Contraceptive Practices Research Articles

Women’s Endogenous Bargaining Power and Fertility Preferences: A Collective Model Approach in Pakistan

This study introduces a collective model of fertility decisions (where preferences towards children may differ between couples), by using the Pakistan Demographic and Health Survey (2017-18) data with an instrumental variables (IV) approach. The age and occupational difference between spouses, the wife’s cash earnings relative to husband, wealth quintiles, the beating of a wife by the husband is justified, media exposure, current use of any contraceptive have shown direct and positive impacts on women’s bargaining power. Accounting for the endogeneity of bargaining power, age, education, and occupational difference and their square terms and wife’s cash earnings relative to husband’s cash earnings may use as instruments. The results of IV estimation showed that women’s bargaining power, wealth quintiles, beating of wife by husband are justified, media exposure, current use of any contraceptive, and types of method (modern) came out as highly significant determinants in reducing the husband’s fertility preferences. The findings recommend that improving women’s bargaining power, educational attainment, exposure to the media, and contraceptive practice for achieving desired fertility preferences, are some of the substantial challenges on which policymakers should pay careful consideration in Pakistan.

Knowledge and Practice of Post-partum Contraceptives of Pregnant Patients Attending Khulna Medical College Hospital

Introduction: There should be a gap between pregnancies for the sake of both mother and child. Post-partum contraceptive is required to delay pregnancy after delivery and to pursue family planning. Aim of the study: The aim of this study was to evaluate the knowledge and practice of post-partum contraceptives in pregnant women. Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Khulna Medical College, Khulna, Bangladesh during the period from January 2019 to December 2020. Result: In this study, the mean age was 25.91 years (SD± 4.97 years) ranging between 16-39 years. In this study, most of the pregnant women (69%) did not get any postpartum FP during the hospital discharge. In this study, most of the pregnant women (77%) had ANC in their last pregnancy. In this study, most of the pregnant women (76%) did not get postpartum family planning counseling during ANC checkups. For most of the pregnant women (84%), the resumption of menstruation after the last pregnancy was less than 6 months. In this study, the current pregnancy of most of the study people (76%) was unplanned/unintended. There was no unplanned pregnancy loss (abortion) between last and current pregnancy for most of the pregnant women (80%). For most of the pregnant women (76%), the gap between last and current pregnancy was 1-2 years. In this study, most of the pregnant women (79%) did not have adequate knowledge and practice of contraceptives. Most of the pregnant women (14%) did not use any contraceptive due to a lack of knowledge. Followed by 10% did not use due to ignorance, 4% did not use due to irregular meetings with husband and 3% did not use as the family did not allow. In this study, most of the pregnant women (31%) did not use any method for postpartum contraceptives after the last pregnancy. Followed by, 20% used POP, 17% used condom, 15% used OCP, 10% used injection, 3% used PPIUD, 3% used LAM and 1% used implant. Conclusion: Most pregnant women do not have adequate knowledge and practice of contraceptives. Most pregnant women do not use any post-partum contraceptives. Women, using post-partum contraceptives, prefer POP, condoms, and OCP. The husband is the decision-maker for contraceptive usage in most cases.

Contraceptive Awareness and Practices in Patients With Rheumatic Diseases Using Disease Modifying Anti-Rheumatic Drugs

Objective: To determine the contraceptive awareness and practices in patients with rheumatic diseases using disease modifying anti-rheumatic drugs.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Outpatient of Rheumatology, Department at Pakistan Institute of Medical Sciences, Islamabad Pakistan, from Jan to Apr 2021.
 Methodology: Patients with any rheumatic disease and taking teratogenic disease modifying anti-rheumatic drugs were included in the study. Patients were asked about if they were counseled regarding the risk of teratogenicity with the antirheumatic drugs and when to stop the drug before pregnancy.
 Results: Out of total 150 patients, 87 (58.0%) female patients had Rheumatoid arthritis and 26 (17.3%) had Systemic lupus erythematosus. The majority of female patients (104, 69.3%) were using Methotrexate and 21 (14.0%) females were using Leflunomide. Only 53 (35.3%) females were counseled about drug teratogenicity. Most of the female patients (102, 68.0%) were never counseled about the use of contraception while taking anti-rheumatic drugs. The rate of use of contraceptives was even worse and merely 15 (10.0%) females were using contraceptives.
 Conclusion: Majority of the patients with rheumatic diseases being treated with teratogenic disease modifying anti-rheumatic drugs, were not using any form of contraception. The rate of contraceptive use and counseling regarding contraceptives was noted to be very low.

