Practice Of Family Planning Research Articles

A Study of Relationship between Maternal Height and Fertility: Indian Concern

Demographers, as well as public health professionals, have been quite interested to study the relationship between maternal body size and fertility. In this paper, the relationship between mother height, number of surviving children and parity is investigated for India and its major states. The mean number of children ever born is high in shorter mother and mean duration of first birth interval among the taller mothers is less than the shorter mothers. Taller women tend to have fewer children but more surviving children. The National Family Health Survey (NFHS) collect the information on fertility, infant and child mortality and the practice of family planning. For this study authors have used NFHS-4 data.

A study of knowledge, attitude, and practice of contraception among nursing staff in All India Institute of Medical Sciences, Jodhpur, Rajasthan.

Objective:Despite the increase in contraceptive usage over the years, there still exists a gap in the knowledge, attitude, and practices regarding contraception. The study has been designed to assess the knowledge, attitude, practice, and preferences on contraceptive methods among the nursing staff, to determine the association between knowledge and attitude on contraceptive methods with the variables.Materials and Methods:A cross-sectional descriptive study of 173 nursing staff using a structured questionnaire on knowledge, attitude scale, and practice and preference were done at AIIMS, Jodhpur during June 2018 to August 2019.Results:It was observed that 82.6% were of 21–30 years of age, 86.7% were Hindus, 67% were from the nuclear family, 41% were married between 19 and 25 years, 86.7% were nulliparous, 75.7% had access to various contraceptives through health workers, 79.8% got information through media. 73.4% were willing to use postpartum contraception. In our study, a major reason for 80.9% to use family planning was to prevent unintended pregnancies. Majority 71% had the favorable attitude and 14.4% had an unfavorable attitude toward contraceptive methods. In this study, 64.1% preferred male condom as Rank 1, intrauterine device 57.8% as Rank 2, and Lactational Amenorrhea Method 58.3% as Rank 3 for postpartum contraception. There was an association between the practice of family planning and marital status, age, and family size.Conclusions:The study showed that the majority of the females nursing staff had moderate knowledge and favorable attitude toward contraception use.

Updates on contraception services for women at high risk of human immunodeficiency virus: World Health Organization

Use of contraception has been recommended to prevent pregnancy, practice family planning and also to prevent the acquisition of sexually transmitted infections. It is important to advocate that regardless of geographical settings, all the women should have access to the wide range of contraceptives, so that based on their preferences or values, an appropriate and well-informed choice can be made. The revised recommendation for women at high risk of HIV advocates for the use of any form of reversible contraception, including progestogen-only injectables. In conclusion, the sexual and reproductive health needs of all women are quite variable and it becomes even more challenging for the women who are either at high risk of HIV or HIV positive. The recent recommendations to expand the range of services offered, including contraceptive methods, is an important step, but will also require strengthening of the existing services.

Barriers and Facilitators of Family Planning Use in Fishing Communities of Lake Victoria in Uganda.

Introduction: Family planning (FP) is a key element in the conduct of research and is essential in managing family sizes. Although fishing communities (FCs) are targeted populations for HIV prevention research, their FP practices are poorly understood. We explored barriers and facilitators of FP use in FCs of Lake Victoria in Uganda. Methods: We employed a mixed-methods approach comprising a cross-sectional survey, in-depth interviews, and focus group discussions in 2 FCs. Multivariable logistic regression was used to analyze quantitative data and a thematic approach to generate themes from the qualitative data. Results: Up to 1410 individuals participated in the survey and 47 in the qualitative study. Just over a third (35.6%) used FP. The most commonly used methods were condoms, pills, and injectables. In Kigungu community, participants whose religion was Anglican and Muslim were more likely to use FP than Catholics (adjusted odds ratio [aOR] 1.45; 95% CI 1.05-1.99 and aOR 1.45; 95% CI 1.05-2.07, respectively). Participants were more likely to use FP if they had satisfactory FP knowledge compared to those with no satisfactory FP knowledge (aOR 1.79; 95% CI 1.23-2.61), or if they were married compared to their single counterparts (aOR 1.84; 95% CI 1.32-2.57). In both communities, participants were more likely to use FP if they had 2 or more sexual partners in the past 12 months than those with less than 2 sexual partners (aOR 1.41 95% CI 1.07-1.87 and aOR 2.60; 95% CI 1.36-4.97). Excessive bleeding and delayed fecundity; fertility desire; gender preferences of children; method stock outs and lack of FP trained personnel constituted barriers to FP use. There were also cultural influences in favor of large families. Conclusion: FP use in FCs is suboptimal. Barriers of FP use were mainly biomedical, religious, social, and cultural, which underscores a need for FP education and strengthening of FP service provision in FCs.

