Postpartum amenorrhoea in Ethiopia: the role of weaning, child death, and socioeconomic factors

Using data from the 1990 National Family and Fertility Survey (NFFS) and employing discrete-time hazards models, we examine the effect of weaning, child death, and socioeconomic factors on postpartum amenorrhoea in Ethiopia. The results show that 91 in every 100 mothers breastfed their child for at least 6 months. The median duration of breastfeeding stands at 18 months, and amenorrhoea lasts for a median duration of 12 months. Significant variations in breastfeeding and amenorrhoea duration are also observed among the different categories of breastfeeding women. The median duration of breastfeeding for lactating women is 24 months, 6 months for those who weaned, and 2 months for those whose child died. The median duration of postpartum amenorrhoea is 14 months for breastfeeding women, 12 months for those who weaned, and 6 months for those whose child died. Discrete-time hazard models reveal that child death has the strongest effect on the resumption of menses. Net of other factors, the risk of returning to menses increased 3 times for mothers whose child died. The effect of child death, however, decreases over time. Weaning also has a significant positive effect; and, like child death, its effect diminishes as time passes. The study further shows significant differences in the risk of returning to postpartum menses by socioeconomic characteristics of the women, even though they are breastfeeding.     

Animal model for the study of methanol toxicity: comparison of folate-reduced rat responses with published monkey data

The postpartum period is an ideal time to begin contraception, as women are more highly motivated to adopt contraception at this time and it is convenient for both patients and service providers. For intrauterine device (IUD) contraception, this period offers other advantages, such as ease of insertion and minimal adverse impacts on breastfeeding. Among early studies, most postpartum insertions were performed anywhere from a few hours to seven days or more after delivery, and retention of the IUD in the uterus was poor. Since the 1970s, immediate postplacental insertion (IPPI), i.e., IUD insertion performed within 10 minutes after placental delivery, has been advocated, and fairly, low expulsion rates have been reported. Up to now, IPPI has not been widely accepted in clinics because its expulsion rate still appears to be higher than that of interval insertion. In order to further study IPPI and perfect this contraceptive technique, it is essential to comprehensively review IPPI results and compare the Chinese experience with that of the rest of the world.     

Socioeconomic development, status of women, family planning, and fertility in Bangladesh: a district level analysis

In this paper we examine the effects of socioeconomic development, the status of women, and family planning on fertility and the extent to which these effects vary among the nineteen districts of Bangladesh. The 1983 and 1991 Bangladesh Contraceptive Prevalence Survey data are used to examine the effects of these factors on differences in contraceptive use among currently married women aged 15-49. The proportion of currently married women aged 15-49 using contraception was 46.3 per cent in 1991, a considerable increase from 26.5 per cent in 1983. Contraceptive use rates for all the districts increased substantially over the period between 1983 and 1991 and the gap between Dhaka's rate and those of other districts was narrower in 1991 than in 1983. An analytical model composed of socioeconomic development, status of women, and family planning variables is tested using logistic regression. The logit model is used to evaluate the effects of a selected group of variables on the probability of using contraceptive methods. The analysis demonstrates clearly that socioeconomic development and women's status significantly impact the use of contraceptive methods in Bangladesh. The results also suggest that better-educated, employed women are more likely to use contraception than those who have little or no formal education and who are not employed. In 1983, rural-urban differences in contraceptive use were significant, but in 1991 area of residence was not significant, which suggests that family planning programs may have played an important role in providing contraceptive information and technology to rural areas. Our analysis also suggests that family planning programs operated more efficiently in some districts than in others, and regional differences remained important in 1991 as they were in 1983. Decomposition analysis suggests that shifts in population structure favored increased contraceptive use in Bangladesh. This analysis also indicates that change in rate is also important, contributing about 21 per cent of the overall increase in contraceptive use.     

