scholarly journals Evaluation of a multi-level intervention to improve postpartum intrauterine device services in Rwanda

2019 ◽  
Vol 2 ◽  
pp. 38
Author(s):  
Rosine Ingabire ◽  
Julien Nyombayire ◽  
Alexandra Hoagland ◽  
Vanessa Da Costa ◽  
Amelia Mazzei ◽  
...  
Keyword(s):  
Family Planning ◽  
Unintended Pregnancy ◽  
Intrauterine Device ◽  
Intervention Development ◽  
Health Centers ◽  
Labor And Delivery ◽  
African Countries ◽  
Government Clinic ◽  
Multi Level

Background. The copper intrauterine device is one of the most safe, effective, and cost-effective methods for preventing unintended pregnancy. It can be used postpartum irrespective of breastfeeding to improve birth spacing and reduce unintended pregnancy and maternal-child mortality. However, this method remains highly underutilized. Methods. We developed a multi-level intervention to increase uptake of the postpartum intrauterine device (PPIUD, defined as insertion up to six weeks post-delivery) in Kigali, Rwanda. High-volume hospitals and health centers were selected for implementation of PPIUD counseling and service delivery. Formative work informed development of a PPIUD counseling flipchart to be delivered during antenatal care, labor and delivery, infant vaccination visits, or in the community. Two-day didactic counseling, insertion/removal, and follow-up trainings were provided to labor and delivery and family planning nurses followed by a mentored practicum certification process. Counseling data were collected in government clinic logbooks. Insertions and follow-up data were collected in logbooks created for the implementation. Data were collected by trained government clinic staff and abstracted/managed by study staff. Stakeholders were involved from intervention development through dissemination of results. Results. Two hospitals (and their two associated health centers) and two additional health centers were selected. In 6-months prior to our intervention, 7.7 PPIUDs/month were inserted on average at the selected facilities. From August 2017-July 2018, we trained 83 counselors and 39 providers to provide PPIUD services. N=9,020 women received one-on-one PPIUD counseling after expressing interest in family planning who later delivered at a selected health facility. Of those, n=2,575 had PPIUDs inserted (average of 214.6 insertions/month), a 29% uptake. Most PPIUDs (62%) were inserted within 10 minutes of delivery of the placenta. Conclusions. This successful, comprehensive intervention has the potential to make a significant impact on PPIUD uptake in Rwanda. The intervention is scalable and adaptable to other sub-Saharan African countries.

scholarly journals Evaluation of a multi-level intervention to improve postpartum intrauterine device services in Rwanda

2018 ◽  
Vol 2 ◽  
pp. 38 ◽  
Author(s):  
Rosine Ingabire ◽  
Julien Nyombayire ◽  
Alexandra Hoagland ◽  
Vanessa Da Costa ◽  
Amelia Mazzei ◽  
...  
Keyword(s):  
Family Planning ◽  
Unintended Pregnancy ◽  
Intrauterine Device ◽  
Intervention Development ◽  
Health Centers ◽  
Labor And Delivery ◽  
African Countries ◽  
Government Clinic ◽  
Multi Level

Background. The copper intrauterine device is one of the most safe, effective, and cost-effective methods for preventing unintended pregnancy. It can be used postpartum irrespective of breastfeeding to improve birth spacing and reduce unintended pregnancy and maternal-child mortality. However, this method remains highly underutilized. Methods. We developed a multi-level intervention to increase uptake of the postpartum intrauterine device (PPIUD, defined as insertion up to six weeks post-delivery) in Kigali, Rwanda. High-volume hospitals and health centers were selected for implementation of PPIUD counseling and service delivery. Formative work informed development of a PPIUD counseling flipchart to be delivered during antenatal care, labor and delivery, infant vaccination visits, or in the community. Two-day didactic counseling, insertion/removal, and follow-up trainings were provided to labor and delivery and family planning nurses followed by a mentored practicum certification process. Counseling data were collected in government clinic logbooks. Insertions and follow-up data were collected in logbooks created for the implementation. Data were collected by trained government clinic staff and abstracted/managed by study staff. Stakeholders were involved from intervention development through dissemination of results. Results. Two hospitals (and their two associated health centers) and two additional health centers were selected. In 6-months prior to our intervention, 7.7 PPIUDs/month were inserted on average at the selected facilities. From August 2017-July 2018, we trained 83 counselors and 39 providers to provide PPIUD services. N=9,020 women received one-on-one PPIUD counseling after expressing interest in family planning who later delivered at a selected health facility. Of those, n=2,575 had PPIUDs inserted (average of 214.6 insertions/month), a 29% uptake. Most PPIUDs (62%) were inserted within 10 minutes of delivery of the placenta. Conclusions. This successful, comprehensive intervention has the potential to make a significant impact on PPIUD uptake in Rwanda. The intervention is scalable and adaptable to other sub-Saharan African countries.