Trajnost i promena. Abortusna kultura, liberalizacija propisa i pokušaji seksualne edukacije stanovništva Jugoslavije (1918–1991)

Prispevek preučuje ureditev in prakso načrtovanja družin v Jugoslaviji v 20. stoletju. Čeprav so se družbeno-gospodarske razmere v državi spreminjale, dvigal se je življenjski standard in kontracepcija je postala širše dostopna, je za večino parov v celotnem dvajsetem stoletju splav, najprej nezakonit, nato zakonit, ostal eden od osnovnih "metod" spontanega in nepremišljenega načrtovanja starševstva. Paradoksalno je, da je bil, kljub svobodnejši spolnosti in seksualni revoluciji, ki sta se zgodili po vojni, ter prizadevanjem za odpiranje svetovalnih centrov, širjenju kontracepcije in t. i. "humanizaciji odnosov med spoloma", eden temeljnih uspehov državne politike na področju načrtovanja družine dekriminaliziranje splava in njegova "selitev" v bolnišnice in ambulante. Na podlagi virov iz Arhiva Jugoslavije in relevantnih periodičnih publikacij ter literature bo avtorica skušala odgovoriti na vprašanje, zakaj je imela državna politika pri tem skromne rezultate, pa tudi, kakšni motivi so vplivali na pare, da so se odločali za družine z enim ali dvema otrokoma.

Provider-Initiated Family Planning Within HIV Services in Malawi: Did Policy Make It into Practice?

Malawi's guidelines for Clinical Management of HIV in Children and Adults promote the practice of provider-initiated family planning (PIFP) for all clients over the age of 15. The guidelines recommend that providers should offer all clients condoms, offer injectables to female clients, and refer clients to another provider or site if clients prefer another family planning method. This study assessed to what extent family planning services had been integrated into HIV services among 41 facilities in Malawi (hospitals, health posts, health centers; public and nonprofit private) and how the reproductive rights of people living with HIV were being addressed. Data were collected through facility audits (N=41), provider interviews (N=122), client exit interviews (N=425), and mystery client visits (N=58). This study found that contrary to clinical protocols, only 14% of clients at the antiretroviral therapy (ART) clinic had reported being asked about their family planning/fertility intentions during the visit that day. Only 24% of providers at the facility had received training on family planning-HIV integration, and 21% had no family planning training at all. Overwhelmingly, ART clients relied on condoms to meet their family planning needs. Only 24% of ART clinics had injectables available, and only 15% of ART clinics had a full range of family planning methods (short- and long-acting, hormonal and non-hormonal) available to clients. These findings suggest that Malawi's strong national policies on family planning-HIV integration, and specifically PIFP, are not being implemented in practice and thus not adequately addressing the family planning needs of clients with HIV. To improve PIFP, Malawi requires targeted systems changes. Facilities need to broaden their family planning method mix offerings. Furthermore, providers need more training on family planning and the importance of HIV clients having access to family planning services, and referral services need to be strengthened so providers can ensure clients have access to their method of choice in a timely manner.

Modern contraceptive methods knowledge and practice among blind and deaf women in Ethiopia. A cross-sectional survey