Gender preference and birth spacing in Matlab, Bangladesh

Gender preference, particularly son preference, is believed to sustain high fertility in many Asian countries, but previous research shows unclear effects. We examine and compare gender-preference effects on fertility in two otherwise comparable populations in Bangladesh that differ markedly in their access to and use of contraception. We expect, and find, stronger effects of gender preference in the population that has more access to contraception and higher levels of contraceptive use. Thus gender preference may emerge as a significant barrier to further national family planning efforts in Bangladesh. We find that if a woman has at least one daughter, the risk of a subsequent birth is related negatively to the number of sons. Women with no daughters also experience a higher risk of having a subsequent birth; this finding suggests that there is also some preference for daughters. Son preference is strong in both the early and later stages of family formation, but women also want to have at least one daughter after having several sons.     

Investigation on breastfeeding and lactational amenorrhoeic women in mountainous areas of Pengxian County, Southwest China

OBJECTIVE: To determine the distributions of the duration of postpartum breastfeeding, amenorrhoea, and contraceptive use, a community-based epidemiological investigation was carried out in Pengxian County, Southwest China in March 1992. METHODS: 1,040 women who had given live births during the reference period were interviewed. A current-status life table analysis was used. RESULTS: At 1 month postpartum, 100% infants were breastfed, at 6 months 95%, and at 12 months 82%. The level of amenorrhoea at 1 month postpartum was 90%, at 3 months 74%, at 6 months 62%, and at 12 months 36%. Contraceptive use was initiated at the second month postpartum with 19% of users, at 6 months 48%, and at 12 months 91%. CONCLUSION: The results indicate that at population level advising women to begin using contraceptives in 3 months postpartum is fairly reasonable, and the non-medicated IUD is recommended to be the first choice for the lactating women.     

The use of behavioral methods of contraception in women seeking abortion

AIMS: To determine the extent to which behavioural methods, used alone or with other methods of contraception, contribute to contraceptive failure in women seeking termination of pregnancy. METHOD: A clinical audit was conducted of the use of behavioural methods of contraception, in 1342 women attending the Parkview Clinic for termination of pregnancy, over a four year period 1992-6. The information was obtained through standard interview and patient records. RESULTS: The women seen were representative of New Zealand women undergoing termination of pregnancy. Approximately one third of women (34.9%) used one or more behavioural methods in the month prior to conception. The two most common methods were periodic abstinence and coitus interruptus, both used by approximately 17%. Other methods used less frequently and not solely for contraceptive purposes, were cleansing of the vagina and breastfeeding. Pacific Island and Asian women were more likely to use behavioural methods than European and Maori women. Many women (45.6%) using behavioural methods also used other methods of contraception, especially the condom. CONCLUSIONS: Behavioural methods were found more commonly than previously reported. Greater understanding of the use of behavioural methods will assist in the implementation of preventive programmes to reduce the number of terminations.     

Family planning knowledge, attitudes and practices in women with schizophrenic spectrum disorders

This study set out to test three hypotheses about family planning in women with schizophrenic spectrum disorders, as compared to demographically comparable non-mentally ill control women: that they (1) report at least as much unprotected intercourse while not desiring pregnancy; (2) have less knowledge about contraception; and (3) perceive more, and different, obstacles to obtaining or using birth control. A semistructured Family Planning Interview was administered to subjects (n = 44) with Research Diagnostic Criteria diagnoses of schizophrenia and schizoaffective disorder, and to non-mentally ill control subjects (n = 50). The participants had high rates of unprotected intercourse, as did non-mentally ill controls. They had significantly less reproductive and contraceptive knowledge than the control subjects, and were more likely to perceive birth control as difficult to obtain. The most common reason women with schizophrenic spectrum disorders gave for failing to use birth control was that they did not expect to have sex, while that given by non-mentally ill subjects related to side-effects of birth control. Important obstacles to family planning in women with schizophrenic spectrum disorders include relative lack of knowledge and difficulty planning ahead. Although many women with schizophrenia could benefit from long-acting, reversible contraception, many may be unaware of those options and/or may find them difficult to obtain. Integrating family planning with mental health care might better address the unique needs of this population.     

