Factors associated with early resumption of sexual intercourse among postnatal women in Uganda

Comparative study of postpartum sexual function: Second-degree tears versus episiotomy outcomes

PURPOSE

The effects of episiotomy and second-degree tears on postpartum sexual function are key areas of enquiry in women's health research. Episiotomy and second-degree tears are common procedures and injuries that occur during childbirth. Understanding their impact on post-childbirth sexuality is crucial to women's overall well-being. This study aimed to examine the relationship between episiotomy, second-degree tears, and post childbirth sexuality.

METHODS

A cross-sectional design was employed, including 83 women who gave birth to Cáceres in 2017. Participants were evaluated based on sociodemographic and sexual health factors.

RESULTS

No significant differences were found in dyspareunia or sexual function between women who underwent episiotomies and those with second-degree tears. However, women who underwent episiotomies waited longer before resuming sexual activity after childbirth. Factors such as age, number of previous births, employment status, educational level, and breastfeeding status affected the timing and frequency of postpartum sexual activity.

CONCLUSION

Dyspareunia negatively affects various aspects of sexual function. When comparing episiotomy and second-degree tears, their impacts on postpartum sexual function were similar. However, episiotomy delays the resumption of sexual activity. Sociodemographic factors significantly influence postpartum sexual health. These findings highlight the importance of individualised interventions and support for new mothers during the postpartum period to address potential sexual health concerns.

'Feeling Ready': A Feminist Poststructural Analysis of Postpartum Sexual Health

There exists a lack of literature surrounding how postpartum individuals define feeling 'ready' to resume sexual activities after childbirth. Many factors may influence feelings of desire or readiness for sexual activities, such as breastfeeding. Therefore, it is important to understand why and how postpartum individuals understand and make meaning of their experiences surrounding postpartum sexual activities, as well as how those experiences are influenced or negotiated through relations of power. This study was guided by feminist poststructuralism and discourse analysis. Eleven participants who were between 1 and 6 months postpartum and living in Nova Scotia, Canada, were interviewed using semi-structured interviews. Participants challenged certain discourses surrounding sexual activities postpartum, including the social discourse that positions sexual activities as a requirement within romantic relationships and the discourse that positions health care providers as the authority on postpartum sexual health. 'Feeling ready' centered on four main issues: (1) navigating physical recovery; (2) personal knowing and emotional readiness; (3) the 6-week check; and (4) redefining intimacy. This article describes one branch of the findings within the overall study. Choosing to resume sexual activities postpartum, or feeling ready to do so, is individual, fluid, and complex. This research has important implications for practice and policy, specifically as it pertains to postpartum care.

Burden and factors for the early resumption of sexual intercourse in the puerperium among new mothers at Kawempe national referral hospital and Mengo hospital, Uganda

Background

Early resumption of sexual intercourse in the puerperium is a concern for couples because it is often not discussed during pre-natal or postpartum care.

Objective

This cross-sectional survey aimed to establish the current burden and factors associated with the early resumption of sexual intercourse within the puerperium at the National Referral Hospital and Mengo Hospital.

Methods

We conducted a descriptive cross-sectional study among 445 parous women attending the six-week postpartum review and the young child clinic at Kawempe National Referral and Mengo Hospitals between March and May 2021.

Results

The prevalence of ERSP within the puerperium was 39%. This study's earliest time to resume sexual intercourse was one week; the majority had resumed by week four (9.2%). Factors associated with the early resumption of sexual relations were the person's tribe, going to the husband's home after birth, and parity. The prevalence of sexual morbidities was 13%. Seventy-five (75%) of mothers did not receive information from the health care workers on when they can resume sex following childbirth.

Conclusion

Puerperal sexual intercourse is still prevalent in Uganda. Interventions to reduce the resumption of sexual intercourse in the puerperium should focus on these determinants to delay puerperal sexual intercourse.

THE EFFECT OF EDUCATION AND EMPLOYMENT ON SEXUAL ACTIVITY AFTER CHILDBIRTH

The aim of the study was to explore the relationship between educational level, employment status and sexual activity after delivery. The study was conducted on 286 women with experience of vaginal delivery who completed the questionnaire about age, education, employment, and health status for themselves and partners. Time of the first intercourse and its frequency in the first year after childbirth was observed. Relationship between the variables observed was explored by using multiple linear regression. The mean pregnancy duration was 39 weeks. The mean age of participants was 29.9 (16 to 44) years. Most women had high education (n=170, 59.4%), 114 (39.9%) had secondary, and 2 (0.7%) had primary educational level. Although there were significant differences in the time of the first intercourse and maternal educational level (p=0.013872), partner's employment status (p=0.007403) and maternal age (p= 0.01107), as well as differences in the frequency of intercourse in the first year following delivery and partner's educational level (p=0.016929), multiple correlation coefficients indicated a very weak correlation. According to study results, the correlation of educational level, employment status and sexual activity after childbirth is weak.

Multilevel analysis of early resumption of sexual intercourse among postpartum women in sub-Saharan Africa: evidence from Demographic and Health Survey Data

BACKGROUND

Resuming sexual activity early after childbirth can cause reproductive health problems such as unwanted pregnancy, unsafe abortion, and short birth intervals, especially if contraception is not used. However, it is uncommon for healthcare providers to discuss postpartum sexual practices during prenatal and postnatal care. Therefore, this study aimed to assess early resumption of sexual intercourse and associated factors among postpartum women in sub-Saharan Africa.

