Evaluation of a short in-person and online antenatal educational intervention for high-risk pregnant women linked to antenatal consultation

INTRODUCTION

The aim of this study was to evaluate a short educational intervention that focused on labor pain (through visual analogue scale, VAS), postpartum anxiety, and birthing experience before and during the SARS-CoV-2 (COVID-19) pandemic.

METHODS

This was a quasi-experimental study conducted between November 2019 and May 2021 in Brazil in 100 women with a high-risk pregnancy in the third trimester of pregnancy with an intervention group with in-person or virtual sessions (during the COVID-19 pandemic) and a non-intervention group. The antenatal intervention included breathing and relaxation techniques, upright positions, and information about labor. For evaluation, an antenatal questionnaire, State-Trait Anxiety Inventory (STAI) and a postpartum questionnaire were used. For data analysis, Student's t-test, chi-squared and Fisher's exact tests, ANOVA, bivariate, and multivariate regression analysis, were used.

RESULTS

When comparing the women in the intervention group to the non-intervention group, it was observed that the latter group reported higher fear of pain at labor during antenatal consultations (p<0.013); more women needed analgesia at 0-4 cm dilation (17/40) (p<0.018); the duration of labor was ≥12 hours (37/50) (p<0.037); while the intervention reported having a regular, good or excellent labor period (36/50) (p=0.014). The multiple regression analysis for labor pain showed a significant relationship between mode of delivery (cesarean delivery: RR; SE -21.43; 5.32, p<0.001) and labor pain, and good satisfaction with labor (RR; SE -13.86; 6.40, p=0.033).

CONCLUSIONS

Women from the intervention group had more satisfaction and less pain during labor than women from the non-intervention group.

Experiences of male partners of women with endometriosis-associated pelvic pain: a qualitative study

OBJECTIVES

The purpose of the study was to assess the experiences of male partners of women with endometriosis-associated pain after medical treatment in their everyday lives.

METHODS

We conducted a phenomenological study based on semi-structured interviews with 11 male partners of women with endometriosis-associated pelvic pain at the Department of Obstetrics and Gynaecology, University of Campinas Medical School, Brazil. A thematic analysis of manifest content was performed, a coding frame was drafted, and the main analysis categories were elaborated.

RESULTS

The interviewed men had been in stable relationships for a median length of 14 years. They reported that they did not have information about endometriosis before their partners' diagnosis and that the endometriosis-associated pelvic pain suffered by their partners affected their personal everyday life, marital relationship, sexual relationship, and intimacy.

CONCLUSION

Male partners of women with endometriosis-associated pain reported that the disease has both a profound impact on their lives and on their relationship. Our study contributed to an increased understanding of the life experience of men living with women with endometriosis-associated pelvic pain and may contribute to encourage healthcare professionals to incorporate strategies for guidance of the couple during treatment.

Assessment of the availability of sexual and reproductive healthcare for Venezuelan migrant women during the SARS-CoV-2 pandemic at the north-western border of Brazil-Venezuela

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Access to essential SRH services.

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Less SRH services offered.

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Lack of availability and access to contraceptives.

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Impact on health infrastructure.

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Reallocation of beds to attend COVID-19 cases.

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Shortage of healthcare providers.

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Challenges and opportunities for strengthening SRH services.

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Doubts about the management of the pandemic due to conflicting messages.

Background

The public healthcare system of Roraima state, at the north-western border Brazil-Venezuela, experienced an impact due to the incoming of Venezuelan migrants and to the SARS-CoV-2 (COVID-19) pandemic. After the beginning of the pandemic, the Brazilian government closed the border; however, migration continued through informal paths. There is scarce information regarding the availability of sexual and reproductive health (SRH) services at settings impacted both by migration and the COVID-19 pandemic. Consequently, we aimed to assess the availability and access to SRH services for Venezuelan migrant at Roraima state during the COVID-19 pandemic.

