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Asmamaw DB, Belachew TB, Negash WD. Multilevel analysis of early resumption of sexual intercourse among postpartum women in sub-Saharan Africa: evidence from Demographic and Health Survey Data. BMC Public Health 2023; 23:733. [PMID: 37085836 PMCID: PMC10120166 DOI: 10.1186/s12889-023-15687-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 04/16/2023] [Indexed: 04/23/2023] Open
Abstract
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.
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Affiliation(s)
- Desale Bihonegn Asmamaw
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O.Box: 196, Gondar, Ethiopia.
| | - Tadele Biresaw Belachew
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wubshet Debebe Negash
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Fatah H, Vakilian K, Moslemi A, Janani F. The effect of EX-PLISST and GATHER models on sexual function with gestational diabetes. SEXOLOGIES 2022. [DOI: 10.1016/j.sexol.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Ghasemi V, Beheshti Nasab M, Saei Ghare Naz M, Shahsavari S, Banaei M. Estimating the prevalence of dyspareunia according to mode of delivery: a systematic review and meta-analysis. J OBSTET GYNAECOL 2022; 42:2867-2878. [PMID: 35980976 DOI: 10.1080/01443615.2022.2110461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The present study aimed to examine the prevalence of dyspareunia in the post-partum period in relation to the mode of delivery. In this systematic review and meta-analysis, published articles until February 2020 were searched through the related key term based on mesh term in national and international databases. In the initial search, 1391 articles were found that after removing duplicate, unrelated or non-English and non-Persian articles, finally 20 studies with a sample size of 11354 of women who had given birth were introduced in this study. The prevalence of dyspareunia following vaginal delivery, C-section, and instrumental delivery with 95%CI was 42%(31-56%), 26%(19-34%), and 37%(28-46%) respectively. In addition, the prevalence of dyspareunia in primiparous was higher than multiparous (34%vs.24%), in breastfeeding women was higher than non-breastfeeding women (48%vs.33%), in women who non-used hormonal contraceptive methods were higher than who used hormonal contraceptive methods (43%vs.35%) and its prevalence was similar in women with and without episiotomy. The results indicated that vaginal delivery, breastfeeding, used hormonal contraceptive and primiparity have an impact on dyspareunia. Thus, considering the high prevalence of dyspareunia, and its impact on the quality of life of couples in the postpartum period, attention to, planning, and designing effective interventions in this regard are essential.IMPACT STATEMENTWhat is already known on this subject? Dyspareunia is one of the common experiences of women in the post-partum period. One of the most important factors affecting dyspareunia in the post-partum period is the mode of delivery.What do the results of this study add? The present study adds to examine the prevalence of dyspareunia in the postpartum period in terms of the mode of delivery. So far, no study has been found which comprehensively and systematically estimating the prevalence of dyspareunia in relation to the type of delivery mode in women who have given birth recently. In addition to the type of delivery the prevalence of dyspareunia was estimated based on parity, breastfeeding, episiotomy and consumption of hormonal contraceptive status.What are the implications of these findings for clinical practice and/or further research? This finding will be a small step to familiarise physicians and midwives as well as people with the relationship between delivery mode and dyspareunia. In addition, in the absence of medical indications and the possibility of choosing the mode of delivery selectively, help them decide and choose the appropriate method of termination of labour and ultimately improve the mental and physical health of the birthing person, family and community.
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Affiliation(s)
- Vida Ghasemi
- Department of Public Health, Asadabad School of Medical Sciences, Asadabad, Iran
| | - Maryam Beheshti Nasab
- Department of Midwifery, Faculty of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Marzieh Saei Ghare Naz
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeideh Shahsavari
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mojdeh Banaei
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Wood SN, Pigott A, Thomas HL, Wood C, Zimmerman LA. A scoping review on women’s sexual health in the postpartum period: opportunities for research and practice within low-and middle-income countries. Reprod Health 2022; 19:112. [PMID: 35527298 PMCID: PMC9079206 DOI: 10.1186/s12978-022-01399-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/01/2022] [Indexed: 11/24/2022] Open
Abstract
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.
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Doke PP, Vaidya VM, Narula APS, Patil AV, Panchanadikar TM, Wagh GN. Risk of non-resumption of vaginal sex and dyspareunia among cesarean-delivered women. J Family Med Prim Care 2021; 10:2600-2607. [PMID: 34568142 PMCID: PMC8415658 DOI: 10.4103/jfmpc.jfmpc_2482_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/21/2021] [Accepted: 03/12/2021] [Indexed: 12/15/2022] Open
Abstract
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.