METHODS

Secondary data analysis from the most recent Demographic and Health Surveys data from the period of 2014 to 2019/2020 of 23 countries in sub-Saharan Africa were used. A total weighted sample of 118,371 women who gave birth in the three years before the surveys were used. We analyzed the data using Stata version 14. A multilevel mixed-effect logistic regression model was fitted to identify factors associated with early resumption of sexual intercourse. Variables with a p-value < 0.05 in the multilevel mixed-effect logistic regression model were declared significant factors associated with the outcome variables.

RESULTS

The magnitude of early resumption of sexual intercourse among postpartum women was 67.97% (95% CI: 67.60, 68.34). Urban resident (AOR = 1.91; 95% CI: 1.83, 2.06), women with primary education 1.11 (AOR = 1.11; 95% CI: 1.07 to 1.31) and secondary education and above level 1.17 (AOR = 1.17; 95% CI: 1.09 to 1.29), husbands with primary education 1.32 (AOR = 1.32; 95% CI: 1.27, 1.38) and secondary education and above level 1.15 (AOR = 1.15; 95% CI: 1.11 to 1.25), family planning use (AOR = 95%; CI: 1.77, 1.91), fertility intention wanted then 1.24 (AOR = 1.24; 95%; CI: 1.19, 1.32) and wanted later 1.27 (AOR = 1.27; 95%; CI: 1.22, 1.46), religion (AOR = 2.08; 95%CI: 1.97, 2.17), and place of delivery (AOR = 1.51; 95%CI = 1.36, 1.65) were significantly associated with early resumption of sexual intercourse.

CONCLUSION

The study revealed that more than two-thirds of the women had resumed sexual intercourse early after childbirth. Hence, the concerned bodies should strengthen the integration of postpartum education on sexual resumption with maternal, neonatal, and child health care services to reduce the early resumption of sexual intercourse. In addition, healthcare providers providing counseling on the resumption of postpartum sexual intercourse should focus on these factors to ensure a more effective outcome.

Knowledge, Attitude and Practices of Postpartum Females Regarding the Acceptance of Immediate Postpartum Contraception: A Cross-Sectional Study From North India

The immediate postpartum period is a great time to encourage the acceptance of contraceptive methods; the time is influenced by both emotional and physical factors. At this stage, the administration of intrauterine contraceptives is relatively easier with lesser complications due to the prior obstetric event. A single-center cross-sectional study was conducted using a self-constructed questionnaire-based interview on 331 women in their immediate postpartum period who had delivered a healthy live-born infant. The majority (59.8%) of study participants had unplanned pregnancies. We conducted behavior change communication sessions for postpartum family planning which resulted in 89% of participants accepting the methods with the prime reasons for acceptance being temporary child spacing (41%) and a definitive desire for no more children (34%). The odds were higher in women with more than five pregnancies [adjusted odds ratio (AOR) = 1.951, 95% CI = 1.389-2.925] and women whose last pregnancy was planned [AOR = 1.248, 95% CI = 1.002-3.215].The hindrance to adopt and adhere to postpartum contraception stems from a variety of socio-economic factors which are unique to low-income countries. Individually tailored behavior change communication/counseling approaches may help overcome misconceptions and meet the heterogeneous needs for family planning in the immediate postpartum phase.

Return of Sexual Activity Within Six Weeks of Childbirth Among Married Women Attending Postpartum Clinic of a Teaching Hospital in Ethiopia

Introduction:

Postpartum sexual health gets very little attention compared to pregnancy and childbirth, even though most maternal deaths and disabilities occur during this time. Therefore, the study aimed to assess return of sexual activity within 6 weeks of childbirth among married women attending postpartum clinic of a teaching hospital in Ethiopia, 2021.

Methods

The hospital-based cross-sectional study design was implemented from September to October 2021. Eligible postpartum women were sampled by systematic random sampling technique. The data was entered into EPI-info and exported to SPSS version 24 for further analysis. All variables with a p-value < 0.05 in multivariable analyses were taken as associated factors with the return to sexual activity before 6 weeks of childbirth.

Results

A total of 421 postpartum women participated in the study. The prevalence of women who return to sexual activity 6 weeks after childbirth was 31.6%. The study revealed that monogamy (Adjusted Odds Ratio (AOR) = 4.4, 95% Confidence Interval (CI) (2.1, 9.4)), parity (AOR= 0.11, 95% CI (0.02–0.81)) and (AOR = 0.1, 95% CI (0.015–0.72)), postnatal care (AOR= 1.8, 95% CI (1.01–3)) and infants feeding status (AOR=2.3, 95% CI (1.3–4)) were significantly associated with return of sexual activity before 6 weeks of childbirth.

Conclusion

The findings of this study suggested that, nearly one-third of postpartum women engaged to sexual activity within 6 weeks of childbirth. Return of sexual activity within 6 weeks of childbirth associated with monogamy type of marriage, parity, postnatal care, and child feeding status. Strengthening postpartum counseling regarding the appropriate time to resume sexual activity is crucial. Regular postpartum visits following deliveries should also be encouraged by health care providers.

A scoping review on women’s sexual health in the postpartum period: opportunities for research and practice within low-and middle-income countries

Background

Women’s sexual health is generally defined and explored solely in relation to reproductive capacity, and often omits elements of sexual function and/or dysfunction. Concerted focus is given to women’s health during pregnancy; however, women’s sexual health is largely neglected after childbirth. This scoping review explored how the sexual health of postpartum women has been defined, measured, and researched in low- and middle-income countries (LMICs).

Methods

Articles eligible for review were those that investigated women’s sexual health during the first 12 months postpartum and were conducted among women aged 15–49 in LMICs. Eligibility was further restricted to studies that were published within the last 20 years (2001–2021). The initial PubMed search identified 812 articles, but upon further eligibility review, 97 remained. At this time, the decision was made to focus this review only on articles addressing sexual function and/or dysfunction, which yielded 46 articles. Key article characteristics were described and analyzed by outcome.

