Análisis cualitativo de la atención en los servicios de planificación familiar ofrecidos a pacientes quechuahablantes en Ayacucho, Perú / Qualitative analysis of the care in the family planning services offered quechua-speaking patients in Ayacucho, Peru

RESUMEN Objetivos . El objetivo del estudio fue abordar y analizar la atención médica brindada a mujeres quechuas de bajos ingresos que usan el Seguro Integral de Salud (SIS) para acceder a los servicios de planificación familiar, y determinar si existe un temor significante hacia los métodos anticonceptivos por las esterilizaciones forzosas ocurridas en el pasado. Materiales y métodos. Se realizaron 100 entrevistas en profundidad en 70 mujeres, 10 esposos y 20 trabajadores de salud, en tres centros de salud de la provincia de Vilcashuamán en Ayacucho. Resultados . Se encontró que no existe un temor significativo hacia la planificación familiar por las esterilizaciones ocurridas en el pasado, tal como se planteó la hipótesis. Tampoco se halló una barrera lingüística significativa, ya que la mayoría de los trabajadores de salud hablaban quechua o estaban dispuestos a aprenderlo. Hubo algunos malentendidos y malos tratos entre pacientes y trabajadores de salud, referidos al uso de los servicios asistenciales que brinda el estado. Un temor generalizado sobre el cáncer fue evidente en relación con la anticoncepción. Conclusiones . No se encontró un temor significante hacia las esterilizaciones pasadas, por el contrario, las mujeres temen más a la relación entre el cáncer y la anticoncepción. La capacitación de los trabajadores de salud debe centrarse en comprender las perspectivas de los pacientes y reducir el estigma respecto a la pobreza, además de explicar las razones para ser beneficiario del SIS y del programa JUNTOS.

ABSTRACT Objectives. The aim of this study was to address and analyze the medical care provided to low-income Quechua women who use the Seguro Integral de Salud (SIS, in Spanish) (comprehensive health insurance) to access family planning services, and to determine whether there is a significant fear toward contraceptive methods because of the forced sterilizations occurred in the past. Materials and Methods. One hundred (100) in-depth interviews were conducted with 70 women, 10 husbands, and 20 health workers in three health centers in the province of Vilcashuaman in Ayacucho. Results. It was found that there is no significant fear of family planning due to past sterilizations, as hypothesized. No significant language barrier was found either, as most health workers spoke or were willing to learn Quechua. There were some misunderstandings and abuse between patients and health workers referred to the use of healthcare services provided by the state. A widespread fear of contraception-related cancer became evident. Conclusions . No significant fear of past sterilizations was found; on the contrary, women are more afraid of the relationship between cancer and contraception. Health worker training should focus on understanding patient perspectives and reducing stigma around poverty, as well as explaining the reasons for being a recipient of the SIS and the "JUNTOS" program.

Task sharing for family planning services, Burkina Faso

Problem: In Burkina Faso, the coverage of services for family planning is low due to shortage of qualified health staff and limited access to services.Approach:Following the launch of the Ouagadougou Partnership, an alliance to catalyse the expansion of family planning services, the health ministry created a consortium of family planning stakeholders in 2011. The consortium adopted a collaborative framework to implement a pilot project for task sharing in family planning at community and primary health-care centre levels in two rural districts. Stakeholders were responsible for their areas of expertise. These areas included advocacy; monitoring and evaluation; and capacity development of community health workers (CHWs) to offer oral and injectable contraceptives to new users and of auxiliary nurses and auxiliary midwives to provide implants and intrauterine devices. The health ministry implemented supportive supervision cascades involving relevant planning and service levels.Local setting In Burkina Faso, only 15% (2563/17 087) of married women used modern contraceptives in 2010.Relevant changes Adoption of new policies and clinical care standards expanded task sharing roles in family planning. The consortium trained a total of 79 CHWs and 124 auxiliary nurses and midwives. Between January 2017 and December 2018, CHWs provided injectables to 3698 new users, and auxiliary nurses or midwives provided 726 intrauterine devices and 2574 implants to new users. No safety issues were reported.Lessons learnt The pilot project was feasible and safe, however, financial constraints are hindering scale-up efforts. Supportive supervision cascades were critical in ensuring success