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Affiliation(s)
- Prakash Prabhakarrao Doke
- Department of Community Medicine, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India
| | - Varsha Mahesh Vaidya
- Department of Community Medicine, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India
| | - Arvinder Pal Singh Narula
- Department of Community Medicine, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India
| | | | | | - Girija Narendra Wagh
- Department of Obstetrics and Gynecology, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India
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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. PLoS One 2021; 16:e0247769. [PMID: 33780453 PMCID: PMC8007007 DOI: 10.1371/journal.pone.0247769] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/14/2021] [Indexed: 11/20/2022] Open
Abstract
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.
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Banaei M, Kariman N, Ozgoli G, Nasiri M, Ghasemi V, Khiabani A, Dashti S, Mohamadkhani Shahri L. Prevalence of postpartum dyspareunia: A systematic review and meta‐analysis. Int J Gynaecol Obstet 2020; 153:14-24. [DOI: 10.1002/ijgo.13523] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/06/2020] [Accepted: 12/08/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Mojdeh Banaei
- Student Research Committee School of Nursing and Midwifery Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Nourossadat Kariman
- Midwifery and Reproductive Health Research Center School of Nursing and Midwifery Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Giti Ozgoli
- Midwifery and Reproductive Health Research Center School of Nursing and Midwifery Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Maliheh Nasiri
- Department of Biostatistics School of Nursing and Midwifery Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Vida Ghasemi
- Asadabad Faculty of Medical Sciences Asadabad Iran
| | - Azam Khiabani
- Mother and Child Welfare Research Center Hormozgan University of Medical Sciences Bandar Abbas Iran
| | - Sareh Dashti
- Department of Community Health Faculty of Medicine and Health Sciences University Putra Malaysia Serdang Selangor Malaysia
- Department of Midwifery Mashhad Branch Islamic Azad University Mashhad Iran
| | - Leila Mohamadkhani Shahri
- Student Research Committee School of Nursing and Midwifery Shahid Beheshti University of Medical Sciences Tehran Iran
- Department of Midwifery College of Nursing & Midwifery Karaj Branch Islamic Azad University Karaj Iran
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Olofinbiyi BA, Awoleke JO, Atiba BP, Olaogun OD, Olofinbiyi RO, Awoleke AO. Predictors of Maternal Preference for Sex-Selective Pregnancy Termination in a Developing Nation with Restrictive Abortion Laws. Matern Child Health J 2020; 25:813-820. [PMID: 33244681 DOI: 10.1007/s10995-020-03062-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The rapid and unexpected increase in the sex ratio at birth in Nigeria between 1996 and 2014 is yet to be fully explained. The contribution of sex-selective abortion has not been explored. METHODS A cross-sectional survey of pregnant women was employed to address this need. RESULTS Preference for sex-selective abortion was noted in 8.6% of the respondents. The association between parity ≥ 4 and preference for sex-selective abortion was statistically significant. Women who were child gender-biased were significantly more likely to prefer sex-selective abortion. Experiencing intimate partner violence, and having problems with in-laws for inability to give birth to their desired gender, were predictors of maternal preference for sex-selective abortion. Women who preferred sex-selective abortion, however, felt it was necessary to campaign against gender preference. CONCLUSION Preference for sex-selective abortion exists in Nigeria, despite our restrictive abortion laws. However, the women's underlying reasons may include gender balancing in the family and an escape from discrimination. Improving contraceptive uptake, restriction of disclosure of fetal sex for non-medical indications, and sanctions against violent partners/oppressive in-laws are advocated. Rapid progress towards achieving a world free of the offensive gender inequalities that force women to opt for sex-selective abortion ab initio is desirable.
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Affiliation(s)
- Babatunde Ajayi Olofinbiyi
- Department of Obstetrics and Gynaecology, Ekiti State University Teaching Hospital, P.M.B. 5355, Ado Ekiti, Nigeria
| | - Jacob Olumuyiwa Awoleke
- Department of Obstetrics and Gynaecology, Ekiti State University Teaching Hospital, P.M.B. 5355, Ado Ekiti, Nigeria.
| | | | - Oluwole Dominic Olaogun
- Department of Obstetrics and Gynaecology, Ekiti State University Teaching Hospital, P.M.B. 5355, Ado Ekiti, Nigeria
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Abstract
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.
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Alnuaimi K, Obeisat S, Almalik M, Ali R, Alshraifeen A. A phenomenological study of Jordanian women's experience of sexual intercourse after giving birth. Midwifery 2020; 88:102761. [PMID: 32516678 DOI: 10.1016/j.midw.2020.102761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/13/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
Abstract
AIM to explore the sexual experiences of Jordanian women on the first occasion after giving birth. METHODS phenomenological qualitative research. Twenty-five Jordanian women were purposively recruited from two maternal health centres and interviewed. FINDINGS four themes emerged: "culture and religion v/s health professionals in resumption of sexual intercourse"; "enduring physical and psychological discomforts"; "husbands' role in resumption of sexual intercourse"; and "newborn babies' role in the experience of sexual intercourse". CONCLUSION health professionals need to adopt appropriate maternal clinical guidelines to meet women's needs. There is a need to give greater emphasis on sexual health care provided to women during pregnancy and after giving birth.
