Utilization of Reproductive and Child Health Services and Client Satisfaction from Urban Primary Health Centers by Recently Delivered Women Living in Urban Slums of Lucknow, India

Background: Due to rapid urbanization, there is an increase in population in slums often lacking access to basic health services. Objective: The purpose of this study was to assess the utilization of reproductive and child health services by recently delivered women and their children residing in catchment areas of urban PHCs, to evaluate their level of satisfaction and to determine the factors associated with utilization of these services by recently delivered women. Settings and Design: The study was conducted in the catchment areas of urban primary health centre of Lucknow. Methods and Material: A cross-sectional study was conducted among 320 women having children less than 24 months in the slums covered under selected U-PHCs, sampled through a multi-stage random sampling technique using a semi-structured questionnaire. Statistical analysis used: SPSS-26 and MedCalc software were used for data analysis. Results: Utilization of RCH services by recently delivered women from UPHC was 39%. About 24% of recently delivered women availed ANC services from UPHC and 56.7% utilized family planning services and 95.8% immunization services for children. Child care services for diarrhea and ARI were availed by 9.9 and 3.1% of women, respectively. Satisfaction regarding maternal care and immunization services was seen in 84 and 95.8% of women. Poor satisfaction regarding child care was seen in 56.5% of women. Conclusions: The utilization of RCH services was found to be poor in the study population. Most recently delivered women were satisfied with all services except child care.

Demand and unmet need for modern contraception among mothers from a Pelotas Birth Cohort

ABSTRACT OBJECTIVE To determine the total demand and unmet need for contraception with modern methods and their determinants among mothers participating in the 2015 Pelotas Birth Cohort. METHODS Data from the 48-month follow-up of mothers participating in the 2015 Pelotas Birth Cohort were analyzed. Only biological mothers (aged up to 49 years) of children belonging to the 2015 Birth Cohort and who answered the 48-month questionnaire were included in the study sample. Logistic regression and respective 95% confidence intervals were used to determine associated factors. RESULTS The study sample consisted of 3577 biological mothers. The prevalence of use of any contraceptive and of modern contraceptives was 86.0% (95%CI: 84.8-87.1) and 84.9% (95%CI: 83.7-86.1), respectively. The prevalence of unmet need for modern contraceptives was 10.7% (95%CI: 9.7-11.7), and the total demand for contraceptives was 95.6%. The factors associated with an unmet need for modern contraception were being over 34 years of age (OR = 0.6, 95%CI: 0.5-0.8), not having a husband or partner (OR = 1.9, 95%CI: 1.4-2.6), not being the head of the household (OR = 0.6, 95%CI: 0.4-0.9), having had three or more pregnancies (OR = 1.9, 95%CI: 1.3-2.6), and having had an abortion at least once after the birth of the child participating in the cohort (OR = 1.9, 95%CI: 1.0-3.6). CONCLUSIONS Despite the high prevalence of modern contraceptive use, one in ten women had an unmet need for modern contraception and was at risk of unplanned pregnancy.

Seguridad de la Interrupción Voluntaria del Embarazo (IVE) en dos Instituciones Prestadoras de Salud en Medellín, Colombia, en 2019. Cohorte histórica / Safety of voluntary interruption of pregnancy (VIP) in two healthcare institutions in Medellín, Colombia, in 2019. Historical cohort

RESUMEN Objetivos: caracterizar una cohorte de mujeres con interrupción voluntaria del embarazo (IVE) y describir las complicaciones intraoperatorias según la técnica aplicada. Materiales y métodos: estudio descriptivo, de cohorte histórica en mujeres intervenidas a IVE en dos Instituciones Prestadoras de Salud-IPS en Medellín, Colombia, en el 2019. Se excluyeron aquellas mujeres con infección pélvica, e infecciones de transmisión sexual (ITS). Se realizó un muestreo consecutivo, se evaluaron variables sociodemográficas, de salud sexual y reproductiva, características clínicas del embarazo, causa legal de la IVE, características de la atención y las complicaciones hasta los 7 días posteriores al procedimiento de las técnicas de IVE. Finalmente, se hace análisis descriptivo. Resultados: durante el periodo de estudio hubo 1.520 mujeres elegibles de las cuales 46 fueron intervenidas en otras instituciones por lo que quedaron 1.474 candidatas a ingresar al estudio, de estas se excluyeron 30 por presentar infecciones pélvicas o de transmisión sexual, por lo que, finalmente, se analizaron 1.444 mujeres gestantes. Los riesgos para la salud de la mujer fueron la causa legal más frecuente con un 94,3%. El 99% de las mujeres tenían asesoría previa, y el 78,4% aceptó algún método anticonceptivo post-IVE. El 95,6% de las mujeres fueron intervenidas por la técnica de aspiración manual endouterina (AMEU) y al 4,4% se la practicó la técnica de dilatación y curetaje (D&C). En un 17,56% de las pacientes intervenidas con D&C se presentaron complicaciones hasta el séptimo día posoperatorio, no hubo complicaciones en el grupo sometido a AMEU, el 80% de las mujeres asistieron a control el séptimo día post-IVE. Conclusiones: la AMEU es un procedimiento seguro que no generó complicaciones intraoperatorias en el procedimiento, mientras la D&C se acompañó de complicaciones en una de cada seis pacientes. Se requieren estudios prospectivos que evalúen la seguridad y costos de las diferentes alternativas de IVE.