Results

Of the final included articles, five studies focused on positive sexual health, 13 on negative sexual health, and the remaining 28 on both positive and negative sexual health or without specified directionality. The most common outcome examined was resumption of sex after childbirth. Most studies occurred within sub-Saharan Africa (n = 27), with geographic spread throughout the Middle East (n = 10), Asia (n = 5), North Africa (n = 3), and cross-geography (n = 1); notably, all five studies on positive sexual health were conducted in Iran. Negative sexual health outcomes included vaginismus, dyspareunia, episiotomy, perineal tears, prolapse, infection, obstetric fistula, female genital cutting, postnatal pain, uterine prolapse, coercion to resume sex, sexual violence, and loss of sexual desire/arousal. Most studies were quantitative, though eight qualitative studies elucidated the difficulties women endured in receiving information specific to sexual health and hesitance in seeking help for sexual morbidities in the postpartum period.

Conclusions

Overall, the evidence base surrounding women’s sexual health in the postpartum period within LMICs remains limited, with most studies focusing solely on the timing of resumption of sex. Integration of sexual health counseling into postnatal care and nonjudgmental service provision can help women navigate these bodily changes and ultimately improve their sexual health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12978-022-01399-6.

Women’s sexual health is often studied in relation to reproductive health and childbearing. While reproductive health during pregnancy and immediately after is well documented, it remains unclear how women’s sexual health is addressed, particularly within low- and middle-income countries. The aim of this review is to understand how researchers have measured, defined, and examined postpartum sexual health. In October 2021, we searched PubMed database with the following criteria: published in the last 20 years; conducted in a low- or middle-income context; examined sexual function and/or dysfunction among women aged 15–49 within 1 year after childbirth. From this inclusion criteria, we identified 46 relevant articles. Most studies were conducted in sub-Saharan Africa. Only five studies focused exclusively on positive sexual health, and the majority of studies examined the resumption of sex after childbirth. Multiple qualitative studies described women’s reluctance to seek help for postpartum sexual health issues and highlighted the difficulties they faced in receiving information specific to sexual health. Overall, the evidence base surrounding women’s sexual health after childbirth within low- and middle-income contexts is limited. Future research should examine sexual health beyond resumption of sex after childbirth and explore barriers to help-seeking for women experiencing sexual health issues. Further exploration of positive sexual health is needed across contexts.

Resumption of Sexual Intercourse Among Postnatal Women Enrolled on Lifelong Antiretroviral Therapy in Uganda

The postnatal period is critical to the delivery of interventions aimed at improving maternal health outcomes. This study examined the timing to resumption of sexual intercourse and associated factors among postnatal women living with HIV (WLWH) in Uganda. A sample of 385 women was drawn from a larger prospective cohort study conducted between 2013 and 2015. We used survival analysis to estimate the postpartum time periods during which women had a higher risk of sexual intercourse resumption within 6 months after childbirth. Cox proportional hazards regression was used to examine associated factors with sexual intercourse resumption. The cumulative probability of sexual intercourse resumption was lowest (6.2%) in the sub-acute postpartum period (1-45 days since delivery) and highest (88.2%) in the delayed postpartum period (151-183 days since delivery). Having a live-term baby (adjusted HR 0.52, 95% CI 0.31-0.85, p = 0.01) and an advanced education (adjusted HR 0.63, 95% CI 0.40-0.98, p = 0.04) were associated with a lower risk of sexual intercourse resumption. Desire for another child (adjusted HR 1.36, 95% CI 1.08-1.73, p = 0.01), having a sexual partner (adjusted HR 5.97, 95% CI 3.10-11.47, p < 0.001) and contraceptive use (adjusted HR 2.21, 95% CI 1.65-2.95, p < 0.001) were associated with a greater risk of sexual intercourse resumption. However, only 1 in 4 women who resumed sexual intercourse by the 90th day after childbirth, reported currently using contraception. HIV programs should focus on supporting postnatal women to align the timing of sexual intercourse resumption with their return to contraceptive use. Interventions aimed at improving contraceptive uptake among postnatal WLWH should target the delayed postpartum period.

Factors associated with postpartum resumption of sexual intercourse among women in China: A retrospective multicenter study

OBJECTIVE

To examine the prevalence and factors associated with early resumption of sexual intercourse among postnatal women in China.

METHOD

We conducted a retrospective multicenter study of 15 834 postpartum women from 60 hospitals in 15 different locations across China. Data were obtained from questionnaires administered to the participants. All dates were analyzed using a one-way ANOVA and two-level Cox multiple linear regression models.

RESULTS

More than half of the participating women (55.9%) resumed sexual intercourse by 3 months postpartum. The independent variables associated with the postpartum resumption of sexual intercourse included sociodemographic characteristics (age, geographic location, educational attainment) and medical histories, including the previous abortion (incorporate with spontaneous and voluntary abortion) frequency, menstrual recovery, exclusive breastfeeding, and number of living children (p < 0.05).

CONCLUSION

More than half of the women in this study resumed sexual intercourse within 3 months postpartum. Women with a lower educational attainment and from the western regions of China were more likely to resume sexual intercourse earlier. Increasing age, delayed recovery of menses, and exclusive breastfeeding were associated with a delayed resumption of sexual intercourse. Women who had greater experience with abortion or the number of living children resumed sexual intercourse earlier than their counterparts.

Risk of non-resumption of vaginal sex and dyspareunia among cesarean-delivered women

Context:

Many women have postpartum sexual dysfunction. The mode of delivery is an important determinant.

Aims:

To calculate the risk ratio of non-resumption of vaginal sex and dyspareunia during the postpartum period among cesarean-delivered women.