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Affiliation(s)
- Karimeh Alnuaimi
- Maternal and Child Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, P.O. Box (3030), Irbid, 22110 Jordan.
| | - Salwa Obeisat
- Maternal and Child Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, P.O. Box (3030), Irbid, 22110 Jordan.
| | - Mona Almalik
- Maternal and Child Health Nursing Department, Faculty of Nursing, University of Mutah, Jordan.
| | - Reem Ali
- Maternal and Child Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, P.O. Box (3030), Irbid, 22110 Jordan.
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Jambola ET, Gelagay AA, Belew AK, Abajobir AA. Early Resumption of Sexual Intercourse and Its Associated Factors Among Postpartum Women in Western Ethiopia: A Cross-Sectional Study. Int J Womens Health 2020; 12:381-391. [PMID: 32440232 PMCID: PMC7212774 DOI: 10.2147/ijwh.s231859] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 04/16/2020] [Indexed: 12/11/2022] Open
Abstract
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.
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Affiliation(s)
- Ebisa Turi Jambola
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Abebaw Addis Gelagay
- Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Aysheshim Kassahun Belew
- Department of Human Nutrition, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Amanuel Alemu Abajobir
- Maternal and Child Wellbeing Unit, African Population and Health Research Centre, Nairobi, Kenya
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Banaei M, Alidost F, Ghasemi E, Dashti S. A comparison of sexual function in primiparous and multiparous women. J OBSTET GYNAECOL 2019; 40:411-418. [PMID: 31537138 DOI: 10.1080/01443615.2019.1640191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Childbirth is one of the most important influencing factors for sexual function. Therefore, this study was conducted with the aim of comparing sexual function in primiparous and multiparous women. This cross-sectional analytical study was performed using systematic random sampling on 420 women in the postpartum period who referred to Bandar Abbas health Centres in 2018. The data were collected using an interview method which consisted of a Female Sexual Function Index questionnaire and a demographic questionnaire. The data analysis was performed using the SPSS Version 23 software. The results showed that sexual dysfunction was lower in multiparous women compared to primiparous women (p = .006). Low sexual activity in primiparous women can be due to less privacy and more time and energy loss. Several factors including housing situation, monthly income, episiotomy incision, and the education level of the couple were influential in the sexual function of the primiparous women (p < .05). Sexual function differs between primiparous and multiparous women in postpartum period and the number of deliveries can affect sexual performance.IMPACT STATEMENTWhat is already known on this subject? Sexual function in humans is affected by a complexity of interactions. Childbirth is among the most one of the important factors that influences sexual function. Pregnancy and childbirth affect all organs of the female body, especially the genital tract, and the resulting changes may cause problems in sexual intercourse. Negative childbirth experiences from previous deliveries can affect sexual performance.What do the results of this study add? Regarding the high prevalence of sexual problems during the postpartum period and the direct impact of this on spousal relationship, and also given the controversial data on the relationship between parity and sexual dysfunction, the present study was conducted to compare postpartum sexual function between primiparous and multiparous women.What are the implications of these findings for clinical practice and/or further research? The sexual and emotional intimacy of couples may be affected due to the changes in women's sexual function as the result of physiological and anatomical changes during pregnancy and postpartum. Therefore, to improve the quality of sexual relations, screening and counselling for sexual disorders should not be limited to pregnancy and postpartum periods, but should also be included in pre-pregnancy counselling centres.