Family planning practices and attitudes among former Soviet new immigrant women in Israel

One hundred young new immigrant women from the former U.S.S.R. now living in Israel answered a detailed semi-open questionnaire regarding their knowledge, attitudes and behaviors in fertility and birth control issues. A collective family planning profile of these women is largely in line with that of the urban population of Slavonic U.S.S.R., combining early marriage, early and low fertility, the latter achieved by both abortion and contraception. Most respondents and their partners tried to prevent unwanted pregnancies, usually starting from traditional methods and switching over time to modern ones. An IUD remained most popular contraceptive among parous women, while use of the pill, very rare in the U.S.S.R., has almost doubled upon migration, mostly among younger women. Still, they kept some misleading ideas on the pros and cons of traditional versus modern methods, suggesting lack of adequate information also upon migration. Like their ex-compatriots, our women preferred to solve their birth control problems without external professional involvement. Contrary to the expected, free abortion ideology was not universally advocated by our respondents, and most were fully aware of abortion limitations in Israel. While rationally condemning abortion in both moral and health terms, most respondents still use it, this gap between beliefs and practice being indicative of their readiness to adopt efficient contraception. This switch occurs faster in women actively involved with host society via work or studies. Younger women were found to be more flexible and advanced in their family planning practices than were older ones, while almost no differences were related to education and origin within the U.S.S.R. This exploratory study suggests that any investment into promotion of healthy fertility control practices among new immigrants will be cost-effective in the near future.     

Social nesting: Changes in social network and support across the transition to parenthood in couples that conceived spontaneously or through assisted reproductive technologies.

Research showed that following the birth of a first child, parents increase contact with family members and diminish contact with friends, however, these changes may differ when conception is achieved through assisted reproductive technologies (ART). Based on the convoy model (Kahn & Antonucci, 1980) perspective of close relationships, we examined changes across the transition to parenthood in the social networks and support of men and women that conceived spontaneously or through ART. Thirty one women and 22 men (22 couples) that conceived through ART and 28 women and 24 men (24 couples) with a spontaneous conception provided data on social network and support from nuclear family, extended family, and friends twice: at 24-weeks pregnancy and 4-months postpartum. Results demonstrated that, regardless of method of conception, during the transition to parenthood new parents showed a strong nesting movement towards their nuclear family, perceiving increasing levels of nuclear family support across time. Extended family seemed to have only a secondary role on the social nesting movement and a withdrawal from friends was also observed. Considering the primary role nuclear family members seem to have on providing effective support to child-rearing, a greater emphasis on the importance of parents’ relationship with their own parents and siblings could be made and social and working policies that prevent the displacement of families geographically also should be considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acute necrotic myelopathy with pulmonary tuberculosis

A method for estimating conception rates, using vital statistics data, is developed and applied to data on five-year age groups of California women for 1971. The approach is deterministic and allocates total exposure time to the known pregnancy outcomes of live birth, spontaneous abortion, and induced abortion. The population at risk is defined to exclude women who are known to be sterile or sexually inactive. Early fetal loss, premarital conception, and contraceptive use are taken into account. Estimates are made of the fecundability which would obtain if no contraception were used.     

Haiti: unions, fertility and the quest for survival

This essay examines Haitian cultural and programmatic barriers to modern contraception and reports on types of unions as they relate to pregnancy and the prevalence of contraception. Findings from three mini-surveys representing 2383 rural and urban women in unions show that the most popular unions are maryé and plasé (legal marriage and setting up an household). Among rural women living in unstable relationships, vivav'ek, remen and menaj (living with someone, lovers, living as a pair), about 18% reported being pregnant at the time of the surveys. Findings also reveal that more urban women use contraceptive methods (23%) than do rural women (13%). However, the choice of contraceptive method appears to be influenced by medical staff and the availability of methods. Discussion examines the results of the surveys, women's position within the culture and attitudes toward the use of modern contraception. It also gives suggestions for improving family planning services by reinforcing the training of providers and supplementing their work with a team of volunteers who would encourage and support first-time users and dissatisfied users with meetings and home visits. It is also suggested that the promotion of informal education and the teaching of practical skills in mothers' clubs would encourage women to become economically independent from their partners so they would not focus on reproduction as a means to tie a man to them for emotional and economic purposes.     