Methods

We conducted a cross-sectional study with data collected during the pandemic using an electronic questionnaire. We interviewed three policy makers responsible for the directorate of primary care both at the municipal and state level; the directors of the two public hospitals and the two referral centres for women's health in Boa Vista, and in Pacaraima the director of the hospital and of the basic health post. We also interviewed 20 out of the 34 (58.8%) managers of the basic health posts in Boa Vista and 10 healthcare providers (physicians and nurses). Data collected covered issues pertaining to access to SRH services, and explored the impacts of the COVID-19 on continuation, access, and use of SRH services.

Results

It was reported that 60% of the beds in the public sector were reallocated for COVID-19 cases and 26 out of the 34 (76%) health posts assessed interrupted the provision of SRH services, including contraceptive provision and gynaecological consultation, since these were considered not essential services. Most of the participants, (25/36; 69.4%) reported that both the state and the municipal health authorities implemented community outreach using telephone, social media, radio, and television, with guidance for the population on how to seek care using the healthcare network.

Conclusions

The healthcare system in Roraima was impacted firstly by the need to provide SRH to a large number of Venezuelan migrant women, and after an effort to adapt to the reality that this migrant crisis posed; this system was affected by the needs to adapt to the COVID-19 pandemic.

Pregnant women’s knowledge of non-pharmacological techniques for pain relief during childbirth

INTRODUCTION

The objective of the study was to assess knowledge of pregnant women in the third trimester of pregnancy on non-pharmacological techniques for pain relief during labor and childbirth.

METHODS

A cross-sectional study was conducted at a tertiary care facility of the University of Campinas, Brazil. The participants were 171 pregnant women, aged 18–35 years with 36 or more weeks of a singleton pregnancy. Participants responded to a questionnaire with data about sociodemographic and obstetric characteristics, knowledge on non-pharmacological techniques for pain relief during childbirth, the source of the information on these techniques, practice of physical activity and occurrence of pain during pregnancy. Parous women responded on the use of non-pharmacological techniques for pain relief during childbirth in previous deliveries. Multiple regression analysis with stepwise criteria of selection of variables was used to identify variables significantly associated with knowledge of non-pharmacological techniques for pain relief during childbirth.

RESULTS

A total of 165 (96.5%) participants reported knowledge on at least one non-pharmacological technique; 87.1% on the use of a warm shower during labor for pain relief, 80.7% on the use of the birthing ball, and 74.8% on breathing techniques. There were no significant differences between nulliparous and parous women. The main source of information reported was the Internet. Multivariate analysis showed that pregnant women who had pain during pregnancy reported more knowledge on the use of warm showers during labor (OR=2.64; 95% CI: 1.03–6.73).

CONCLUSIONS

Most women had knowledge of at least one non-pharmacological technique for pain relief during childbirth.

Reproductive health among Venezuelan migrant women at the north western border of Brazil: A qualitative study

BACKGROUND

Venezuela has been immersed in an economic and social crisis with a high number of migrant people. An important proportion of Venezuelan migrants have crossed the north western border Brazil-Venezuela were the United Nations High Commissioner for Refugees (UNHCR) has established 13 shelters. Our objectives were to know perspectives and views of Venezuelan migrant women hosted at UNHCR shelters on some SRH issues.

METHODS

We conducted a qualitative study between November 2019 and February 2020 with 12 focus group discussions (FGDs), with 111 Venezuelan migrant women of reproductive age (18-49 years old). FGDs were performed in a closed space that guaranteed confidentiality, were recorded, verbatim transcribed and data were analised for thematic manifest content.

FINDINGS

The themes identified were perspectives on: i) health care for pregnant and postnatal women, ii) access to modern contraceptive methods, and iii) HIV and sexually transmitted diseases (STDs). Despite the general satisfaction with obstetric care, women noted few challenges pertaining to their experiences during first entry to antenatal care, labour, delivery and postnatal care. They were in agreement that access to long-acting reversible contraceptives was difficult, mainly to the copper-intrauterine device (IUD); which when available it was erratic. Hormonal-IUD and implants were almost inexistent. This was of major concern to the women, as it prevented them from the ability to plan their reproductive lives. Although knowledge on STDs/HIV prevention and transmission was adequate; the predominance of traditional gender imbalance in the relations was observed and these attitudes have been discussed as a barrier for migrant women to protect themselves against HIV/STD infection.

