Department of Obstetrics and Gynaecology, Abia State University Teaching Hospital Aba, Nigeria. firstname.lastname@example.org
Factors associated with utilization of long acting and permanent contraceptive methods among married women of reproductive age in Mekelle town, Tigray region, north Ethiopia.
Department of Public Health, Mekelle University, Mekelle, Ethiopia.
BACKGROUND Ethiopia is the second most populous country in Sub-Saharan Africa. Total Fertility Rate of Ethiopia is 5.4 children per women, population growth rate is estimated to be 2.7% per year and contraceptive prevalence rate is only 15% while the unmet need for family planning is 34%. Overall awareness of Family Planning methods is high, at 87%. The prevalence of long acting and permanent contraceptive methods (LAPMs) in Tigray region was very low which accounts for 0.1% for implants and no users for intra-uterine contraceptive device (IUCD) and female sterilization. Moreover almost all modern contraceptive use in Ethiopia is dependent on short acting contraceptive methods. The objective of this study was to assess factors associated with utilization of long acting and permanent contraceptive methods (LAPM) among married women of reproductive age group in Mekelle town. METHODS A cross sectional community based survey was conducted from March 9-20, 2011. Multistage sample technique was used to select the participants for the quantitative methods whereas purposive sampling was used for the qualitative part of the study. Binary descriptive statistics and multiple variable regressions were done. RESULTS The study consisted of quantitative and qualitative data. From the quantitative part of the study the response rate of the study was 95.6%. Of the qualitative part two FGDs were conducted for each married women and married men. 64% of the married women heard about LAPMs. More than half (53.6%) of the married women had negative attitude towards practicing of LAPMs. The overall prevalence of LAPMs use was 12.3% however; there were no users for female or male sterilization. The main reason cited by the majority of the married women for not using LAPMs was using another method of contraception 360 (93.3%). Mothers who had high knowledge were 8 times more likely to use LAPMs as compared with those who had low knowledge (AOR = 7.9, 95% CI of (3.1, 18.3). Mothers who had two or more pregnancies were 3 times more likely to use LAPM as compared with those who had one pregnancy (AOR = 2.7, 95% CI of (1.4, 5.1). CONCLUSION A significant amount of the participants had low knowledge on permanent contraceptive particularly vasectomy. More than half (53.6%) of married women had negative attitude towards practicing of LAMPs. Few of married women use female sterilization and none use of female sterilization and or vasectomy. Positive knowledge of LAMPs, women who had two and above pregnancies and women who do not want to have additional child were significantly associated. Information education communication should focus on alleviating factors hinder from practicing of LAPMs.
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Lessons learned from the outcome of bloodless emergency laparotomies on Jehovah's Witness women presenting in the extremis with ruptured uterus.
Department of Obstetrics and Gynaecology, Abia State University Teaching Hospital, PMB 7004, Aba, Nigeria. email@example.com
OBJECTIVE We compared the outcomes of bloodless emergency laparotomies for uterine rupture in twenty Jehovah's Witness (JW) women who were in a state of haemorrhagic shock with 45 other women who received blood transfusion. METHODS The case records of twenty Jehovah's Witness patients, who underwent bloodless emergency laparotomies for ruptured uterus complicated by haemorrhagic shock between 1 January 2000 and 31 December 2006 were reviewed. We also reviewed the case records of 45 other patients who underwent similar surgical procedures for similar indications and in whom blood was transfused. The outcome variables compared were maternal deaths, infectious morbidity, acute respiratory distress syndrome, disseminated intravascular coagulation, length of post laparotomy ventilatory support, and length of postpartum hospitalization. RESULTS Demographic and obstetric characteristics were similar in both groups. Seventeen out of the twenty Jehovah's Witness patients who refused blood transfusion survived the laparotomies and were discharged home in good condition. Three died of peritonitis. Six out of the 45 patients who received blood transfusion also died of peritonitis and one died of disseminated intravascular coagulopathy. The average duration of post partum hospitalization was 8 days in the group of patients transfused and 7 days in the group not transfused. Disseminated intravascular coagulation occurred post partum in two of the patients transfused. No case of acute respiratory distress syndrome or amniotic fluid embolism was identified in either group. CONCLUSION Patients who are in haemorrhagic shock from ruptured uterus and refuse blood transfusion can still be salvaged in a low resource setting. The study adds evidence that major operative procedures can be carried out on Jehovah's Witness patients without blood transfusions or blood products.
