Ethical considerations in women's sexual and reproductive health care

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Ethics in Perinatal Medicine

Background: The current trend in perinatal medicine addresses the challenge posed to newborn survival by newborn prematurity and other morbidities requiring neonatal newborn intensive care. These ethical concerns span through the spectrum of education, clinical practice and research, domicile in obstetrics and neonatology. Effective application of ethics to perinatal medicine requires basic knowledge bioethics in health care and medical research.Objectives: The objective of the article is to highlight the basic aspects of ethics, review research ethics and practical ethical issues in perinatal medicine and provide an analytical application of the principles involved in bioethics.Methodology: A search for the relevant literature available on the internet, journal publications, textbooks and monographs was conductedResult: The basics of ethics span through the definition of medical ethics, ethical codes and bioethics. It also includes the various bioethical orientations (historical, duty-based, utilitarian, feminist, casuistry, communitarian and virtue orientation), together with the guiding principles of modern bioethics and their levels of application (micro-ethical, macro-ethical, meso-ethical and mega-ethical level). Research ethics developed tremendously during the 20th century and it was boosted by a number of regulations such as Nuremberg code, CIOMS, Helsinki declaration, Belmont Report and the Nigerian National Code of Health Research Ethics. Ethics in perinatal medicine focus on medical decision making and foeto-maternal conflict as well as the concept of a foetus as a patient and medical futility. It includes prenatal diagnosis and interventions for severe congenital malformations of the foetus, safe mother hood and cord blood collection and newborn care.Conclusion: Bioethics is an important component of perinatal medicine. The consideration and application of bioethics in all aspect of perinatal medicine will undoubtedly improve the quality of care for obstetric patients and their newborn infants

Adolescent and pre-pregnancy nutrition in Nigeria

Good nutrition during adolescent and pre-pregnancy period is critical towards a healthy pregnancy and normal birth weight infant. This article is a review of Adolescent and pre-pregnancy nutrition in Nigeria. Undernutrition in adolescent girls aged 15–19 years in Nigeria has been variously reported to range between 23% and 57.8%. Undernutrition was more prevalent among the rural compared to the urban adolescent, and was attributable more to socio-economic, and dietary factors. A high proportion of energy amongst adolescent, was derived from carbohydrates such as rice, yam, and cassava. Proteins were derived mainly from legumes and pulses, while fats were derived mainly from palm and vegetable oil. Iron was mainly of plant origin and had low bioavailability due to the presence of absorption inhibitors – tannins and phytates. A high levels of vitamin A was prevalent due to consumption of red palm oil. Undernourished adolescent girl and pre-pregnant women are likely to give birth to undernourished infants with the risk of transmitting undernutrition to the future generation. The recommendation towards the implementation of adolescent and pre-pregnancy nutrition in Nigeria include – The establishment of a countrywide school-based nutrition programme; Integration of Nutritional counselling with primary health care services, targeting out of school adolescents; Development of dietary guidelines and IEC materials on nutrition; and Establishment of Preconception clinic to counsel women on family planning and appropriate diet as well as monitor their body weight prior to pregnancy.Key words: Adolescent; Nigeria; nutrition; pre-pregnancy

Pain Relief in Postabortion Care Practiced by Healthcare Professionals in South Eastern Nigeria

Background: Postabortion care (PAC) is aimed at reducing maternal morbidity and mortality resulting from the incomplete abortion and abortion complications. The use of analgesia is an integral part of high quality PAC. Knowledge of the pattern of use of analgesia in PAC by healthcare professionals would help in planning group specific training programs for more effective PAC. Aim: This study is aimed at assessing the use of analgesia in PAC among healthcare professionals in South Eastern Nigeria.Subjects and Methods: This is a cross‑sectional questionnaire‑based survey carried out among healthcare professionals in Anambra State, Nigeria between June 1 and September 30, 2006.  Participants were chosen using a multistage sampling technique. Pretested questionnaires assessing the practice of postabortion counseling were then administered. The data were analyzed using SPSSversion 20.0 software. Frequencies were within 95% confidence limits.Results: A total of 437 health professionals were included in the study. The mean age was 38.2 (10.4) years. Formal PAC training influenced the use of analgesia positively (P < 0.001). The use of analgesia in PAC was also significantly higher among professionals working in tertiary healthcare center and private specialist hospitals when compared with other facilities (P = 0.02). In general complications were more when analgesia was not employed. Older professionals were more likely to employ pain relief in PAC (P = 0.01). Furthermore, doctors were significantly more likely to employ pain relief in PAC when compared to nurses (P = 0.001).Conclusion: This study revealed a low level of use of analgesia in PAC among the healthcare  professionals. It also demonstrated a significant association between formal PAC training and use ofanalgesia in PAC. It is, therefore, recommended that increased PAC training and re‑training activities with emphasis on the need for analgesia should be conducted for healthcare professionals to improve the quality of PAC received by clients.KEY WORDS: Pain relief, post abortion care, Nigeri

Women's sexual health and contraceptive needs after a severe obstetric complication ("near-miss"): a cohort study in Burkina Faso

