Task Shifting/Sharing on Contraceptive Counselling Services between Midwives and Physicians A Randomized Control Trial in Kisumu County, Kenya

Introduction: Unsafe abortion, led to 120,000 Kenyan women receiving Post Abortion Care (PAC) in 2012. 70% of those women, had not used  contraceptives before pregnancy. The aim of the study was to determine if post abortion contraceptive counselling could be shared between  physicians and midwives in Kisumu County, Kenya. Methodology: A total of 128 women were included in this cohort study that was nested in a larger randomized controlled trial, whereby women  sought PAC at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) and Kisumu County Hospital (KCH) from October 2015 to September 2017. The 128 women were randomly assigned to a midwife or a physician for contraceptive counselling. Then a follow up after 7–10 days or three months. Associated factors for contraceptive uptake, contraceptive method choice, adherence, and satisfaction level, were analyzed using chi square, Fishers exact test , IBM SPSS Statistics for Windows, Version 22.0. Results: In the study, there was no difference between midwives (98.5%) and physicians (93.5%) in providing contraceptive counselling to post abortion women. 95.3% of the participants accepted while 4.7% did not accept use of contraceptives. The most commonly used contraceptive  method after counselling was hormonal injection at 39%. After 3-months follow-up 79.7% retained the chosen contraceptive method while 20.3% had changed the usual type of contraception and 3.9% had stopped using contraceptives. Among the respondents who still used a method, 96.1% were satisfied with the chosen methods, with no difference between midwifes and physicians (p=0.799). Parity had significant influence on contraceptive uptake and adherence (p= 0.000.). Conclusion: Post abortion seeking women were satisfied with contraceptive counselling they received regardless of whether the provider was a  midwife or a physician. The result emphasizes that physicians task sharing of contraceptive counselling with midwives is conceivable, with possibilityfor physicians focusing on more complicated cases. Keywords: Contraceptive counselling, Contraceptive uptake, Post Abortion Women, Midwives, Physicians, Kenya

Post Abortion Women’s Perception On Contraceptive Counselling Provided By Service Providers: A Qualitative Study In Kisumu County, Kenya

Background: Contraceptive Counselling is the process in which service providers engage with Patients to help them identify a suitable  contraceptive method and in a follow up interaction until the effectiveness of the process is achieved. Establish good rapport between the service providers and the recipients. Contraceptive uptake among post abortion patients is affected by the perception the women have on contraceptive counselling by the service providers. Contraceptive knowledge is high and its usage is low among post abortion patients. Aim: The main aim of this study was to explore how patients seeking post abortion care perceived contraceptive counselling provided by service providers in Kisumu County, Kenya. Methodology: A sample of 20 post abortion patiens participated in the In-depth interviews where open ended questions with probes were used to collect data. The interviews were conducted in two facilities, Jaramogi Oginga Odinga Teaching and Referral Hospital and Kisumu East DistrictHospital (Kisumu County Hospital) (both in Kisumu County, Kenya). The interviews were recorded and verbally transcribed. NVivo version 11 was used to sort out the data. Thematic analysis was used to analyse data. The sorted data was coded and structured in nine themes with regard to quality of care in contraceptive services. Choice of contraceptive method, information provided to recepients, interpersonal relationship, continuityand follow up, technical competence, affordability of contraceptive services, partner preference, myths and misconceptions, suggestions and concerns was emphasized. Results: The patients were able to obtain information about the various methods of contraception enabling them to make informed choices as a result of the discussions with the service providers. The good interpersonal relationship of the service providers with the respondents establishedgood rapport and reduced the stigma. Respondents were now able to revisit clinics after abortion without fear and contraceptives provided free of charge after discussions with the respondents who felt comfortable using them. Partners were important in contraceptive decision making, suchthat those who had partners found it easy to decide. Conclusion: The Respondents perceived contraceptive counselling positively indicating the friendliness of the service providers that made them feel confident with the contraceptive counselling and comfortable to discuss abortion with them. Respondents did not like the term abortion because itdemoralized them. Keywords: Contraceptive counselling, Contraceptive experience, Missed  Opportunities, Contraceptive Uptake, Physicians and Midwives, Post  Abortion Car

Knowledge, Practices, and Restrictions Related to Menstruation among Young Women from Low Socioeconomic Community in Mumbai, India.