Marriage Without Meaningful Consent and Compromised Agency in Married Life: Evidence From Married Girls in Jharkhand, India

PurposeMarriage without meaningful consent persists in India, yet early marriage programs have rarely addressed consent, and research on the practice and its consequences for married life is limited. This study explores how consent in marriage decisions affects married life, specifically, agency, gender attitudes, spousal communication, contraception, and marital violence outcomes. MethodsA subset of 1991 married girls and young women was drawn from a 2018 state-representative survey of adolescents and youth aged 15–21 years in Jharkhand. We compared outcomes between those in self-arranged marriages (n = 392), those in semi-arranged marriages who were acquainted with their husbands before marriage (n = 612), and those in fully parent-arranged marriages with no premarital contact (n = 995). Logistic regression analyses identify associations between marriage decision-making and outcomes of interest, controlling for confounding sociodemographic factors. ResultsCompared with girls whose marriages were self-arranged, those in both fully parent- and semi-arranged marriages were less likely, respectively, to make household decisions (odds ratios [OR], .37 and .60), hold egalitarian gender role attitudes (OR, .48 and .66), uphold girls' rights (OR, .41 and .48), communicate with their husbands (OR, .48 and .64), and practice contraception (OR, .51 and .67). Those in fully family-arranged marriages also had less freedom of movement (OR, .64) and were less likely to express self-efficacy (OR, .64). Marital violence was unrelated to marriage arrangements. ConclusionsSelf-arranged marriage is associated with more positive outcomes than family-arranged ones, including semi-arranged ones, but marriage arrangements are unrelated with marital violence. Findings reaffirm the need to breakdown prevailing patriarchal norms and promote girls' right to meaningful, “free and full consent”.

Improving effective contraception uptake through provision of bridging contraception within community pharmacies: findings from the Bridge-it Study process evaluation

ObjectiveTo present process evaluation results from the Bridge-it Study, a pragmatic cluster randomised cross-over trial to improve effective contraception uptake through provision of the progestogen only pill (POP) plus sexual...

Women’s knowledge and practices of modern contraceptives in rural Jammu

Background: India was the first country in the world to adapt a national population control program in 1952. So, it is important for couples and society as a whole to understand and adopt the methods of family planning. Use of contraceptives can prevent at least 25% of all maternal deaths by preventing unintended pregnancies and unsafe abortions and also protect against sexually transmitted infections.Methods: A cross-sectional study was conducted in the women of the reproductive age group (15-49 years) in gynae OPD of community health centre of block Bishnah in district Jammu.Results: The study was conducted in 408 women of the reproductive age group. Almost all the women had knowledge of various spacing methods, maximum being for being for oral contraceptive pills (OCPs) (96%), followed by intrauterine contraceptive devices (IUCD) (93.8%) and 90.9% for condoms. However, they had less knowledge about injectable contraceptives (13.9%).Conclusions: Family planning related knowledge was found to be very encouraging with two-third having a positive attitude as well. Main identified reasons for contraceptive defaults were unsustain availability, side-effects, need of a child and family opposition. It is hence, important to improve education of women to overcome barriers to modern contraceptive methods.