BACKGROUND: Little is known about the reproductive health of women who survive obstetric complications in poor countries. Our aim was to determine how severe obstetric complications in Burkina Faso affect reproductive events in the first year postpartum. METHODS: Data were collected from a prospective cohort of women who either experienced life threatening (near-miss) pregnancy-related complications or an uncomplicated childbirth, followed from the end of pregnancy to one year postpartum or post-abortum. Documented outcomes include menses resumption, sexual activity resumption, dyspareunia, uptake of contraceptives, unmet needs for contraception and women's reproductive intentions.Participants were recruited in seven hospitals between December 2004 and March 2005 in six towns in Burkina Faso. RESULTS: Reproductive events were associated with pregnancy outcome. The frequency of contraceptive use was low in all groups and the method used varied according to the presence or not of a live baby. The proportion with unmet need for contraception was high and varied according to the time since end of pregnancy. Desire for another pregnancy was highest among near-miss women with perinatal death or natural abortion. Women in the near-miss group with induced abortion, perinatal death and natural abortion had significantly higher odds of subsequent pregnancy. Unintended pregnancies were observed mainly in women in the near-miss group with live birth and the uncomplicated delivery group. CONCLUSIONS: Considering the potential deleterious impact (on health and socio-economic life) of new pregnancies in near-miss women, it is important to ensure family planning coverage includes those who survive a severe complication

Litigations and the Obstetrician in Clinical Practice

The expectation of obstetrics is a perfect outcome. Obstetrics malpractice can cause morbidity and mortality that may engender litigation. Globally, increasing trend to litigation in obstetrics practice has resulted in high indemnity cost to the obstetrician with consequent frustration and overall danger to the future of obstetrics practice. The objective was to review litigations and the Obstetrician in Clinical Practice, highlighting medical ethics, federation of gynecology and obstetrics (FIGO’s) ethical responsibility guideline on women’s sexual and reproductive health and right; examine the relationship between medical ethics and medical laws; X‑ray medical negligence and litigable obstetrics malpractices; and make recommendation towards the improvement of obstetrics practices to avert misconduct that would lead to litigation. Review involves a literature search on the internet in relevant journals, textbooks, and monographs. Knowledge and application of medical ethics are important to the obstetricians to avert medical negligence that will lead to litigation. A medical negligence can occur in any of the three triads of medicare viz: Diagnosis, advice/counseling, and treatment. Lawsuits in obstetrics generally center on errors of omission or commission especially in relation to the failure to perform caesarean section or to perform the operation early enough. Fear of litigation, high indemnity cost, and long working hours are among the main reasons given by obstetricians for ceasing obstetrics practice. Increasing global trend in litigation with high indemnity cost to the obstetrician is likely to jeopardize the future of obstetrics care especially in countries without medical insurance coverage for health practitioners. Litigation in obstetrics can be prevented through the Obstetrician’s mindfulness of its possibility; acquainting themselves of the medical laws and guidelines related to their practice; ensuring adequate communication with, and consent of patients during treatment together with proper and correct documentation of cases. The supervision of resident‑in‑training, development and implementation of obstetrics protocol, and continuing medical education of obstetricians are also important factors to the prevention of litigation in obstetrics.Keywords: Clinical practice, Litigation, Obstetricia

Perceptions and Practices on Menstruation Amongst Nigerian Secondary School Girls

This Cross-sectional descriptive study was conducted amongst 550 secondary school girls in southeastern Nigeria to determine their perceptions, problems, and practices on menstruation. Majority of the students, (75.6%), were aged 15-17 years. Only 39.3% perceived menstruation to be physiological. Abdominal pain/discomfort, (66.2%), was the commonest medical problem encountered by the respondents, although 45.8% had multiple problems. Medical problems were most commonly discussed with the mother, (47.1%), and least commonly discussed with the teachers, 0.4%. Analgesics, (75.6%), were most commonly used to relieve menstrual pain. Only 10% of respondents used non-pharmacologic remedies. Unsanitary menstrual absorbents were used by 55.7% of the respondents. Menstruation perceptions are poor, and practices often incorrect. A multi-dimensional approach focusing on capacity building of mothers, and teachers on sexuality education skills; using religious organizations as avenues for sexuality education; and effectively using the Mass Media as reproductive health education channels are recommended towards improving adolescents\' perceptions and practices on menstruation.Keywords: Perception and practice, menstruation, Nigerian school-girlsAfrican Journal of Reproductive Health Vol. 12 (1) 2008: pp. 74-8

Impact of Reproductive Health on Socio-economic Development: A Case Study of Nigeria

The link between reproductive health, sexual and reproductive right, and development was highlighted at the International Conference on Population and Development held in Egypt. Developmental disparities are related to socio-economic differences which have led to the identification of distinct socio-economic classifications of nations. Human development represents the socioeconomic standing of any nation, in addition to literacy status and life expectancy. Africa accounts for 25% of the world’s landmass but remains the world’s poorest continent. Nigeria, the most populous country in Africa, has policies and programmes geared towards the improvement of its socio-economic standing and overal development, with little positive result. Reproductive health is a panacea towards reversing the stalled socio-economic growth of Nigeria as evident from the linkage between reproductive health and development, highlighted in Millennium Development Goals 3, 4, 5 and 6. Fast tracking Nigeria’s development requires implementation of reproductive health policies and programmes targeted on women and children (Afr J Reprod Health 2011; 15[1]: 7-12)