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Affiliation(s)
- Mojdeh Banaei
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Farzane Alidost
- MSc of Midwifery, Department of Reproductive Health, Nursing and Midwifery Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Erfan Ghasemi
- Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sareh Dashti
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
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Serrano Drozdowskyj E, Gimeno Castro E, Trigo López E, Bárcenas Taland I, Chiclana Actis C. Factors Influencing Couples' Sexuality in the Puerperium: A Systematic Review. Sex Med Rev 2019; 8:38-47. [PMID: 31447412 DOI: 10.1016/j.sxmr.2019.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The puerperium is a period of adaptation in which various transformations take place in the lives of women and men on their way to becoming mothers and fathers. These changes can also have repercussions on their sexual relations. How the couple deals with this transition is crucial to the well-being of the couple and affects how parents relate to the baby. AIM This study aimed to explore the factors that influence sexuality in both women and men during postpartum. METHODS We conducted a bibliographic review of 236 articles found on the PubMed database and published from 2008 to January 2019. MAIN OUTCOME MEASURE The main outcome measure was the impact of various physical, psychological, and sociocultural factors on couples' sexual functioning during postpartum. RESULTS The main problems that couples face after childbirth can be classified as (i) psychological changes, such as loss of a sense of self, transitioning to parenthood, taking on the new roles of mother and father, and feelings of abandonment among men; (ii) body changes in women that affect their self-image and perineal trauma; (iii) hormonal changes in women and men that can lead to reduced sexual desire in both and vaginal dryness or dyspareunia in women; (iv) changes in the marital relationship, including changes in each other's roles, taking time for intimacy, and initiating sexual intercourse; (v) sociocultural influences, such as social support, culturally expected roles, and beliefs regarding when to resume sex; and (vi) lifestyle changes, especially with regard to baby care. CONCLUSION Sexuality during postpartum is influenced by multiple factors: physical, psychological, and sociocultural. Our findings offer a deeper understanding of how the transition to parenthood affects sexual relationships during the postpartum period. Implications regarding caring for and promoting the sexual health of individuals and couples after childbirth are discussed, and some medical recommendations for parents are offered. Serrano Drozdowskyj E, Gimeno Castro E, Trigo López E, et al. Factors Influencing Couples' Sexuality in the Puerperium: A Systematic Review. Sex Med Rev 2020;8:38-47.
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Affiliation(s)
- Elena Serrano Drozdowskyj
- Perinatal Mental Health Unit, Consulta Dr Carlos Chiclana, Madrid, Spain; Universidad Pontificia de Comillas, Madrid, Spain
| | | | - Elena Trigo López
- Perinatal Mental Health Unit, Consulta Dr Carlos Chiclana, Madrid, Spain
| | - Inés Bárcenas Taland
- Perinatal Mental Health Unit, Consulta Dr Carlos Chiclana, Madrid, Spain; Universidad Francisco de Victoria, Madrid, Spain
| | - Carlos Chiclana Actis
- Perinatal Mental Health Unit, Consulta Dr Carlos Chiclana, Madrid, Spain; Universidad San Pablo CEU, Madrid, Spain
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Shabangu Z, Madiba S. The Role of Culture in Maintaining Post-Partum Sexual Abstinence of Swazi Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16142590. [PMID: 31330772 PMCID: PMC6678937 DOI: 10.3390/ijerph16142590] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/13/2019] [Accepted: 07/14/2019] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Zinhle Shabangu
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria 0001, South Africa
| | - Sphiwe Madiba
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria 0001, South Africa.
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Fuentealba-Torres M, Cartagena-Ramos D, Fronteira I, Lara LA, Arroyo LH, Arcoverde MAM, Yamamura M, Nascimento LC, Arcêncio RA. What are the prevalence and factors associated with sexual dysfunction in breastfeeding women? A Brazilian cross-sectional analytical study. BMJ Open 2019; 9:e025833. [PMID: 31028040 PMCID: PMC6502039 DOI: 10.1136/bmjopen-2018-025833] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE This study determined the prevalence and factors associated with sexual dysfunction in breastfeeding women. DESIGN Cross-sectional analytical study. SETTING Population-based study of individuals living in the northeast region of São Paulo state, Brazil. PARTICIPANTS From May to August 2017, 372 women aged ≥18 years were selected who gave exclusive, predominant or complementary breast feeding up to 23 months postpartum, and who did not have contraindications for the resumption of intercourse. Pregnant women, those diagnosed with mental health problems, users of medications that affect sexual function (antihypertensives, antidepressants or antipsychotics) and women unable to read or understand the instructions for the study were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES The breastfeeding women completed the Female Sexual Function Index, the EUROHIS-QOL 8-item index and a questionnaire to collect participants' sociodemographic, clinical and interpersonal data. A bivariate analysis was performed, and variables with p values<0.20 were analysed by multivariate logistic regression. RESULTS Sexual dysfunction was present in 58.3% of the study population. Factors significantly associated with female sexual dysfunction (FSD) included placing a low importance on sexual intercourse (adjusted OR [AOR]=2.49, 95% CI=1.22 to 5.09), limited communication with the partner (AOR=2.64, 95% CI=1.43 to 4.86), decreased frequency of sexual intercourse (AOR=2.17, 95% CI=1.30 to 3.61) and low quality of life (AOR=2.23, 95% CI=1.33 to 3.74). CONCLUSIONS The prevalence of FSD appears with a great magnitude in breastfeeding women. The risk factors for sexual dysfunction are biopsychosocial and these findings may lead to improved counselling for prenatal and postnatal care.