Settings and Design:

This large multisite study was conducted in 13 selected hospitals in Pune District during 2017–19.

Methods and Material:

A total of 3,112 women (half cesarean delivered and half vaginally) were interviewed by trained health workers using a structured questionnaire. Women were interviewed at 4 weeks, 6 weeks, and 6 months.

Statistical analysis used:

Chi-square test was applied. A risk ratio with a 95% confidence interval was calculated.

Results:

At 6 weeks, the risk ratio of non-resumption of vaginal sex was significantly high among cesarean-delivered participants (1.14). Cesarean-delivered women had a lesser risk ratio of dyspareunia at both follow-ups (0.59, 0.49). Even at 6 months, about one-third vaginally delivered women had dyspareunia. The proportion of women non-resuming vaginal sex gradually decreased from 6 weeks to 6 months. The proportion of women having dyspareunia also decreased from 6 weeks to 6 months following childbirth. Residence in the rural area and cesarean delivery were the significant determinants of an early resumption of vaginal sex. Dyspareunia was significantly high among vaginal delivered than cesarean. About 25% of women continued to have dyspareunia up to 6 months.

Conclusions:

A large number of women suffer from dyspareunia; hence antenatal and postnatal care should include some counseling and management about the resumption of sex and dyspareunia.

Early resumption of postpartum sexual intercourse and its associated risk factors among married postpartum women who visited public hospitals of Jimma zone, Southwest Ethiopia: A cross-sectional study

Introduction

Postpartum sexual resumption without the use of contraception is a risk for unintended and closely spaced pregnancies. Although counseling related to the resumption of postpartum sexual intercourse is a key component of postpartum sexual health, it is not widely addressed during the postnatal period. Thus, this study aimed to assess the early resumption of postpartum sexual intercourse and its associated risk factors among married postpartum women who visited public hospitals of Jimma zone, Southwest Ethiopia, for child immunization services.

Methods

The facility-based cross-sectional study design was undertaken, and a systematic random sampling technique was carried out to select 330 participants. Data were collected using a pretested interviewer-administered questionnaire from August to September 2019. Obtained data were analyzed using descriptive statistics. A bivariate analysis was used to determine the significance of the association. Variables that showed association in the bivariate analysis at p-value <0.2 were fitted into a multivariable logistic regression model to control for confounders, and the significance of association was determined at p-value <0.05 with a 95% confidence interval (CI).

Results

Approximately 53.9% of the respondents practiced early resumption of postpartum sexual intercourse. Factors such as low income (AOR = 0.19 (95% CI = 0.10-.37)), monogamous marriage 3.78(1.32–10.79), practicing sexual intercourse during pregnancy (AOR = 4.55 (95% CI = 1.29–15.97)), a cesarean delivery (AOR = 0.06 95%CI = (0.03–0.15)) and use of contraceptives (AOR = 3.7(95%CI = 1.92–7.14)) were significantly associated with early resumption of postpartum sexual intercourse.

Conclusion and recommendation

The findings of this study suggested that, most postpartum mothers resumed sexual intercourse during the early postpartum period and its associated risk factors include low income, monogamous marriage, practicing sexual intercourse during pregnancy, cesarean delivery, and use of contraceptives. Discussion with couples about postpartum sexual health during the antenatal and postnatal period is crucial to prevent unwanted pregnancies and adverse health outcomes.

Impact of childbirth on women's sexuality in the first year after the delivery

AIM

The aim was to compare the quality of sexual life before pregnancy and after delivery and to find out whether and how selected factors affect women's sexuality during this period.

METHODS

The study group consisted of 433 women who completed the survey containing basic demographic questions and two Female Sexual Function Index (FSFI) questionnaires: a retrospective one, regarding time before pregnancy and the current period. The inclusion criteria: time between 10 weeks and 1 year after delivery, vaginal intercourses before pregnancy and the resumption of vaginal intercourses after delivery.

RESULTS

We observed the negative impact of labor on the total FSFI score, regardless of the time that had passed since birth and the delivery mode. The decrease by at least 10% of the initial FSFI score was noticed in 44.3% of the participants. FSD (Female Sexual Dysfunction) occurred statistically more commonly after delivery than before pregnancy (45.3% vs 17.1%; P < 0.001). The following factors had an impact on the risk of post-partum FSD: pre-pregnancy FSD (adjusted odds ratio [aOR] = 4.17 [95% confidence interval [CI] 2.38-7.31]) and nulliparity (aOR = 1.67 [95% CI 1.09-2.53]).

CONCLUSION

Childbirth has an undeniable impact on women's sexuality. The prevention and treatment of sexual dysfunctions is very important, especially in this crucial period of life.

Factors associated with early resumption of sexual intercourse among women during extended postpartum period in Northwest Ethiopia: a cross sectional study

BACKGROUND

Postpartum sexual health and practice need to be integrated in the current maternal healthcare services to address sexual health problems. However, postpartum sexual practice has received little attention, and was not often discussed by healthcare providers during prenatal and postnatal care. Thus, this study was aimed to assess early resumption of sexual intercourse and associated factors among postpartum women in Gondar city, Northwest Ethiopia.

METHODS

A community based cross-sectional study was conducted from January 20 to February 20, 2020. A systematic random sampling technique was used to select 634 postpartum women. A pretested, structured and interviewer-administered questionnaire was used to collect data. Data were entered into Epi Info 7.2.2 and exported to SPSS version 20 for analysis. Bivariable and multivariable logistic regressions analysis were done. Variables with p- value of < 0.05 were considered as statistically significant.