scholarly journals Evaluation of a multi-level intervention to improve post-partum intrauterine device services in Rwanda

2018 ◽  
Vol 2 ◽  
pp. 38 ◽  
Author(s):  
Rosine Ingabire ◽  
Julien Nyombayire ◽  
Alexandra Hoagland ◽  
Vanessa Da Costa ◽  
Amelia Mazzei ◽  
...  
Keyword(s):  
Unintended Pregnancy ◽  
Post Partum ◽  
Intrauterine Device ◽  
Intervention Development ◽  
Cost Effective ◽  
High Volume ◽  
Health Centers ◽  
Labor And Delivery ◽  
African Countries ◽  
Multi Level

Background. The copper intrauterine device is one of the most safe, effective, and cost-effective methods for preventing unintended pregnancy. It can be used post-partum irrespective of breastfeeding to improve birth spacing and reduce unintended pregnancy and maternal-child mortality. However, this method remains highly underutilized. Methods. We developed a multi-level intervention targeting supply, demand, and sustainability to increase uptake of the post-partum intrauterine device (PPIUD, defined as insertion up to six weeks post-delivery) in Kigali, Rwanda. High-volume hospitals and health centers were selected for implementation of promotions and service delivery. Formative work informed development of a PPIUD promotional flipchart delivered in-clinic (during antenatal care, labor and delivery, or infant vaccination visits) or in the community. Two-day PPIUD didactic counseling, insertion/removal, and follow-up trainings were provided to labor and delivery and family planning nurses followed by a mentored practicum certification process. Stakeholders were involved from intervention development through dissemination of results. Results. Two hospitals (and their two associated health centers) and two health centers were selected. In the 6-months prior to our intervention, only one nurse and one midwife from each hospital were providing PPIUD services, and just 46 PPIUDs had been placed at the selected health facilities. From August 2017-July 2018, we trained 83 promotional agents and 39 providers to provide PPIUD services. N=9,073 women received PPIUD promotions who later delivered at a selected health facility, and of those n=2,633 had PPIUDs inserted (29% uptake). Most PPIUDs (60%) were inserted within 10 minutes of delivery of the placenta, with an additional 13% intra-cesarean, 17% between 10 minutes and 48 hours after delivery, and 8% between 4 and 6 weeks after delivery. Conclusions. This successful, comprehensive intervention has the potential to make a significant impact on PPIUD uptake in Rwanda. The intervention is scalable and adaptable to other sub-Saharan African countries.

scholarly journals A follow up study of postpartum intrauterine device insertion in a tertiary health care centre

2017 ◽  
Vol 6 (7) ◽  
pp. 2800
Author(s):  
. Ranjana ◽  
Anita Verma ◽  
Indu Chawla
Keyword(s):  
Family Planning ◽  
Removal Rate ◽  
Post Partum ◽  
Intrauterine Device ◽  
Uterine Cavity ◽  
P Value ◽  
Expulsion Rate ◽  
Follow Up Study ◽  
Uterine Anomalies

Background: In view of high rate of unintended pregnancy in our country, particularly in post-partum women, there is a need for reliable, effective and long-term contraception such as intrauterine device (IUCD) in post-partum women. This study was done to determine the efficacy and safety of Post-Partum Intrauterine Device (PPIUCD) and to compare the outcomes of PPIUCD insertion after vaginal delivery and caesarean section.Methods: This follow up study was carried out in the department of Obstetrics and Gynecology, Dr. R.M.L Hospital, PGIMER, New Delhi over a period of 7 month from January 2016 to July 2016. PPIUCD (cu T- 380 A) insertions were done in 136 women who fulfilled the inclusion criteria. Women having haemoglobin less than 8 gm%, rupture of membranes more than 18 hours, obstructed labour, Uterine anomalies, distorted uterine cavity by fibroid, significant postpartum haemorrhage, coagulation disorders, fever or clinical symptoms of infection during labour were excluded from the study. Post insertion counselling was done, and these women were advised to follow up at 6 weeks and then after 6 months postpartum in the family planning O.P.D. At the follow-up visit, the women were asked for any symptoms of unusual vaginal discharge, irregular or heavy bleeding per vagina, and any expulsions if noticed.Results: Total number of cases that reported for follow up in family planning OPD was 118. Therefore, 18 patients were lost in the follow up. In 58.47% women, there was no complaint. Heavy menstrual bleeding was found in 17.79% women and pelvic pain in 16.10% women. The expulsion rate was 5.08% and IUCD removal was done in 12.71% women. Though, the incidence of expulsion and removal rate was more in vaginal insertions than in caesarean insertions but this difference was not statistically significant, while the incidence of missing threads were found more in intra caesarean insertion (28% vs. 11.76% with p value <0.05). Continuation rate at 6 month was 82.20%.Conclusions: PPIUCD insertion is a safe, convenient and effective method of contraception. Although the expulsion rate and removal rate was more in vaginal PPIUCD insertions, the benefits of providing highly effective contraception immediately after delivery outweigh this disadvantage, particularly in our country where most of the women do not come for contraceptive advice after delivery.

