Salpingectomie bilatérale aux fins de contraception permanente : série de cas et facteurs limitant le changement de pratique.

OBJECTIVE: The Society of Obstetricians and Gynaecologists of Canada (SOGC) and the Society of Gynaecologic Oncology of Canada (GOC) recommend complete removal of the fallopian tubes as a permanent contraceptive method because of its association with a reduced risk of ovarian cancer. Currently, many women are not offered bilateral salpingectomy as an alternative to tubal ligation for permanent contraception. METHOD: As part of a quality improvement initiative, we reviewed all cases of sterilization performed at our university centre between 1 January and 31 December 2018. A literature review of the clinical and ethical considerations that prevent clinicians from offering bilateral salpingectomy as permanent contraception is also presented. RESULTS: The records of 111 women who underwent tubal sterilization were reviewed. Of these, 31.5% underwent bilateral salpingectomy; 46.8% underwent tubal fulguration; 12.6% underwent clip ligation; and 9.1% underwent tubal implant ligation (Essure). According to the information on file, only 36.3% of women were offered bilateral salpingectomy, and of these, 83.8% chose this method. CONCLUSION: Bilateral salpingectomy should be offered to all women seeking permanent contraception. The benefits and very low risks associated with this procedure should make it a first choice option.

Family planning, antenatal and delivery care: cross-sectional survey evidence on levels of coverage and inequalities by public and private sector in 57 low- and middle-income countries.

OBJECTIVE: The objective of this study was to assess the role of the private sector in low- and middle-income countries (LMICs). We used Demographic and Health Surveys for 57 countries (2000-2013) to evaluate the private sector's share in providing three reproductive and maternal/newborn health services (family planning, antenatal and delivery care), in total and by socio-economic position. METHODS: We used data from 865 547 women aged 15-49, representing a total of 3 billion people. We defined 'met and unmet need for services' and 'use of appropriate service types' clearly and developed explicit classifications of source and sector of provision. RESULTS: Across the four regions (sub-Saharan Africa, Middle East/Europe, Asia and Latin America), unmet need ranged from 28% to 61% for family planning, 8% to 22% for ANC and 21% to 51% for delivery care. The private-sector share among users of family planning services was 37-39% across regions (overall mean: 37%; median across countries: 41%). The private-sector market share among users of ANC was 13-61% across regions (overall mean: 44%; median across countries: 15%). The private-sector share among appropriate deliveries was 9-56% across regions (overall mean: 40%; median across countries: 14%). For all three healthcare services, women in the richest wealth quintile used private services more than the poorest. Wealth gaps in met need for services were smallest for family planning and largest for delivery care. CONCLUSIONS: The private sector serves substantial numbers of women in LMICs, particularly the richest. To achieve universal health coverage, including adequate quality care, it is imperative to understand this sector, starting with improved data collection on healthcare provision.

Effectiveness of demand generation interventions on use of modern contraceptives in low- and middle-income countries.

OBJECTIVES: To synthesise evidence on the implementation, costs and cost-effectiveness of demand generation interventions and their effectiveness in improving uptake of modern contraception methods. METHODS: A Cochrane systematic review was conducted. Searches were performed in electronic databases (MEDLINE, EMBASE) and the grey literature. Randomised controlled trials, cluster randomised trials and quasi-experimental studies, including controlled before-after studies (CBAs) and cost and cost-effectiveness studies that aimed to assess demand interventions (including community- and facility-based interventions, financial mechanisms and mass media campaigns) in low- and middle-income countries were considered. Meta-analyses and narrative synthesis were conducted. RESULTS: In total, 20 papers meeting the inclusion criteria were included in this review. Of those, 13 were used for meta-analysis. Few data were available on implementation and on the influence of context on demand interventions. Involving family members during counselling, providing education activities and increasing exposure to those activities could enhance the success of demand interventions. Demand generation interventions were positively associated with increases in current use (pooled OR 1.57; 95% CI: 1.46-1.69, P < 0.01). Financial mechanism interventions (vouchers) appeared effective to increase use of modern contraceptive methods (pooled OR 2.16; 95% CI: 1.91-2.45, P < 0.01; I2 = 0%). Demand interventions improved knowledge (pooled OR 1.02; 95% CI 0.63-1.64, P = 0.93) and attitudes towards family planning and improved discussion with partners/husbands around modern contraceptive methods. However, given the limited number of studies included in each category of demand generation interventions, the dates of publication of the studies and their low quality, caution is advised in considering the results. Very limited evidence was available on costs; studies including data on costs were old and inconsistent. CONCLUSION: Demand generation interventions contribute to increases in modern contraceptive methods use. However, more studies with robust designs are needed to identify the most effective demand generation intervention to increase uptake of modern contraceptive methods. More evidence is also needed about implementation, costs and cost-effectiveness to inform decisions on sustainability and scaling-up.

[Request for an abortion, the role of frontline professionals]. / Demande d'IVG, le rôle des professionnels de première ligne.

The reception given by professionals to a woman requesting an elective abortion is key. The initial exchange of information is usually by telephone. Time is limited, hence the requirement for caregivers to demonstrate their availability and professionalism in organising personalised care.