RESULTS

The magnitude of early resumption of sexual intercourse after childbirth was found to be 26.9% (95% CI: 23.2, 30.8). Urban resident (AOR = 6.12, 95% CI: 2.41, 15.66), parity of one (AOR = 2.26, 95% CI: 1.66, 7.78), husband demand (AOR = 2.66, 95% CI: 1.72, 4.11), postnatal care (AOR = 1.45, 95% CI: 1.06, 2.18) and use of family planning (AOR = 2.72, 95% CI: 1.51, 3.43) were factors significantly associated with early resumption of sexual intercourse.

CONCLUSION

The study found that more than one fourth of women had resumed sexual intercourse within six weeks of following childbirth. The finding of this study suggests the need of integrating discussions of postpartum sexual activity into routine prenatal, intrapartum and postnatal care with collaborative effort of policy makers, program planners, health care providers and other stakeholders. Moreover, spousal communication on postpartum sexual activity should be encouraged.

Predictors of puerperal menstruation

Background

Puerperal period is an important and thought-provoking period for puerperal mothers. Surprisingly, reports have indicated that there is increasing number of women resuming menstruation within six weeks of childbirth (puerperal menstruation). To the best of knowledge, there is no prior study on predictors of puerperal menstruation.

Objective

To determine frequency and predictors of puerperal menstruation.

Methods

This was a single tertiary health institution cross-sectional study at ESUT Teaching Hospital, Parklane, Enugu, Nigeria that included data from May 2015 to December 2018. Women were interviewed at the end of the first six weeks of their childbirth. Women with HIV positive or had uterine rupture or peripartum hysterectomy were excluded. Bivariate analysis was performed by the chi-squared test and conditional logistic regression analysis was used to determine variables associated with puerperal menstruation. Statistical significance was accepted when P- value is <0.05.

Results

A total of 371 women met the inclusion criteria. The return of menses within 6 weeks was present in 118(31.8%) women versus 253 (68.2%) women without puerperal menstruation, given a ratio of 1:3. Of the 371 women, 249 (67.1%) were on exclusive breastfeeding. The significant associated risk factors were age (p = 0.009), parity (p<0.001), early use of family planning (p = 0.001), socio-economic status (p<0.001) and manual removal of placenta (p = 0.007). At conditional logistic regression analysis, early use of family planning (p = 0.001), exclusive breastfeeding (p = 0.027) and manual removal of placenta (p = 0.012) were independently associated with puerperal menstruation. Induction/augmentation of labor, postpartum misoprostol use and mode of delivery were not statistically significant (p>0.05, for all)

Conclusion

One in 3 women resumes menstruation within 6 weeks of childbirth. The major predictor was early initiation of family planning, and exclusive breastfeeding with manual removal of placenta a major protective factor. These interesting issues require further investigation to better understand the mechanism of puerperal menstruation.

Early Resumption of Sexual Intercourse and Its Associated Factors Among Postpartum Women in Western Ethiopia: A Cross-Sectional Study

Background

Women are often forced to recommence sexual intercourse after childbirth to maintain intimacy and fulfill their partners’ desires. Early resumption of postpartum sexual intercourse leads to sexual health problems and unwanted pregnancy if not complemented with appropriate contraceptive use. However, sexual practice during the early postpartum period has received little attention in clinical and research settings. The aim of this study was therefore to assess the early resumption of sexual intercourse and its associated factors among postpartum women attending public health institutions in Nekemte town, Western Ethiopia.

Methods

An institution-based cross-sectional study was carried out from March to April 2019. A systematic random sampling technique was used to select 528 postpartum women. An interviewer-administered, pretested, and structured questionnaire was used to collect data. Data were coded and entered into Epi Info 7.2.1, and exported to SPSS version 20.0 to run bivariable and multivariable logistic regressions.

Results

One in five postpartum women (20.2%, 95% CI: 17.1–23.6) practiced an early resumption of sexual intercourse, of whom three-fifths (58%) did not use any contraceptives. Women’s secondary education (AOR=0.22, 95% CI: 0.07–0.71), husband’s elementary (AOR=0.23, 95% CI: 0.06–0.87) and secondary education (AOR=0.25, 95% CI: 0.07–0.88), as well as women’s fertility status (parity of one) (AOR=3.52, 95% CI: 1.24–10.01), normal vaginal delivery (AOR=5.44, 95% CI: 1.84–16.12), giving birth to a male child (AOR=1.94, 95% CI: 1.05–3.60), desire for another child (AOR=5.71, 95% CI: 1.89–17.25), and pressure from the husband to initiate intercourse (AOR=9.89, 95% CI: 4.99–19.58) were significantly associated with early resumption of sexual intercourse.

Conclusion

A significant proportion of postpartum women who resume early sexual intercourse do not use any contraceptives. Interventions that focus on strengthening the integration of postpartum sexual health education and service use are warranted.

Effect of sexual health education on sexual function and resumption of sexual intercourse after childbirth in primiparous women

INTRODUCTION

A large number of women experience sexual health problems during the postpartum period. This study aimed to evaluate the effect of sexual health education on sexual function and time of sexual intercourse resumption after childbirth in primiparous women in Southeast Iran.

MATERIALS AND METHODS

This randomized clinical trial was conducted on 94 primiparous women randomly divided into two groups of intervention and control. The intervention group was subjected to three training sessions 3-5, 10-14, and 30-45 days after childbirth (first session lasting 20 min and other sessions 60 min). On the other hand, the participants in the control group only received the routine postpartum training. The Female Sexual Function Index (FSFI) was completed by all participants before and 8 weeks after the intervention. Data were analyzed in SPSS software (version 22) using descriptive and inferential statistics, such as Chi-square test, independent t-test, and paired sample t-test. P < 0.05 was considered statistically significant.