CONCLUSION

These migrant women needed help to understand the language and functioning of the healthcare system, to overcome barriers and challenges while seeking access to SRH care. They faced significant gender vulnerability that needs to be addressed within their new life. Our findings could be useful for health authorities and international organisations to start actions to improve SRH and mitigate suffering.

Perspective of pregnant women regarding antenatal preparation: A qualitative study

BACKGROUND

Antenatal Education programs have been recommended for pregnant women to help them during gestation, childbirth and development of parenthood. Evidence on the perspectives and expectations of pregnant women regarding antenatal education in hospital settings, specifically in developing countries is still scarce. In-depth understanding is a key issue to organize interventions.

AIM

Identify experiences, needs and expectations of a group of pregnant women regarding antenatal education.

METHODS

A qualitative study was conducted. Data were collected through semi-structured interviews at the antenatal clinic of a public maternity teaching hospital in the southeastern region of Brazil. The interviews were recorded, transcribed verbatim and thematic analysis was performed. Twenty-two pregnant women were recruited following the logic of purposive sampling.

FINDINGS

All the participants reported they would like to receive guidance on non-pharmacological techniques for pain management during labor. The participants reported barriers to performed physical exercise; however, they also said that if they were encouraged by healthcare professionals they would exercise. According to the majority, the exercises should be of low intensity, and the improvement of general wellbeing was the most commented benefit. Also participants said that antenatal education meetings should be linked to antenatal consultations to facilitate participation. According to some participants, knowledge about antenatal education was acquired in conversations with other women, from lay media, and some reported a lack of guidance during antenatal consultation.

CONCLUSION

The participants of our study reported they would like to participate in antenatal education groups to receive guidance on non-pharmacological techniques to use during labor and childbirth.

A Qualitative Study on the Practice of Yoga for Women with Pain-Associated Endometriosis

OBJECTIVES

To understand the meaning women with pain-associated endometriosis attribute to yoga practice regarding their physical and emotional state at the beginning of the practice; pain management by integrating body and mind; secondary benefits of the practice of yoga, such as self-knowledge, self-care, and autonomy; and the role of the yoga group as psychosocial support.

DESIGN

Qualitative study conducted simultaneously with a randomized clinical trial.

SETTING

Public university hospital in southeastern Brazil between August 2013 and December 2014.

PARTICIPANTS

Fifteen women with pain-associated endometriosis who practiced yoga for 8 weeks.

INTERVENTION

After completing the twice-a-week program, all women participated in a single, semi-structured interview. Interviews were recorded and transcribed verbatim, and thematic analyses were performed.

OUTCOME MEASURES

The main themes of analysis were women's expectations regarding the practice of yoga, physical and emotional state of women at the beginning of yoga practice, control and pain management through the integration of body and mind, secondary benefits, acquisition of self-knowledge and autonomy, and the role of yoga group as psychosocial support.

RESULTS

All participants reported that yoga was beneficial to control pelvic pain. They related that they were aware of the integration of body and psyche during yoga practice and that this helped in the management of pain. Women said they had identified a relationship between pain management and breathing techniques (pranayama) learned in yoga and that breathing increased their ability to be introspective, which relieved pain. The participants have developed greater self-knowledge, autonomy, and self-care and have reduced the use of pain and psychiatric medications. They created ties among themselves, suggesting that the yoga group allowed psychosocial support.

CONCLUSIONS

Bodily and psychosocial mechanisms to control pain were identified in women with endometriosis. To reach such control, it is crucial that mind and body integrative techniques are learned.

Knowledge and attitudes of Latin American obstetricians and gynecologists regarding intrauterine contraceptives

Background

Intrauterine contraceptives (IUCs), including the copper intrauterine device and the levonorgestrel-releasing intrauterine system (LNG-IUS), are among the reversible contraceptive methods with high effectiveness. However, use is low in many settings, including some Latin American countries, mainly due to the influences of myths, fears, and negative attitudes, not only of users and potential users, but also of different cadres of health care professionals. The purpose of this study was to assess the knowledge and attitudes of a group of Latin American obstetricians and gynecologists regarding IUCs.