BackgroundEvidences from various parts of the world reveal that women with disabilities are facing widespread barriers in accessing public services. Service providers and program managers do not grasp the relevance of their work and interventions in addressing the sexual and reproductive health needs of women with disabilities. The present study therefore aimed to assess family planning knowledge and practice among women with sensory disabilities.MethodsA mixed method approach using quantitative and qualitative methods was employed to collect the data. The study included 326 blind and deaf women using respondent driven sampling technique and 29 purposely selected key informants. We carried out the study from August 2016–April 2017. The quantitative data were analyzed using SPSS and the qualitative analysis was done using Open code software version 4.02 and triangulated with the quantitative findings.ResultsThe findings showed that nearly two third of the respondents of were sexually active. The majority (97.2%) of study respondents had heard about FP methods, however the level of comprehensive knowledge on modern contraceptive methods was 32.5%. The prevalence of unwanted pregnancy was 67.0% and abortion was 44%.Almost half of sexually active respondents ever used modern contraceptive methods, yet the contraceptive prevalence at the time of survey was 31.1%. Implants were the most commonly used (51%) contraceptive method among current users.ConclusionsThe use of modern contraceptive methods among women with sensory disabilities was low. Thus, the government and concerned organizations need to address the attitudinal, social, and physical barriers women with sensory disabilities are facing while seeking, accessing to and using family planning services.

Competency assessment of the medical interns and nurses and documenting prevailing practices to provide family planning services in teaching hospitals in three states of India.

ObjectivesThe objectives of the study were to assess the knowledge and skills of medical interns and nurses regarding family planning (FP) services, and document the prevailing FP practices in the teaching hospitals in India.Study designA cross-sectional study was conducted in three states (Delhi, Rajasthan, and Maharashtra) of India, among randomly selected 163 participants, including medical interns (n = 81) and in-service nurses (n = 82), during 2017. The semi-structured, pre-tested interview schedule, was used to assess the knowledge and status of training received; and objective structured clinical examination (OSCE) based checklist was used to evaluate the skills.ResultsAbout 60% of the interns and 48% of the nurses knew more than five contraceptives that could be offered to the clients. About 22% (11.1% interns and 33.3% nurses) respondents believed that contraceptives should not be given to a married woman coming alone, and 31.9% (17.3% interns and 46.3% nurses) respondents reported that it was illegal to provide contraceptives to unmarried people. Nearly 43.3% interns and 69.5% nurses refused to demonstrate intrauterine contraceptive device (IUCD) insertion in the dummy uterus as per OSCE, and among those who did, 12.3% interns and 18.3% nurses had failed. About 63% interns and 63.4% of nurses had observed IUCD insertion, and 12.3% interns and 17.1% had performed IUCD insertion, during their training.ConclusionsKnowledge and skills of interns and nurses regarding FP services were inadequate. The medical training during graduation or internship, and during the job, was found to be inadequate to provide quality FP services as per guidelines of nursing/medical council of India and Government of India on FP.

Natural Family Planning: Knowledge and Practices Assessment Among Couples In Its Utilization: A Study Carried Out In The Bamenda Health District, North West Cameroon

People everywhere have developed various means of family planning methods in fertility regulation for reasons such as ensuring better maternal and infant health, paternal care for children, reducing the burden of poverty, improving standards of living, quality education. The rate of population growth worldwide has caused political leaders to encourage national and regional fertility regulation project as vital support for regulation of individual fertility have been evident in all cultures at all-time even in those societies in which social and religious rules have favored the abundant production of children. The main objective was to assess the knowledge and practice of natural family planning among couples in Bamenda Health District. The descriptive cross-sectional study design was used in which the investigator collected data from couples on their knowledge in the practice of NFP methods and their findings analyzed. A sample size of 50 couples was recruited for the study; 50 questionnaires were administered to them within the study period. A random sampling technique was used, where three catholic churches were selected in the Bamenda Health District. Questionnaires were administered systematically to couples who practice NFP in the reproductive age group in the various churches. Results show that the high level of awareness of NFP methods did not give a corresponding encouragement to couples in practicing NFP methods. Culture and religion played a major role in a couple’s decision to practice NFP methods and this is reflected in the husband’s domination in most decisions taking by couples in reproductive health issues. Furthermore, women are found to be more involved in the practice of NFP than men. Both husbands and wives decide on the choice of family planning to be used and comparing following the man and the woman, the man-made the major decisions (26%) as to (24%) for the woman. Also following the decision on child spacing, the woman made the major decisions (34%) as opposed to the man (22%). On the decision concerning the family size, the man-made the major decisions.