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Affiliation(s)
| | - Denisse Cartagena-Ramos
- Maternal-Infant and Public Health, University of Sao Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Inês Fronteira
- Department of International Public Health and Biostatistics, Universidade Nova de Lisboa Escola Nacional de Saude Publica, Lisboa, Lisboa, Portugal
| | - Lúcia Alves Lara
- Departament of Gynecology and Obstetrics, University of Sao Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Luiz Henrique Arroyo
- Maternal-Infant and Public Health, University of Sao Paulo, Sao Paulo, São Paulo, Brazil
| | | | - Mellina Yamamura
- Maternal-Infant and Public Health, University of Sao Paulo, Ribeirão Preto, São Paulo, Brazil
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Fuentealba-Torres M, Cartagena-Ramos D, Lara LAS, Alves JD, Ramos ACV, Campoy LT, Alonso JB, Nascimento LC, Arcêncio RA. Determinants of Female Sexual Function in Breastfeeding Women. JOURNAL OF SEX & MARITAL THERAPY 2019; 45:538-549. [PMID: 30836903 DOI: 10.1080/0092623x.2019.1586020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Knowledge about the determinants of female sexual function in breastfeeding women is limited. A total of 355 breastfeeding women completed the Female Sexual Function Index (FSFI) and the Qol-8 quality of life questionnaire. FSFI scores decreased in the first six months of breast feeding. There was a positive relationship between FSFI scores and the importance of sex, level of communication, income, quality of life, and receiving brief sexual counseling.
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Affiliation(s)
- Miguel Fuentealba-Torres
- a Department of Maternal-Infant Nursing and Public Health , University of São Paulo , Ribeirão Preto , Brazil
| | - Denisse Cartagena-Ramos
- a Department of Maternal-Infant Nursing and Public Health , University of São Paulo , Ribeirão Preto , Brazil
| | - Lucia A S Lara
- b Faculty of Medicine of Ribeirão Preto, Department of Gynecology and Obstetrics , University of São Paulo , Ribeirão Preto , Brazil
| | - Josilene D Alves
- a Department of Maternal-Infant Nursing and Public Health , University of São Paulo , Ribeirão Preto , Brazil
| | - Antônio C V Ramos
- a Department of Maternal-Infant Nursing and Public Health , University of São Paulo , Ribeirão Preto , Brazil
| | - Laura T Campoy
- a Department of Maternal-Infant Nursing and Public Health , University of São Paulo , Ribeirão Preto , Brazil
| | - Jonas B Alonso
- c Collage of Nursing , University of São Paulo , Ribeirão Preto , Brazil
| | - Lucila C Nascimento
- a Department of Maternal-Infant Nursing and Public Health , University of São Paulo , Ribeirão Preto , Brazil
| | - Ricardo A Arcêncio
- a Department of Maternal-Infant Nursing and Public Health , University of São Paulo , Ribeirão Preto , Brazil
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Tran NT, Yameogo WME, Gaffield ME, Langwana F, Kiarie J, Kulimba DM, Kouanda S. Postpartum family-planning barriers and catalysts in Burkina Faso and the Democratic Republic of Congo: a multiperspective study. Open Access J Contracept 2018; 9:63-74. [PMID: 30519124 PMCID: PMC6236096 DOI: 10.2147/oajc.s170150] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Nguyen Toan Tran
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland, .,Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology, Sydney, NSW, Australia.,Institute of Demography and Socioeconomics, University of Geneva, Geneva, Switzerland
| | - Wambi Maurice E Yameogo
- Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso.,Institut Africain de la Santé Publique, Ouagadougou, Burkina Faso
| | - Mary Eluned Gaffield
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland,
| | - Félicité Langwana
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - James Kiarie
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland,
| | | | - Seni Kouanda
- Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso.,Institut Africain de la Santé Publique, Ouagadougou, Burkina Faso
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Holden EC, Lai E, Morelli SS, Alderson D, Schulkin J, Castleberry NM, McGovern PG. Ongoing barriers to immediate postpartum long-acting reversible contraception: a physician survey. Contracept Reprod Med 2018; 3:23. [PMID: 30455978 PMCID: PMC6222995 DOI: 10.1186/s40834-018-0078-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/09/2018] [Indexed: 11/10/2022] Open
Abstract
Background Postpartum women are at risk for unintended pregnancy. Access to immediate long-acting reversible contraception (LARC) may help decrease this risk, but it is unclear how many providers in the United States routinely offer this to their patients and what obstacles they face. Our primary objective was to determine the proportion of United States obstetric providers that offer immediate postpartum LARC to their obstetric patients. Methods We surveyed practicing Fellows and Junior Fellows of the American College of Obstetricians and Gynecologists (ACOG) about their use of immediate postpartum LARC. These members are demographically representative of ACOG members as a whole and represent all of the ACOG districts. Half of these Fellows were also part of the Collaborative Ambulatory Research Network (CARN), a group of ACOG members who voluntarily participate in research. We asked about their experience with and barriers to immediate placement of intrauterine devices and contraceptive implants after delivery. Results There were a total of 108 out of 600 responses (18%). Participants practiced in a total of 36 states and/or US territories and their median age was 52 years. Only 26.9% of providers surveyed offered their patients immediate postpartum LARC, and of these providers, 60.7% work in a university-based practice. There was a statistically significant association between offering immediate postpartum LARC and practice type, with the majority of providers working at a university-based practice (p < 0.001). Multiple obstacles were identified, including cost or reimbursement, device availability, and provider training on device placement in the immediate postpartum period. Conclusion The majority of obstetricians surveyed do not offer immediate postpartum long-acting reversible contraception to patients in the United States. This is secondary to multiple obstacles faced by providers.