The main objective was to assess knowledge, practices, and restrictions faced by young women regarding their menstrual hygiene. The views of adult women having young daughters were also included and both views were compared. In addition, the factors influencing the menstrual hygiene practices were also studied. The study was carried out during 2008 in Mumbai, India. The mixed methods approach was followed for the data collection. Both qualitative and quantitative methods were used to collect the data. For quantitative survey, totally 192 respondents (96 adult and 96 younger women) were selected. While young women were asked about questions related to their menstruation, adult women were asked questions to find out how much they know about menstrual history of their daughters. The qualitative data helped to supplement the findings from the quantitative survey and to study the factors affecting menstrual practices in young women. The mean age at menarche reported was 13.4 years and 30-40% of young girls did not receive any information about menstruation before menarche. It is thus seen that very few young girls between the age group 15 and 24 years did receive any information before the onset of menstruation. Among those who received some information, it was not adequate enough. The source of information was also not authentic. Both young and adult women agreed on this. Due to the inadequate knowledge, there were certain unhygienic practices followed by the young girls resulting in poor menstrual hygiene. It also leads to many unnecessary restrictions on young girls and they faced many health problems and complaints, which were either ignored or managed inappropriately. The role of health sector was almost negligible from giving information to the management of health problems of these young girls. This paper reemphasizes the important, urgent, and neglected need of providing correct knowledge to the community including adolescent girls

"I did not plan to have a baby. This is the outcome of our work": a qualitative study exploring unintended pregnancy among female sex workers.

BACKGROUND: High number of unintended pregnancies-often leading to induced abortions-are reported among female sex workers (FSWs), highlighting a major unmet need for contraception. To better understand barriers to contraceptive use, we explored FSW's pregnancy perceptions and experiences of unintended pregnancy. We hypothesized that sex work exacerbates barriers to contraceptive use and that FSW's pregnancy perceptions and experiences of unintended pregnancy influence future commitment to contraceptive use. METHODS: We conducted in-depth interviews with 11 FSWs (January-June 2019) in Dar es Salaam, Tanzania. We purposively sampled FSWs with a positive pregnancy test from those participating in a HIV vaccine preparedness cohort. We used open ended questions to explore how FSWs make decisions when facing barriers to contraceptive use, dealing with unintended pregnancy and adhering to contraceptive use after experiencing unintended pregnancy. All interviews were conducted in Kiswahili, audio-recorded, transcribed and translated into English. Grounded theory approach was used to analyse transcripts. Open and selective coding was performed using Nvivo software. RESULTS: FSWs reported that sex work impedes good contraceptive behaviour because sex workers felt unable to negotiate consistent condom use, avoided health services due to stigma, missed monthly contraceptive supplies because of inconvenient clinic operating hours or skipped contraceptive pills when intoxicated after taking alcohol. FSWs who perceived pregnancy to be a burden terminated the pregnancy because of fear of loss of income during pregnancy or child rearing expenses in case child support was not assured by their partners. FSWs who perceived pregnancy to be a blessing decided to keep the pregnancy because they desired motherhood and hoped that children would bring prosperity. Family planning counselling and availability of contraceptives during postpartum care influenced the initiation of contraception among FSWs. Financial hardships related to childrearing or painful abortion experiences influenced FSWs' commitment to good contraceptive practices. CONCLUSION: Our results demonstrate that FSWs face barriers to initiating and adhering to contraceptive use because of sex work stigma, inability to negotiate condoms and failure to access medical services at their convenience. Our findings underscore the need to integrate contraceptive services with HIV programs serving FSWs in their areas of work

Quality of Care in Contraceptive Services Provided to Young People in Two Ugandan Districts: A Simulated Client Study