Department of Obstetrics and Gynaecology, Abia State University Teaching Hospital, P.M.B. 7004, Aba, Abia State, Nigeria.
BACKGROUND Herpes simplex virus (HSV) is a major cause of genital ulcer disease worldwide and a significant factor for increased risk of acquisition and transmission of the Human Immune Deficiency Virus (HIV). The determination of the level of knowledge of genital herpes is necessary for the design and implementation of its specific preventive strategies as well as the reduction of the contribution of genital herpes to HIV transmission. OBJECTIVE To determine antenatal women's knowledge on genital herpes infection. DESIGN A cross sectional descriptive study. SETTING Antenatal clinic of Abia State University Teaching, Hospital, Aba, Nigeria. SUBJECTS Three hundred and fifty consecutive and consenting antenatal clinic attendees of Abia State University Teaching Hospital (ABSUTH), Aba, South Eastern, Nigeria. RESULTS Seventy nine respondents (22.6%) had ever heard of genital herpes whilst sixty two (17.7%) had ever had recurrent blisters around their genitals. Two hundred and sixteen respondents (61.7%) reported having had cold sores or blisters around the lips or mouth following an episode of fever. Seventy four (21.1%) of the respondents knew that the virus that causes cold sores or blisters can be sexually transmitted. Higher educational levels attained and occupations other than being a housewife or farmer were associated with a greater awareness of genital herpes (p < 0.05) among the subjects. CONCLUSION The antenatal attendees showed a poor knowledge of genital herpes infection. Discussion of genital herpes should be considered in the antenatal clinic setting along with the counselling of pregnant women regarding genital herpes, HIV infection and maternal-to-child transmission of both HSV and HIV.
Department of Obstetrics and Gynaecology, Abia State University Teaching Hospital, Aba, Nigeria. firstname.lastname@example.org
Uterine rupture during a first pregnancy is rare. We present the case of spontaneous intrapartum uterine rupture in a 40 year old primigravida with no prior uterine surgery, and a structurally normal uterus. The patient had obstructed labor. Operative findings were a male fresh stillbirth weighing 3800 g, massive hemoperitoneum, and an anterior transverse rupture at the lower uterine segment. Repair of the rupture was done without bilateral tubal ligation. Although a rare event, the primigravid uterus is not immune to rupture as exemplified by this report.
Department of Obstetrics and Gynaecology, Abia State University Teaching Hospital, P.M.B. 7004, Aba, Abia State, Nigeria.
BACKGROUND In order for individual health institutions in Nigeria to contribute towards the achievement of the Millennium Development Goals (MDG) with regards to maternal health, there is need for research on the local causes of and factors influencing adverse maternal outcomes. This would enable care providers and policy makers appreciate the burden of the problem and know where to focus as they distribute resources. OBJECTIVES To compare the socio-demographical characteristics, obstetrical complications and foetal outcome in booked verses unbooked mothers who delivered at this hospital. DESIGN A hospital based retrospective study. SETTING The Abia State University Teaching Hospital (ABSUTH), Aba in South Eastern Nigeria. SUBJECTS Three thousand, seven hundred and thirty four mothers who delivered in the hospital between 1st January 2005 and 31st December 2007. RESULTS Unbooked mothers constituted 17.0% of the 3734 deliveries in the studied period. Compared to booked mothers, unbooked mothers were younger in age (28.2 +/- 5.80 vs. 29.3 +/- 6.04; p<0.001) and had a lower educational status (P<0.001). Majority of the unbooked were of lower social class; p<0.001. Unbooked mothers had a statistically significant higher incidence of pre-eclampsia/eclampsia (OR 3.88; 95%CI 2.61-5.77; p<0.001) and were 13 times more likely to die in the hospital than booked patients (OR: 13.54; 95%CI: 6.89-27.03); p<0.0001). Unbooked mothers were about half as likely to deliver by spontaneous vaginal delivery compared to booked mothers (OR 0.64; 95%CI 0.55-0.73; P<0.001) and eight times more likely to be delivered by emergency laparotomy due to uterine rupture than booked mothers (OR 8.80; 95%CI 3.84-20.55; P<0.001). Unbooked mothers were nine times more likely to have babies with birth asphyxia. CONCLUSION The study showed a positive correlation between lack of proper antenatal care and adverse pregnancy outcome with poorer outcomes in unbooked than booked patients. Improving the availability and accessibility of quality antenatal and delivery care services in our environment will improve pregnancy outcome.