ABSTRACT Objectives: To characterize a cohort of women with voluntary interruption of pregnancy (VIP) and to describe intraoperative complications according to the technique used. Materials and methods: Descriptive study in a historical cohort of women undergoing VIP in two healthcare institutions in Medellín, Colombia, in 2019. Women with pelvic infection and Sexually Transmitted Infections (STIs) were included. Consecutive sampling was used. Sociodemographic, sexual and reproductive health, clinical characteristics of the pregnancy, legal cause of the VIP, characteristics of the care process and complications of the VIP techniques up to postprocedural day 7 were the measured variables. A descriptive analysis was carried out. Results: Overall, 1,520 women were identified as eligible during the study period. Of them, 46 were intervened in other institutions, leaving 1,474 candidates to enter the study. Of them, 30 were excluded because of pelvic or sexually transmitted infections. Ultimately, 1,444 pregnant women were included in the analysis. Risk to the mother's health was the most frequent legal cause in 94.3% of cases. Ninety-nine percent of women received pre-procedural counseling, and 78.4% agreed to use some form of contraception after VIP. Manual vacuum aspiration (MVA) was used in 95.6% of women and dilation and curettage (D&C) in 4.4%. Complications up to postoperative day 7 occurred in 17.56%, and there were no complications in the MVA group; 80% of women attended the follow-up visit on post-VIP day 7. Conclusions: MVA is a safe procedure which was not associated with intraperatory comoplications. D&C was associated to complications in one of each six patients. Prospective studies to assess the safety and cost of the different VIP options are required.

Profile of health facilities and determinants of the family planning services supply to unmarried adolescents in Burkina Faso, Ghana, and Niger

Objectives: Despite numerous interventions to facilitate adolescents' access to family planning (FP) services in West Africa, studies reveal that unmarried adolescents have difficulties accessing these services. This study analyses the supply of the FP services package to unmarried adolescents as well as the profiles of the facilities that provide this package in Burkina Faso, Ghana, and Niger. Also, it examines the determinants of the supply of this package. Design: The study adopted a spatiotemporal descriptive analysis and a binary logistic Generalized Estimating Equation (GEE) model. The data come from surveys conducted in the three countries between 2013 and 2019 as part of the Performance Monitoring and Accountability 2020 program. Participants: The target population consists of health facilities that provide health services. Results: The study indicates that more than 80% of FP services are provided by basic health facilities in Burkina Faso and Niger, while in Ghana, the profile is more diversified, including hospitals, polyclinics, and public and private primary health centres. The econometric analysis indicates that regional ownership, examination of client opinion data, ownership of a functioning computer, and knowledge of the served population are the main determinants of the supply of the FP services package to unmarried adolescents. Conclusion: By identifying facility profiles and determinants of FP services supply, this study provides a pathway for action to ensure that adolescents have access to these services regardless of their marital status in West Africa.

Incidencia a un año de deseo sexual hipoactivo en mujeres que planifican con implante subdérmico de levonorgestrel. Estudio de cohorte. Armenia, Colombia, 2014-2019 / One-year incidence of low libido in women using levonorgestrel subdermal implant as contraception. Cohort study. Armenia, Colombia, 2014-2019

RESUMEN Objetivo: definir la incidencia de deseo sexual hipoactivo (DSH) en mujeres que planifican con el implante subdérmico de levonorgestrel (LNG) después de 12 meses, y conocer otros efectos adversos. Materiales y métodos: estudio de cohorte, cuyas participantes fueron mujeres mayores de 18 años sin hijos ni embarazos previos y con pareja estable, a quienes se les había insertado el implante de LNG al menos tres meses previos en una clínica privada de carácter universitario en Armenia (Quindío), Colombia, entre 2014 y 2019. Se excluyeron mujeres con antecedentes de disfunción sexual, infecciones de transmisión sexual en los últimos 6 meses, peso mayor a 89 Kg y dificultades para el seguimiento. El muestreo fue consecutivo. Se describieron las características de la población estudiada, se estimó la incidencia acumulada de DSH y efectos adversos relacionados con el implante subdérmico de LNG Resultados: participaron 238 mujeres cuya edad media fue de 24,69 (DE ± 5,82) años. Se determinó una incidencia de deseo sexual hipoactivo del 18,82%. El 60,25% de las mujeres fueron diagnosticadas con DHS en los primeros 6 meses de seguimiento. Los efectos adversos se hicieron presentes desde los primeros 3 meses de la inserción del implante, el sangrado irregular (62,34%) fue el más frecuente, seguido de la amenorrea (38,91%) y el aumento de peso (33,89%). Conclusiones: es importante que los médicos y las usuarias se informen sobre la presencia del trastorno de deseo sexual hipoactivo y los efectos adversos que pueden surgir con el uso del implante subdérmico de levonorgestrel. Las futuras investigaciones deben confirmar estos hallazgos, así como su eventual base fisiológica.

ABSTRACT Objective: To determine the incidence of low libido in women using the levonorgestrel (LNG) sub-dermal implant for contraception after 12 months and to identify other adverse effects. Materials and methods: Cohort study that included women over the age of 18, with no children or prior gestations and in a stable relationship, with an LNG implant inserted at least three months before in a private teaching hospital in Armenia (Quindío), Colombia, between 2014 and 2019. Women with a history of sexual dysfunction, sexually transmitted infections in the past six months, weighing more than 89 kg and difficult to follow were excluded. Consecutive sampling was used. The characteristics of the study population were described, the cumulative incidence of low libido and the adverse effects related to the LNG sub-dermal implant after 12 months of follow-up were estimated. The tool used was the Female Sexual Dysfunction Index (FSFI). Descriptive statistics were applied. Results: The participants were 238 women with a mean age of 24.69 (SD ± 5.82) years. An 18.82% incidence of low libido was found. In 60.25% of the women were diagnosed with low libido in the first 6 months of follow-up. Adverse effects manifested as early as 3 months after the insertion of the implant, the most frequent being irregular bleeding (62.34%), followed by amenorrhea (38.91%) and weight gain (33.89%). Conclusions: It is important for practitioners and users to become aware of the presence of low libido disorder and the adverse events that may occur with the use of the levonorgestrel subdermal implant. Future research is required to confirm these findings and the underlying physiological cause.