Less Reproduction, More Production: Birth Control in the Early People’s Republic of China, 1949–1958

In the early People’s Republic of China (PRC), Communist officials initially placed strict constraints on birth control use, encouraging high fertility rates. However, in an effort to enhance agricultural and industrial productivity, such restrictions were gradually repealed and by the 1970s, aggressive promotion of family planning had become the norm. Drawing on both archival and oral history, this article considers the lived experience of birth control use from the founding of the People’s Republic until 1958, a period that is often overlooked in studies of reproduction and contraception in modern China, but that had important implications for later trends. Despite claims that discussion of sexuality was suppressed in the PRC and an early ban on certain publications related to sexual hygiene, a considerable amount of literature on sex and birth control was published in major cities in the 1950s. Narratives on sex and birth control in women’s magazines and sex handbooks, however, varied widely and access to birth control and surgeries, such as abortions and sterilizations, differed dramatically according to location, class, and education level. This essay probes the circumstances under which women or couples practiced birth control while demonstrating the diversity of contraceptive discourses and practices in the early People’s Republic. Though underexplored, the early years of the PRC remain critical to histories of reproduction in China because many of the gender dynamics, socioeconomic pressures, and cultural preferences that informed contraceptive practices in the 1950s continued to do so for decades to come.

Determination of prevalence, knowledge, attitude and practices of contraceptive use in an urban population in South India: a community based study

Background: Family planning influences mothers and infant’s health, population growth and regional and national development. Studying the knowledge, attitude and practice of contraceptive methods of a region aids in overcoming the barriers in the utilization of the services providing them.Methods: A community based cross sectional study was done among 350 married women of an urban population by systematic random sampling using a structured questionnaire.Results: From a total of 350 women enrolled, majority were of the Hindu religion (84.9%) and from the lower socio-economic status (68%). The prevalence of use of contraceptive methods was 75.4% and it was predominantly female sterilization. It was significantly higher (p<0.001) in women aged above 32 years, married for more than 10 years, having more than two children and last child birth of more than seven years. Only 142 (40.6%) of the participants had adequate knowledge of contraceptive methods. However, 299 (85.4%) had a positive attitude to contraception and 296 (84.6%) had good practice of family planning (FP) methods.Conclusions: The knowledge and use of contraceptive methods especially temporary methods needs to be improved in our community. The utilization of media can be improved in addressing this shortfall. Health care providers being the bulk source of information on contraceptive methods must be pro-active in every interaction with women and men of reproductive age group by providing information on the various methods.

Birth control East and West: reading eugenics in Mo Yan’s Frog and Eudora Welty’s “Lily Daw and the Three Ladies”

This essay undertakes a cross-cultural comparison of the eugenics movement in China and the U.S. South through a comparative reading of Mo Yan’s Frog (2009) and Eudora Welty’s “Lily Daw and the Three Ladies” (1941). By positioning each work within its own particular political and cultural milieu, it argues that both writers, while demonstrating a shared criticism of gender hierarchy and biopolitical violence, cast a similar eye on the intertwinement of modernity, science, and nationalism in the cultural practice of birth control. Set in a rural northeast town, Mo Yan’s Frog unmasks how disease and the discourse of scientism in eugenics serve China’s modernity dream and political legitimacy at a critical historical juncture. By comparison, Welty’s regional story brings to the fore gender politics in eugenics, and denounces its role in soothing exacerbating social problems attendant upon the South’s pursuit of modernity. The provocative interlocutions between Welty and Mo Yan on eugenics also open up new and fertile terrains for rethinking community and the politics of identity today.

Barriers in Use of Family Planning Methods among Outpatient Women Seeking Antenatal Care in Tertiary Care Hospitals of Karachi, Pakistan

Objective: To identify the barriers in practicing family planning methods (FPM) among reproductive age group women attending antenatal clinics of two tertiary care hospitals of Karachi Pakistan. Methods: A cross sectional study was conducted in antenatal clinics of Obstetrics Outpatient Department of two tertiary care hospitals of Karachi Pakistan, 450 women of 15-49 years of age were included in the study by consecutive sampling, interviewed by using structured questionnaire after taking the informed consent. The data were entered and analyzed by using SPSS version 21. Frequencies and percentages were calculated, and logistic regression analysis was performed to determine the barriers related to use of family planning methods. Results: The mean age of women was 26.6 with SD 4.6 years. The odds of using FPM by women who received advise of FP in last delivery were 2.9 times more as compared to women who did not receive FP advise (OR=2.9, 95%CI: 2.8- 3.1) in last delivery. The other variables which showed significant association with use of FPM were living in joint family (OR=1.8, 95%CI=1.7-1.9), having more than two female children (OR=3.0,95%CI=1.7-5.3), Husbands' in favor of use of FPM (OR=24.2,95% CI=1.7-5.3), women ever consulted with family planning clinics (OR=7.7, 95%CI=2.3- 26.0), women received antenatal care in last pregnancy (OR=2.1,95%CI=1.3-3.3) and women received post-partum care in last pregnancy (OR=2.7,95%CI=1.5-4.7). Conclusion: Socio-cultural, minimal access, lack of information, husbands' involvement were the major barriers identiied in this study. Antenatal care and family planning counseling can play a major role in uptake of FPM.