Methods

A survey was conducted during a scientific meeting organized in Chile in 2014 to present and discuss updated information about contraception. Obstetricians and gynecologists from 12 Latin American countries, who reported that they provide daily contraception services in both the public and private sectors, participated in the meeting. Participants who agreed to take part in the survey responded to a multiple-choice questionnaire on issues regarding knowledge, use, and attitudes about IUCs.

Results

Of the 210 obstetricians and gynecologists participating in the meeting, the respondents to each question varied from 168 (80.0%) to 205 (97.6%). Almost 50% recognized that the failure rate of combined oral contraceptives, patches, and vaginal rings is 8%–10%. Furthermore, 10% of the participants did not recognize the high contraceptive effectiveness of long-acting reversible contraceptive methods. Additionally, almost 80% of the respondents answered that they did not offer IUCs to nulligravidas and almost 10% did not offer IUCs to adolescents, albeit almost 90% of the respondents reported that nulligravidas are candidates for an LNG-IUS.

Conclusion

Some deficiencies and contradictions in terms of knowledge and attitudes were identified from the answers of the Latin American obstetricians and gynecologists who participated in the survey. The knowledge and attitudes of health care professionals about IUCs are important in order to provide adequate counseling and to expand the use of IUCs.

Knowledge and attitudes of Latin American gynecologists regarding unplanned pregnancy and use of combined oral contraceptives

Background

Unintended pregnancy is a public health problem and unmet medical need worldwide. It is estimated that in the year 2012, almost 213 million pregnancies occurred, and the global pregnancy rate decreased only slightly from 2008 to 2012. It was also estimated that 85 million pregnancies (40% of all pregnancies) were unintended and that 38% ended in an unintended birth.

Objectives

To assess knowledge and attitudes of Latin American (LA) obstetricians and gynecologists (OBGYNs) regarding unintended pregnancies and aspects of combined oral contraceptive (COC) use.

Methods

A survey was conducted during a scientific meeting about contraception in 2014, in which OBGYNs from 12 LA countries who provide attention in contraception were invited to respond to a multiple-choice questionnaire to assess their knowledge and attitudes regarding unplanned pregnancy and some aspects regarding COC use.

Results

A total of 210 OBGYNs participated in the study. Their knowledge regarding COC failure was low. The participants reported they believed that their patients habitually forgot to take a pill and that their patients did not know what to do in these situations. They were aware of the benefits of COC use; however, they were less prone to prescribe COCs for the purpose of protecting against ovarian and endometrial cancer, and one-quarter of them had doubts about the association between COC use and cancer risk.

Conclusion

The interviewed LA OBGYNs showed some flaws in terms of knowledge of COC failure rates and the non-contraceptive benefits and risks of COCs. To adequately counsel their patients regarding COC intake, OBGYNs must be updated regarding all aspects of COC use.

Perceptions and actions of healthcare professionals regarding the mother-child relationship with premature babies in an intermediate neonatal intensive care unit: a qualitative study

BACKGROUND

The mother-child interaction after delivery may be hampered when the newborn baby is hospitalized. The objective of the study was to understand perceptions and actions of healthcare professionals (HCPs), working in an intermediate neonatal intensive care unit (NICU), regarding mother-child relationship of hospitalized premature babies in the first weeks after delivery and the professionals' support for the development of this relationship within an NICU environment. The psychoanalytic concept of holding defined by Winnicott was used as the theoretical framework.

METHODS

A qualitative study was conducted with 20 HCPs (physicians, medical residents, nurses, and nurse technicians) working at an intermediate NICU of a referral hospital in Brazil. Semi-structured interviews were conducted, recorded and transcribed verbatim; and thematic analysis was performed.

RESULTS

The HCPs referred to the difficulty that these mothers had to develop the mother-child relationship within this environment. If they observed that the mother had initial inhibitions to interact with her baby, they tried to facilitate this process, since they were aware of the importance of early bonding for the child's well-being. They attributed the mothers' difficulty to the fragile appearance of the premature baby, the limited contact often imposed by the routine of the unit and the lack of participation in the decisions regarding the care given to her baby. HCPs tried to help women bond with her child by giving support and encouragement. Most of the physicians reported that the nurses represented a link between physicians and the mothers of the hospitalized babies.