Testosterone Is a Contraceptive and Should Not Be Used in Men Who Desire Fertility

Testosterone has a variety of functions and is commonly used in older men to treat symptoms of hypogonadism, such as decreased libido, decreased mood and erectile dysfunction. Despite its positive effects on sexual function, it has a negative effect on fertility. Exogenous testosterone therapy can negatively affect the hypothalamic-pituitary gonadal axis and inhibit the production of follicle stimulating hormone and luteinizing hormone. The purpose of this review is to discuss the contraceptive properties of testosterone therapy and to discuss strategies to increase testosterone in men with the desire to preserve fertility.

Abandono, cambio o falla de los anticonceptivos hormonales en población universitaria / Dropout, change or therapeutic failure to hormonal contraception in university women

Resumen OBJETIVO: Estimar la prevalencia de abandono, cambio o falla de los anticonceptivos hormonales que derivan en embarazos no deseados en mujeres universitarias entre 17 y 30 años. MATERIALES Y MÉTODOS: Estudio observacional y transversal efectuado entre el 1 de agosto y el 30 de noviembre de 2018 en estudiantes de la Facultad de Ciencias de la Salud de la Universidad de Boyacá, usuarias actuales o pasadas de métodos de anticoncepción hormonal. Variables de estudio: datos sociodemográficos, causas de abandono del tratamiento, cambio de método de planificación y falla del anticonceptivo. RESULTADOS: Se recolectaron 615 encuestas, se eliminaron 4 por datos incompletos. El promedio de edad de las estudiantes fue de 20.5 años (DE ± 3.6). El 26.15% recibió asesoría por distintos sujetos y medios diferentes al personal de salud. De las sustancias con interacción con los anticonceptivos hormonales, 25% consumía alcohol. Las principales reacciones adversas fueron: cefalea, aumento de peso y sangrado uterino anormal. Principales motivos de abandono: efectos adversos. El 10.3% de las encuestadas experimentó falla del anticonceptivo. CONCLUSIONES: Si bien el estudio evidencia que la primera causa de abandono fue el cese de la actividad sexual, un alto porcentaje de usuarias tuvo reacciones adversas leves y, de acuerdo con la persona que les suministró la información, se advirtieron dificultades para el apego a los anticonceptivos hormonales.

Abstract OBJECTIVE: The objective of the study was the prevalence of abandonment, change and therapeutic failure, which could trigger unwanted pregnancies in university women between 17 and 30 years of age, who have used hormonal contraceptives as a method of family planning. MATERIALS AND METHODS: An observational, cross-sectional study was carried out during the period between August 1 and November 30, 2018, where students from the faculty of health sciences of the University of Boyacá. The variables studied corresponded to sociodemographic data, causes of treatment abandonment, change of planning method and therapeutic failure. RESULTS: The average age of the population was 20.5 years, evidence of the use of oral contraceptives and 26.15% were advised by personnel other than health. Alcohol was the main substance of consumption that interacts with hormonal contraceptives. The main adverse reactions were headache, weight gain and abnormal uterine bleeding. The main reasons for abandonment are related to the presence of adverse effects. The therapeutic failure was presented in 10.3% of the respondents. CONCLUSIONS: Although the evidence of the first cause of abandonment was the life of sexual life, there is a high percentage of users with adverse reactions and, according to the person who likes the information, it can be noticed that there is difficulty in the attachment to the use of this type of medication.

Effects of a Community Outreach Program for Maternal Health and Family Planning in Tigray, Ethiopia

PURPOSE: We examined the effects of a community outreach program for maternal health in Tigray, Ethiopia, on women's knowledge about pregnancy, childbirth, postpartum care, and family planning, and assessed their participation in antenatal care, postpartum checkups, institutional childbirth, and contraceptive use. METHODS: We recruited Ethiopian women of reproductive age (15 to 49 years) in Tigray, Ethiopia. Two villages in Tigray, Kihen and Mesanu, which have similar population sizes and living environments, were chosen as the intervention and comparison groups, respectively. A two-group pretest-posttest design with cluster sampling was employed. We conducted self-report questionnaire surveys using face-to-face interviews. The 2.5-year community outreach program was developed based on Rogers' diffusion of innovation theory. It consisted of mass media use and health education for lay women in the community, along with training of health care providers, including nurses, midwives, and health extension workers, in maternal health care. RESULTS: The intervention group showed significant increases in knowledge and behaviors regarding maternal health and family planning compared to the comparison group (p < .001). In particular, there was a dramatic increase from 10.8% to 93.5% in the institutional birth rate in the intervention group. CONCLUSION: The community outreach program and health care professional training effectively improved knowledge and behaviors regarding maternal health in Ethiopian women. Mass media and interpersonal communication channels for health education may be useful health interventions in developing countries.