Quantitative and qualitative impact of One Key Question on primary care providers’ contraceptive counseling at routine preventive health visits

ObjectivesOne Key Question (OKQ) is a clinical screening tool to assess pregnancy desire in the next year. We aimed to 1) describe the effect of OKQ implementation on contraceptive counseling rates at preventive health visits and 2) evaluate primary care providers’ perception of OKQ implementation on their contraceptive counseling practices. Study designWe performed a quantitative retrospective chart review of preventive health visits at eight federally qualified health centers in Utah between 2014 and 2017. Implementation of OKQ included a brief training and inclusion of OKQ in the electronic medical record. Providers received OKQ training in August 2015 and re-training in March 2017. We assessed OKQ and contraceptive counseling documentation rates using interrupted-time-series analysis. We then conducted semi-structured interviews with providers and queried them about the impact of OKQ. We identified dominant themes using modified grounded theory to create an explanatory framework. ResultsAbstracting 6634 charts yielded 9840 visits with 56 unique providers (51% physician assistant, 34% physician, 14% nurse practitioner). Interrupted-time-series analysis showed a documentation increase of OKQ in late 2015 (2.6%) and again in spring 2017 (9%), however rates remained low. Contraceptive counseling rates (39.7%) did not change after OKQ implementation. Charts with evidence of a current contraceptive method were less likely to have a OKQ response documented. Interviewees reported OKQ's algorithm did not alter their contraceptive counseling. ConclusionsOKQ did not change documented rates of contraceptive counseling and uptake was low in quantitative and qualitative analyses. Our study suggests limited usefulness of OKQ in the primary care setting. ImplicationsImplementation of the One Key Question tool through training and optional EHR field did not increase documented rates of contraceptive counseling in a large federally qualified health center or affect provider contraceptive counseling. Our study suggests limited usefulness of OKQ as a robust screening tool in this primary care setting.

Contraception knowledge and practices among women in Peshawar

Background: Contraception is an integral component for addressing the population emergency faced by resource deprived third-world countries like Pakistan but studies in this regard are lacking. Aims and Objectives: This study was conducted to assess the knowledge and practice of contraception among women in Peshawar. Materials and Methods: This cross-sectional prospective observational study was carried out from March 2020 to November 2021. All women of reproductive age were included in the study. Biodata, socio-economic status (SES), reproductive data, knowledge and practice of contraception were collected from a total of 1260 women during the study period. Results: One thousand two hundred and sixty females of reproductive age visiting the hospital were studied. Regarding reproductive health and contraception 431 (34.2%) had no knowledge and 415 (32.9%) had wrong information. Only 387 (30.7%) patients had correct information about fertility window, 447 (35.5%) had erroneous knowledge about it and 426 (33.8%) were completely uninformed about it. 609 (48.3%) patients were of low SES. 617 (49%) patients were motivated for contraception while 643 (51%) rejected it. 377 (29.9%) patients used no method for contraception, 398 (31.6%) used injectables while the remaining methods included; 225 (17.9%) implants, 68 (5.4%) natural withdrawal and 67 (5.3%) intrauterine contraceptive device. Conclusions: The study population lacked or had inadequate knowledge about reproductive health and contraception. Further, studies should be carried out for a wider understanding of the lack of contraceptive knowledge and practices to control the ballooning population growth and the lack of reproductive and contraceptive health services and practices.

ASSESSMENT OF FACTORS AFFECTING CONTRACEPTION UTILIZATION AMONG PREPARATORY SCHOOL STUDENTS IN GONDAR TOWN, AMHARA REGION, ETHIOPIA

Objective: The study was aimed to assess factors affecting contraception utilization among preparatory school students in Gondar town, Amhara region, Ethiopia. Methods: An institutional-based cross-sectional study design was employed. A multistage sampling procedure was employed in the study area. The data were entered, clean and analysis using statistical package for social science (SPSS) version 16 software. Descriptive, bivariate, and multivariate analyses were employed. Multivariate analysis with 95% confidence interval (CI) was computed to identify factors associated with contraception service utilization at p<0.05. Results: The response rate of this study was 97%. The result showed that 90.4% of study participants knew about contraception services utilization. However, the practice of contraception was only 24% (95% confidence interval (CI): (20.8%-27.4%). Based on the finding of multivariate analysis among explanatory variables, age, media exposure, marital status, and ever had girl or boyfriends were significantly associated with contraception services utilization. Conclusion: Interventions are needed to improve adolescent sexual and reproductive health such as promote parent adolescent communication, strengthening of youth centers, working with community and religious leaders, and increase the accessibility of services which are important to encourage adolescent contraception service utilization.