Contraception: traditional and religious attitudes

Humans have tried to control fertility for centuries. Primitive, preliterate societies practiced infanticide and abortion. When primitive women understood the advantages of conception control, they tried, when possible, to use contraception. In the 4th century B.C., Plato and Aristotle advocated a one-child family. Greek medical literature reported a hollow tube inserted through the cervix into the uterus and a potion as contraceptives. Islamic physicians had much knowledge about conception control. The attitudes toward contraception. In the 5th century B.C., Saint Augustine condemned contraception, even among married couples. The condom emerged in the early modern period. Yet, they were usually worn to protect against disease, e.g., bilharzia in Egypt and syphilis in Europe. The cervical cap and the diaphragm are examples of occlusive pessaries. By 1880, contraceptives and spermicides were advertised. In 1928, the IUD joined the existing contraceptives. Today we have combined oral contraceptives. Judaic law requires husbands to fulfill their wives sexual needs, separate from their duty to procreate. It also calls men, not women, to procreate and forbids men from masturbating, thus Judaic law does not forbid women from practicing contraception. The Roman Catholic church forbids contraceptive use because it is a sin against nature. Some Protestant denominations have allowed contraceptive use. Islamic law states that children are gifts from Allah. Some Moslems believe that they must have many children, but Allah and the Prophet state that children have rights to education and future security. These rights allow couples to prevent pregnancy. Neither Hinduism nor Buddhism prohibit contraceptive use. Differences in husband-wife communication, sex roles, access to contraceptives, and traditional family values will have more of an effect on contraceptive use and fertility than theological barriers or the social class of religious groups.     

Durable effects of implementation intentions: Reduced rates of confirmed pregnancy at 2 years.

Objective: To assess the long-term impact of implementation intention formation in reducing consultations for emergency contraception and pregnancy testing among teenage women. Design: Teenage women visiting a family planning clinic were randomly assigned to implementation intention versus control conditions. Main outcome measures: Objective measures of consultation outcomes were obtained from clinic records at 2-year follow-up (N = 227). Results: Rates of consultation for emergency contraception and pregnancy testing in the implementation intentions condition were 19% and 33% lower, respectively, compared to the rates observed in the control condition. Pregnancy rates were 43% lower. Intervention participants who consulted for emergency contraception and pregnancy testing at baseline were more than twice as likely to change to consulting for contraceptive supplies over the follow-up period compared to equivalent control participants (19% vs. 9%). Conclusion: The impact of implementation intention formation on reducing pregnancy risk among teenagers is durable over 2 years. Implementation intentions were successful in changing behavior among precisely those participants who were at greatest risk of becoming pregnant. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Assessment of the promotion component in the postpartum/postabortion program

To study the low acceptance rate of contraception, the authors investigated the postpartum postabortum program of family planning in 8 hospitals run by the Mexican Ministry of Health. During 1 week all patients, 502 women who were leaving the hospital were interviewed; the personnel in charge of family planning were also interviewed. The number of acceptors leaving the hospital went from 1% of patients in Hermosillo to 47% in the General Hospital, a rate of acceptance much lower than that observed with other programs. Sociocultural characteristics of patients were very similar in all hospitals, and acceptance of IUDs was much greater than acceptance of the pill. In all hospitals, promotion of contraception consisted of a talk given to groups of patients and never to individuals; in most hospitals there were no other possibilities to receive contraceptive information. Most patients, either before or after the talk, still equated family planning with better education for children and better social conditions for the family; very few mentioned the health of mothers and children. 4% of patients did not know what contraceptives were available at the hospital even after the talk; many patients stated that the type of presentation and the vocabulary used were too difficult. Only 4% left the hospital with an adequate knowledge of both oral contraception and the IUD. Duration of the talk went from 7-39 minutes, depending on the hospital. The personnel delivering the talk were not specifically prepared for that purpose, and many times failed to answer questions or to expound on important aspects of contraception, such as side effects or contraindications. No teaching materials were available and even the meeting rooms were inadequate. It is obvious that postabortum postpartum programs of family planning should be restructured and reorganized, personnel should be trained, patients should receive individual attention, husbands should be encouraged to participate, and simple, inexpensive teaching materials, such as slides and prints, should be made available.     