Percepción del embarazo adolescente en el Departamento Norte de Santander, Colombia / Perception of adolescent pregnancy in the Department of North Santander, Colombia

RESUMEN Objetivo Analizar la percepción del embarazo adolescente en el Departamento Norte de Santander. Método Se realizó una investigación descriptiva de corte transversal con 406 madres adolescentes entre 10 y 19 años pertenecientes a las 6 subregiones del departamento. Se aplicó una encuesta estructurada y se tabularon los datos en el Paquete Estadístico para las Ciencias Sociales (SPSS [Statical Package for Social Sciencies]; versión No.23) Resultados El 69 % de las adolescentes considera que la falta de educación sexual está asociada al embarazo no planificado. El 66 % reconoce que los embarazos no planificados se pueden prevenir con el uso de métodos anticonceptivos, pues los embarazos indeseados son la principal causa de deserción escolar para un 62 % de las adolescentes. Discusión La garantía de un mayor acceso a la educación sexual integral junto con el acceso libre y fácil a los métodos anticonceptivos puede reducir la problemática del embarazo adolescente.(AU)

ABSTRACT Objetive Analyze the perception of adolescent pregnancy in the Department of North Santander. Method A descriptive cross-sectional study was conducted with 406 adolescent mothers between 10 and 19 years old in 6 sub-regions of the department. We used a structured survey and the Statistical Package for the Social Sciences (SPSS; Version No. 23) was employed for the data tabulation. Results 69 % of adolescents believe that unplanned pregnancy is associated with the lack of sexual education. 66 % say that it is preventable with the use of contraceptive methods. It is known that unwanted pregnancies are the main cause of school dropouts for 62 % of adolescents. Discussion: Ensuring greater access to sex education and facilitating the free and easy access to contraception can reduce the problem of teen pregnancy.(AU)

Knowledge, attitudes and practices of post abortion family planning services in Tianjin obstetrics and gynecology personnels / 天津医药

Objective To better understand the knowledge, attitudes, practice (KAP) status and relative demand to post abortion family planning service (PAFPS) in medical staffs of obstetrics and gynecology department in Tianjin. Meth?ods By using random, stratified and clustered sampling approach, 290 obstetrics and gynecology personnels in Tianjin were selected. A Self-Administered Questionnaire on PAFPS KAP was employed to survey the general characteristics, aware?ness of PAFPS knowledge, attitudes to PAFPS and the occurrence of unintended pregnancy themselves, and service capabili?ties of PAFPS and request of continuing education. Results The respondents showed defects in PAFPS forms, follow-up ar?rangements and contraceptive method after abortion. The average knowledge score was higher in tertiary medical institution than that of secondary medical institutions. The score was higher in clinical doctors than that of nurses, and the higher the ti?tle, the higher the score. The 95.34%of respondents believed that it was necessary to develop PAFPS widely. But 93.55%of respondents thought that it can be difficult to carry out PAFPS as being required because of unclear service process, shortage of funds, human resource constraints, inadequate facilities and weak sense of services. The 53.36%of respondents, who had sexual life history, occurred unintended pregnancy themselves. The current defects of PAFPS were no standardized service processes, missing of medium-term and long-term follow-up, missing of collective consulting, providing contraceptives not timely and hadn′t pay attention to contraceptive advice. There were 90.68%medical personnels showed demand on relative training. Conclusion It′s necessary to perform continuing education about PAFPS to obstetrics and gynecology personnels via different intervention. At the same time, we should increase investment and make the service processes perfectly, so as to improve the level of PAFPS in obstetrics and gynecology medical staffs.

Clinical and psychological repercussions of videolaparoscopic tubal ligation: observational, single cohort, retrospective study / Repercussões clínicas e psíquicas da ligadura tubária videolaparoscópica: estudo observacional de coorte única, retrospectivo

CONTEXT AND OBJECTIVE: Tubal ligation is one of the most commonly used contraceptive methods worldwide. Since the controversy over the potential effects of tubal sterilization still continues, this study aimed to evaluate the clinical and psychological repercussions of videolaparoscopic tubal ligation. DESIGN AND SETTING: Observational, single cohort, retrospective study, conducted in a tertiary public hospital. METHODS: A questionnaire was applied to 130 women aged 21-46 years who underwent videolaparoscopic tubal ligation by means of tubal ring insertion or bipolar electrocoagulation and sectioning, between January 1999 and December 2007. Menstrual cycle interval, intensity and duration of bleeding, premenstrual symptoms, dysmenorrhea, dyspareunia, noncyclic pelvic pain and degree of sexual satisfaction were assessed in this questionnaire. Each woman served as her own control, and comparisons were made between before and after the surgical procedure and between the two techniques used. RESULTS: The clinical and psychological repercussions were significant, with increases in bleeding (P = 0.001), premenstrual symptoms (P < 0.001), dysmenorrhea (P = 0.019) and noncyclic pelvic pain (P = 0.001); and reductions in the number of sexual intercourse occurrences per week (P = 0.001) and in libido (P = 0.001). Women aged ≤ 35 years at the time of sterilization were more likely to develop menstrual abnormalities. The bipolar electrocoagulation method showed greater clinical and psychological repercussions. CONCLUSION: Regardless of the technique used, videolaparoscopic tubal ligation had repercussions consisting of increased menstrual flow and premenstrual symptoms, especially in women aged ≤ 35 years, and also had a negative influence on sexual activity. .

CONTEXTO E OBJETIVO: A ligadura tubária é um dos métodos contraceptivos mais utilizados em todo o mundo. Como a controvérsia sobre seus possíveis efeitos ainda continua, o objetivo deste estudo foi avaliar as repercussões clínicas e psíquicas da laqueadura videolaparoscópica. TIPO DE ESTUDO E LOCAL: Estudo observacional de coorte único, retrospectivo, conduzido em hospital público terciário. MÉTODOS: Foi aplicado um questionário a 130 mulheres, entre 21-46 anos, submetidas à ligadura tubária videolaparoscópica, pelas técnicas de eletrocoagulação bipolar/secção ou inserção do anel tubário, entre janeiro de 1999 e dezembro de 2007. Nesse questionário avaliou-se: intervalo do ciclo menstrual, intensidade e duração do sangramento, sintomas pré-menstruais, dismenorreia, dispareunia, dor pélvica não cíclica e grau de satisfação sexual. Cada mulher serviu como seu próprio controle, foi realizada análise comparativa entre os períodos pré- e pós-cirúrgico e entre as duas técnicas utilizadas. RESULTADOS: As repercussões clínicas e psicológicas mostraram-se significativas, com aumento de sangramento (P = 0,001), de sintomas pré-menstruais (P < 0,001), dismenorreia (P = 0,019), dor pélvica não cíclica (P = 0,001), e redução no número de relações sexuais por semana (P = 0,001) e na libido (P = 0,001). Mulheres com idade ≤ 35 anos, no momento da laqueadura, mostraram-se mais propensas a desenvolverem alterações menstruais. A técnica de eletrocoagulação bipolar mostrou maiores repercussões clínicas e psíquicas. CONCLUSÃO: A ligadura tubária videolaparoscópica, independentemente da técnica, repercutiu com ...