Department of Obstetrics and Gynaecology, Abia State University Teaching Hospital, PMB, Aba, Nigeria.
OBJECTIVES To determine the incidence and risk factors of macrosomia in a Nigerian centre, and to assess the relation of maternal body mass index (BMI) at birth and of the total weight gain during pregnancy to macrosomia and adverse pregnancy outcome. DESIGN A retrospective review of fetal macrosomia over a 5-year period. SETTING Abia State University Teaching Hospital, Aba in Southeast Nigeria. SUBJECTS A total of 9,970 parturients managed from 1 January 1999 to 31 December 2003. Out of 249 documented cases of infants with birth weights > or =4,500 g, 240 (96.4%) maternal and neonatal records of macrosomia were available for review. Maternal and neonatal characteristics of the 240 cases were compared with 8,800 other parturients with singleton fetuses in vertex presentation. RESULTS Macrosomic babies represented 2.5% of the infants delivered (249 of 9,970). Most of the mothers (92.5%) were multiparous. Maternal median weight gain was 11 kg (7-15), while the mean weight gain was 12.5 kg. Maternal median BMI was 28.1 kg/m(2) at delivery, while the mean BMI was 30.3 kg/m(2)(range 23-40) at delivery. Macrosomia was suspected in 80% on the basis of clinical examination, sonography, and the presence of the following risk factors in association: previous delivery of an infant weighing >4,000 g (62.5%), maternal weight at booking of more than 80 kg (90%), maternal BMI before delivery of > or =28 kg/m(2)(50%), gestational diabetes mellitus (2.5%), and weight increase of more than 13 kg during pregnancy (5%). The mean birth weight of the babies was 4,750 g (4,500-5,000). The overall CS rate was 15%. The difference in the CS rate between these mothers and the control was not significant (P = 0.41). Only 9 (3.8%) mothers were successfully delivered with the aid of ventouse due to delayed second stage of labor. There was a significant difference in the complication rates between the mothers of large infants and the control (P < 0.001). Four maternal deaths were associated with macrosomia for a maternal mortality rate of 1667/100,000. Four infants had shoulder dystocia and associated injuries. The perinatal mortality rate was 112.5/1,000 births. CONCLUSIONS The higher the total body weight at birth, the higher the rate of macrosomia. Macrosomia had implications for high morbidity and mortality in the mothers and their infants. Delivery methods need to be evaluated. Caesarean section should be more readily used.
Department of Obstetrics and Gynaecology, Abia State University Teaching Hospital, PMB 7004, Aba, Abia State, Nigeria.
BACKGROUND Given considerable evidence that routine episiotomy increases maternal morbidity and without evidence to support maternal or neonatal benefit, has episiotomy use changed among health care providers? To date, very limited information exists relating to the past and current practice of episiotomy in many developing countries. OBJECTIVE To determine the prevalence of episiotomy at Aba in South Eastern Nigeria, examine factors influencing the performance of episiotomy and document complications associated with the procedure. DESIGN A hospital based retrospective study. SETTING The Abia State University Teaching Hospital (ABSUTH), Aba in South Eastern Nigeria, from January 2001 to December 2005. SUBJECTS Four thousand, one hundred and seventy two mothers who delivered vaginally within the study period. RESULTS There were 1877 episiotomies, for an episiotomy rate of 45%. Ninety per cent of the primigravid parturients had episiotomy. Women undergoing episiotomy were younger (mean age 24.7 years; range 16-37) than women without episiotomy (mean age 28.5 years, range 20-43). When controlled for parity and maternal age, other risk factors were occipito-posterior position, vacuum extraction, forceps delivery, vaginal breech delivery, and a history of Caesarean section. Episiotomy use was also associated with major perineal lacerations and increased length of hospital stay. CONCLUSION The episiotomy rate of 45 per 100 vaginal deliveries in this study is obviously higher than evidence-based recommendations for optimal patient care. A policy of systematic reduction in the incidence of episiotomy can be pursued in this hospital. Greater attention needs to be paid to selection of women to undergo episiotomy.