Male involvement in family planning in Northern Nigeria: A review of literature

Background: Demand and utilization of family planning (FP) in Northern Nigeria has been consistently low. Evidence from literature has demonstrated that male involvement in FP programming can be successful in increasing demand for FP services. Materials and Methods: A search of peer-reviewed and gray literature was carried out to explore the status of male awareness and utilization of FP methods, and the barriers to male involvement in FP, in Northern Nigeria. Results: Males in the region generally have a good awareness of FP. However, they had negative perceptions, low levels of usage of FP, and poor spousal communication about FP.Sociocultural and religious barriers played major roles in hindering male involvement in FP. Misconceptions about FP, such as that FP is a woman's activity and that it also encourages promiscuity among women, were factors limiting its acceptance. Conclusion: There is a need to address the misconceptions and equip men with complete and correct information about FP. There is also a need for research on effective strategies to address the sociocultural and religious barriers to male involvement in FP in Northern Nigeria and the development of effective culturally sensitive male-involvement FP initiatives

Knowledge, attitude and uptake of family planning services among women of reproductive age group attending outpatient clinic at a tertiary health institution in Edo State, Nigeria

Globally, family planning service is an essential element of reproductive health care and contributes immensely to the reduction of the worldwide burden of maternal and child morbidity and mortality. This study was designed to assess the knowledge, attitude and uptake of family planning services, among women of reproductive age group attending outpatient clinic at Irrua Specialist Teaching Hospital, Irrua, Nigeria. A cross-sectional study was carried out among women of reproductive age group attending outpatient clinics from December 2017 to January 2018. Respondents were selected using multi-stage sampling technique. Questionnaires were used for data collection. Data were analyzed using Statistical Package for Social Sciences SPSS version 17. A total of 191 (95.5%) women aged between 15 and 49 years were successfully interviewed during the study. Majority, 174/191 (91.1%) of the respondents had a good knowledge of family planning services; 125/174 (72.0%) had a positive attitude towards the use of various types of contraceptives and 29 (15.0%) were completely against the use of contraceptives. Majority of the respondents, 132 (69.0%) were not using any form of family planning. Condom was the most frequently used contraceptive method; where it accounts for 60.0% while sterilization contributes the least that is 22.0%. Major factors associated with the uptake of contraceptives include marital status (p=0.029) and the occupation of the respondents (p=0.010). Respondent's knowledge towards family planning was good but this did not translate to use. Also, over half of the respondents had positive attitude towards family planning. The uptake of family planning services was higher than the average for Edo State and for Nigeria. Common barriers to uptake included fear of side effects and for religious reasons. The state and local government should bridge the gap between awareness and uptake of contraception; by providing correct information to women of reproductive age to break down common barriers

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.

Introducción de la anticoncepción de emergencia en la Norma Oficial Mexicana de Planificación Familiar (NOM-005-SSA2-1993) / Introducing Emergency Contraception in the Mexican Family Planning Official Norm

Objetivos: Entender el proceso de inclusión de las pastillas de anticoncepción de emergencia (PAE) en la Norma Oficial Mexicana de Planificación Familiar e identificar los factores que influyeron en este cambio. Material y métodos: Se realizaron entrevistas a profundidad con ocho tomadores de decisiones que ocupan cargos de alta jerarquía dentro de instituciones del gobierno estatal y federal. Resultados: El factor que determinó la inclusión de las PAE fue la extensa revisión de la evidencia científica que comprueba que no son abortivas, realizada por expertos del Centro Nacional de Equidad de Género y Salud Reproductiva. Además, el amplio apoyo de organizaciones civiles, la demanda de la población y la visión abierta del Secretario de Salud, contribuyeron de forma importante. La inclusión de las PAE en el cuadro básico de medicamentos fue vista como un paso lógico posterior a su inclusión en la Norma Oficial Mexicana. Conclusiones: La introducción de las PAE en México demuestra la importancia de la evidencia científica en la toma de decisiones. El proceso duró cerca de una década, lo cual refleja problemas en la traducción de los resultados de investigación en políticas públicas. Se deben tomar medidas para agilizar este proceso en beneficio de las mujeres y la sociedad en general.