How gender and religion impact uptake of family planning: results from a qualitative study in Northwestern Tanzania

BackgroundWomen in Tanzania report a high unmet need for both information about and access to family planning. Prior studies have demonstrated the complex and variable relationship between religious faith and beliefs about family planning in sub-Saharan Africa. We hypothesized that a major reason for the poor uptake of family planning in Tanzania is that women and their partners are uncertain about whether pregnancy prevention is compatible with their religious beliefs.MethodsTwenty-four focus group discussions with 206 participants were conducted in Mwanza, Tanzania between 2016 and 2017: six groups were conducted among Christian men, six among Christian women, six among Muslim men, and six among Muslim women. Among Christians, 98% were Protestants. Focus groups were also divided by gender and religion to facilitate discussion about gender-specific and religion-specific factors influencing family planning utilization. Qualitative data were analyzed using a thematic, phenomenological approach.ResultsWe identify two important themes regarding the intersections of religion and family planning practices. First, we report that dynamics of family planning are experienced differently based on gender, and that male authority conflicts with female embodied knowledge, leading to negotiation or covert contraceptive use. Second, religious acceptability of family planning methods is of central importance, though participants differed in their interpretations of their religion’s stance on this question. Most who found family planning incompatible with their faith affirmed their responsibility to give birth to as many children as God would give them. Others found family planning to be acceptable given their moral responsibility to care for and protect their children by limiting the family size.ConclusionsBoth religious tradition and gender dynamics strongly influence the uptake of family planning, with a wide range of interpretations of religious traditions affecting the perceived acceptability of family planning. Regardless of gender or religious affiliation, participants were unified by a desire to live according to religious tradition. Future efforts to improve uptake of family planning are likely to have maximal impact if they are tailored to inform, involve, and empower male heads of households, and to address questions of religious acceptability.

Awareness and practice of family planning services among married women of reproductive age in a rural municipality of Saptari district, Nepal

Introductions: Unwanted pregnancies and maternal deaths can be avoided by use of family planning (FP) services. Use of modern methods of contraceptive among married women age 15-49 years in Nepal is 43%. Generally, fertility is higher among women in rural areas than in urban. This study aims to assess the awareness and practice of FP services among married women of reproductive age in a Rural Municipality of Saptari district, Nepal. 
 Methods: Cross-sectional study with two stage sampling technique through face-to-face interview using structured questionnaire interview schedule in local language, Maithili, was done to find out awareness and practice regarding FP services in married women of 15-49 years in a Municipality of Saptari district, province 2, Nepal, from April 2018 to March 2019. Descriptive and inferential data analysis done using SPSS version16.0 software. 
 Results: Out of 280 respondents, 257 (91.78%) had adequate awareness regarding FP services, 167 (59.64%) were current FP users, 125 (74.85%) practiced female sterilization and 39 (23.35%) used temporary methods. Common reason for not using temporary FP methods included side effects 103 (90%). Level of awareness regarding FP services was not significantly associated with their practices. 
 Conclusions: Majority of respondents had adequate awareness regarding family planning services but FP practice was low.

Evaluating the impact of community health volunteer home visits on child diarrhea and fever in the Volta Region, Ghana: A cluster-randomized controlled trial.