Métodos anticonceptivos en el Siglo XX: mujeres que se opusieron a maridos, familia y credo religioso / Contraceptive methods in the twentieth century: women who opposed husbands, family or religion

Objetivo: Analizar la aplicación de métodos anticonceptivos a las mujeres costarricenses entre los años 1930 y 1945. Desarrollo: En Costa Rica a mediados del siglo XX, se dieron transformaciones sociales y económicas importantes, cambios que propiciaron el deseo de tener pocos hijos y además se redujeron los “costos del control”, considerando entre estos los obstáculos de tipo cultural, religioso y familiar, que tuvieron que resolver las mujeres para modificar sus prácticas reproductivas. Conclusión: La disponibilidad de los métodos anticonceptivos para las mujeres costarricenses influyó en el descenso de la natalidad, además de la aplicación del Programa Nacional de Planificación Familiar y Educación Sexual.

Objective: This paper intends to analyze the application of contraceptives to women in Costa Rica between 1930 and 1945. Main thesis: In Costa Rica, during the mid-twentieth century, there were important social and economic changes that led to the desire to have fewer children, and also “control costs” were reduced, considering among these, the barriers of cultural, religious and family type that women had to resolve to modify their reproductive practices. Conclusion: The availability of contraception for Costa Rican women influenced the declining birth rate, as well as the implementation of the National Family Planning and Sexual Education Program.

Evaluation of knowledge, attitude and behavior of Turkish university students regarding family planning / Avaliação de conhecimento, atitude e comportamento de alunos de universidade turca com relação a planejamento familiar / Evaluación de conocimientos, actitud y comportamiento de estudiantes universitarios de Turquía respecto de planificación familiar

Research conducted to define general knowledge of university students' attitudes and behaviors about family planning. The sample consisted of 755 Sakarya University students. Data were collected from an open-ended questionnaire form and face-to-face interviews. The data analysis process was conducted using specific software. Most participants (59.7%) were over 22 years old and female, and 1.2 % of the females were married. Women in the study had a positive outlook regarding the positive effects of family planning on sexual health and stated that family planning is important to both society and our economy. The awareness and knowledge regarding family planning was found to be strongest among older participants. The family planning concept was understood correctly by about half of the students. Finally, young people did not have sufficient knowledge about family planning, its methods or where to obtain information on the topic.

Pesquisa foi realizada para definir o conhecimento das atitudes e comportamento dos estudantes universitários sobre planejamento familiar. Estudo envolveu 755 alunos da Universidade Sakarya. Os dados foram coletados de um questionário aberto e técnica face a face. A análise de dados foi feita com um software específico. A maioria dos participantes (59,7 %) com mais de 22 anos foi feminina e 1,2% casadas. As mulheres no estudo têm uma visão positiva dos efeitos do planejamento familiar na saúde sexual e declararam sua importância para a sociedade e economia. A conscientização e conhecimento sobre planejamento familiar foram considerados positivos entre os participantes mais velhos. O conceito de planejamento foi entendido corretamente por cerca de metade dos alunos. Finalmente, os jovens não tinham conhecimento suficiente sobre planejamento familiar, seus métodos ou onde buscar informações sobre o assunto.

Investigación que objetivó definir conocimientos generales de estudiantes universitarios y su actitud y comportamiento acerca de planificación familiar. Muestra constituida por 755 estudiantes de la Universidad de Sakarya. Datos obtenidos mediante preguntas abiertas efectuadas presencialmente. Se analizaron los resultados utilizando software específico. La mayoría de los participantes (59,7%) tenía más de 22 años, pertenecía al sexo femenino, 1,2% de ellos estaba casado. Las mujeres participantes poseían una visión positiva del efecto benéfico de la planificación familiar en la salud sexual, y establecieron que la planificación familiar es importante a nivel social y económico. La percepción y conocimientos acerca de planificación familiar resultó ser más positiva entre las participantes de mayor edad. El concepto de planificación familiar era entendido correctamente por aproximadamente la mitad de los estudiantes. Se concluye en que la juventud no poseía conocimientos suficientes sobre planificación familiar, sus métodos o de cómo obtener información respecto del tema.

Stakeholder perceptions of a total market approach to family planning in Nicaragua / Percepciones de grupos interesados sobre la aplicación de un enfoque de mercado total a la planificación familiar en Nicaragua

OBJECTIVE: To assess private-sector stakeholders' and donors' perceptions of a total market approach (TMA) to family planning in Nicaragua in the context of decreased funding; to build evidence for potential strategies and mechanisms for TMA implementation (including public-private partnerships (PPPs)); and to identify information gaps and future priorities for related research and advocacy. METHODS: A descriptive exploratory study was conducted in various locations in Nicaragua from March to April 2010. A total of 24 key private-sector stakeholders and donors were interviewed and their responses analyzed using two questionnaires and a stakeholder analysis tool (PolicyMakerTM software). RESULTS: All survey participants supported a TMA, and public-private collaboration, in family planning in Nicaragua. Based on the survey responses, opportunities for further developing PPPs for family planning include building on and expanding existing governmental frameworks, such as Nicaragua's current coordination mechanism for contraceptive security. Obstacles include the lack of ongoing government engagement with the commercial (for-profit) sector and confusion about regulations for its involvement in family planning. Strategies for strengthening existing PPPs include establishing a coordination mechanism specifically for the commercial sector and collecting and disseminating evidence supporting public-private collaboration in family planning. CONCLUSIONS: There was no formal or absolute opposition to a TMA or PPPs in family planning in Nicaragua among a group of diverse nongovernmental stakeholders and donors. This type of study can help identify strategies to mobilize existing and potential advocates in achieving articulated policy goals, including diversification of funding sources for family planning to achieve contraceptive security.