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Affiliation(s)
- Emily C Holden
- 1Obstetrics, Gynecology and Women's Health, Rutgers-New Jersey Medical School, 185 South Orange Avenue, E-level, Newark, NJ 07103 USA
| | - Erica Lai
- 1Obstetrics, Gynecology and Women's Health, Rutgers-New Jersey Medical School, 185 South Orange Avenue, E-level, Newark, NJ 07103 USA
| | - Sara S Morelli
- 1Obstetrics, Gynecology and Women's Health, Rutgers-New Jersey Medical School, 185 South Orange Avenue, E-level, Newark, NJ 07103 USA.,2Reproductive Endocrinology and Infertility, University Reproductive Associates, 214 Terrace Avenue, Hasbrouck Heights, NJ 07604 USA
| | - Donald Alderson
- 3Rutgers University Biostatistics and Epidemiology Services Center, Rutgers University, 65 Bergen St, Newark, NJ 07103 USA
| | - Jay Schulkin
- 4Department of Obstetrics and Gynecology, University of Washington, Box 356460, Seattle, WA 98195-6460 USA
| | - Neko M Castleberry
- 5American College of Obstetricians and Gynecologists, 409 12th Street, SW, Washington, DC 2002420024-9998 USA
| | - Peter G McGovern
- 1Obstetrics, Gynecology and Women's Health, Rutgers-New Jersey Medical School, 185 South Orange Avenue, E-level, Newark, NJ 07103 USA.,2Reproductive Endocrinology and Infertility, University Reproductive Associates, 214 Terrace Avenue, Hasbrouck Heights, NJ 07604 USA
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Baqui AH, Ahmed S, Begum N, Khanam R, Mohan D, Harrison M, Al Kabir A, McKaig C, Brandes N, Norton M, Ahmed S. Impact of integrating a postpartum family planning program into a community-based maternal and newborn health program on birth spacing and preterm birth in rural Bangladesh. J Glob Health 2018; 8:020406. [PMID: 30023053 PMCID: PMC6036944 DOI: 10.7189/jogh.08.020406] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Short birth intervals are associated with an increased risk of adverse perinatal outcomes. However, reduction of rates of short birth intervals is challenging in low-resource settings where majority of the women deliver at home with limited access to family planning services immediately after delivery. This study examines the feasibility of integrating a post-partum family planning intervention package within a community-based maternal and newborn health intervention package, and evaluates the impact of integration on reduction of rates of short birth intervals and preterm births. Methods In a quasi-experimental trial design, unions with an average population of about 25 000 and a first level health facility were allocated to an intervention arm (n = 4) to receive integrated post-partum family planning and maternal and newborn health (PPFP-MNH) interventions, or to a control arm (n = 4) to receive the MNH interventions only. Trained community health workers were the primary outreach service providers in both study arms. The primary outcomes of interest were birth spacing and preterm births. We also examined if there were any unintended consequences of integration. Results At baseline, short birth intervals of less than 24 months and preterm birth rates were similar among women in the intervention and control arms. Integrating PPFP into the MNH intervention package did not negatively influence maternal and neonatal outcomes; during the intervention period, there was no difference in community health workers’ home visit coverage or neonatal care practices between the two study arms. Compared to the control arm, women in the intervention arm had a 19% lower risk of short birth interval (adjusted relative risk (RR) = 0.81, 95% confidence interval (CI) = 0.69-0.95) and 21% lower risk of preterm birth (adjusted RR = 0.79; 95% CI = 0.63-0.99). Conclusions Study findings demonstrate the feasibility and effectiveness of integrating PPFP interventions into a community based MNH intervention package. Thus, MNH programs should consider systematically integrating PPFP as a service component to improve pregnancy spacing and reduce the risk of preterm birth.