RESULTS

The mean score of FSFI in the intervention group was increased from 12.70 ± 6.166 before the onset of the intervention to 17.36 ± 5.407 after 8 weeks (P = 0.01). In the control group, the mean score of FSFI was decreased from 13.09 ± 4.306 to 12.29 ± 3.511 on the 8th week postpartum (P = 0.06). The mean times of sexual intercourse resumption in the intervention and control groups were 5.82 ± 0.17 and 5.81 ± 0.22 weeks, respectively, which were not significantly different between the two groups (P = 0.879).

CONCLUSION

Sexual health education for women in the postpartum period could improve their sexual function after childbirth. However, it is recommended to use sexual health education programs in women during the postpartum period to promote female sexual function.

Resumption of postpartum sexual activity and menses among HIV-infected women on lifelong antiretroviral treatment compared to HIV-uninfected women in Africa

OBJECTIVE

To determine time from delivery to resumption of sexual activity and menses among HIV-infected women on antiretroviral treatment (ART) and HIV-uninfected women.

METHODS

HIV-infected women on ART and HIV-uninfected women were recruited from five health facilities at delivery and followed prospectively for a maximum of 1 year in Blantyre, Malawi from January 2016 to September 2017. Sociodemographic, clinical, and laboratory data were collected at delivery and 1.5, 3, 6, 9, and 12 months. Descriptive, time to event Kaplan-Meier, and multivariable Cox proportional hazards analyses were conducted.

RESULTS

Data on 878 women (460 [52.4%] HIV-uninfected and 418 [47.6%] HIV-infected, P=0.156) who attended at least one follow-up visit were analyzed. Among HIV-uninfected compared to HIV-infected women, respectively, the median number of days to resumption of sexual activity was 180 vs 181; to irregular menses was 82 vs 71; and to regular menses was 245 vs 366. In multivariable models, being married was associated with early resumption of sexual activity (hazard ratio [HR] 1.91, P<0.001), and being HIV-infected and use of an effective method of family planning were associated with later start of regular menses (HR<1.0, P<0.050).

CONCLUSION

Counseling of women on reproductive intentions should start early irrespective of HIV infection or use of ART.

The Role of Culture in Maintaining Post-Partum Sexual Abstinence of Swazi Women

Eswatini is one of the countries in the African continent where post-partum sexual abstinence is practiced. Beside scarcity of research exploring sexual abstinence in Eswatini, there are only a few studies that explore post-partum abstinence across HIV-positive and negative women in sub-Saharan Africa. The study explored the practice of post-partum sexual abstinence in Swazi women and examined how cultural beliefs influence and promotes the perpetuation of the practice. The study population consisted of post-partum women who were selected, using purposive sampling. Thematic approach was used for data analysis. Despite feeling that the period for post-partum, sexual abstinence was long; the participants adhered to the practice as prescribed by their culture. Nevertheless, they felt that the practice is imposed on women only because while they are observing post-partum abstinence, their partners get to sleep with other sexual partners. They raised concerns that the practice increases the risk of acquiring HIV and sexually transmitted infections. There is an element of coercion to the practice of post-partum abstinence, the myths and misconceptions around the early resumption of sexual intercourse forces the practice on women. At the family and community level, the discussions to change the way sexual abstinence is viewed and practiced are crucial.

[Couples' competences in immediate postpartum family planning in the Biyem-Assi health district Cameroon]

Introduction

La planification familiale en post-partum immédiat reste encore peu connue et peu pratiquée par la plupart des couples au Cameroun. Pourtant, juste après un accouchement, nombreux sont ceux qui désirent différer la naissance de leur prochain enfant. Cette étude avait pour objectif de déterminer le niveau de compétences et le besoin éducationnel des couples en matière de planification familiale en post-partum immédiat dans le District de Santé de Biyem-Assi.

Méthodes

Il s'agissait de mener une enquête CAP (connaissances, attitudes et pratiques), dans le District de Santé de Biyem-Assi. La collecte des données s'est faite à l'aide de deux questionnaires de 40 questions chacun, rédigés en français, l'un adressé aux femmes en couple et en post-partum et l'autre aux hommes en couple et ayant au moins un enfant. Les données recueillies ont été saisies dans le logiciel CSPro version 6.2, puis analysées à l'aide du logiciel SPSS version 20.0.

Résultats

Un total de 300 individus a été interrogé avec un sex-ratio de 1. Plus de la moitié (56,7%) avait une connaissance approximative de la planification familiale en post-partum immédiat. Pour 36% des répondants, le post-partum immédiat n'était pas un moment approprié pour l'utilisation d'une méthode contraceptive moderne, l'interaction entre contraceptifs et lait maternel (65,4%) et l'infertilité de la femme (26,3%) étaient les principales raisons évoquées. Les pratiques contraceptives en post-partum immédiat de 60,5% des couples vivant dans le District de Santé de Biyem-Assi étaient inadéquates. Par conséquent, la plupart des enquêtés avaient un niveau de compétences insuffisant (32,6%) et faible (23,3%) en matière de planification familiale en post-partum immédiat.

Conclusion

Certains préjugés et de fausses idées persistent dans la population du District de Santé de Biyem-Assi en ce qui concerne les méthodes contraceptives modernes, et constituent un frein à la pratique contraceptive en général et en post-partum immédiat en particulier. Des efforts de sensibilisation et d'éducation des couples pour l'amélioration de leurs compétences en matière de contraception en post-partum immédiat s'avèrent nécessaires.