Awareness, acceptability, and use of male condoms for contraception and prevention of sexually transmitted infection among female students in a tertiary institution in South Eastern Nigeria.
Abia State University Teaching Hospital, Aba, Nigeria.
OBJECTIVE To compare the incidence of antenatal and intrapartum complications and perinatal outcomes among women who had delivered five or more times (grandmultiparous) with those of age-matched controls who had delivered two to four times (multiparous). DESIGN A case-control study. SETTING A tertiary referral hospital in Aba, Nigeria. SAMPLE Seven hundred and thirty-four grandmultiparous women were compared with 734 age-matched multiparous controls. METHODS Maternal case records were retrieved from medical records department and analyzed with additional information obtained from the labor ward records. Statistical analysis was done using EPI info version 6; χ² test was used to analyze categorical variables. RESULTS Grandmultiparity was associated with a significantly higher risk of antenatal anemia (P < 0.05), multiple pregnancy (P < 0.01), fetal macrosomia (P < 0.01), perinatal mortality (P < 0.01), and primary postpartum hemorrhage (P < 0.05). A significantly higher rate of cesarean deliveries was observed in the multiparous controls (P < 0.01), than the grandmultiparous women. CONCLUSION Our study shows that there is an increased risk of antenatal anemia, multiple pregnancy, primary postpartum hemorrhage, and adverse perinatal outcomes in grandmultiparous women independent of maternal age.
Knowledge and practice of cervical cancer screening using Pap smear among women attending antenatal clinic at Aba, south-eastern Nigeria.
Department of Obstetrics and Gynaecology, Abia State University Teaching Hospital, Aba, Abia State, Nigeria.
This is a case report of a patient with utero-cutaneous fistula following Caesarean Section and criminal abortion. Her case was further complicated by the discovery of products of conception within the fistula. At laparotomy, adhesiolysis with the freeing of the uterus and fistulectomy were performed. She had an uneventful recovery.
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Department of Obstetrics & Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
OBJECTIVE : To promote the use of long-acting reversible contraceptive (LARC) methods (intrauterine devices [IUDs] and implants) and provide contraception at no cost to a large cohort of participants in an effort to reduce unintended pregnancies in our region. METHODS : We enrolled 9,256 adolescents and women at risk for unintended pregnancy into the Contraceptive CHOICE Project, a prospective cohort study of adolescents and women desiring reversible contraceptive methods. Participants were recruited from the two abortion facilities in the St. Louis region and through provider referral, advertisements, and word of mouth. Contraceptive counseling included all reversible methods but emphasized the superior effectiveness of LARC methods (IUDs and implants). All participants received the reversible contraceptive method of their choice at no cost. We analyzed abortion rates, the percentage of abortions that were repeat abortions, and teenage births. RESULTS : We observed a significant reduction in the percentage of abortions that were repeat abortions in the St. Louis region compared with Kansas City and nonmetropolitan Missouri (P<.001). Abortion rates in the CHOICE cohort were less than half the regional and national rates (P<.001). The rate of teenage birth within the CHOICE cohort was 6.3 per 1,000, compared with the U.S. rate of 34.3 per 1,000. CONCLUSION : We noted a clinically and statistically significant reduction in abortion rates, repeat abortions, and teenage birth rates. Unintended pregnancies may be reduced by providing no-cost contraception and promoting the most effective contraceptive methods. LEVEL OF EVIDENCE : II.
Obstet Gynecol. 2012 Oct 3;: 23037916
Department of Obstetrics & Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
OBJECTIVE:: To promote the use of long-acting reversible contraceptive (LARC) methods (intrauterine devices [IUDs] and implants) and provide contraception at no cost to a large cohort of participants in an effort to reduce unintended pregnancies in our region. METHODS:: We enrolled 9,256 adolescents and women at risk for unintended pregnancy into the Contraceptive CHOICE Project, a prospective cohort study of adolescents and women desiring reversible contraceptive methods. Participants were recruited from the two abortion facilities in the St. Louis region and through provider referral, advertisements, and word of mouth. Contraceptive counseling included all reversible methods but emphasized the superior effectiveness of LARC methods (IUDs and implants). All participants received the reversible contraceptive method of their choice at no cost. We analyzed abortion rates, the percentage of abortions that were repeat abortions, and teenage births. RESULTS:: We observed a significant reduction in the percentage of abortions that were repeat abortions in the St. Louis region compared with Kansas City and nonmetropolitan Missouri (P<.001). Abortion rates in the CHOICE cohort were less than half the regional and national rates (P<.001). The rate of teenage birth within the CHOICE cohort was 6.3 per 1,000, compared with the U.S. rate of 34.3 per 1,000. CONCLUSION:: We noted a clinically and statistically significant reduction in abortion rates, repeat abortions, and teenage birth rates. Unintended pregnancies may be reduced by providing no-cost contraception and promoting the most effective contraceptive methods. LEVEL OF EVIDENCE:: II.