BackgroundAlthough there is mounting evidence demonstrating beneficial effects of community health workers (CHWs), few studies have examined the impact of CHW programs focused on preventing infectious diseases in children through behavior changes. We assessed the preventive effects of community health volunteers (CHVs), who receive no financial incentive, on child diarrhea and fever prevalence in Ghana.Methods and findingsWe conducted a cluster-randomized controlled trial in 40 communities in the Volta Region, Ghana. Twenty communities were randomly allocated to the intervention arm, and 20 to the control arm, using a computer-generated block randomization list. In the intervention arm, CHVs were deployed in their own community with the key task of conducting home visits for health education and community mobilization. The primary outcomes of the trial were diarrhea and fever prevalence at 6 and 12 months among under-5 children based on caregivers’ recall. Secondary outcomes included oral rehydration treatment and rapid diagnostic testing for malaria among under-5 children, and family planning practices of caregivers. Generalized estimating equations (GEEs) with a log link and exchangeable correlation matrix were used to determine the relative risk (RR) and 95% confidence intervals (CIs) for diarrhea, fever, and secondary outcomes adjusted for clustering and stratification. Between April 18 and May 4, 2015, 1,956 children were recruited and followed up until September 20, 2016. At 6 and 12 months post-randomization, 1,660 (85%) and 1,609 (82%) participants, respectively, had outcomes assessed. CHVs’ home visits had no statistically significant effect on diarrhea or fever prevalence at either time point. After a follow-up of 12 months, the prevalence of diarrhea and fever was 7.0% (55/784) and 18.4% (144/784), respectively, in the control communities and 4.5% (37/825) and 14.7% (121/825), respectively, in the intervention communities (12-month RR adjusted for clustering and stratification: diarrhea, RR 0.73, 95% CI 0.37–1.45, p = 0.37; fever, RR 0.76, 95% CI 0.51–1.14, p = 0.20). However, the following were observed: improved hand hygiene practices, increased utilization of insecticide-treated bed nets, and greater participation in community outreach programs (p-values < 0.05) in the intervention group. In a post hoc subgroup analysis, the prevalence of diarrhea and fever at 6 months was 3.2% (2/62) and 17.7% (11/62), respectively, in the intervention communities with ≥70% coverage and a ≥30-minute visit duration, and 14.4% (116/806) and 30.2% (243/806) in the control communities (RR adjusted for clustering, stratification, baseline prevalence, and covariates: diarrhea, RR 0.23, 95% CI 0.09–0.60, p = 0.003; fever, RR 0.69, 95% CI 0.52–0.92, p = 0.01). The main limitations were the following: We were unable to investigate the longer-term effects of CHVs; the trial may have been underpowered to detect small to moderate effects due to the large decline in diarrheal and fever prevalence in both the intervention and control group; and caregivers’ practices were based on self-report, and the possibility of caregivers providing socially desirable responses cannot be excluded.ConclusionsWe found no effect of CHVs’ home visits on the prevalence of child diarrhea or fever. However, CHV programs with high community coverage and regular household contacts of effective duration may reduce childhood infectious disease prevalence.Trial registrationInternational Standard Randomised Controlled Trial Registry, ISRCTN49236178.

Ideological Diversity and Birth Control Differentials in Pakistan: A Study of Islamabad

Population explosion was not a grave problem in the early days of Islam or in the period of Islamic legislation. Thus, no explicit negation or affirmation of it is available either in the religious texts or in the religious jurisprudence or law. That is why presently the ulema from both the ends  the opponents as well as the proponents of family planning, extract some selective Quranic verses, Ahadith and inferences of jurisprudence in favour of their respective viewpoints. Such diverging views have made the future of family planning programmes doubtful in Pakistan. With this background, the present study shows that in the contemporary situation, it is solely the individual who makes the final decision about approving or disapproving family planning. This decision-making process is influenced by the personal attributes of the practitioners. In order to evaluate these attributes, the researcher has attempted to analyze and highlight the perception of family planning by Muslim residents of Islamabad i.e. the Capital city of Pakistan. The people surveyed are predominantly from different social, geographical and economic backgrounds and from different religious callings, along the sectarian continuum. The researcher’s task has thus been to observe the responses and to point out whether the objective variables i.e. geographical, income and class, occupation and age factors etc. are more significantly associated with knowledge, attitude and practice of family planning or the subjective variables like religion and sect appear to be more important determining factor of family planning practice in a traditional society like that of Pakistan.

Preventable warfarin-induced birth defects: A missed opportunity?

