We run a one-stop clinic for HIV-positive women, offering sexually transmitted infection screening, cervical cytology and family planning. We completed an audit cycle, and showed that all aspects of our care had improved since the introduction of this integrated service.

While the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides numerous benefits to many enrolled families across the United States, including access to nutritious foods, some recent drops in maternal participation in Kentucky resulted from failures to retrieve those benefits. We explored perceived benefits of and encountered barriers to food benefit retrieval. Journey mapping included direct observations of client appointments, clinic lobby areas, and a shopping experience and was augmented with focus groups conducted in two urban and two rural areas. Major touchpoints before WIC appointments, during those appointments at clinics, and after appointments when redeeming food benefits were identified. Across touchpoints, mothers identified childcare, transportation issues, long waits, confusion regarding eligibility, problems scheduling appointments, and stigma as barriers to their ability to retrieve food instruments. Despite these barriers mothers value the benefits of WIC, especially access to healthy foods, infant formula, and nutrition education. This work demonstrates a method by which WIC mothers’ experiences shed light on client service shortfalls and possible opportunities to improve client services.

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Background Establishing effective postnatal contraception is essential for HIV-seropositive women to avoid the risk of unwanted pregnancy and minimise HIV transmission to HIVseronegative partners. The authors describe their experience of providing postnatal contraception to HIV-seropositive women who attend a community-based integrated sexual health clinic.Methods The authors performed a retrospective case note review of all women who received care for HIV in pregnancy to term at their clinic from September 2000 to October 2010. Results A total of 107 pregnancies among 95 women were eligible for review. Attendance for contraceptive advice within 4 weeks of delivery occurred in 82/107 (77%) pregnancies. DepoProvera® was prescribed in 21 (21/82, 26%) cases; an intrauterine contraceptive was arranged in 22/82 (27%) cases and sterilisation had occurred as part of a Caesarean delivery in 10/82 (12%) cases. In seven women who discontinued antiretroviral therapy at delivery one subdermal implant was fitted and the combined contraceptive pill was prescribed six times. In 17/ 82 (21%) cases women opted to use condoms alone. Attendance for postpartum contraceptive advice was missed following 21/107 (20%) pregnancies. Conclusions Uptake of a second contraceptive method in addition to condoms is high among women who attend clinic for contraceptive advice in the immediate postnatal period. However, 20% of women did not attend and their contraceptive choices remain unknown. These women are at risk of unwanted pregnancy and transmission of HIV to seronegative partners if appropriate contraceptive methods are not reestablished postpartum.

There has long been interest in the possible relationship between oral contraceptive (OC) use and diabetes mellitus. In 1991, we reported our findings (in this Journal) on 45 women who had been referred to hospital for diabetes during follow-up in the Oxford-Family Planning Association (Oxford-FPA) contraceptive study. No association was found with OC use. 1 We nonetheless thought it would be of interest to comment briefly on the findings for this disease up to the time that individual follow-up of the study participants ceased in July 1994 (follow-up of cancer registrations and death notifications is still continuing).The Oxford-FPA study methods have been described in detail elsewhere. 2 In brief, the study includes 171032 white women who, when recruited between 1968 and 1974, were married and aged between 25 and 39 years. At entry, 56% were using OCs, 25% a diaphragm and 19% an intrauterine device. These women (save for certain subgroups -see Vessey and Painter 3 ) were followed up annually and information was collected about changes in contraceptive methods, pregnancies and their outcome, hospital referrals and deaths. Women who at entry to the study reported that they were suffering from diabetes were excluded from the present analyses. There were 81 cases remaining. Only the first hospital referral (inpatient or outpatient) was taken into account in the analyses.As expected, hospital referral was strongly positively related to age and body mass index (BMI). In addition, referral was three times as common in women of lower social class (IV-VI) as in women of upper social class (I-II), a difference only partly explained by BMI. Analyses of hospital referral rates in relation to OC use were therefore adjusted for age, BMI and social class.Our first analysis compared women ever using OCs with those never doing so. The rate ratio was 0.8 with a 95% confidence interval (CI) ranging from 0.5 to 1.3. Rate ratios for hospital referral in relation to total duration of OC use were as follows (95% CIs are given in parentheses): never used, 1.0 (reference category); 1-48 months, 0.9 (0.3-2.1); 49-96 months, 0.7 (0.3-1.7); 97-144 months, 0.9 (0.5-1.7); 145 months or more, 0.6 (0.2-1.6). Corresponding rate ratios in relation to interval since last use of OCs were as follows: never used, 1.0 (reference category); current-48 months, 0.7 (0.3-1.4); 49-96 months, 0.7 (0.3-1.7); 97-144 months, 0.6 (0.2-1.5); 145 months or more, 1.5 (0.7-2.8). The data were too few to enable analyses to be done by type of OC, but it should be noted that preparations containing 50 µg oestrogen made up 67% of OC exposure. OCs containing a greater amount of oestrogen provided only 2% of exposure.We recognise the shortcomings of our data, which include the small number of affected women and the associated fact that only those referred to hospital with diabetes were identified. Nonetheless we believe that our case finding has been unbiased with respect to OC use. Furthermore, as we have pointed out previously, 1 if such a bias existed it might be...