Knowledge, attitudes and practices towards family planning among women in the rural southern region of Jordan.
Department of Maternal and Child Health Nursing, Faculty of Nursing, University of Jordan, Amman, Jordan. email@example.com
Data about family planning among women in rural and remote areas of Jordan are lacking. This study explored the prevalence of use and knowledge and attitudes towards family planning among rural Jordanian women. A descriptive study was conducted with 807 ever-married women aged 15-49 years in a household survey of 29 villages in the southern region of Jordan. The most common contraceptive methods ever used were oral contraceptive pills (31.1%); intrauterine device (24.8%) and withdrawal (19.5%). Of the women interviewed, 37% were currently using contraception. Being pregnant (11%) and breastfeeding (10%) were the most reported reasons for not using contraceptives. None of the women reported obtaining supplies or the cost of them as barriers, while opposition from husband or family members or religious reasons were reported by less than 1% of the women. About 95% of the women agreed that using family planning had positive advantages for health. The results highlight some educational needs among these women.
Hum Reprod Update. 2012 Jun 13;: 22699009
Family planning 2011: better use of existing methods, new strategies and more informed choices for female contraception.
BACKGROUNDThis paper explores recent developments in female contraception, using them to illustrate how adaptation of existing methods, improved service delivery and understanding contraceptive behaviour might increase contraceptive uptake and correct and consistent use, and how the development of new methods holds some promise for capitalizing on the potential non-contraceptive benefits.METHODSSearches were performed in Medline and other databases. Selection criteria included high-quality studies and studies relevant to clinical reproductive medicine. Summaries were presented and discussed by the European Society of Human Reproduction and Embryology (ESHRE) Workshop Group.RESULTSThe topics discussed include: adapted regimens for combined oral contraceptive pills, non-invasive methods of female sterilization, the need to improve the awareness of pregnancy risk to increase the use of emergency contraception, improvements in the evidence base for the safety and service delivery of intrauterine methods, emphasis on the potential benefits of combined oral contraceptives for women with hirsutism and acne, the potential of female sterilization to prevent ovarian cancer, and the promise of anti-progesterones and new approaches to dual protection.CONCLUSIONSAlthough great strides have been made in recent years in increasing contraceptive use among women in many countries where contraceptive prevalence is low or there is a high unmet need for contraception, much more can, and needs to, be done.
Contraception. 2012 Mar 30;: 22465114
Trends in contraceptive patterns and behaviors during a period of fertility transition in China: 1988-2006.
Institute of Population Research, Peking University, Beijing 100871, China.
BACKGROUND: This paper explores how contraceptive patterns and behaviors changed during the course of China's population transition and a period of low fertility from 1988 to 2006. STUDY DESIGN: Based on data from Chinese nationwide surveys of family planning and reproductive health undertaken in 1988, 1997, 2001 and 2006, this study uses a multinomial logit model to analyze changes in, regional differences in and determinants of contraceptive behaviors during this period. RESULTS: The overall prevalence of contraceptive use among married women aged 15-49 years changed little during these 20 years, holding steady at about 90%. However, there were notable changes in the method mix: the predominant methods used were the long-term methods of the intrauterine device (IUD) and female sterilization, and contraceptive use gradually shifted from sterilization to IUDs and condoms. There existed a close relationship between contraceptive methods used and sociodemographic characteristics. Hans, rural, old and less educated women are more likely to use sterilization, while minorities, urban, young and educated women are more likely to use IUDs. CONCLUSION: There are marked changes in the method mix among different demographic groups during the course of China's population transition and a period of low fertility. The findings indicate that future works aimed at promoting reproductive health should be diverse among different populations.