OBJECTIVES: Understand the process of including Emergency Contraception (EC) in the Mexican Family Planning Norm (NOM) and identify factors that influenced this achievement. MATERIALS AND METHODS: We conducted in-depth interviews with eight prominent decision-makers of state and federal government institutions. RESULTS: The determining factor for the inclusion of EC in the Norm was the external review of scientific evidence, done by experts from the National Centre for Equity of Gender and Reproductive Health, proving that EC pills are not abortifacients. Other important factors that contributed to the inclusion were the ample support of civil organizations, the population's demand and the Minister of Health's support of EC. The inclusion of EC in the essential drug list was perceived as a logical next step after its inclusion in the NOM. CONCLUSIONS: The introduction of EC in Mexico highlights the importance of scientific evidence for decision-making. The process took about a decade, which reflects the complexity of converting research results into public policies. Measures should be taken to speed the processes that benefit women and society as a whole.

Atenção ao planejamento familiar no Brasil hoje: reflexões sobre os resultados de uma pesquisa / Family planning in Brazil today: an analysis of recent research

Realizou-se estudo com uma primeira etapa descritiva, de corte transversal, e segunda etapa qualitativa, de estudo de casos. Avaliou-se a disponibilidade de métodos anticoncepcionais nas Unidades Básicas de saúde de municípios brasileiros, e características da atenção ao planejamento familiar e a articulação com a estratégia de saúde da família. Inicialmente, foram aplicados, por telefone, questionários sobre o recebimento recente de métodos anticoncepcionais, em municípios selecionados a partir de um plano complexo de amostragem. Na etapa qualitativa foram selecionados propositalmente e visitados quatro municípios, onde se realizaram observação e entrevistas semi-estruturadas com gestores e profissionais de saúde. Procedeu-se a análise estatística descritiva e regressão logística múltipla dos dados quantitativos. Para os qualitativos adotou-se a técnica de análise temática do conteúdo. Verificou-se que as ações de planejamento familiar, com freqüência, são executadas de forma isolada e que os profissionais das equipes de saúde da família não entendiam o planejamento familiar como parte da atenção básica e não se consideravam capacitados para prestar assistência nessa área. A atenção ao planejamento familiar continua a ser marcada pela indisponibilidade de métodos anticoncepcionais nos serviços públicos de saúde.

This two-component study (descriptive cross-sectional and qualitative) assessed the availability of contraceptives in primary care clinics in Brazilian municipalities. The family planning program was also analyzed as part of the country's Family Health Strategy. Phone interviews were held with local health managers to obtain information on contraceptive supply in a selected sample of municipalities. Four municipalities were selected and visited for the qualitative analysis, using direct observation and semi-structured interviews with health professionals and managers. Descriptive statistical and multiple logistic regression analyses were performed. Content analysis technique was used for qualitative data. According to the results, family planning activities are often not integrated with other health activities. Health professionals and managers failed to understand family planning as part of primary health care and felt unable to assist patients. Family planning in Brazil is marked by the unavailability of contraceptives in public health programs.

Introduction of emergency contraception in India.

Emergency contraception is a safe and effective method for preventing unwanted pregnancy following unprotected sexual exposure. The method had not been included in the National Family Programme of India. A Consortium on National Consensus for Emergency Contraception met in New Delhi in January 2001, to reach a consensus on strategies for introduction of emergency contraception in India. During the consortium experts from different walks of life deliberated on issues related to emergency contraception introduction and formulated national consensus statements and guidelines. This paper describes highlights of consortium activity which has led to introduction of emergency contraception in India.

Parivar Seva's experience with emergency contraceptive pills.

Parivar Seva, an NGO working in the area of reproductive health carried out an operation research project as a feasibility study on emergency contraception recently. The study was conducted among 1120 clients coming after unprotected sexual intercourse or improper use of any contraceptive method by using emergency contraception pills coming within 3 days and IUCD coming between 3 and 5 days of unprotected sexual intercourse. It was found that failure of emergency contraception was as low as 0.6%. The success rate in term of preventing pregnancy was 99.4% both with combined oral contraception pills and laevonorgesterol. There lies the scope for introducing emergency contraception in India wide and it can occupy a unique position in a range of contraceptive choices currently available to Indian women, as it can prevent unwanted pregnancies. A coalition of 30 like minded organisations including the Parivar Seva had formed a subcommittee on emergency contraception to evolve strategies to address promotion of emergency contraception.