Reproductive Health Issues and Assessment of Knowledge, Attitude and Practice (KAP) on Family Planning (FP) among Rohingya Female Refugees

Introduction: Reproductive health issues are responsible for one-third of health problems among women. Having lack of access to contraception is one of the major risk factors. Woman refugees often face discrimination and they have limited access to basic needs including healthcare. These have caused an increase to the woman’s reproductive health issues. Objectives: Along with identifying the reproductive health issues, this study aims to evaluate family planning (FP) through assessment of three components of knowledge, attitude and practice. Methodology: This study is a cross-sectional study involving Rohingya female refugees attending the Islamic Medical Association of Malaysia (IMAM) Response and Relief Team (IMARET) Mobile Clinic in Selayang, Selangor, Malaysia. Data collection was done through questionnaires with the help of trained translators. Results and Discussions: Reproductive health issue has a minor and negative correlation with all three domains of Knowledge, Attitude and Practice of family planning, (r = -0.11, r = -0.22, and r = -0.18, p > 0.05) respectively. Out of 86 respondents only (n = 7, 8.1%) had at least one reproductive health issue, whereas none reported having sexually transmitted diseases. The most common reproductive health issues reported were pre-eclampsia and gestational diabetes (n = 5, 71.4% respectively). Knowledge on contraception methods was poor in the Rohingya female refugees while the practice of contraceptive in this study was only 33.7%. Among the contraception methods used, almost half (n = 15, 51.7%) have used contraceptive pills followed by injection (n = 8, 27.6%), whereas the least practiced method was condoms (n = 2, 6.9%). This study finds that 57% of the respondents had positive attitudes towards family planning. Majority (n = 53, 61.6%) agreed on the use of contraception to control birth interval and more than half of the respondents (n = 54, 62.8%) said that the benefit of contraception outweighs the negative effects. Conclusion: Limited knowledge and practice of contraception methods were found among the Rohingya female refugees, however, majority showed positive attitude on family planning. In conclusion, there is urgent need to improve the family planning education among the Rohingya female refugees to increase practice of contraceptives. This study is of guiding significance for improving the reproductive health of refugee women, but there are still some problems in the article, which need to be revised.

Attitude, Practice, and Factors Affecting Contraceptive Use among Women Attending Postnatal Care in a Tertiary Health Facility in Jos North LGA, Plateau State, Nigeria

The high population growth rate has been associated with the increased level of poverty, morbidity, mortality, and decreased life expectancy. Modern contraception is an important factor in controlling fertility through prevention of unintended and unwanted pregnancies. Contraception (birth control) prevents pregnancy by interfering with the normal process of ovulation, fertilization, and implantation. Contraceptive use is still very low in Nigeria and Sub-Saharan Africa (SSA), where the levels of fertility and unmet need for family planning are high. The attitude of women toward contraception will usually affect the practice and utilization of contraceptives. The objective of this study is to assess the attitude, prevalence, and factors affecting contraceptive use among women attending Postnatal care in a tertiary health facility in Jos North L. G. A Plateau State, Nigeria. There was a descriptive cross-sectional study done between September to October 2019, with a sample size of 250 women. Respondents were determined using a multi-stage sampling method. Data collection was done using an interviewer-administered, pre-tested, structured questionnaire. The data was collected, entered, and analyzed using IBM Statistical package for social sciences (SPSS) version 20.0. Most women have a positive attitude 162 (64.8%) toward contraception while 88 (35.2%) had negative attitude toward contraception. Three quarters (75.2%) of women are willing to use contraception. The prevalence of contraceptive use among respondents was 35.6% while the prevalence of previous use of contraceptives among the respondents was 71.2%. Fifty (27.9%) used condom (barrier method), 40 (22.9%) used withdrawal method. Majority of the other respondents were spread across OCPs, injectables and implants. Major factors affecting the use of contraceptives were majorly attributed to informed choice with 60.1%, Partner’s decision (44.1%) and mild or no adverse reaction (12.8%). While major factors preventing use were lack of interest in 69.4%, partners’ decision in 14.9% and fear of side effects 12.5% of respondents. Respondents showed a wide acceptance of family planning services as majority of them see it as beneficial and are willing to go for another method after current pregnancy.

