Postpartum sterilization choices made by HIV-infected women.

OBJECTIVE: To assess if HIV-infected women made different choices for postpartum sterilization after implementation of the Pediatric AIDS Clinical Trials Group protocol 076 (November 1, 1994) compared to before implementation. STUDY DESIGN: A retrospective cohort study in which medical records were reviewed to obtain demographic, obstetric and HIV-related data from January 1993 through December 2002. HIV-infected women who completed a pregnancy by birth or abortion were divided into two comparison groups: "Pre-076" and "Post-076". The primary outcome was sterilization by postpartum tubal ligation.Results. Forty-two women (74%) in the Pre-076 group chose sterilization compared to 139 of 310 women (45%) in the Post-076 group (unadjusted OR 3.44, 95% CI 1.83, 6.47). Seventy-one percent of women younger than 21 years of age in the Pre-076 Group chose sterilization compared with only 35% of women younger than 21 years in the Post-076 group (p = 0.0136). Similarly, 78% of primiparous women chose sterilization after their first pregnancy in the Pre-076 group, compared to 14% in the Post-076 group (p < 0.001). CONCLUSIONS: Since the implementation of PACTG 076 protocol in November 1994, fewer HIV-infected women chose postpartum sterilization. The typical woman who now chooses postpartum sterilization is less likely to be young or primiparous than those who chose sterilization before PACTG Protocol 076 implementation

Feasibility of postpartum placement of the levonorgestrel intrauterine system more than 6 h after vaginal birth

The objective of this study was to determine the feasibility of postpartum LNG-IUS placement on the postpartum ward

A high cholecystectomy rate in a cohort of Mexican American women who are postpartum at the time of oral contraceptive pill initiation

Opinions differ regarding the association between gallbladder disease and oral contraceptive (OCs). The objective of this paper is to quantify cholecystectomy rate among women initiating OCs

Intrauterine Device Placement During Cesarean Delivery and Continued Use 6 Months Postpartum: A Randomized Controlled Trial

To compare intrauterine device (IUD) use at 6 months postpartum among women who underwent intracesarean delivery (during cesarean delivery) IUD placement versus women who planned for interval IUD placement 6 or more weeks postpartum

Drug interactions between hormonal contraceptives and antiretrovirals

To summarize published evidence on drug interactions between hormonal contraceptives and antiretrovirals

Evaluation of service quality in family planning clinics in Lusaka, Zambia

To determine the quality of contraceptive services in family planning clinics in Lusaka, Zambia using a standardized approach

Effect of HIV status on fertility desire and knowledge of long-acting reversible contraception of postpartum Malawian women

The objectives of this study were to describe the most recent pregnancy intentions and family planning preferences of HIV-infected and HIV-uninfected postpartum Malawian women, and to assess whether HIV status is associated with fertility desire and knowledge of intrauterine contraception (IUC) and the subdermal contraceptive implant. We conducted a cross-sectional analysis of the baseline characteristics of Malawian women enrolled in a prospective cohort study assessing postpartum contraceptive uptake and continuation. Women at a government hospital completed a baseline survey assessing reproductive history, family planning preferences, and knowledge of IUC and the implant. We used Pearson's chi-square tests to compare these parameters between HIV-infected and HIV-uninfected women. Modified Poisson regression was performed to assess the association between HIV status and fertility desire and knowledge about IUC and the implant. Of 634 postpartum women surveyed, HIV-infected women were more likely to report their most recent pregnancy was unintended (49% versus 37%, p=0.004). Nearly all women (97%) did not want a child in the next two years but HIV-infected women were more likely to desire no more children (adjusted PR: 1.59; 95% CI: 1.33, 1.89). HIV-infected women were also less likely to know that IUC (adjusted PR 0.72; 95% CI: 0.61, 0.84) and the implant (adjusted PR 0.83; 95% CI: 0.75, 0.92) are safe during breastfeeding. Postpartum women strongly desire family spacing and many HIV-infected postpartum women desire no more children, suggesting an important role for these long-acting methods. Education about the efficacy and safety of IUC and the implant particularly during breastfeeding may facilitate postpartum use

Scientists' warning to humanity on illegal or unsustainable wildlife trade

Illegal or unsustainable wildlife trade is growing at a global level, threatening the traded species and coexisting biota, and promoting the spread of invasive species. From the loss of ecosystem services to diseases transmitted from wildlife to humans, or connections with major organized crime networks and disruption of local to global economies, its ramifications are pervading our daily lives and perniciously affecting our well-being. Here we build on the manifesto 'World Scientists' Warning to Humanity, issued by the Alliance of World Scientists. As a group of researchers deeply concerned about the consequences of illegal or unsustainable wildlife trade, we review and highlight how these can negatively impact species, ecosystems, and society. We appeal for urgent action to close key knowledge gaps and regulate wildlife trade more stringently.Peer reviewe

Association between contraceptive implant knowledge and intent with implant uptake among postpartum Malawian women: a prospective cohort study

Abstract Background Long-acting reversible contraception (LARC) can assist women with birth spacing and reduce unintended pregnancies. Sub-Saharan Africa has low uptake of the two available methods of LARC, the subdermal implant and intrauterine contraception (IUC). Our primary objectives were to: 1) calculate the incidence of LARC use among postpartum Malawian women, and 2) assess if LARC knowledge and intent to use LARC were associated with LARC uptake. Methods This study was a prospective cohort study of 634 postpartum women who were recruited from the postpartum ward of Bwaila Hospital in Lilongwe, Malawi. Study participants completed a baseline survey in the postpartum ward. Follow-up telephone surveys about contraceptive use were conducted at 3, 6, and 12 months postpartum. Cox proportional hazards regression analysis was performed to evaluate if implant knowledge and intent to use implant were associated with implant uptake. Results One hundred thirty-seven implant and 10 IUC placements were reported over 12 months of follow-up; given the low rate of IUC uptake, further analysis was only done for implant uptake. The incidence rate for implant uptake was 35.6 per 100 person-years (95 % CI 30.0, 42.2). Correct implant knowledge (adjusted HR = 1.69; 95 % CI 1.06, 2.68) and intent to use implant (adjusted HR 1.95; 95 % CI 1.28, 2.98) were both associated with implant uptake. Conclusions More women reported implant use than IUC use in our study. Correct implant knowledge and intent to use implant were both associated with implant uptake, with a stronger association for intent. Interventions to increase LARC uptake should focus on improving LARC knowledge and removing barriers to LARC. Trial registration Clinical Trial Registration #: NCT0189302

Contraceptive adherence among HIV-infected women in Malawi: a randomized controlled trial of the copper intrauterine device and depot medroxyprogesterone acetate

To evaluate contraceptive adherence to the copper intrauterine device (Cu-IUD) and the injectable depot medroxyprogesterone acetate (DMPA) among women with HIV in Lilongwe, Malawi