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Affiliation(s)
- Abdullah H Baqui
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Nazma Begum
- Johns Hopkins University-Bangladesh, Dhaka, Bangladesh
| | - Rasheda Khanam
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Diwakar Mohan
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Meagan Harrison
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ahmed Al Kabir
- Research, Training and Management (RTM) International, Dhaka, Bangladesh
| | | | - Neal Brandes
- US Agency for International Development, Washington, D.C., USA
| | - Maureen Norton
- US Agency for International Development, Washington, D.C., USA
| | - Saifuddin Ahmed
- Department of Population, Family and reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Kopp DM, Tang JH, Stuart GS, Miller WC, O'Shea MS, Hosseinipour MC, Bonongwe P, Mwale M, Rosenberg NE. Dual Method Use among Postpartum HIV-Infected and HIV-Uninfected Malawian Women: A Prospective Cohort Study. Infect Dis Obstet Gynecol 2017; 2017:1475813. [PMID: 28804240 PMCID: PMC5540462 DOI: 10.1155/2017/1475813] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 06/04/2017] [Indexed: 11/24/2022] Open
Abstract
Dual method use, use of condoms plus another effective contraceptive method, is important in settings with high rates of unintended pregnancy and HIV infection. We evaluated the association of HIV status with dual method use in a cohort of postpartum women. Women completed baseline surveys in the postpartum ward and telephone surveys about contraceptive use 3, 6, and 12 months later. Nonpregnant women who completed at least one follow-up survey were eligible for this secondary analysis. Prevalence ratios were calculated using generalized estimating equations. Of the 511 sexually active women who completed a follow-up survey, condom use increased from 17.6% to 27.7% and nonbarrier contraceptive use increased from 73.8% to 87.6% from 3 to 12 months after delivery. Dual method use increased from 1.0% to 18.9% at 3 to 12 months after delivery. Dual method use was negligible and comparable between HIV-infected and HIV-uninfected women at 3 months but significantly higher among HIV-infected women at 6 months (APR = 3.9, 95% CI 2.2, 7.1) and 12 months (APR = 2.7, 95% CI 1.7, 4.3). Dual method use was low but largely driven by condom use among HIV-infected women at 6 and 12 months after delivery.
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Affiliation(s)
- Dawn M. Kopp
- UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
- UNC Department of Obstetrics & Gynecology, 101 Manning Drive, Chapel Hill, NC 27514, USA
| | - Jennifer H. Tang
- UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
- UNC Department of Obstetrics & Gynecology, 101 Manning Drive, Chapel Hill, NC 27514, USA
| | - Gretchen S. Stuart
- UNC Department of Obstetrics & Gynecology, 101 Manning Drive, Chapel Hill, NC 27514, USA
| | - William C. Miller
- UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
- UNC Department of Epidemiology, 135 Dauer Drive, Chapel Hill, NC 27599, USA
- Division of Epidemiology, Ohio State University, 1841 Neil Avenue, Columbus, OH 43210, USA
| | - Michele S. O'Shea
- UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Mina C. Hosseinipour
- UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
- UNC Department of Medicine, 125 MacNider Hall, Chapel Hill, NC 27599, USA
| | - Phylos Bonongwe
- Department of Obstetrics & Gynaecology, Malawi College of Medicine, Private Bag 360, Chichiri, Blantyre, Malawi
| | - Mwawi Mwale
- Bwaila Hospital, Lilongwe District Health Office, Lilongwe, Malawi
| | - Nora E. Rosenberg
- UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
- UNC Department of Epidemiology, 135 Dauer Drive, Chapel Hill, NC 27599, USA
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Atif K, Afsheen A, Naqvi SAH, Niazi SA, Ullah Khan H. Trends of contraception among ladies of local population in Pakistan; why, how, when and what? Pak J Med Sci 2016; 32:751-5. [PMID: 27375727 PMCID: PMC4928436 DOI: 10.12669/pjms.323.9662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective: To analyze trends of use of methods of contraception along with study of impact of various demographic and social factors on contraception in Peshawar, Pakistan. Methods: A cross-sectional descriptive study with random purposive sampling was conducted at Combined Military Hospital Peshawar, from Mar 2015-Nov 2015. Self-designed questionnaire with demographic details and questions pertinent to contraceptive practices was utilized as study instrument. Females reporting to concerned hospital for contraceptive advice and prescription were distributed with questionnaire and written informed consent form. Formal approval was taken from ethical committee of hospital. Data was analyzed via descriptive analysis (SPSS-21), qualitative data was expressed as frequencies and percentages; quantitative as mean±standard deviation (SD). Main outcome variable i-e contraceptive device used; was cross-tabulated with independent variables. Results: Response rate was 53.2% (n-426). Usage of contraceptive device was as follows; 51.2% Nil, 9.4% barriers, 22.3% oral/injectable hormones, 13.4% IUCDs, 3.8% sterilization. There was a strong relationship between type of contraceptives used and age (p<0.001), client’s education (p<0.001), husband’s education (p<0.001), number of children (p<0.001), religion (p0.013), socioeconomic class (p<0.001), and religious beliefs about use of contraceptives (p<0.001). More Muslims considered contraception irreligious than non-Muslims (p 0.02). There was no significant impact of husbands’ pressure to not to use contraceptives on type of contraception practised (p 0.114). Conclusion: Contraceptive devices are under-utilized in the study participants. Multidisciplinary approach should be applied to enhance client education, awareness and counseling to utilize these devices more appropriately and regularly.