An exploratory survey regarding the Maryland Contraceptive Equity Act: clinician awareness and impact on contraception provision

ObjectiveThe Maryland Contraceptive Equity Act took effect in January 2018 with the goal of reducing insurance barriers to contraception. We sought to assess the Act's impact on contraceptive provision. Study DesignFrom March-August 2019, we emailed an exploratory survey to clinicians providing contraception in Maryland that queried awareness of the Act and changing practices. ResultsThe survey had a 13% response rate (164/1256 clinicians). Fifty (31%) were aware of the Act. Clinicians rated the Act was somewhat likely to change prescribing practices (3.5/5 point Likert Scale, SD 1.3). ConclusionThe majority of clinicians providing contraception in Maryland are not aware of the Act. If aware of the Act, clinicians may change their contraceptive prescribing practices.

POSB233 Factors Affecting Contraceptive Use and Unmet Need for Family Planning Among HIV Positive Women in a Resource Restricted Setting

Resource restricted settings have less access to health care services. Women living with HIV have relatively lower contraceptive prevalence rate and higher unmet need for family planning as compared to general population. This study assessed contraceptive practices and factors affecting contraceptive use and unmet need for family planning among women living with HIV of reproductive age in a resource restricted setting.

Knowledge, Attitudes of Pregnant Women and Practices of Women Who Have Recently Given Birth on Contraception in the Immediate Postpartum Period at Principal Clinic of the Togolese Association of Family Well-Being Planning Center (ATBEF)

Background: The use of modern contraceptive methods contributes to the reduction of maternal and neonatal mortality. The initiation of a contraceptive method in the immediate postpartum period is one of the strategies to avoid missing out on contraceptive opportunities. This strategy will reduce the unmet need for contraception which is still high in the country. Objective: To describe the knowledge and attitudes of pregnant women and the practices of women who have given birth about immediate postpartum contraception. Methodology: This was a cross-sectional and descriptive study conducted at the main clinic of ATBEF from 20th March to 20th October 2020. Our study included pregnant women whose gestational age was greater than or equal to 37 weeks of amenorrhea who came for prenatal consultation or for any other consultation and then gave birth in the center. Data collection was based on a survey form. Data analysis and entry was done with the Epi info 2000 version 6.04 software. The parameters studied were: socio-demographic characteristics, knowledge and attitudes of pregnant women about contraception in the immediate postpartum period, and contraceptive practices of the women who gave birth. Results: During the study period, 201 women were selected for the survey. The average age of the respondents was 26.2 years. They were nulliparous in 41.3% of cases. Our respondents had knowledge of modern contraceptive methods in 82.10% of cases. About 59.2% of the respondents had an unfavourable attitude towards the adoption of contraceptive methods in the immediate postpartum period. The main reason was adverse effects in 33.6%. Of the 82 women who had a favourable attitude, 29 women had adopted a contraceptive method after delivery, which corresponds to a rate of use of 14.4% of the respondents. The main reason for non-adoption of a contraceptive method after childbirth for those who had a favourable attitude was the opposition of the husband in 34%. Conclusion: Couple counselling during prenatal and postnatal care and intensified awareness raising on planning and ideal spacing of pregnancies for health will increase the number of contraceptive users in the immediate postpartum period.

Knowledge and Practices of contraceptives in married women population; A cross sectional survey from Lahore, Pakistan

Background: About one third of all pregnancies are unplanned and 20% of all pregnancies end n abortion and to cope with this problem nearly all general practitioners provide contraceptive advice. Objectives: A cross sectional study was conducted in the OPD of Gynae and Obstreitics unit of Shama hospital, Government hospital Kot Khawaja Saeed, Ganga Ram , Rasheed latifand Farooq hospital from December 2017-March 2018 to determine the knowledge and practice of contraceptive utilization in married women of Lahore.
 Method: This study was carried out among 308 married women between the ages 17-50 years by administering a well-developed and validated questionnaire. Data was analyzed by using SPSS version 16.
 Results: Study results showed about 85% of participants have knowledge about contraceptives and 19.1% were aware about the ADR’S of contraceptives. The main source of information identified was health care providers (62.2%) and television (37.4%). The most commonly used contraceptives were oral contraceptive pills 36.1%, followed by condoms, injectable, IUD’s and barrier method. Known uses of contraceptives were 41.5% and the major reason for known use were prohibition by religion (23.8%) followed by lack of knowledge, economic problems and other reasons such as opposed by family members.
 Conclusion: The study shows low use of contraceptives despite high level of awareness. It highlights the need to motivate people for effective and appropriate use of contraceptives and to avoid the unwanted pregnancies and abortions.