CONCLUSION

The HCPs reported attitudes and actions indicative of holding. A more in-depth understanding of the relationship between HCPs and mothers of premature babies at an NICU during the first days after delivery, and the needs of the mothers and her baby to be close to facilitate bonding should be part of the routine discussions of the NICU health team.

Infertility care and the introduction of new reproductive technologies in poor resource settings

BACKGROUND

The overall prevalence of infertility was estimated to be 3.5-16.7% in developing countries and 6.9-9.3% in developed countries. Furthermore, according to reports from some regions of sub-Saharan Africa, the prevalence rate is 30-40%. The consequences of infertility and how it affects the lives of women in poor-resource settings, particularly in developing countries, has become an important issue to be discussed in reproductive health. In some societies, the inability to fulfill the desire to have children makes life difficult for the infertile couple. In many regions, infertility is considered a tragedy that affects not only the infertile couple or woman, but the entire family.

METHODS

This is a position paper which encompasses a review of the needs of low-income infertile couples, mainly those living in developing countries, regarding access to infertility care, including ART and initiatives to provide ART at low or affordable cost. Information was gathered from the databases MEDLINE, CENTRAL, POPLINE, EMBASE, LILACS, and ICTRP with the key words: infertility, low income, assisted reproductive technologies, affordable cost, low cost.

RESULTS

There are few initiatives geared toward implementing ART procedures at low cost or at least at affordable cost in low-income populations. Nevertheless, from recent studies, possibilities have emerged for new low-cost initiatives that can help millions of couples to achieve the desire of having a biological child.

CONCLUSIONS

It is necessary for healthcare professionals and policymakers to take into account these new initiatives in order to implement ART in resource-constrained settings.

The prevalence of perinatal depression and its associated factors in two different settings in Brazil

BACKGROUND

The prevalence of antepartum and postpartum depression (PPD) and its association with certain risk factors was evaluated.

METHOD

The Edinburgh Postnatal Depression Scale (EPDS) was applied and sociodemographic data was obtained at the beginning of the third trimester of pregnancy and at 4-6 weeks postpartum.

RESULTS

The prevalence of depression was 24.3% during pregnancy (n=600 women) and 10.8% in the postpartum period (n=555). The factors independently associated with antepartum depression were the absence of a partner (PRadj 1.93; 95%CI: 1.44-2.58), a lower socioeconomic class (1.75; 1.18-2.60), being non-white (1.48; 1.09-2.01) and multiparity (1.32; 1.01-1.74). For postpartum depression, the factors were the occurrence of psychological violence (PRadj 3.31; 95%CI: 2.02-5.43), use of alcohol during pregnancy (2.14; 1.33-3.45), being non-white (1.85; 1.11-3.08) and physical violence (2.14; 1.13-4.08). The sensitivity of depression during pregnancy as a predictor of PPD was 75%, while specificity was 81%. There were no differences between the two settings.

LIMITATIONS

EDPS does not diagnose depression and as a screening instrument it could overestimate the true prevalence of depression.

CONCLUSIONS

The use of the EPDS instrument during pregnancy would allow a screening for identifying women at higher risk of developing PPD and then a proposal of specific interventions to manage this condition. Postpartum depression was prevalent in around 10% of the women and was associated with unfavorable sociodemographic conditions including the use of alcohol and with the occurrence of psychological and physical violence.

Opinion and experience of Brazilian women regarding menstrual bleeding and use of combined oral contraceptives

OBJECTIVE

To describe the opinion and experience of Brazilian women regarding menstruation and the use of combined oral contraceptives (COCs) to control monthly bleeding and induce amenorrhea.

METHODS

Women attending regional public healthcare clinics for non-gynecologic conditions, and female members of staff from university schools unrelated to the field of medicine completed a questionnaire.

RESULTS

Of the 1111 women interviewed, 64.3% reported disliking menstruation. The desired frequency of bleeding was never (65.3%), less than monthly (18.2%), and every month or more often (16.5%). More than 60% of the women reported that they would use COCs to control menstrual bleeding, 82.0% would use COCs to reduce the amount of bleeding experienced, and 86.1% would use COCs to induce amenorrhea. When compared with women who disliked menstruation, those who reported that they liked to experience monthly bleeding had fewer years of schooling (OR1.98; 95% CI, 1.30-2.97), low socioeconomic status (OR 1.66; 95% CI, 1.12-2.46), fewer days of menstruation each month (OR 1.62; 95% CI, 1.11-2.36), and 1 or more child (OR 1.13; 95% CI, 1.01-1.26).

