Access to postpartum tubal ligation services in Cape Town, South Africa - an observational study

Background: Many women receiving antenatal care in public health services in Cape Town choose bilateral tubal ligation as their preferred method of postpartum contraception during their antenatal course. If the sterilisation does not occur immediately, these women are discharged on an alternative form of contraception and, ideally, an interval date for bilateral tubal ligation is arranged. Objectives: To assess the access to tubal ligation services in the Metro West area of Cape Town, South Africa, in women who request permanent contraception following delivery, looking specifically at the number of women requesting bilateral tubal ligation who receive the procedure intrapartum, immediately postpartum or as an interval procedure. Other objectives included determining the reproductive outcomes if bilateral tubal ligation was not performed, investigating the alternative forms of contraception provided and to study the demographics of the population requesting bilateral tubal ligation as a form of contraception. Methods: The study was conducted as a cross-sectional observational study collecting data over a period of 3 months, from June 2019 to August 2019. Maternity case records for deliveries between June 2019 and August 2019 from four facilities were reviewed. The facilities, representing all levels of care, were Vanguard Midwife Obstetric Unit, Wesfleur Hospital (district hospital), New Somerset Hospital (regional hospital), Groote Schuur Hospital (tertiary hospital). Results: There were 260 women who requested tubal ligation as their choice of contraception. Only 50% of these received a tubal ligation. Of the 131 tubal ligations performed, 2 were interval sterilisations. Ninety-one percent (120/131) of the tubal ligations were done at the time of caesarean section. Of the 129 women who received alternative forms of contraception, 13 women had a recurrent pregnancy. Conclusion: The study suggests that only 50% of women requesting tubal ligation as form of contraception actually end up receiving the procedure. Alternative forms of contraception are widely used and relied upon, but not without risks of recurrent pregnancy. Interval tubal ligation was not easily accessed by those women who were referred for the procedure.

Facteurs determinants le regret apres ligature tubaire

Introduction: La ligature tubaire peut generer regret. Le but de cette etude est d'etudier le vecu apres la sterilisation ainsi que le regret et ses facteurs de risque. Methodes: Il s'agit d'une etude retrospective chez 52 femmes sterilisees entre 2004 et 2010. Resultats: Vingt cinq (48) femmes avaient regrette la realisation de la ligature tubaire. La moyenne d'age etait de 40;5 ans. Le temps consacre aux explications etait tres court dans tous les cas. Trois quart des femmes n'etait pas au courant des complications de la ligature tubaire. Le regret etait du au facteur religieux (23); aux algies pelviennes (11;5); au desir d'autres enfants (9;6) ou a la prise de connaissance d'autres moyens contraceptifs (3;9). Conclusion: Un certains nombre de facteurs de risque de regret de la ligature tubaire sont retrouves dans la litterature; comme dans notre serie; dont l'age; le desir de procreer; l'information incomplete; le delai de reflexion et le facteur religieux