“At Least I Didn’t Get Raped”: A Qualitative Exploration of IPV and Reproductive Coercion among Adolescent Girls Seeking Family Planning in Mexico

2020 ◽  
pp. 088626052095957
Author(s):  
Jasmine Uysal ◽  
Jamila K. Stockman ◽  
Elizabeth Miller ◽  
Teresita Rocha-Jimenez ◽  
Gudelia M. Rangel ◽  
...  
Keyword(s):  
Family Planning ◽  
Community Health ◽  
Unintended Pregnancy ◽  
Adolescent Girls ◽  
Partner Violence ◽  
Community Health Centers ◽  
Health Centers ◽  
Gender Based Violence ◽  
Reproductive Coercion ◽  
Increased Risk

Adolescent girls who report intimate partner violence (IPV) are at an increased risk of experiencing reproductive coercion (RC); both these forms of gender-based violence (GBV) are associated with unintended pregnancy. Yet little is known about these experiences among adolescent girls in Mexico. Qualitative data were collected as part of formative research for the adaptation of an evidence-based intervention to address RC and IPV in community health centers in Tijuana, Mexico. From September, 2017 to January, 2018, adolescent girls aged 16 to 20 years old ( n = 20) seeking voluntary family planning (FP) services were identified and recruited from two publicly funded community health centers. We conducted semi-structured, in-depth interviews and analyzed the transcripts using inductive and deductive techniques. Participants in this sample commonly described experiencing IPV and RC (including pregnancy coercion and contraceptive sabotage), which many girls reported resulted in unintended pregnancy. Further, participants’ narratives and general lack of knowledge on how to cope with IPV or RC illuminated the acceptability of offering GBV prevention intervention within FP clinics serving this population. Findings highlight an urgent need to prevent IPV and RC, and reduce risk for unintended pregnancy among adolescent girls in this region and the potential of FP clinics to serve as a safe space for intervention delivery. Findings contribute to the limited qualitative evidence from Mexico, describing adolescent girl’s experiences of IPV and RC, strategies for preventing pregnancy in the context of RC, and opportunities for support from FP providers.

scholarly journals Pregnancy Intention, Ambivalence, and Contraceptive use in Community Health Center (CHC) Populations

2019 ◽  
Author(s):  
Tishra Beeson ◽  
Jenna Kress ◽  
Janelle Wylie ◽  
Susan F. Wood
Keyword(s):  
Family Planning ◽  
Reproductive Health ◽  
Community Health ◽  
Unintended Pregnancy ◽  
Community Health Centers ◽  
Pregnancy Intention ◽  
Health Centers ◽  
Reproductive Age ◽  
Pregnancy Intentions ◽  
Increased Risk

Abstract Introduction: Understanding the complexity of pregnancy intentions and resulting behaviors is essential to ensuring high quality, patient-centered reproductive health services that meet the needs of women and their partners. Community Health Centers (CHCs) play an important role in providing family planning care for traditionally underserved women, who may be at increased risk of experiencing unintended pregnancy. This study presents emerging findings on pregnancy intentions, ambivalence, and contraceptive behaviors among patients in CHC settings. Methods: This study employed a national survey (n=1,557) of women of reproductive age (18-44 years), sampled from 19 different CHC sites. The survey gathered information on patient characteristics, experiences with care, decision-making criteria and utilization of contraceptive services. Pregnancy intention was measured using the One Key Question®. Results: Approximately 12% of women reported that they wanted to become pregnant in the next year, while 88% were not actively seeking to become pregnant. Nearly 30% of those who did not desire a pregnancy reported not using contraception at the time of the survey. 1-in-4 women were pregnancy ambivalent and used contraception at approximately the same rates as women seeking to become pregnant. Conclusions: Women who express pregnancy ambivalence use contraception at similar rates to those who intend to become pregnant in the next year, potentially increasing their risk for unintended pregnancy. Understanding the characteristics and behaviors of underserved patients across different pregnancy intentions may help ensure that women receive the information, services, and support they need to achieve their reproductive health goals. Keywords: pregnancy intentions, family planning, community health centers, CHC, One Key Question®