[Postpartum family planning at the district hospital of the commune II of Bamako, Mali]. / Planification familiale du postpartum a l'hopital de district de la commune II de Bamako, Mali.

Postpartum family planning is the prevention of pregnancy during the 12 months following childbirth. OBJECTIVE: To study the use of contraceptive methods in the postpartum period in the obstetrics gynecology department of the district hospital of the commune II of Bamako. MATERIALS AND METHODS: We conducted a descriptive and analytical cross-sectional study with prospective data collection from January 1, 2019 to December 31, 2020. All women who had given birth who had chosen and benefited from a contraceptive method were included. The statistical test used was Fisher's test with a significance level set at 5%. RESULTS: In 2 years, the contraceptive prevalence in the postpartum was 26.1%. More than 2/3 of counseling (61%) was done during prenatal consultations, 8% during the latency phase, 26% in the immediate postpartum and 5% during the postnatal visit. The most chosen methods were implants (47.1%), intrauterine device (29.6%), miro-progestin pills (12.5%), injectable progestogens (8%) and condoms (3.2%). CONCLUSION: Postpartum family planning contributes to increasing contraceptive prevalence.

La planification familiale du postpartum est la prévention des grossesses durant les 12 mois qui suivent l'accouchement. OBJECTIF: Etudier l'utilisation des méthodes contraceptives dans le postpartum dans le service de gynécologie obstétrique de l'hôpital de district de la commune II de Bamako. MATÉRIELS ET MÉTHODES: Nous avons mené une étude transversale descriptive et analytique avec collecte prospective des données du 1er janvier 2019 au 31 décembre 2020. Ont été incluses, toutes les accouchées ayant choisi et bénéficié d'une méthode contraceptive. Le test statistique utilisé a été le test de Fisher avec un seuil de significativité fixé à 5%. RÉSULTATS: En 2 ans, la prévalence contraceptive dans le postpartum était de 26,1%. Plus des 2/3 des counselings (61%) ont été faits lors des consultations prénatales, 8% pendant la phase de latence, 26% dans le postpartum immédiat et 5% lors de la visite postnatale. Les méthodes les plus choisies ont été les implants (47,1%), le dispositif intra-utérin (29,6%), les pilules miro-progestatives (12,5%), les progestatifs injectables (8%) et les préservatifs (3,2%). CONCLUSION: La planification familiale du postpartum contribue à augmenter la prévalence contraceptive.

[Knowledge, attitudes and practices of Bamako media Men' on family planning]. / Connaissances, attitudes et pratiques des Hommes de medias de Bamako sur la planification familiale.

INTRODUCTION: Contraceptive prevalence is low in Mali. The information provided by the media men can help to increase or decrease the use of contraceptive methods. OBJECTIVE: To study the knowledge, attitudes and practices of Bamako media Men on family planning. MATERIAL AND METHODS: We carried out a descriptive cross-sectional study with prospective data collection from June 1 to August 30, 2019. It concerned journalists and presenters of 15 radio and 6 televisions in Bamako. RESULTS: During the 3 months, 615 media Men agreed to participate in this study. These are men and women from 36 to 45 years old in 37.2% of cases, married in 81.3% of cases. The radio with 85.5% was their main source of information on family planning. They all knew at least one contraceptive method. The best-known methods were pills (94.3%), injectables (57%) and implants (49.1%). They were in favor of the practice of family planning in 77.2% of cases, 76.9% had already used a method and 56.7% had already hosted a program on family planning. CONCLUSION: Media men are essential in the transmission of information. The quality of the information provided by these Media men can be influenced by their personal perceptions and attitudes. Their better involvement in the promotion of family planning can help to increase contraceptive prevalence.

INTRODUCTION: La prévalence contraceptive est faible au Mali. Les informations transmises par les Hommes de médias peuvent contribuer à augmenter ou à diminuer l'utilisation des méthodes contraceptives. OBJECTIF: Etudier les connaissances, attitudes et pratiques des Hommes de médias de Bamako sur la planification familiale. MATÉRIEL ET MÉTHODES: Nous avons réalisé une étude transversale descriptive avec collecte prospective des données du 1er juin au 30 août 2019. Elle a concerné les journalistes et les animateurs de 15 radios et 6 télévisions de Bamako. RÉSULTATS: Durant les 3 mois, 615 Hommes de médias de Bamako ont accepté de participer à cette étude. Il s'agissait d'hommes et de femmes âgés de 36 à 45 ans dans 37,2% des cas, mariés dans 81,3% des cas. La radio avec 85,5% était leur principale source d'information sur la planification familiale. Ils connaissaient tous au moins une méthode contraceptive. Les méthodes les plus connues étaient les pilules (94,3%), les injectables (57%) et les implants (49,1%). Ils étaient favorables à la pratique de la planification familiale dans 77,2% des cas, 76,9% avaient déjà utilisé une méthode et 56,7% avaient déjà animé une émission sur la planification familiale. CONCLUSION: Les Hommes de médias sont essentiels dans la transmission de l'information. La qualité de l'information fournie par ces Hommes de médias peut être influencée par leurs perceptions et attitudes personnelles. Leur meilleure implication dans la promotion de la planification familiale peut contribuer à augmenter la prévalence contraceptive.