Contraception. 2012 Mar 27;: 22459235
Contraceptive choices of overweight and obese women in a publically funded hospital: possible clinical implications.
Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL 60611, USA.
BACKGROUND: Despite the growing obesity epidemic in the United States, family planning for overweight and obese women has been understudied. The aim of this study was to describe the contraception methods selected by normal weight, overweight and obese women. STUDY DESIGN: We retrospectively reviewed 7262 charts of women who underwent first trimester surgical termination of pregnancy at the John H. Stroger, Jr. Hospital of Cook County between January 1, 2008, and January 1, 2010. We analyzed the relationship between body mass index (BMI) and choice of contraceptive method, after adjusting for age, race, smoking and level of education. RESULTS: When compared to patients with BMI <25 kg/m(2), overweight (BMI 25-29.9 kg/m(2)) and obese patients (BMI ≥30 kg/m(2)) were more likely to select the intrauterine device (OR 1.3, 95% CI 1.28-1.32 for overweight; OR 1.6, 95% CI 1.59-1.61 for obese), contraceptive ring (OR 1.4, 95% CI 1.28-1.52 for overweight; OR 1.6, 95% CI 1.57-1.63 for obese) and tubal ligation (OR 1.5 95% CI 1.44-1.62 for overweight; OR 2.9, 95% CI 2.79-3.01 for obese). They were less likely to choose injectable contraception (OR 0.7, 95% CI 0.59-0.81 for overweight; OR 0.52, 95% CI 0.48-0.56 for obese). There was no relationship between BMI and choice of condoms, oral contraceptive pills and implantable methods. CONCLUSION: In our population, the contraceptive choices of overweight and obese women differed from those of normal weight women. These differences in contraceptive selection are important to recognize in light of the potential effect of BMI on the safety and efficacy of different contraceptive methods. Further research is needed to evaluate the contraceptive preferences, risks and benefits for overweight and obese women.
BMC Public Health. 2012 ;12 :197 22424141
Factors impacting knowledge and use of long acting and permanent contraceptive methods by postpartum HIV positive and negative women in Cape Town, South Africa: a cross-sectional study.
Women's Health Research Unit, University of Cape Town, Cape Town, South Africa. firstname.lastname@example.org
BACKGROUND The prevention of unintended pregnancies among HIV positive women is a neglected strategy in the fight against HIV/AIDS. Women who want to avoid unintended pregnancies can do this by using a modern contraceptive method. Contraceptive choice, in particular the use of long acting and permanent methods (LAPMs), is poorly understood among HIV-positive women. This study aimed to compare factors that influence women's choice in contraception and women's knowledge and attitudes towards the IUD and female sterilization by HIV-status in a high HIV prevalence setting, Cape Town, South Africa. METHODS A quantitative cross-sectional survey was conducted using an interviewer-administered questionnaire amongst 265 HIV positive and 273 HIV-negative postpartum women in Cape Town. Contraceptive use, reproductive history and the future fertility intentions of postpartum women were compared using chi-squared tests, Wilcoxon rank-sum and Fisher's exact tests where appropriate. Women's knowledge and attitudes towards long acting and permanent methods as well as factors that influence women's choice in contraception were examined. RESULTS The majority of women reported that their most recent pregnancy was unplanned (61.6% HIV positive and 63.2% HIV negative). Current use of contraception was high with no difference by HIV status (89.8% HIV positive and 89% HIV negative). Most women were using short acting methods, primarily the 3-monthly injectable (Depo Provera). Method convenience and health care provider recommendations were found to most commonly influence method choice. A small percentage of women (6.44%) were using long acting and permanent methods, all of whom were using sterilization; however, it was found that poor knowledge regarding LAPMs is likely to be contributing to the poor uptake of these methods. CONCLUSIONS Improving contraceptive counselling to include LAPM and strengthening services for these methods are warranted in this setting for all women regardless of HIV status. These study results confirm that strategies focusing on increasing users' knowledge about LAPM are needed to encourage uptake of these methods and to meet women's needs for an expanded range of contraceptives which will aid in preventing unintended pregnancies. Given that HIV positive women were found to be more favourable to future use of the IUD it is possible that there may be more uptake of the IUD amongst these women.
