Reproductive Health and Family Planning Services in Africa: Looking beyond Individual and Household Factors

Worldwide, there have been remarkable gains in the provision and utilization of reproductive health and FP services. However, in Africa, despite increasing availability, utilization of these services is less than 50%, even though there are wide variations among and within the countries across the continent. Articles from peer-reviewed journals, technical reports, Internet articles, grey literature (official government documents, technical reports, etc.) and Demographic and Health Survey (DHS) reports were used as resource materials. Manual search of reference list of selected articles was done for further relevant materials. We also used for comparative analysis, the online StatCompiler tool (https://www.statcompiler.com/en/) to extract data. Reproductive health and contraceptives have a lot of benefits to the individual, family and community. However, despite near universal knowledge and availability of reproductive health and FP services in Africa, utilization of these services is less than optimal. Several factors operating at individual, household and within the community influence utilization of services. These factors are the cause of poor maternal health and care that might hinder population health and the attainment of Sustainable Development Goals (SDGs). Interventions to promote and sustain utilization of services should target these factors at different levels depending upon relative role/s of these factors.

The Role of Information Technologies in Natural Family Planning

Freedom is needed in family planning and in the decision on how many children the couple will have, not to be influenced by a third person, political situations, or religious conviction. There is a need for information, education, and communication about possibilities in natural family planning, in order to be able to choose the right way, because there are many options even without side effects. Nowadays, we can add to these traditional possibilities of natural family planning also information technologies and electronic devices, which are increasingly available to a large portion of the population. Their reliability, with correct usage, is comparable to the barrier methods and in some cases to hormonal contraceptive methods. Next development of these devices can more increase their reliability. Of course, the active approach of users is needed.

The Case of Langerhans Cell Histiocytosis (Abt-Letterer-Siwe Disease) in Twin Girls

Abt-Letterer-Siwe disease is a form of Langerhans cell histiocytosis and occurs in 2–10 cases per 1 million of the child population per year. The Russian and foreign literature provide descriptions of this disease in children of different ages. Family cases of this pathology are described in a small number. The chapter presents a rare clinical observation of the Abt-Letterer-Siwe disease in twin girls.

Planning Methods in Ecuador’s Indigenous People

Sexual and reproductive health (SRH) is a fundamental human right that implies knowledge and exercise of sexual and reproductive rights (SSR). Among the latter are access to knowledge and use of contraceptive methods; therefore, SSR should be experienced as a constant experience that allows women to achieve full satisfaction and security in their sexual and reproductive sphere through their subjectivity, their body, and their social and cultural life. Knowing about family planning allows having the desired number of children determining the interval between pregnancies and choosing the contraceptive method according to the social, cultural and psychological beliefs, needs and conditions of each woman. However, indigenous women from Canton Cañar (Ecuador) have less access and knowledge to contraceptive methods, mainly due to the influence of social, cultural, religious and economic factors, among others. The lack of information about family planning in indigenous populations of the South of Ecuador has motivated this study; through a medical-anthropological approach, it is intended to determine what is the preference regarding contraceptive methods in indigenous Cañari women in the context of the Cañari culture and what are their perceptions regarding such methods.

Venous Thromboembolism in the Context of Reproduction: The Royal College of Obstetricians and Gynecologists Recommendations

Venous thromboembolism complicates 1–2 of every 1000 deliveries. It may manifest as deep vein thrombosis or pulmonary embolism. Pregnancy-associated venous thromboembolism is an important major cause of maternal morbidity and mortality. Prophylaxis and therapy in pregnancy are complicated by the need to take both fetal and maternal well-being into consideration. Risk factors for venous thromboembolism during pregnancy or the puerperium are multiple. They include, but are not limited to, thrombophilia, multiparity, orthopedic injuries, medical comorbidities, prior venous thromboembolism, smoking, gross varicose veins, age, if older than 35, obesity, multiple pregnancy, preeclampsia, cesarean section, prolonged labor, instrumental vaginal delivery, stillbirth, preterm birth, postpartum hemorrhage, hyperemesis gravidarum, ovarian hyperstimulation syndrome, immobility, long periods of hospitalization, and long haul travel. This chapter is a clinical guide that covers prophylaxis and therapy of pregnancy-associated venous thromboembolism, based on evidence-based research and consensus opinion.

Multifetal Gestations

In recent years, multiple pregnancy rates have increased significantly. Twin pregnancy rate increased by 76% between 1980 and 2009, from 18.9 to 33.3 in 1000 births. Triplets and high-order multiple pregnancies have increased by 400% in the 1980s and 1990s. Two main reasons of this increase in the incidence of multiple pregnancies are: (1) maternal age at the time of conception, shifting to advanced ages where multiple pregnancies are more common and (2) a more common use of assisted reproductive techniques. The main problem in multiple pregnancies is spontaneous preterm delivery and associated neonatal morbidity and mortality. Although numerous attempts have been made to prolong the gestation period and improve outcomes, none of them have been effective. In this article, the complications encountered in multiple pregnancies will be summarized and evidence-based approaches that can be used in their management will be reported.