Deborah L. Covington

The effect of counseling on sterilization acceptance by high-parity women in Nigeria

To inform women of the risks associated with high parity and to increase understanding of birth control methods especially voluntary surgical contraception the University of Benin Teaching Hospital launched a family planning and education program for pregnant women who had had 4 or more previous deliveries. More than 1000 high-parity women admitted for prenatal care during a 19-month period were randomly allocated either to a treatment group exposed to 4 individualized counseling sessions on family planning methods and the health risks associated with high parity or to a control group that received only the standard family planning information provided at the prenatal clinic. Overall 71% of the women in the treatment group were using an effective method of birth control at 6 weeks postpartum compared with 51% of the women in the control group. About 40% of women in both groups had indicated at admission that they did not want more children but women in the treatment group were significantly more likely to choose female sterilization as their postpartum contraceptive method than women in the control group--13% compared with 3%. By age the proportions sterilized in the treatment group ranged from 4% of those younger than 30 to 28% of those 35 and older; comparable proportions for the control group were 2% and 9% respectively. 6% of women in the treatment group who had 4 living children underwent sterilization compared with 46% of those with 7 or more living children. Among control patients the proportions were 0 and 5% respectively. (authors) (summaries in ENG FRE SPA)

Sterilization regret in Sri Lanka: A retrospective study

Of 817 Sri Lankan women who elected for sterilization 14% regretted their decision. These women said that they either wanted another child or that they did not wish to be sterilized. Factors that determined regret included: not having a child of each sex being married less than five years being under the age of twenty-five having husbands who disagreed with the sterilization and other factors. Oddly some women regretted not having the sterilization sooner. The questions asked and the varying responses are discussed. 85% of the women who expressed regret wanted more children. It is important to note that no regret was related to the amount of payment. Counseling and education are methods of correcting this problem. Programs should inform women of other methods of reversible contraception and emphasize the irreversibility of sterilization.

Interval sterilizations. A substitute for postpartum procedures, an example from Southeast Brazil.

From December 1979 to February 1980, data were collected on access to postpartum sterilization for all obstetric patients at a large maternity hospital in Campinas, Brazil. Of the 827 women wanting no additional children and having knowledge of sterilization, 481 (58%) reported that they wanted to be sterilized. Of these women, 226 (47%) were sterilized postpartum. One year following their deliveries, follow-up forms were administered to the women desiring sterilization, but who had not been sterilized postpartum, to determine if they had been sterilized over the course of the year. Only 13% of the women had been sterilized, but almost 75% of the women not sterilized said they were still interested in getting sterilized. Of the women interviewed, 18% either had become pregnant again since the initial survey or were currently pregnant.

Physician Attitudes and Family Planning in Nigeria

This study examines family planning attitudes and practices of 681 Nigerian physicians selected from cities in which large university teaching hospitals are located. About half of the physicians were practicing family planning; the method of choice was the IUD. Obstetrician/gynecologists and general practitioners were more likely to provide methods to their patients than were other types of physicians. The physicians were concerned about population growth and favored family planning, yet a substantial minority believed that family planning is foreign to the culture and that it promotes promiscuity. Physicians were reluctant to promote family planning on a wide scale; many disapproved of non-physicians providing oral contraceptives or IUDs.

Side effects and discontinuation of oral contraceptive use in southern Brazil

Oral contraceptives have many advantages, but sometimes also have side effects which can cause users to switch appropriately or inappropriately to less effective methods or abandon contraception. In Brazil, 2/3 of married women of childbearing age were using contraception in 1981, and 1/2 of these were using orals. Contraceptive behavior following reported side effects in users of oral contraceptives in Southern Brazil is examined in this study, in relation to diverse factors. Among 2904 currently-married women, aged 15-44, almost 75% reported that they had used the pill at some time, and of these, 45.6% were still doing so. Data on perceived side effects were gathered for all women. There was no independent medical evaluation of the effects, so the data did not necessarily represent actual prevalence of pill related problems. Women who reported problems with the pill were less likely to be current users (25%) than women who did not (65%). However, overall contraceptive prevalence was about the same in both groups (66.2% and 67.0% respectively), indicating that women who stop using oral contraceptives usually switch to another method. However, they are more likely to be using traditional methods than women in the general population, especially if they want more children. Termination of pill use varies little according to the type of problem reported. Women with problems who sought medical attention were more likely to stop using the pill, and 82.4% of women advised to stop by their physician did so, but the major factor affecting discontinuation was the reported experience of a problem. The most frequently reported problems were headaches (38.1%), nausea (34.1%), nervousness (27.9%), and vertigo (18.3%). Physician intervention should help to avoid womens abandoning oral contraceptives unnecessarily.

