Ten steps for successful breast-feeding: assessment of hospital performance, its determinants and planning for improvement.

This paper discusses results from a project which aims to document the maternity hospital practices in istanbul within the context of Ten Steps for Successful Breastfeeding. Instruments developed for use in hospital level implementation of the WHO/UNICEF baby friendly hospital initiative were used in five hospitals (two public and three private). No hospital was implementing all Ten Steps. A core hospital team on lactation management and a sufficient number of health personnel skillful in breastfeeding counselling and adequate delivery room conditions are required to implement the Ten Steps. It is very difficult to provide these conditions in public hospitals with an excessive patient load. On the other hand, the fee for service system and the policy of changing practices according to the wishes of the clients can also become barriers to successful breastfeeding, as may occur in some private hospitals.

[Contraceptive methods used in Istanbul and factors affecting method choice and continuation]. / Istanbul'da kullanilan gebelikten korunma yontemleri, bu yontemlerin tercih ve kullanimini surdurmede etkili faktorler.

PIP: This paper presents and discusses the results of a collaborative research to investigate use of modern versus traditional contraceptive methods in a new settlement area in Istanbul. Two lay interviewers administered a questionnaire to a total of 867 women on current and past contraceptive use. 90% (778) of the 867 currently nonpregnant women of mean age 31.4 years were using a method of contraception at the time of the study. The majority of women practicing contraception (46%) employed withdrawal, alone or in combination, followed by 29% who used an IUD. Among ever-users, withdrawal and IUD remain the two most common methods. The use of these methods was found to be unrelated to age, family size, or education, but there was a negative association of withdrawal use and a positive association of permanent method use with long-term residence in Istanbul. Contraception is widely acknowledged in Turkey. Almost every woman has heard of every method. People believe that there are side effects, and some side effects may actually be occurring, as also supported by the present data. In this community, despite the high failure rate of withdrawal, it appears that convenience and cleanliness of the method also play important roles in the choice. (author's modified)^ieng