OBJETIVO: Evaluar las percepciones de los grupos interesados y de los donantes del sector privado sobre la aplicación de un enfoque de mercado total a la planificación familiar en Nicaragua en el contexto de una reducción del financiamiento; establecer datos científicos que avalen posibles estrategias y mecanismos para ejecutar este tipo de enfoque (lo que incluye alianzas entre los sectores público y privado); y determinar las brechas de información y las prioridades futuras en la investigación y la promoción de este enfoque. MÉTODOS: Entre marzo y abril del 2010 se llevó a cabo un estudio exploratorio descriptivo en varios lugares de Nicaragua. Se entrevistaron 24 personas de varios grupos interesados y de donantes clave del sector privado y se analizaron sus respuestas mediante dos cuestionarios y una herramienta de análisis específica (programa informático PolicyMakerTM). RESULTADOS: Todos los encuestados respaldaron la aplicación de un enfoque de mercado total y la colaboración entre los sectores público y privado respecto de la planificación familiar en Nicaragua. Según las respuestas obtenidas en la encuesta, las oportunidades para desarrollar alianzas adicionales entre los dos sectores respecto de la planificación familiar incluyen mejorar y ampliar los marcos gubernamentales existentes, como el actual mecanismo de coordinación de Nicaragua para la seguridad anticonceptiva. Los obstáculos son la falta de colaboración actual del gobierno con el sector comercial (con fines de lucro) y la confusión acerca de la reglamentación para participar en la planificación familiar. Las estrategias para fortalecer las alianzas existentes entre los sectores público y privado comprenden el establecimiento de un mecanismo de coordinación específico para el sector comercial, y la recolección y difusión de datos que avalen la colaboración entre los dos sectores respecto de la planificación familiar. CONCLUSIONES: En la evaluación de varios grupos interesados y de donantes del sector no gubernamental no se encontró ninguna oposición formal o absoluta a un enfoque de mercado total o a la conformación de alianzas entre los sectores público y privado respecto de la planificación familiar en Nicaragua. Este tipo de estudio puede ayudar a identificar estrategias que motiven a los promotores de la causa actuales y potenciales a alcanzar las metas políticas enunciadas, lo que incluye la diversificación de las fuentes de financiamiento para la planificación familiar a fin de alcanzar la seguridad anticonceptiva.

Initiation of effective postpartum contraceptive use in public hospitals in Guatemala / Inicio de un método anticonceptivo eficaz durante el puerperio en hospitales públicos de Guatemala

OBJECTIVE: Low frequency of effective contraceptive use remains a challenging problem. This article examines the frequency of effective postpartum contraception and the methods used before discharge in public hospitals in Guatemala. It also discusses the need to implement best practices in providing family-planning and contraceptive services. METHODS: In March 2006, a surveillance system was implemented to collect data on the initiation of effective contraceptive methods. Postpartum women were monitored in 34 public hospitals. Univariate and bivariate analyses were performed, and a chi-square test for linear trends was used to compare female surgical sterilization rates after vaginal delivery and cesarean section. RESULTS: Between 1 March 2006 and 31 December 2008, of the 218 656 women who had a postpartum event, 31 percent received an effective contraceptive method before hospital discharge. The frequency of initiation of effective postpartum methods varied across hospitals. Hospital results were consistent with national data on women of reproductive age. Among women who underwent surgical sterilization, differences between those who had delivered vaginally and those who had a cesarean section were statistically significant. CONCLUSIONS: The overall frequency of initiation of effective postpartum contraceptive use is low in public hospitals in Guatemala. It is higher, however, in hospitals at lower health care levels with strong community ties. Routine data collection revealed specific areas for improvement, particularly the need to enhance health providers' knowledge of medical eligibility criteria for effective contraceptive use postpartum. The priority is to promote the provision of highquality family-planning and contraceptive services in Guatemala's public health system.

OBJETIVO: La baja frecuencia del uso de métodos anticonceptivos eficaces sigue siendo un arduo problema. En este artículo se analiza la frecuencia con que se adopta un método de anticoncepción eficaz durante el puerperio y los diferentes métodos anticonceptivos empleados antes del egreso de los hospitales públicos de Guatemala. También se analiza la necesidad de mejorar las prácticas de los servicios de planificación familiar y anticoncepción. MÉTODOS: En marzo del 2006, se implantó un sistema de vigilancia para recopilar datos sobre el inicio de métodos anticonceptivos eficaces. Se hizo un seguimiento de mujeres durante el puerperio en 34 hospitales públicos. Se llevaron a cabo análisis de una sola variable y de dos variables, y se utilizó la prueba de la chi al cuadrado de las tendencias lineales con objeto de comparar las tasas de esterilización quirúrgica femenina después del parto vaginal y la cesárea. RESULTADOS: Entre el 1 de marzo del 2006 y el 31 de diciembre del 2008, de las 218 656 mujeres a las que se les hizo un seguimiento durante el puerperio, en 31 por ciento se inició un método anticonceptivo eficaz antes del alta hospitalaria. La frecuencia de inicio de un método anticonceptivo eficaz en el puerperio varió entre los diferentes hospitales. Los resultados hospitalarios concordaron con los datos nacionales sobre las mujeres en edad fecunda. En las mujeres que se sometieron a esterilización quirúrgica, las diferencias entre las que habían dado a luz por vía vaginal y las sometidas a una cesárea fueron estadísticamente significativas. CONCLUSIONES: En general, existe una baja frecuencia de inicio de un método anticonceptivo eficaz durante el puerperio en los hospitales públicos de Guatemala. Sin embargo, es mayor en los hospitales de inferior nivel de atención de salud cuyos vínculos con la comunidad son intensos. La recopilación sistemática de datos reveló que determinadas áreas debían ser objeto de mejora, en particular era necesario mejorar el conocimiento de los proveedores de servicios de salud en materia de criterios médicos sobre la indicación del uso de un método anticonceptivo eficaz durante el puerperio. La promoción de la provisión de servicios de planificación familiar y anticoncepción de alta calidad en el sistema de salud pública de Guatemala constituye una prioridad.