Risks and costs of illegally induced abortion in Bangladesh

This article reports on women admitted to Dhaka Medical College Hospital for incomplete, illegally induced abortion. Women with low complication rates more often had abortions induced by medical practitioners. These women were younger, of lower parity and better educated than women having abortions initiated by other practitioners. Poorly educated women from slum areas almost always had an abortion induced by a nonmedical practitioner through the insertion of a solid object. These women experienced high complication rates and often required hysterectomies. This group also had high mortality rates. The drain on hospital resources needed to treat these abortion patients was great.

Sterilization in Honduras: assessing the unmet demand.

The purpose of this study was to evaluate and compare the availability of sterilization services at two hospitals in Honduras. Approximately 7,000 women who had given birth at the Hospital Materno Infantil in Tegucigalpa and the Hospital Leonardo Martinez in San Pedro Sula were asked about their desire for sterilization. Of the women who wanted to be sterilized, a considerable percentage had not been sterilized four months after they had given birth--58 percent of those who had delivered at Materno Infantil and 79 percent of those who had delivered at Leonardo Martinez. Twenty-three percent of the women who delivered at Materno Infantil and 4 percent of the women who delivered at Leonardo Martinez were sterilized before they were discharged. The difference may be attributed to the poor quality of the facilities at Leonardo Martinez.

Why Women Don't Get Sterilized: A Follow-up of Women in Honduras

In 1980, a study to determine interest in and access to sterilization for females was initiated at two Ministry of Health hospitals in Honduras. Results of the baseline study showed that 42 percent of women desiring sterilization from the Tegucigalpa hospital and 21 percent from the San Pedro Sula hospital had had a tubal ligation. A second study was conducted two years later, following up the interested but unsterilized women from the baseline study. Results show that 33 percent of women in the Tegucigalpa group, compared to 15 percent in the San Pedro Sula group, had been sterilized. Part of this difference can be attributed to an increase in sterilization facilities in Tegucigalpa over the two years after the baseline study was conducted. Among the major reasons women gave for not having been sterilized were financial and time constraints. Over the two-year period, the authors estimate that, of women interested in sterilization at delivery, 52 percent in total were sterilized in Tegucigalpa and 29 percent in San Pedro Sula.

Caesarean Delivery in Selected Latin American Hospitals

Rates of caesarean birth vary widely in a selection of 20 Latin American hospitals, ranging from a low of under 3% to a high of almost 50%. Data from four of the hospitals with caesarean rates that span the wide range are analysed. Despite their disparate levels, these hospitals show the same pattern with respect to age and parity: higher rates for nulliparous and for older women. The proportion with reported indications for caesarean delivery increases with the incidence of the surgery. However, a higher proportion of emergency caesareans is evident in hospitals with a lower incidence. Variations in indications by institution may therefore be of limited use in explaining variations in the caesarean rate. Costs could be cut by reducing the rate, but only in hospitals where it is high; in hospitals with low rates, no cost savings may be realized and the health of the mother and child endangered.

The hospital environment and infant feeding: results from a five country study

As the proportion of mothers in developing countries giving birth in hospitals increases slowly the potential for hospital personnel and practices to affect infant feeding preferences is also likely to increase. Information for this study was obtained from 144 obstetrics-related employees of 26 hospitals in 5 countries whose profiles showed considerable variation in factors such as urbanization infant mortality and % of hospital births. All countries showed high initial breastfeeding prevalence but prevalence after 12 months ragned from 22% in Jamaica to 88% in Bangladesh. Hospital breastfeeding prevalences were high in all 5 countries: more than 90%. In 23 hospitals normal healthy babies were given to their mothers immediately after birth. Few hospitals would reunite mother and child quickly in cases of maternal or perinatal complications. By concensus mothers on antibiotics could breastfeed; 1/2 of the respondents felt mothers with low fevers could also but fewer felt mothers on intravenous units or receiving narcotics should. Most respondents were aware of the importance of colostrom and combination of breastfeeding with oral rehydration therapy. Other topics explored were milk allergies let-down reflex breast shape mastitis feeding frequency and nutrition. Bottle feeding was promoted for healthy babies and mothers in very few hospitals. The study covered infant feeding and contraception the most prescribed agents being barrier agents. Hospitals can influence breastfeeding prevalence by promoting early and constant contant. Formula use should not be actively promoted especially to less sophisticated populations. The recently developed progestogen pill which appears not to affect lactation could be an effective postpartum contraceptive. Hospitals should formulate clearly articulated policies for breastfeeding promotion.