Changes in contraceptive use following integration of family planning into ART Services in Cross River State, Nigeria.
One strategy for meeting the contraceptive needs of HIV-positive women is to integrate family planning into HIV services. In 2008 in Cross River State, Nigeria,family planning was integrated into antiretroviral (ART) services in five local government areas. A basic family planning/HIV integration model was implemented in three of these areas, and an enhanced model in the other two. We conducted baseline interviews in 2008 and follow-up interviews 12-14 months later with 274 female ART clients aged 18-45 in 2009 across the five areas. Unmet need for contraception was high at baseline (28-35 percent). We found that modern contraceptive use rose in the enhanced and basic groups; most of the increase was in consistent condom use. Despite an increase in family planning counseling by ART providers, referrals to family planning services for noncondom methods were low. We conclude by presenting alternative strategies for family planning/HIV integration in settings where large families and low contraceptive use are normative.
BACKGROUND In China, contraception is the most commonly used practice adopted by couples seeking to limit their number of children and to determine the time interval between births. Since 1980, the implementation of mandatory contraceptive strategy has reduced the fertility rate. Using large-scale data from national statistics and nationally representative sample surveys, the current study aims to assess Chinese trends in contraceptive use and determinants of choice from 1980 to 2010 among married women and men aged 20-49 years. STUDY DESIGN Since 1980, national data on contraceptive methods utilization have been gathered by the National Population and Family Planning Commission of the People's Republic of China (NPFPC). Additionally, data from three roughly representative decennial samples (1988, 1997, 2006) of Chinese women of aged 20 to 57 years have been gathered by the NPFPC through the National Family Planning and Reproductive Health Surveys in China. RESULTS A relatively stable Chinese mode of contraception has been established and maintained since the 1980s. This is characterized by long-term contraceptive use which is still dominant in current China. In addition, China's total contraceptive prevalence rates remain at the highest level across the globe from 1980 to 2010. However, the overall method composition of contraceptive use within China has changed since the mid-1990s. Over the study period, the prevalence rate of sterilization increased from 30.21% in 1980 to 46.47% of married women of reproductive age (20-49 years) in 1994 and then declined to 31.7% in 2010. At the same time, intrauterine device usage increased (39.83% in 1980 to 48.15% in 2010), as did oral contraception (0.3% in 1980 to 0.98% in 2010) and condom usage (2.35% in 1980 to 9.32% in 2010). The results from the multinomial logit model show that an individual's contraceptive choice depends not only on individual characteristics, including ethnicity, age, education level, household registration, region, number of living children and sex of the last living child, but also on the strength of family planning policies. A positive coefficient indicates that the looser the strength of family planning policies is, the more likely the individual is to choose condoms or another short-term contraceptive method. CONCLUSIONS Long-term contraceptive use is still dominant in China. In fact, over the 30-year period (1980-2010) and in comparative world perspective, China continues to have the highest total contraceptive prevalence rate. Additionally, an individual's contraceptive choice is jointly influenced by the strength of family planning policies and individual characteristics.
A comparative study on attitude of contraceptive methods users towards common contraceptive methods.
Department of Midwifery, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
Family planning is a method of thinking and a life style which is chosen voluntarily and according to the attitudes and responsible determination of the couples in order to promote the hygiene and convenience of the family. This study aimed to identify and compare the attitudes of the users of common contraceptive methods with regard to each method separately. The descriptive study was conducted in 2010. The study samples included 378 women using common contraceptive methods as LD pills, IUD (intrauterine devices), condom, withdrawal, tubectomy (females sterilization) and vasectomy as well as withdrawal method. The samples were selected through systemic random sampling from 9 health care centers. The data collection tool was a researcher-made. In order to determine the validity and reliability of the questionnaires, the content validity and Cronbach's alpha correlation coefficient methods were used. In order to analyze the data, the descriptive and inferential statistical methods (ANOVA) were used. Mean score of attitude regarding different contraceptive methods in the group who were users of the same method was above the users of all the methods; however, total attitude score toward the contraceptive methods was approximately similar to each other in all the groups and there was no significant difference among the different groups. The findings of this study showed that attitude is an important factor in choosing the contraceptive methods; therefore, this issue should to be taken into account by the family planning planners and consultants.