Family Planning in a Family Health Unit / Planejamento familiar em Unidade de Saúde da Família / Planificación familiar en Unidad de Salud de la Familia

The aim of this study was to identify the care provided by health professionals who work in family planning, in a Family Health Unit in the municipality of Ribeirao Preto, São Paulo. This was a descriptive, cross-sectional and quali-quantitative study. Data were collected through interviews with 11 health professionals. The results revealed that most professionals had not received training in family planning, and that information about contraceptive methods is transmitted in an individual way, having women as the target-public. The contraceptive methods which the professionals suggest and offer more are those considered most effective. These findings indicate that family planning care at the Family Health Unit needs to be adjusted not only to ensure quality of service, but also to ensure sexual and reproductive rights.

O objetivo deste estudo foi identificar a assistência oferecida pelos profissionais de saúde que atuam em planejamento familiar, em uma Unidade de Saúde da Família, no município de Ribeirão Preto, São Paulo. Trata-se de estudo descritivo, com corte transversal e abordagem quali-quantitativa. Os dados foram coletados por meio de entrevista com 11 profissionais da saúde. Os resultados revelaram que a maioria dos profissionais não recebeu capacitação em planejamento familiar, sendo que a informação sobre os métodos anticoncepcionais é transmitida de forma individual, tendo como público-alvo as mulheres. Os métodos anticoncepcionais, considerados mais eficazes, são aqueles sobre os quais os profissionais mais orientam e oferecem. Os achados apontam que a assistência em planejamento familiar na Unidade de Saúde da Família necessita de adequações, não só para assegurar a qualidade do serviço prestado como também para assegurar direitos sexuais e reprodutivos.

El objetivo de este estudio fue identificar la asistencia ofrecida por los profesionales de la salud que actúan en la planificación familiar, en una Unidad de Salud de la Familia, en el municipio de Ribeirao Preto, Sao Paulo. Se trata de un estudio descriptivo con corte transversal y abordaje cuali-cuantitativo. Los datos fueron recolectados por medio de entrevista con 11 profesionales de la salud. Los resultados revelaron que la mayoría de los profesionales no recibió capacitación en planificación familiar, siendo que la información sobre los métodos anti-conceptivos es trasmitida de forma individual, teniendo como público objetivo a las mujeres. Los métodos anticonceptivos considerados más eficaces son aquellos sobre los cuales los profesionales más orientan y ofrecen. Los hallazgos apuntan que la asistencia en planificación familiar en la Unidad de Salud de la Familia necesita de adecuaciones, no sólo para asegurar la calidad del servicio prestado, como también para asegurar los derechos sexuales y reproductivos.

Uso de preservativos, risco e ocorrência de gravidez não planejada e conhecimento e acesso à contracepção de emergência entre mulheres com HIV/aids / The use of preservatives, risk and occurrence of non-planned pregnancies, and awareness about and access to emergency contraception among HIV/aids-infected women

O artigo enfoca o risco e a ocorrência de gravidez não planejada, abortos, conhecimento, acesso e uso da contracepção de emergência entre mulheres com HIV/aids. Utilizou-se abordagem quantitativa observacional realizada através de inquérito domiciliar em Santo André (SP), na qual se constatou que, após a informação sobre a infecção, 62,8 por cento aderiram ao uso do preservativo masculino, 77,2 por cento utilizando-o exclusivamente, 13 por cento associando-o à pílula ou injeções hormonais e 9,8 por cento alternado seu uso com coito interrompido, tabelinha ou duchas vaginais. Falhas mecânicas no uso do preservativo ocorreram com 38 por cento e, somadas às falhas ligadas à alternância com métodos comportamentais, foram responsáveis por 40 por cento dos casos de gravidez não planejada, ocorridas com 24 por cento das entrevistadas, 22 por cento resultando em abortos provocados. A contracepção de emergência era conhecida por 51,4 por cento e apenas 2,7 por cento a utilizaram. Conclui-se que falhas mecânicas ou comportamentais associadas ao uso de preservativo por mulheres com HIV/aids aumentam sua exposição a gestações não planejadas e abortos. É necessário ampliar as opções e fornecimento de métodos anticoncepcionais, incluindo a contracepção de emergência, bem como reorientar constantemente o uso de preservativos entre este público.

This paper focuses both the risk and the occurrence of non-planned pregnancy, abortions, as well as the awareness about and the use of emergency contraception among HIV/aids-infected women. A quantitative observational approach was used after a domiciliary survey in Santo Andre, São Paulo State, Brazil, where it was found that, after receiving the information about the infection, 62.8 percent adopted the use of male condom, 77.2 percent using it exclusively, 13 percent associated with hormone injections, and 9.8 percent alternated with either interrupted intercourse, fertility schedule or vaginal shower. Mechanical flaws by the use of the preservative occurred to 38 percent. Added to flaws associated to the alternation with behavioral methods, they caused together 40 percent of non-planned pregnancy, which occurred to 24 percent of the interviewed women, 22 percent resulting in self-provoked abortions. Emergency contraception was known by 51.4 percent, although only 2.7 percent had used it. The conclusion is that mechanical or behavioral flaws related to the use of preservative by HIV/aids-infected women increased their exposure to non-planned gestations and abortions. It is needed to amplify both the options and the supply of contraceptive methods, including emergency contraception, with constant re-orientation on the use of preservative among this public.