CONCLUSION

Many of the women surveyed disliked monthly menstruation and were interested in the use of COCs to control menstrual bleeding and induce amenorrhea.

Quality of life in women with premature ovarian failure

A cross-sectional and case-control study with a matching for age was performed to evaluate quality of life in 58 women with a diagnosis of premature ovarian failure (POF) and 58 women with normal ovarian function paired for age (± 2 years) (control group). In both groups were excluded women with chronic diseases and iatrogenic or genetic causes. Quality of life was evaluated using the WHOQOL-BREF. Although there were no statistically significant differences in quality of life in general between the two groups, there were statistically significant differences in mean scores in the physical health [61.3 ± 18.0 and 72.8 ± 16.4 for the POF and control groups, respectively (p < 0.0001)] and psychological domains [64.2 ± 16.7 and 69.3 ± 14.1, respectively (p = 0.0455)]. Having POF represented an approximately 2.5-fold greater risk of scoring poorly in the physical health and psychological domains. No statistically significant differences were found between the groups with respect to the social relationships or environment domains or for overall health. Women with POF have more difficulty with respect to their physical health and psychological aspects, indicating a need to provide adequate psychosocial and clinical support for these women to minimize the repercussion of this diagnosis on their activities and quality of life.

Access of people living with HIV to infertility services: perspective of Brazilian healthcare professionals

OBJECTIVE

To evaluate the perspective of professionals in university and public assisted reproductive technology (ART) and HIV/AIDS services in Brazil, on the demand of people living with HIV wishing to conceive.

DESIGN

Mixed qualitative and quantitative, descriptive, cross-sectional and case study.

METHODS

The quantitative component was based on telephone interviews to women's health and HIV/AIDS program managers at state and municipal level. For the qualitative case study, semi-structured interviews were conducted with health professionals of ART and HIV/AIDS services.

RESULTS

Only one university ART service provided care for seropositive couples, but 64% of the HIV/AIDS services at state level and 73% of municipal HIV/AIDS services offered reproductive counseling focused on preventing pregnancy. Difficulty in discussing desire to conceive, lack of political decision and of human and financial resources were the main reasons given by service managers for not offering the opportunity for HIV couples. Lack of appropriate referrals and of updated knowledge on reproductive options were constrains according to the interviews.

CONCLUSION

Desire to reproduce among people living with HIV is poorly addressed in public services in Brazil.

Maternal position during the first stage of labor: a systematic review

Background

Policy makers and health professionals are progressively using evidence-based rationale to guide their decisions. There has long been controversy regarding which maternal position is more appropriate during the first stage of labor. This problem has been examined often and repeatedly and the optimal recommendation remains unclear.

Methods

This is a systematic review of the effect of maternal position during the first stage of labor. The main question addressed here is: Does encouraging women to adopt an upright position or to ambulate during the first stage of labor reduce the duration of this stage? All randomized controlled trials carried out to assess this effect were taken into consideration in this review. The following electronic databases were accessed to identify studies: MEDLINE, Popline, the Scientific Electronic Library On-line and the Latin American and Caribbean Health Science Information. Citation eligibility was independently assessed by two reviewers. The methodological quality of each trial was also evaluated independently by two reviewers and a trial under consideration was included only when consensus had been attained. Allocation concealment and screening for the occurrence of attrition, performance and detection biases were considered when studies were appraised. The decision whether to perform data pooling was based on the clinical similarity of studies.

Results

The search strategy resulted in 260 citations, of which 18 were assessed in full-text. Nine eligible randomized controlled trials were included in the systematic review. Randomization methods were not fully described in eight studies. The allocation concealment was considered adequate in four studies and unclear in five. The investigators pooled the data from seven studies in which the length of the first stage of labor and results were in favor of the intervention, but the high level of heterogeneity (I² = 88.4%) impaired the meaning of this finding. The intervention did not affect other outcomes studied (mode of delivery, use of analgesia, labor augmentation and condition of the child at birth).

