Impact of counselling on selecting a hormonal contraceptive method

Abstract

INTRODUCTIONUnmet need for family planning is an important indicator for assessing the demand for family planning services. As per the national family health survey (NFHS-4), the contraceptive prevalence rate in women age 15-49 years was 53.5 % and the unmet need for family planning among married women was 12.9 %. The contraceptive usage patterns vary widely in India with prevalence of modern contraception reported to be 47.8 %, which ABSTRACTBackground: Unmet need for family planning is an important indicator for assessing the demand for family planning services. As per NFHS-4, the contraceptive prevalence rate in women age 15-49 years was 53.5 % and the unmet need for family planning among married women was 12.9%. Counselling provides the Health care professionals (HCPs) an opportunity to understand the individual need of a contraceptive seeker. Methods: This was a cross-sectional, observational study conducted at GMERS hospital, Valsad during June 2017 to October 2017. Sexually active women of 18 to 40 years who consulted HCPs for contraception and who interested in starting hormonal contraceptive method or expressed interest in switching (changing) to hormonal methods were included in the study. Total 213 women were enrolled in the study. Questionnaires with information on the women's pre-and post-counseling contraceptive choice, her perceptions, and the reasons behind her post-counseling decision were filled both by the HCP and the participating women. The completed questionnaires were collected and analyzed. Results: During pre-counseling, most common hormonal contraceptive method selected by women was combined hormonal contraceptive pills followed by DMPA, LNG-IUS and POPs. In present study, structured contraception counseling helped most women (97.2 %) to choose a contraceptive method. There were statistically significant differences in choice of contraceptive methods during pre and post-counseling except COCs. Among hormonal contraceptive methods, maximum difference was observed for choice of the COCs after counseling as compared to pre-counseling. Counseling helped more than 90% of the women who were indecisive to choose any contraceptive method. More than three fourth of them opted for hormonal methods with a maximum selection of COCs. The most common reasons for selecting COCs was ease of use for COC, breast feeding for POP and the most common reasons for not choosing other available contraceptive methods was discussion with partner. Conclusions: The combined hormonal contraceptive pills were reported to be the most commonly used contraceptive method. There were statistically significant differences in choice of contraceptive methods during pre and postcounseling with maximum difference in COCs. Counseling helped most of the women who were indecisive to choose any contraceptive method.

A retrospective analysis of maternal mortality in an urban tertiary care hospital

“…Various other studies also showed that maximum deaths were due to direct cause but Sreekumari et al in their study found that indirect cause predominated and amounted to 50.49% while direct causes accounted for 42.57% deaths. 4,6,[8][9][10]13,14 In our study, direct obstetric deaths (73.68%) include deaths from haemorrhage 29.47%, PIH 28.42%, sepsis 9.47% and thromboembolism 6.31%. Even today, a large number of maternal deaths is due to the classical triad of haemorrhage, PIH and sepsis.…”

“…5 Patel et al observed a higher mean MMR of 413.3/100,000 live births. 6 In More than half (70.52%) of maternal deaths occurred in post-partum period and included 36.84% deaths after vaginal delivery and 33.68% deaths after LSCS. Antenatal women constituted 29.46% of all maternal deaths and included 10.52% of early pregnancy deaths (septic abortions and ectopic deaths).…”

Determinants and prevalence of modern contraceptive use among sexually active female youth in the Berekum East Municipality, Ghana

“…Despite the benefit of family planning and contraceptive, uptake of contraceptives among adolescents is affected by numerous socio-cultural and demographic factors [15,16] which includes cultural beliefs, peer influence, religion, and fear of side effects [17,18] father's educational background and prior discussion of contraceptive use with a partner [19,20] age of adolescent, education, work status, knowledge of ovulatory cycle, visit of health facility, non-youth-friendly health services and marital status [21,22] spouses or partners made the decision for them to utilize contraception [23]. Other health-related factors reported includes counselling on contraceptive and health provider attitudes [24,25].…”