Uso de servicios de planificación familiar de la Secretaría de Salud, poder de decisión de la mujer y apoyo de la pareja / Use of family planning services and its relationship with women's decision-makingand support from their partner

OBJETIVO: Identificar la influencia de las características reproductivas y el empoderamiento femenino en el uso de servicios de planificación familiar (PF). MATERIAL Y MÉTODOS: Diseño de casos y no casos pareado por controles vecindarios (147 usuarias y 146 no usuarias de servicios de PF de la Secretaría de Salud durante 2003), en dos municipios del estado de Guanajuato, México. Análisis logístico multivariado para identificar diferencias entre usuarias y no usuarias. RESULTADOS: El uso de servicios de PF se asoció positiva y significativamente con poder de decisión de la mujer (alto: RM=3.2; IC95 por ciento 1.4-7.4); comunicación con la pareja para el uso de métodos de PF (RM =3.5; IC95 por ciento 1.4-9.3), y número de embarazos en su vida (> 6 hijos: RM =4.4; IC95 por ciento 1.4-13.8). CONCLUSIONES: El desarrollo de estrategias que involucren a los hombres y que, por otra parte, fomenten y fortalezcan el empoderamiento femenino, puede contribuir a una mayor utilización de servicios de PF.

OBJECTIVE: To identify the influence of reproductive characteristics and women empowerment with the use of family planning services. MATERIAL AND METHODS: Cases and non-cases design with neighborhood controls (147 users and 146 non-users of family planning services during 2003), in Guanajuato State, Mexico. Various indexes were constructed to evaluate women's empowerment and its relationship with family planning use. RESULTS: The use of family planning services was positively and significantly associated with the woman's power to make decisions (High: OR 3.2, CI95 percent 1.4-7.4), a high level of communication with her partner on contraceptive use (OR 3.5, CI95 percent 1.4-9.3); and a greater number of pregnancies (> 6 children: OR 4.4, CI95 percent 1.4-13.8). CONCLUSION: Factors such as a high level of female decision-making and more partner support for contraceptive use are related to the use of family planning services. Therefore, developing strategies that involve men and support female empowerment could contribute to increasing the use of family planning services.

Validation of a job aid to rule out pregnancy among family planning clients in Nicaragua

In Latin America, one of the most common barriers to family planning access is denial of services to women who present at clinics in the absence of menses. Where pregnancy tests are unavailable, many providers fear that nonmenstruating women may be pregnant and, worrying about possible harm to the fetus, require the woman to await the onset of menses before initiating a contraceptive method. In 2005, during a randomized trial of oral contraceptive users in Nicaragua, we assessed a job aid endorsed by the World Health Organization to help providers exclude pregnancy among family planning clients. Among 263 new, nonmenstruating clients, the job aid ruled out pregnancy for 60 percent of the women. Only 1 percent of the women were pregnant, and no woman identified by the job aid as "not pregnant" was pregnant. Provider fears that nonmenstruating clients are pregnant are usually misplaced, while fears that hormonal methods can harm fetuses are exaggerated.

En América Latina, uno de los obstáculos más frecuentes para acceder a los servicios de planificación familiar es la negativa a atender a las mujeres que se presentan en las clínicas sin menstruación. Cuando no hay pruebas de embarazo disponibles, muchos profesionales piensan que las mujeres sin menstruación visible pueden estar embarazadas y por temor a ocasionar algún daño al feto les exigen esperar hasta el inicio de la menstruación para comenzar con algún método anticonceptivo. En 2005, durante un ensayo aleatorizado con usuarias de anticonceptivos orales en Nicaragua, se evaluó una lista de verificación avalada por la Organización Mundial de la Salud para ayudar a los profesionales sanitarios a descartar el embarazo en las mujeres que solicitan servicios de planificación familiar. Este procedimiento permitió descartar el embarazo en 60 por ciento de las 263 mujeres sin menstruación que solicitaban por primera vez ese servicio. Solamente 1 por ciento de las mujeres estaban embarazadas y ninguna de las identificadas por este procedimiento como "no embarazada" lo estaba. El temor de los profesionales de la salud de que las mujeres sin menstruación estén embarazadas es frecuentemente infundado y los temores de que los métodos hormonales puedan dañar al feto son exagerados.

An Assessment of quality of care provided by the Government family Planning clinic and field services in the DPDHS Area Colombo.

Study recommends infrastructure improvement in family planning clinics, regular in-service training of the service providers on family planning and counselling and steps to improve domiciliary follow-up care. Divisional and district administration should pay attention to maintain adequate cleanliness in the clinics, make sure all the necessary instruments for IUD insertion are available in the clincs, regularly update the knowledge of the service providers; especially the PHMM and introduce quality oriented supervision. To improve FP counseling it is importnant to train the service providers on counseling, identifying a place with privacy for this purpose in the clibic, and recorganize poly/combine clinics so as to give more time and opportunity for the service providers to counsel the clients. Study also recommends development of IEC materials, screening checklists, and must know information to PHMM and make these available at field level. Routine evaluation of the quality of the FP services by the divisional and district managers using quality indicators, and incorporation of few quality indicators to the routine information system will be useful in monitoring the quality of the service regularly. Obtaining the views of the clients, service providers and the service managers are also important to improve the quality of the FP service delivery.