Conclusion

Adoption of the upright position or ambulation during first stage of labor may be safe, but considering the available evidence and its consistency, it cannot be recommended as an effective intervention to reduce duration of the first stage of labor.

Factors associated with reproductive options in HIV-infected women

A cross-sectional study was conducted in Campinas, Brazil, in HIV-infected women to evaluate factors associated with reproductive practices. A total of 112 HIV-infected women, 13 to 45 years old, with previous sexual experience were included in the study. Three groups were compared: pregnant women aware of their infection before current pregnancy, sterilized women who had made their reproductive choice after serodiagnosis and women using any reversible contraceptive method. Fisher's Exact Test and multivariate correspondence analysis were used in the statistical analysis. Among women interviewed, 23% were pregnant, 18% had been sterilized and 59% were using a reversible contraceptive method. Being younger was associated with reproductive practices that preserved the possibility of having a child. Reversible contraceptive users had fewer pregnancies and more often reported a desire to have children compared to the other groups. Partner's desire for parenthood was associated with pregnant and sterilized women. The clinical condition of the women and their partners, the serologic status of partner nor counseling about contraceptive choices influenced reproductive practices.

Long-term follow-up of women and men after unsuccessful IVF

The experience of 92 couples, who had unsuccessfully undergone one or more IVF cycles at a university clinic, was evaluated 3-8 years following their last failed attempt. One member of each couple completed a telephone questionnaire regarding life events during their last IVF cycle performed at the clinic and at the time of the interview. Some couples had continued further treatment and some had not. Multivariate correspondence analysis was used to analyse the data. Regarding the long-term experience of couples who had undergone further treatment, for men the main experiences were psychological problems and having adopted a child. For women, the main experiences were related to problems of self-image, psychological problems, loss of hope, and having adopted a child. These women also presented a strong association with problems in their marital relationship and with adoption. For the group that did not undergo further treatment, the women showed a strong association with considering adoption, and a less intense association with psychological problems and loss of hope. The men presented psychological problems and having adopted a child as associated variables. Comparison between men and women showed that recognizing the impossibility of conceiving a child and giving up treatment were strongly associated. Men and women who had not continued with further treatment were more affected in the long term than those who had undergone further treatment after IVF failure.

Physician-patient communication in the prevention of female reproductive tract infections: some limitations

The objective of this study was to describe the information that women with tubal infertility recalled having received from physicians when they consulted for a reproductive tract infection (RTI) and the information physicians reported having provided to women consulting for RTIs. Interviews were conducted with 16 women presenting primary tubal infertility selected on the basis of purposeful sampling criteria. Also, 15 physicians working in the public health network in the city of Campinas, Brazil, were selected at random and interviewed. Analysis of the women's statements concerning previous RTI-related medical consultations showed that they did not recall having received any information on either prevention or the impact of RTI on their reproductive future. Analysis of interviews with physicians showed that the information they provided to women consulting for RTIs was incomplete and unclear. The information women recalled having received and that which physicians remembered having provided at the time of treating a patient with RTI was similar. In conclusion, these women lacked adequate or complete information and that it was probably not possible for them to adopt measures to avoid repetition of RTI and minimize risk of tubal infertility.

Expanding contraceptive choice: findings from Brazil

This article presents findings from a participatory action research project in a municipality in southern Brazil that models a new and holistic approach to broadening women's contraceptive choices. The project encourages a collaborative process between researchers, community members, and public health managers to diagnose service-delivery problems, to design and implement interventions, and to evaluate their effectiveness. Findings from the baseline evaluation revealed major constraints in availability of and access to family planning and reproductive health services for women, as well as severe deficiencies in quality of care. Interventions designed to address these weaknesses, bound by the limited resources of the public sector, focused on training, restructuring of providers' roles and service-delivery patterns, the management process, the creation of a referral center, and the introduction of injectables, vasectomy services, and a program for adolescents. Evaluation results show the project's considerable impact in broadening reproductive options, although not all issues, especially those related to sustainability, have been resolved.