Factors associated with the resumption of sexual intercourse before the scheduled six-week postpartum visit

This retrospective cohort study was aimed at evaluating the factors associated with the resumption of sexual intercourse (SI) before the six-week postpartum visit and was carried out between 1 January and 15 February 2014. The main variables studied included maternal age, number of living children, mode of delivery, complications observed at delivery and resumption or not of SI. Data from women who resumed SI were compared to those of women who did not. Fisher's exact test and t-test were used for comparison. We recruited 120 women, among whom 95 (79.1%) resumed SI. Of these, 65/95 (68.4%) did not attend the postpartum visit while 30 (31.6%) did (P = 0.321). The factors associated with early resumption of SI were maternal age of 20-34 years (P < 0.001), women with one child (P < 0.004) and who had had an uncomplicated vaginal delivery (P < 0.001). Our conclusion is that nursing mothers should receive postpartum contraception before leaving the hospital.

Prevalence of unmet need for contraception and its association with unwanted pregnancy among married women in Angola

Background

Unmet need for contraception and unwanted pregnancy are recognised as significant barriers to promoting women’s reproductive health and well-being. Currently there is no research evidence on these two crucial indicators of reproductive care in Angola. Therefore, we conducted this study with the objectives of exploring the current prevalence of unmet need for contraception and unintended pregnancy as well as their relationship among married women in Angola.

Methods

This study was based on cross-sectional data from Angola Demographic and Health Survey (DHS) conducted in 2015–16. Participants were 7,808 married women aged 15–49 years. Unwanted pregnancy was measured in terms of the mistimed and unintended conception for the last-born child. Unmet need for contraception included those who reported unmet need for spacing and limiting. Data were analysed using bivariate and multivariable techniques.

Results

The combined prevalence of mistimed and unwanted pregnancy was 38.3% (95%CI = 35.9–40.7), and that of unmet need for contraception for spacing and limiting was 51.7% (49.9–53.5). Among the 18 regions, Luanda had the highest prevalence of unmet need for contraception and of unwanted pregnancy with the prevalence being higher than more than one-third of the women. Multivariable analysis significantly revealed a significantly positive association between unmet need and unwanted pregnancy. In all the models, the odds of unwanted pregnancy were found to be as high as four times among women with unmet need compared with those had no unmet need. Compared to women who had no unmet need, those who had unmet need had respectively four (OR = 4.380; 95%CI = 3.690–5.198) and seven (OR = 6.951; 95%CI = 4.642–10.410) times higher odds of experiencing unwanted pregnancy.

Conclusion

This study concludes that the prevalence of unmet need for contraception and unwanted pregnancy are high with significant disparities across the regions. Women in the capital city had the highest prevalence of both unmet need for contraception and unwanted pregnancy. Although the data were cross-sectional and do not indicate causal relationships, the findings showed a strong positive association between unmet need for contraception and unwanted pregnancy. However, it is recommended to conduct further studies to replicate the findings and to explore the influence behavioural and cultural practices on unwanted pregnancy.

Factors contributing to the duration of postpartum abstinence among Nigerian women: semi-parametric survival analysis

Background

The duration of postpartum abstinence is on the decrease but has not been met with increased uptake of contraceptive in Nigeria. This imbalanced transition could result in shorter birth intervals and worsen maternal and child health outcomes. There is a paucity of information on the duration and predictors of time to end of postpartum abstinence in Nigeria. This study was aimed at understanding the time to end of postpartum abstinence and factors predicting the duration in Nigeria.

Methods

The NDHS 2013 data was used. Data of all women who had ever given birth were included. The time to end of postpartum abstinence was censored among currently breastfeeding mothers. The Kaplan Meier Product Limit method was used to estimate the survival and hazard function while the Cox regression was used to fit a model for time to end of postpartum abstinence at 5% significance level. Data were weighed and provisions were made for multicollinearity.

Results

The overall average duration of postpartum abstinence in Nigeria is 3 month. In all, 58% ended postpartum abstinence within the first three months while 18%, 10%, and 14% ended it within 4–6 months, 7–12 months and after one year respectively. Postpartum abstinence did not last beyond 3 months among 83% of the women in the North-West region, compared with 23% in the North Central region, and 34% in the South East. The Muslims had the highest proportion of women who ended postpartum abstinence within the first three months after delivery at 72% compared with Catholic women (31%). The median time to end of postpartum abstinence was lowest (2 months) among women from North West, Muslims, in poorest wealth quintiles and those with no education. The “hazard” of earlier resumption of sexual activity after birth was over 3 times more likely among women in the North West than those in the North Central (aHR = 3.09, 95% CI: 2.95–3.24). Women using contraceptives had a 40% hazard of ending postpartum abstinence earlier. Rural women were 7.6% times less likely to end postpartum abstinence compared to their urban counterpart. Women from rich households have an excess risk of 14% to end postpartum abstinence early compared to women from poor households.

Conclusion

Women of reproductive age in the North West, who are Muslims and with no education are at higher risk of ending postpartum abstinence early. Hence, policymakers and reproductive health stakeholders should design effective intervention targeted at this group of women as a means of controlling fertility.

Postpartum family-planning barriers and catalysts in Burkina Faso and the Democratic Republic of Congo: a multiperspective study

Purpose

To address the high unmet need for postpartum family planning (PPFP) in resource-limited settings, particularly in sub-Saharan Africa, this study aimed to identify PPFP-related barriers and catalysts to inform policies and programs to increase access to postpartum contraception.

Methods

Using qualitative methodology, we explored the perspectives of women, adolescent girls, men, religious and community leaders, service providers, and decision makers from three rural communities in Burkina Faso and three rural-urban communities in the Democratic Republic of Congo. Both countries have high unmet need for PPFP and are priority countries of the French Muskoka Fund for Maternal and Child Health.