National rural health mission--hope or disappointment?

The recently declared National Rural Health Mission has aroused significant interest, being both welcomed and closely scrutinized, since there is a long overdue and outstanding need to strengthen weak and dysfunctional public health systems in rural India. In this setting, Jan Swasthya Abhiyan (JSA) has been involved in analysing various aspects of the Mission. The concern has been that it should develop in a manner that actually strengthens public health systems in an integrated manner, and that it should empower communities to be involved in the planning and utilization of these systems in a Rights-based framework. In this article, one will draw upon and reflect on a few of the major concerns about NRHM that have emerged during the insightful discussions in JSA.

Study of unmet need for family planning in Dar Assalam, Sudan 2001

In this descriptive study, the main objective was to determine the magnitude of unmet need for family planning among women of child-bearing age [15-49 years] in Dar Assalam. Using a detailed questionnaire, we studied 530 ever-married women selected randomly through a multistage sampling technique. Current use of contraception was 21.3%. Using the Westoff model, unmet need was 30.7%. Contraceptive pills were the most commonly used method, 92%. Knowledge on contraception was 61.3% for a single method and 23.4% > or = 2 methods. Knowledge was obtained mainly from relatives, 48.6%

Induced abortion and concurrent adoption of contraception in the rural areas of India (an ICMR task force study).

BACKGROUND: Despite a liberal Medical Termination of Pregnancy (MTP) act and awareness of family planning, maternal mortality attributable to induced abortion is high. AIMS: Assess attitude, behavior, practices and utilization of services by rural women for induced abortion and concurrent acceptance of contraception. SETTINGS AND DESIGN: Cross sectional survey of eligible married women in 13 states in India over one year. MATERIAL AND METHODS: A total of 1851 women who had an induced abortion during the previous 3 years were interviewed. STATISTICAL ANALYSIS USED: Includes proportions, rates and chi-square test. RESULTS: The main reason for seeking abortion was "don't need any more children" (42%), and in 12.4 per cent they specifically mentioned that they "don't need any more daughters". Around 46% of women accessed abortion services from private clinics as compared to government hospital (37.1%) and Primary Health Centre/Community Health Centre (14.0%). The decision to terminate the pregnancy and place of abortion was made by the husband in 42.8% and 52.5% respectively. Regret for abortion was expressed by 29.6% of the women. However, only 7.2% said they would not advice others for induced abortion. Nearly one half of the women undergoing abortion accepted a family planning method concurrently; of these Intra Uterine Device/oral contraceptives and a permanent method was adopted by 37.2% and 49.1% respectively. Acceptance of vasectomy by male partner was found to be low (1.3%). "Husband objected" (32.3%) was the main reason for not accepting post abortal contraception. Majority of the acceptors said they would recommend to others the same place where they had undergone abortion, thus indicating their satisfaction with the source and services received. CONCLUSIONS: Counselling for post-abortal contraceptive should be provided to the couple so that they can make an informed choice.

Ordeal of women for induced abortion in a rural area of Bangladesh.

The study was carried out to document the context of induced abortion, nature of its management, and post-abortion complications in Matlab, Bangladesh. The study included all 91 cases of induced abortion that took place in the study area from July to October 1995. Information was collected from women within 60 days after the abortion. A physician carried out in-depth interviews and physical examinations of 20 randomly-selected cases. The findings depicted a complex context, within which the women had to go for an abortion. In most cases, the complete lack of use or lack of use-effectiveness of family-planning methods resulted in unwanted pregnancies. The women in desperation sought abortion services from traditional sources first. When their conditions worsened, they contacted the available modern service facilities. At times, it was too late and led to serious health consequences. Limited access to safe abortion services, together with an absence of social support, put women in a life-threatening situation. Prevention of unwanted pregnancies and access to safe abortion services are needed to improve the situation.

Reproductive and Child Health (RCH) care and its implementation by IMA.

Reproductive and Child Health (RCH) is extended maternal child health of family welfare or safe motherhood or child survival and safe motherhood programme. Unless IMA members take up implementation of RCH programme, population stabilisation in India will remain unfulfilled.