A Cross Sectional Study to Assess the Knowledge, Attitude and Practice of Contraceptive Methods among Postpartum Women, Kanchipuram, Tamil Nadu, India

Background: Family planning programmes exist to protect the welfare of the mother and child and in turn, care about the welfare of the family. Irrespective of socioeconomic status or place of residence every member of the country should have access to the right contraceptive method. Unplanned pregnancies have serious implications on both the mother’s and child’s morbidity and mortality. It can affect the health of a family as a whole.
 Objectives: To estimate the awareness of different contraceptive methods, its identify factors affecting it’s usage and assess the pattern of usage.
 Materials and methods: In this cross-sectional study, knowledge, attitude and practice of contraceptive methods among postpartum women were assessed using a structured questionnaire. Sample size was 330 and analysis was done through CHI square test.
 Results: Majority of the participants were between the ages of 20 and 30 years. Most of the participants (96%) were aware of at least one contraceptive method.
 Conclusion: Family planning is vital to the health and proper functioning of a family.

Assessment of the Social Factors Affecting the use of Contraceptives and the Stigma Associated

The factors affecting the use of contraceptives and social stigma associated with it has caused significant uncontrolled growth of population, which is the most important problem with developing countries like India. The only effective way of controlling population explosion is through promotion and practice of contraception and family planning. To assess the social factors affecting the use of contraceptives and the stigma associated with it. To assess basic knowledge about contraceptive methods and relationship between knowledge of contraceptives and formal education; Compare knowledge and use of contraceptives in rural and urban populations, different occupational categories and economic statuses; Determine the major source of information about contraceptives in different age groups and to assess reasons for using and not using contraceptives. The research indicated that, still a significant percentage of population do not have proper knowledge, have hesitancy in buying, hesitancy in discussing contraceptive methods. Significant portion of the study group is not using contraceptive methods to prevent STDs or for practicing birth spacing. Low socioeconomic status was associated with not using any form of contraception among women with unintended pregnancies. We have received maximum responses from females (67.0%); from males (33.0%). We have received maximum response from undergraduates (41.2%) and least from people with no formal schooling (4.6%). Educational interventions can help increase knowledge of available contraceptive methods, enabling individuals to make informed decisions and use contraception more effectively. Health education may help overcome the issues related to social stigma on the use of contraceptives and family planning. Keywords: Contraceptives, Family planning, Knowledge, Social stigma

Contraceptive Access at Federally Qualified Health Centers During the South Carolina Choose Well Initiative: A Qualitative Analysis of Staff Perceptions and Experiences

Introduction: Federally qualified health centers (FQHCs) provide essential contraceptive services to low-income individuals; yet, access to all method options, notably intrauterine devices (IUDs) and implants, may be limited at non-Title X FQHCs. The South Carolina (SC) Choose Well initiative is a statewide contraceptive access initiative that was launched in 2017 and extends into 2022. Choose Well established a collaborative network between training and clinical partners and is aimed at facilitating implementation of contraceptive care best practices through capacity-building and training of clinical and administrative staff in partner organizations. The initiative provided funding for workforce expansion and contraceptive methods. We examined perceptions of staff from Choose Well-participating FQHCs regarding contraceptive access during the first 2 years of the initiative, including factors that facilitated or posed access challenges as well as sustaining factors. This study informs the process evaluation of Choose Well while providing data critical for uncovering and scaling up contraceptive access initiatives.Materials and Methods: Interviews were conducted with FQHC staff (n = 34) in 2018 and 2019 to assess Choose Well implementation and were recorded, transcribed, and double-coded via at least 80% interrater reliability or consensus coding. Data were analyzed according to clinical and administrative factors influencing contraceptive access.Results: Increased capacity for contraceptive counseling and provision through training and external funding for IUDs and implants were the most noted clinical factors facilitating access. Streamlining workflow processes was also a facilitator. Buy-in and engagement among staff and leadership emerged as a facilitator at some clinics and as a barrier at others. Policy/structural factors related to costs of devices and insurance coverage were identified as threats to sustainability.Conclusions: The Choose Well initiative contributed to the perception of an increase in contraceptive access at participating FQHCs in SC. Statewide contraceptive access initiatives have the potential to support FQHCs in meeting their clients' contraceptive needs. Organizational buy-in, sustainability of funding, and training are key to realizing the full potential of these initiatives.