Results

Perceived catalysts included negative traditional views on the consequences borne by closely spaced children and their mothers; a 6-week postpartum visit dedicated to PPFP (albeit poorly attended); political will and enabling policies for FP; and support from certain religious leaders and men. Main reported barriers were the lack of male engagement; out-of-pocket copayment for contraceptives; reliance on amenorrhea for pregnancy prevention without knowing its limits; misconceptions about modern contraceptives, including prerequisites for the lactational amenorrhea method; sexual abstinence supported by religious and traditional norms for up to 3-6 months, although women reported earlier resumption of sexual activity; low prioritization of scheduled postpartum visits by women; and limited availability of readily accessible methods, PPFP counseling materials, and clinic days and scheduled visits dedicated to contraceptive services.

Conclusion

Based on results found to be most actionable, the following interventions have the potential to optimize access to PPFP services: counseling women on postpartum-pregnancy risks and options at different points in time before and after childbirth through the use of appropriate information, education, and counseling materials; integrating PPFP services into existing maternal and child health visits; making contraceptives readily available and affordable; and meaningfully engaging male partners.

Increased Risk of HIV Acquisition Among Women Throughout Pregnancy and During the Postpartum Period: A Prospective Per-Coital-Act Analysis Among Women With HIV-Infected Partners

Background

Understanding the absolute and relative risk of human immunodeficiency virus type 1 (HIV) acquisition during pregnancy and the postpartum period can inform HIV prevention strategies for women.

Methods

We used a complementary log-log model and data from 2751 HIV-serodiscordant couples to compare the probability of HIV acquisition among women per sex act during early pregnancy, late pregnancy, the postpartum period, and the nonpregnant period.

Results

At total of 686 pregnancies were identified, and 82 incident HIV infections occurred. After adjustment for condom use, age, preexposure prophylaxis (PrEP) use, and HIV viral load, the per-act probability of HIV acquisition was higher in late pregnancy (adjusted relative risk [aRR], 2.82; P = .01) and the postpartum period (aRR, 3.97; P = .01) as compared to that during nonpregnant period. For a 25-year-old woman not taking PrEP, the HIV acquisition probability per condomless sex act with an HIV-infected male partner with a viral load of 10 000 copies/mL was 0.0011 (95% confidence interval [CI] 0.005-0.0019), 0.0022 (95% CI, 0.0004-0.0093), 0.0030 (95% CI, 0.0007-0.0108), and 0.0042 (95% CI, 0.0007-0.0177) during the nonpregnant period, early pregnancy, late pregnancy, and the postpartum period, respectively.

Conclusion

The HIV acquisition probability per condomless sex act steadily increased during pregnancy and was highest during the postpartum period, suggesting that biological changes during pregnancy and the postpartum period increase HIV susceptibility among women.

Immediate versus delayed postpartum use of levonorgestrel contraceptive implants: a randomized controlled trial in Uganda

BACKGROUND

Use of long-acting, highly effective contraception has the potential to improve women's ability to avoid short interpregnancy intervals, which are associated with an increased risk of maternal morbidity and mortality, and preterm delivery. In Uganda, contraceptive implants are not routinely available during the immediate postpartum period.

OBJECTIVE

The purpose of this study was to compare the proportion of women using levonorgestrel contraceptive implants at 6 months after delivery in women randomized to immediate or delayed insertion.

STUDY DESIGN

This was a randomized controlled trial among women in Kampala, Uganda. Women who desired contraceptive implants were randomly assigned to insertion of a 2-rod contraceptive implant system containing 75 mg of levonorgestrel immediately following delivery (within 5 days of delivery and before discharge from the hospital) or delayed insertion (6 weeks postpartum). The primary outcome was implant utilization at 6 months postpartum.

RESULTS

From June to October 2015, 205 women were randomized, 103 to the immediate group and 102 to the delayed group. Ninety-three percent completed the 6 month follow-up visit. At 6 months, implant use was higher in the immediate group compared with the delayed group (97% vs 68%; P < .001), as was the use of any highly effective contraceptive (98% vs 81%; P = .001). Women in the immediate group were more satisfied with the timing of implant placement. If given the choice, 81% of women in the immediate group and 63% of women in the delayed group would choose the same timing of placement again (P = .01). There were no serious adverse events in either group.

CONCLUSION

Offering women the option of initiating contraceptive implants in the immediate postpartum period has the potential to increase contraceptive utilization, decrease unwanted pregnancies, prevent short interpregnancy intervals, and help women achieve their reproductive goals.

The social stigma of HIV-AIDS: society's role

AIDS is a devastating and deadly disease that affects people worldwide and, like all infections, it comes without warning. Specifically, childbearing women with AIDS face constant psychological difficulties during their gestation period, even though the pregnancy itself may be normal and healthy. These women have to deal with the uncertainties and the stress that usually accompany a pregnancy, and they have to live with the reality of having a life-threatening disease; in addition to that, they also have to deal with discriminating and stigmatizing behaviors from their environment. It is well known that a balanced mental state is a major determining factor to having a normal pregnancy and constitutes the starting point for having a good quality of life. Even though the progress in both technology and medicine is rapid, infected pregnant women seem to be missing this basic requirement. Communities seem unprepared and uneducated to smoothly integrate these people in their societies, letting the ignorance marginalize and isolate these patients. For all the aforementioned reasons, it is imperative that society and medical professionals respond and provide all the necessary support and advice to HIV-positive child bearers, in an attempt to allay their fears and relieve their distress. The purpose of this paper is to summarize the difficulties patients with HIV infection have to deal with, in order to survive and merge into society, identify the main reasons for the low public awareness, discuss the current situation, and provide potential solutions to reducing the stigma among HIV patients.