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Affiliation(s)
- Khaula Atif
- Dr. Khaula Atif, MBBS, MCPS (Family-Medicine), Department of General Administration, Combined Military Hospital, Peshawar Cantonment, Khyber Pakhtun Khwah, Pakistan-54000
| | - Afeera Afsheen
- Dr. Afeera Afsheen, MBBS, MCPS (Gynecology), FCPS (Gynecology). Department of Gynecology, Combined Military Hospital, Peshawar Cantonment, Khyber Pakhtun Khwah, Pakistan-54000
| | - Syed Abid Hassan Naqvi
- Dr. Syed Abid Hassan Naqvi, MBBS, FCPS, FRCS, MS(Ophthalmology). Department of Ophthalmology, Combined Military Hospital, Peshawar Cantonment, Khyber Pakhtun Khwah, Pakistan-54000
| | - Saleem Asif Niazi
- Dr. Saleem Asif Niazi, MBBS, MCPS(ENT), FCPS(ENT). Department of ENT, Combined Military Hospital, Peshawar Cantonment, Khyber Pakhtun Khwah, Pakistan-54000
| | - Habib Ullah Khan
- Dr. Habib Ullah Khan, MBBS, FCPS (General Surgery), FCPS (Neurosurgery). Department of Neurosurgery, Combined Military Hospital, Abbotabad Cantonment, Khyber Pakhtun Khwah, Pakistan
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Andreucci CB, Bussadori JC, Pacagnella RC, Chou D, Filippi V, Say L, Cecatti JG. Sexual life and dysfunction after maternal morbidity: a systematic review. BMC Pregnancy Childbirth 2015; 15:307. [PMID: 26596506 PMCID: PMC4657322 DOI: 10.1186/s12884-015-0742-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 11/17/2015] [Indexed: 12/13/2022] Open
Abstract
Background Because there is a lack of knowledge on the long-term consequences of maternal morbidity/near miss episodes on women´s sexual life and function we conducted a systematic review with the purpose of identifying the available evidence on any sexual impairment associated with complications from pregnancy and childbirth. Methods Systematic review on aspects of women sexual life after any maternal morbidity and/or maternal near miss, during different time periods after delivery. The search was carried out until May 22nd, 2015 including studies published from 1995 to 2015. No language or study design restrictions were applied. Maternal morbidity as exposure was split into general or severe/near miss. Female sexual outcomes evaluated were dyspareunia, Female Sexual Function Index (FSFI) scores and time to resume sexual activity after childbirth. Qualitative syntheses for outcomes were provided whenever possible. Results A total of 2,573 studies were initially identified, and 14 were included for analysis after standard selection procedures for systematic review. General morbidity was mainly related to major perineal injury (3rd or 4th degree laceration, 12 studies). A clear pattern for severity evaluation of maternal morbidity could not be distinguished, unless when a maternal near miss concept was used. Women experiencing maternal morbidity had more frequently dyspareunia and resumed sexual activity later, when compared to women without morbidity. There were no differences in FSFI scores between groups. Meta-analysis could not be performed, since included studies were too heterogeneous regarding study design, evaluation of exposure and/or outcome and time span. Conclusion Investigation of long-term repercussions on women’s sexual life aspects after maternal morbidity has been scarcely performed, however indicating worse outcomes for those experiencing morbidity. Further standardized evaluation of these conditions among maternal morbidity survivors may provide relevant information for clinical follow-up and reproductive planning for women.
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Affiliation(s)
- Carla B Andreucci
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil. .,Federal University of Sao Carlos, Sao Carlos, Brazil.
| | | | - Rodolfo C Pacagnella
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil.
| | - Doris Chou
- Reproductive Health Research unit, World Health Organization, Geneva, Switzerland.
| | - Veronique Filippi
- London School of Hygiene and Tropical Medicine, University of London, London, England, UK.
| | - Lale Say
- Reproductive Health Research unit, World Health Organization, Geneva, Switzerland.
| | - Jose G Cecatti
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil.
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