Postpartum contraceptive practices among urban and peri-urban women in North India: a mixed-methods cohort study protocol

BackgroundPostpartum family planning (PPFP) helps women space childbirths, increase exclusive breastfeeding and prevent unintended pregnancies, leading to reduction in maternal, infant and child morbidities and mortality. Unmet need of family planning is highest among women in the postpartum period due to lack of knowledge, cultural and religious barriers, access barriers and low antenatal care service utilization. However, in spite of low prevalence of postpartum family planning practices, birth-to-birth interval is reportedly high in Delhi, India. This study explores the postpartum contraception practices and the relationship between use of postpartum contraception and subsequent child linear growth.MethodsThis is a mixed method cohort study on PPFP and is nested within an ongoing “Women and Infants Integrated Interventions for Growth Study” (WINGS). Married women aged 18–30 years who have delivered a live baby are recruited for quantitative interviews at 6 weeks, 6, 12, and 24 months postpartum. In-depth interviews are conducted with a randomly selected sub-sample of women at each of the four time points, 35 husbands and 20 local service providers to understand their perspectives on PPFP practices.DiscussionThe findings from the study will provide useful insights into couples’ contraception preferences and choice of contraception, modern and traditional, initiation time and the effect of birth spacing and contraception use on subsequent linear growth of the child. This knowledge will be of significant public health relevance and will help in designing appropriate interventions for appropriate postpartum contraception use and delivery strategies. The study aims to work address the Sexual and Reproductive Health and Rights goal of promoting reproductive health, voluntary and safe sexual and reproductive choices for women.Trial registrationTrial registration number: CTRI/2020/03/023954.

Missed opportunities in contraceptive counselling: findings from a European survey-based study with simulated patient consultation

Purpose Available evidence highlights unmet needs in contraceptive counselling practices. This study aimed to understand current practises and clinician behaviour across Europe. Methods A novel, online approach was used to simulate contraceptive counselling discussions based on three, predefined patient types with a hidden need: poor compliance (patient X), headaches (Y) or desire for a hormone-free option (Z). Clinicians were asked to provide guidance about a contraceptive method for their randomly assigned patient at two time points: (1) after a simulated discussion, (2) after seeing a full patient profile. Descriptive statistical analyses included evaluation of the clinicians’ counselling approach and a change in contraceptive recommendation thereof. Results Out of 661 clinicians from 10 participating European countries, including obstetricians/gynaecologists, midwives and general practitioners, most failed to uncover patient X and Y’s hidden needs (78.8% and 70.5%, respectively), whereas, 63.4% of clinicians uncovered patient Z’s hidden need. Clinicians who uncovered their patients’ hidden needs asked significantly more questions than those who did not (range of mean, 5.1–7.8 vs 1.5–2.2 respectively). Clinicians were more likely to recommend a change of prescription after seeing the full patient profile than after the simulated discussion (increase in prescription change, range: 12.3–30.2%), indicating that clinicians rely on patients speaking up proactively about any concerns. Conclusions Insufficient existing counselling practices result in missed opportunities for shared decision-making and discussion. Clinicians and contraceptive counselling services should empower women by introducing more in-depth contraceptive counselling, incorporating clear, open-ended questions, to improve patient adherence and enhance reproductive planning.