Hepatitis C--role of perinatal transmission

Increasing family planning acceptance and efficacy is considered a key public health issue in many Pacific island nations. To assess the structure of family planning acceptance in Samoa, structured interviews were conducted with 155 reproductive age women from seven villages in both rural and urban settings. The survey data show accord with returns on contraceptive use from Samoan clinics, and demonstrate that awareness and use of contraception have increased markedly in the previous decade but desired family size remains high in younger women. A notable feature of the Samoan women's contraceptive experience is the lack of diversity of reported contraceptive behaviours and attitudes based on age, urban versus rural residence, and education.     

Psychological consequences of intervention in the birth process.

Investigated relationships between type of birth (spontaneous vaginal, forceps, and cesarean) and maternal psychological functioning and attitudes toward the infant. At specific time points throughout pregnancy and up to 3 mo postpartum, 253 women (mean age 28.21 yrs) completed measures assessing personality characteristics, psychological functioning and attitudes toward labor, birth, and the baby. After the birth of their babies, the women were categorized according to the type of birth experienced. There were no significant differences among the 3 birth groups in terms of their demographic status or psychological functioning in the prenatal period. The only measures that significantly differentiated the 3 birth groups were those relating to their birth experience. Contrary to reports in the published literature, type of birth was not found to be a major determinant of either maternal adjustment or psychological functioning in the postpartum period. (French abstract) (50 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sex ratio associated with timing of insemination and length of the follicular phase in planned and unplanned pregnancies during use of natural family planning

This was a multicentred, prospective study of pregnancies among women using natural family planning. The women maintained natural family planning charts of the conception cycle, recording acts of intercourse and signs of ovulation (cervical mucus changes, including peak day and basal body temperature). Charts were used to assess the most probable day of insemination relative to the day of ovulation and length of the follicular phase of the cycle. The sex ratio (males per 100 females) for 947 singleton births was 101.5, not significantly different from the expected value of 105. The sex ratio did not vary consistently or significantly with the estimated timing of insemination relative to the day of ovulation, with the estimated length of the follicular phase or with the planned or unplanned status of the pregnancy. Although these findings may be affected by imprecision of the data, the study suggests that manipulation of the timing of insemination during the cycle cannot be used to affect the sex of offspring.     

Social and psychological aspects of contraception in adolescents

Reasons for the high adolescent birthrate in the U.S., medical, psychological, and social repercussions of teenage pregnancy, and facts and myths about sex education and contraception for young people are discussed. About 30% of U.S. women under 20 become pregnant outside marriage, and many more are pregnant when they marry. The reasons for the high pregnancy rates in young people include recent early menarch, which accounts for 94% fertility in 17.5-year-olds, better health, and ignorance about contraception and basic facts about reproduction. Pregnant adolescents risk toxemia, anemia, puerperal morbidity, prematurity, neonatal mortality, and congenital defects such as mental retardation in the baby. They face family alienation, loss of educational and employment opportunities, forced marriage, and high suicide rates in addition to the trials of puberty. Many girls believe that their fertile period is during menses, that pills are dangerous, that they are not fertile. Studies have shown that sex education can lower repeat pregnancies 67%. Recent research has negated the belief that many young women desire pregnancy unconsciously. Current information shows that supplying contraception will not encourage young people to begin having intercourse. Most sex education courses in the U.S. are given after the average teenagers become active sexually. It is believed that contraception should be provided universally for young people, and that parental authorization of contraception would probably mend family ties, certainly better than would unwanted pregnancy.