Congenital abnormalities and pregnancy losses due to the teratogenic effects of warfarin are prevalent among the South African population. These are potentially preventable if the challenges and barriers faced by at-risk women are understood and addressed effectively. To determine the practice, knowledge and attitudes regarding the teratogenic risks experienced by women administered warfarin. A descriptive study was performed. Quantitative data were collected through a researcher-administered questionnaire. The target population comprised 101 women of reproductive age who received warfarin treatment and attended a single tertiary-level anticoagulation clinic. Patient-related challenges identified in this study are: language barriers, poor understanding of basic terminology and mathematics, poor contraceptive and family planning practices, lack of knowledge regarding the risks of warfarin in pregnancy and passive attitudes towards information attainment. Interventions are necessary to address the challenges in such settings. These include increased awareness of the teratogenic potential of specific chronic medications among healthcare providers, patients and the public. Standardised management protocols for women of reproductive age initiated on teratogenic medications should be implemented, including contraceptive and family planning discussions at follow-up visits. Improvement of the counselling skills of healthcare providers and the availability of translators or healthcare providers fluent in local languages could assist in risk reduction.

Barriers to Access Reproductive Health Care Services by Urban Women

Introduction: Health care is a continuous care from womb to tomb. Bangladesh has made tremendous achievement in the health sector over the last few decades. Early marriage, perception about pregnancy and high financial cost are the factors for less utilization of health care services. Many other barriers like gender inequality, cultural norms and traditions are important barriers too for seeking reproductive health care services. Objectives: To further unpack the pattern of dynamic social barriers faced by urban women in accessing reproductive health care services, which in turn may assist the service stakeholders to design programs to overcome the barriers.&#x0D; Materials and Methods: This is a descriptive empirical social study was executed in Dhaka city from January 2019 to April 2019. Interviewer administered face to face in depth interview was employed to collect data from 122 samples, estimated by peer review and picked up by haphazard sampling, from among married women of reproductive age 15-45years. Data were analyzed by SPSS 20. Emic and etic interpretation were done on the information generated. All ethical issues were taken care of. Results: The perceived barriers to antenatal, natal, postnatal care and family planning practices were poverty, ignorance and husband non co-operation. As many as 78.7% respondents were house wives, about 71.0% respondent’s age at marriage was 13- 18 years, 36.1% were qualified up to intermediate level, 53.3% are 25-35yrs age group, 80% received antenatal care, 32% gone for home delivery and 68.7% were unwilling for postnatal care services. The present study found that ignorance and poverty were the main reasons for non-utilizing health care facilities.&#x0D; Conclusion: There is scope to improve the utilization of reproductive health care services of urban women. Social and cultural barriers are more common. Health care services are needed to be scaled up and the health education component should be strengthened in health care delivery system to achieve Sustainable Development Goal (SDG).&#x0D; Journal of Armed Forces Medical College Bangladesh Vol.13(2) 2017: 7-10

Exploring How Targeted Regulations of Abortion Providers Affect Training and Practice Location [4A

INTRODUCTION: Targeted Regulations of Abortion Providers (TRAP laws) create variable abortion accessibility by state. We explored how TRAP laws affect where physicians choose to receive family planning training and practice. METHODS: We conducted semi-structured telephone interviews with 25 physicians who provide abortion care across the United States and asked them about their experiences providing care in the recent political climate. Using an iterative qualitative coding process, we detected themes around how political climate and state laws around abortion affected personal preference in location of family planning training and practice. RESULTS: State laws surrounding abortion provision often influenced where providers chose to receive family planning training and practice. Reasons for choosing to train in liberal areas with few TRAP laws include a higher patient load and more opportunity to gain procedural skills. Some providers chose to train in restrictive areas for experience in navigating state laws that limit abortion access. When choosing location of practice, those that chose a hostile environment cited a greater need for abortion providers in restrictive areas. Those who practice in liberal areas often had personal reasons, including safety concern for themselves and their families as well as a desire to work in an environment where state laws do not force providers into practicing substandard care. CONCLUSION: Understanding how state TRAP laws affect location of training and practice of abortion providers creates an opportunity to further analyze what training, supports, and resources can be provided to encourage physicians to practice in underserved areas with restrictive abortion policies.