BACKGROUND: Low and inconsistent use of contraceptives by young people contributes to unintended pregnancies. This study assessed quality of contraceptive services for young people aged 15-24 in two rural districts in Uganda. METHODS: Five female and two male simulated clients (SCs) interacted with 128 providers at public, private not-for-profit (PNFP), and private for profit (PFP) health facilities. After consultations, SCs were interviewed using a structured questionnaire. Six aspects of quality of care (client's needs, choice of contraceptive methods, information given to users, client-provider interpersonal relations, constellation of services, and continuity mechanisms) were assessed. Descriptive statistics and factor analysis were performed. RESULTS: Means and categorized quality scores for all aspects of quality were low in both public and private facilities. The lowest quality scores were observed in PFP, and medium scores in PNFP facilities. The choice of contraceptive methods and interpersonal relations quality scores were slightly higher in public facilities. Needs assessment scores were highest in PNFP facilities. All facilities were classified as having low scores for appropriate constellation of services. Information given to users was suboptimal and providers promoted specific contraceptive methods. Minority of providers offered preferred method of choice and showed respect for privacy. CONCLUSIONS: The quality of contraceptive services provided to young people was low. Concurrent quality improvements and strengthening of health systems are needed

Care seeking behaviour and barriers to accessing services for sexually transmitted infections among female sex workers in Laos: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Prompt, correct diagnosis and treatment with health information are essential components of reproductive tract infection (RTI) and sexually transmitted infection (STI) services. This study aims to describe care seeking behaviour and barriers to accessing RTI/STI services among female sex workers (FSWs) in Laos.</p> <p>Methods</p> <p>A cross-sectional survey using closed and open-ended questions was performed in six districts along Road 9, traversing Savannakhet province from Thailand to Vietnam. In total, 407 FSWs were interviewed. The data were analyzed and presented descriptively. Multiple logistic regression analysis was applied to assess associations between respondents' background characteristics and care seeking behaviour.</p> <p>Results</p> <p>About half of the respondents (49%) were less than or equal to 19 years of age, and 50% had started or completed secondary school. Fifty-eight percent had been engaged in sex work for less than 1 year. Eighty-six percent of the respondents reported RTI/STI signs or symptoms currently or in the last 3 months but only two-thirds of those with symptoms sought treatment. Source of treatment for the last RTI/STI episode was the drop-in centre (53%) followed by a public hospital (23%), private clinic (12%), private pharmacy (9%), and herbalist (2%). The main barriers to service use were long waiting time, inconvenient location of the clinic, not knowing where to get the services needed, and negative attitudes among healthcare providers. Care seeking behaviour was associated with longer duration of sex work (OR = 2.6, 95%CI 1.52-5.36). Forty-four percent received health information from peer educators, 34% from fellow friends, 26% from a pimp, and 26% had received information from a healthcare provider during the visit.</p> <p>Conclusion</p> <p>There were several barriers to accessing RTI/STI services and they were related to both structural and individual factors. Innovative STI service strategies to inform FSWs about the importance of early diagnosis and treatment should be established. Continuous training for STI service providers focusing on counseling skills and awareness of the sexual health care needs for FSWs is recommended in order to minimize the barriers experienced by FSWs in this particular setting.</p

Constraints and prospects for contraceptive service provision to young people in Uganda: providers' perspectives

<p>Abstract</p> <p>Background</p> <p>Unintended pregnancies lead to unsafe abortions, which are a leading cause of preventable maternal mortality among young women in Uganda. There is a discrepancy between the desire to prevent pregnancy and actual contraceptive use. Health care providers' perspectives on factors influencing contraceptive use and service provision to young people aged 15-24 in two rural districts in Uganda were explored.</p> <p>Methods</p> <p>Semi-structured questionnaires were used for face- to-face interviews with 102 providers of contraceptive service at public, private not-for-profit, and private for-profit health facilities in two rural districts in Uganda. Descriptive and inferential statistics were used in the analysis of data.</p> <p>Results</p> <p>Providers identified service delivery, provider-focused, structural, and client-specific factors that influence contraceptive use among young people. Contraceptive use and provision to young people were constrained by sporadic contraceptive stocks, poor service organization, and the limited number of trained personnel, high costs, and unfriendly service. Most providers were not competent enough to provide long-acting methods. There were significant differences in providers' self-rated competence by facility type; private for-profit providers' competence was limited for most contraceptives. Providers had misconceptions about contraceptives, they had negative attitudes towards the provision of contraceptives to young people, and they imposed non-evidence-based age restrictions and consent requirements. Thus, most providers were not prepared or were hesitant to give young people contraceptives. Short-acting methods were, however, considered acceptable for young married women and those with children.</p> <p>Conclusion</p> <p>Provider, client, and health system factors restricted contraceptive provision and use for young people. Their contraceptive use prospects are dependent on provider behavior and health system improvements.</p