encouraging women education at least at primary level and advocating the minimal side effect of long-acting contraceptive are recommended to improve long-acting family planning utilization.


Assuntos
Anticoncepção/estatística & dados numéricos , Anticoncepcionais Femininos/administração & dosagem , Serviços de Planejamento Familiar/estatística & dados numéricos , Casamento , Adolescente , Adulto , Estudos de Casos e Controles , Anticoncepção/métodos , Escolaridade , Etiópia , Serviços de Planejamento Familiar/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Análise Multivariada , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
20.
Reprod Health ; 16(1): 97, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286989

RESUMO

BACKGROUND: Unmet need for contraception is high during the postpartum period, increasing the risk of unintended subsequent pregnancy. We developed a client facing mobile phone-based family planning (FP) decision aid and assessed acceptability, feasibility, and utility of the tool among health care providers and postpartum women. METHODS: Semi-structured in-depth interviews (IDIs) were conducted among postpartum women (n = 25) and FP providers (n = 17) at 4 Kenyan maternal and child health clinics, 2 in the Nyanza region (Kisumu and Siaya Counties) and 2 in Nairobi. Stratified purposive sampling was used to enroll postpartum women and FP providers. Data were analyzed using an inductive content analysis approach by 3 independent coders, with consensual validation. RESULTS: FP providers stated that the Interactive Mobile Application for Contraceptive Choice (iMACC) tool contained the necessary information about contraceptive methods for postpartum women and believed that it would be a useful tool to help women make informed, voluntary decisions. Most women valued the decision aid content, and described it as being useful in helping to dispel myths and misconceptions, setting realistic expectations about potential side effects and maintaining confidentiality. Both women and providers expressed concerns about literacy and lack of familiarity with smart phones or tablets and suggested inclusion of interactive multimedia such as audio or videos to optimize the effectiveness of the tool. CONCLUSIONS: The iMACC decision aid was perceived to be an acceptable tool to deliver client-centered FP counseling by both women and providers. Counseling tools that can support FP providers to help postpartum women make informed and individualized FP decisions in resource-limited settings may help improve FP counseling and contraceptive use in the postpartum period.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Técnicas de Apoio para a Decisão , Serviços de Planejamento Familiar/educação , Conhecimentos, Atitudes e Prática em Saúde , Período Pós-Parto/psicologia , Educação Sexual , Telemedicina , Adolescente , Adulto , Aconselhamento , Estudos Transversais , Serviços de Planejamento Familiar/métodos , Estudos de Viabilidade , Feminino , Pessoal de Saúde , Humanos , Gravidez , Pesquisa Qualitativa , Adulto Jovem
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