Multi-Level-Chirurgie bei obstruktiver Schlafapnoe – Erweitertes Follow-up

2004 ◽  
Vol 83 (02) ◽  
Author(s):  
T Verse ◽  
A Baisch ◽  
JT Maurer ◽  
C Schroen ◽  
BA Stuck ◽  
...  
Keyword(s):  
Multi Level

scholarly journals 1535. Impact of Defunding Family Planning Health Centers on Gonorrhea and Chlamydia Cases in Iowa: A Spatiotemporal Analysis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S768-S768
Author(s):  
Megan L Srinivas ◽  
Eileen Yang ◽  
Weiming Tang ◽  
Joseph Tucker
Keyword(s):  
Family Planning ◽  
Low Income ◽  
Rural Areas ◽  
Spatiotemporal Analysis ◽  
Incidence Rates ◽  
Health Centers ◽  
Transmitted Infection ◽  
Missed Opportunities ◽  
Linear Regression Modeling ◽  
The Impact

Abstract Background Fifteen states have defunded family planning health centers (FPHCs), causing thousands to be left without health services. This has accelerated in the COVID-19 era. FPHCs provide low-income individuals in rural areas with essential primary care services, including sexually transmitted infection prevention, testing, and treatment. The purpose of this analysis is to use spatiotemporal methods to examine the impact of FPHC closures in Iowa on the reported number of gonorrhea and chlamydia cases at the county level. Methods This analysis investigates the association between FPHC closures and changes in the number of gonorrhea and chlamydia cases between 2016 and 2018. Iowa implemented defunding policies for family planning clinics, resulting in four FPHC closures in June 2017. 2016 pre-closure STI incidence rates were compared to 2018 post-closure rates. Gonorrhea and chlamydia rates in the four Iowa counties with clinic closures were compared to the 95 Iowa counties without closures. T tests were used to compare changes in reported gonorrhea and chlamydia rates in the two settings. Linear regression modeling was used to determine the relationship between clinic closures and changes in gonorrhea and chlamydia cases. Results The gonorrhea burden in Iowa increased from 83 cases per 100,000 people in 2016 to 153.8 cases per 100,000 people in 2018. The four counties with clinic closures experienced a significantly larger increase (absolute 217 cases per 100,000 population) in their gonorrhea rate compared to counties without FPHC closures (absolute 121 cases per 100,000 population). There was also a significant relationship between clinic closures and increasing gonorrhea rates (p = 0.0015). Over the three-year period, there was no change in chlamydia rates (p = 0.1182). However, there was a trend towards counties with more FPHC closures having a higher number of chlamydia cases (p = 0.057). Conclusion Despite the fact that many STI diagnoses are made and reported by FPHCs, our data suggest that clinic closures may have contributed to an increase in gonorrhea and chlamydia cases. This is consistent with delayed diagnoses and missed opportunities for providing essential STI services to vulnerable and under-served rural residents. Legislative action is urgently needed to curtail this trend. Disclosures All Authors: No reported disclosures

Characteristics and attitudes of family planners in Khartoum, Sudan

1982 ◽  
Vol 14 (1) ◽  
pp. 7-16 ◽  
Author(s):  
M. A. Khalifa
Keyword(s):  
Family Planning ◽  
Birth Control ◽  
Early Stage ◽  
Significant Proportion ◽  
Large Family ◽  
Capital City ◽  
Age Group ◽  
African Countries ◽  
The Mean ◽  
Almost All

SummaryIn a survey of 1475 urban Moslem wives in the age group 15–49 living in the capital city of the Sudan, knowledge of birth control was reported by almost all respondents while a significant proportion had used contraception at least once. The mean age of the users was 32·8 years, their duration of marriage was 15·1 years and their mean number of surviving children was 4·6. Those who had never used contraception had a higher mean age, a longer duration of marriage and more surviving children. Most of the users had an urban residential background and belonged to the high socioeconomic class. They held favourable attitudes to family planning. Although they thought that having a large family (more than five children) was not desirable, their mean preferred family size was no different from that of the never users.The results indicate that contraception is used for the purpose of spacing births rather than limiting their ultimate number. At this early stage of contraceptive adoption in Sudan, the characteristics of the pioneer acceptors are similar to those observed in other African countries.

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