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The promotion of intrauterine contraception in low- and middle-income countries: a narrative review
Context
The contribution of copper-bearing intrauterine devices (IUDs) to overall contraceptive protection has declined in many countries, despite their well-known advantages. In response, initiatives to promote this method have been undertaken.
Objective
To review and interpret the experience of interventions to promote use of IUDs in low- and middle-income countries in order to provide strategic guidance for policies and programs.
Methods
We conducted a systematic search of Medline, Popline, Embase and Global Health electronic databases for relevant journal papers, reports and gray literature since 2010. Telephone interviews were held with two donors and six international family planning organizations.
Results
We identified a total of 31 publications. Four reported the results of randomized control trials and three were derived from quasi-experiments. The majority were based on service statistics. Eight publications concerned interventions for HIV-positive women or couples, nine for postpartum or postabortion cases and 14 for general populations. Intervention approaches included vouchers, franchising of private practitioners, mobile outreach services, placement of dedicated staff in high-volume facilities and demand creation. Most publications adduced evidence of a positive impact and some reported impressively large numbers of IUD insertions. Results to date on the uptake of IUDs in postpartum interventions are modest. There is also almost no evidence of effects on IUD use at national levels. Implant uptake generally exceeded IUD uptake when both were offered.
Conclusion
The evidence base is weak and offers few lessons on what strategies are most effective. The overall impression is that IUD use can be increased in a variety of ways but that progress is hampered by persistent adverse perceptions by both providers and potential clients. Provider enthusiasm is a key to success. The lack of a population impact stems in part from the fact that nearly all interventions are initiated by international organizations, with limited national reach except in small countries, rather than by government agencies
Théorie de l'esprit et compréhension de l'ironie chez les enfants entendants et malentendants
Irony is a complex form of language, that requires pragmatic and cognitive skills to be understood. For children, this ability emerges around the age of 6, and it seems to be related to the theory of mind. For deaf children, whom the theory of mind appears later than hearing children, irony could be more difficult to understand. We have made the hypothesis that hearing children would understand irony better than hearing impaired children, and that this understanding would be linked to the theory of mind. We have tested 10 deaf children's and 9 hearing children's understanding of irony with a story completion test, where they had to choose a literal or ironic ending, their theory of mind with tasks from the NEPSY-II, and we have controlled their language skills with the test É.CO.S.SE. Our results have confirmed our first hypothesis that hearing children's understanding of irony would be better than deaf children. However, we cannot conclude on our second hypothesis, in the absence of significant result. This study confirms the importance attached to the pragmatic disorders in deaf children, because these disorders can only slow their reduced social interactions.L'ironie est une forme de langage complexe, qui nécessite des capacités pragmatiques et cognitives pour être comprise. Chez les enfants, cette compréhension émerge vers l'âge de 6 ans et elle semble être liée à la théorie de l'esprit. Pour les enfants malentendants, chez qui la théorie de l'esprit apparaît plus tardivement que chez les enfants entendants, l'ironie pourrait être plus difficile à maîtriser. Nous avons émis l'hypothèse que les enfants tout-venants seraient de meilleurs compreneurs de l'ironie que les enfants malentendants, et que cette compréhension serait liée à leur capacité de théorie de l'esprit. Nous avons testé, pour 10 enfants malentendants et 9 enfants entendants, la compréhension de l'ironie, avec une épreuve de complétion d'histoires pour lesquelles ils devaient choisir un dénouement littéral ou ironique, et la théorie de l'esprit, avec des tâches issues de la batterie de tests NEPSY-II. Nous avons contrôlé leurs capacités langagières avec les tâches de l'épreuve É.CO.S.SE. Nos résultats confirment bien notre première hypothèse selon laquelle les enfants entendants seraient plus performants que les enfants malentendants ; en revanche, nous ne pouvons conclure quant à la seconde hypothèse, faute de résultat significatif. Ce travail confirme l'importance à accorder aux troubles pragmatiques chez les enfants malentendants, ces troubles pragmatiques ne pouvant que freiner leurs interactions sociales déjà limitées