Association of Partner Support and Partner Communication with Provider Prescribed Contraceptive Method Use among Heterosexual Couples in Kisumu, Kenya

We explored partner support and communication factors associated with provider prescribed contraceptive (PPC) use to inform contraception  interventions among heterosexual couples in Kenya. From April 2014 through September 2016, 252 community recruited couples in Kisumu, Kenya, were enrolled. Men and women were surveyed separately and asked about communication regarding sexual/reproductive health and relationship characteristics. PPC use was defined as female reported use of pills, injection, implant, IUD, or tubal ligation. Multivariable Poisson regression with robust variance estimate was used to identify factors associated with PPC. In multivariable modeling, women who reported discussing the future of their relationship with their partner were 2.46 (95% CI: 1.13-5.36) times more likely, and men who reported discussing condom use were 0.83 (95% CI: 0.72-0.95) time less likely, to report PPC use. These findings call for greater attention to involving male partners, incorporating communication skills, and relationship characteristics into interventions in our and similar settings.  Keywords: Family planning, male involvement, reproductive health, agency, Africa Nous avons exploré le soutien des partenaires et les facteurs de communication associés à l'utilisation de contraceptifs prescrits par le fournisseur (PPC) pour informer les interventions de contraception auprès des couples hétérosexuels au Kenya. D'avril 2014 à septembre 2016, 252 couples recrutés par la communauté à Kisumu, au Kenya, étaient inscrits. Les hommes et les femmes ont été interrogés séparément et interrogés sur la communication concernant la santé sexuelle / reproductive et les caractéristiques des relations. L'utilisation du CPP a été définie comme l'utilisation déclarée par les femmes de pilules, d'injection, d'implant, de DIU ou de ligature des trompes. Une régression de Poisson multivariable avec une estimation de variance robuste a été utilisée pour identifier les facteurs associés au CPP. Dans la modélisation multivariable, les femmes qui ont déclaré discuter de l'avenir de leur relation avec leur partenaire étaient 2,46 (IC à 95%: 1,13-5,36) fois plus susceptibles, et les hommes qui ont  déclaré discuter de l'utilisation du préservatif étaient 0,83 (IC à 95%: 0,72-0,95). Moins susceptibles de signaler l'utilisation du PPC. Ces résultats appellent à une plus grande attention à l'implication des partenaires masculins, à l'intégration des compétences en communication et des caractéristiques relationnelles dans les interventions dans notre environnement et dans des environnements similaires. Mots-clés: Planification familiale, implication masculine, santé reproductive, agence, Afriqu

Postpartum Healthcare Use Between Two Deliveries and Severe Maternal Morbidity, Michigan, 2009-2015

Severe maternal morbidity (SMM) represents a group of life-threatening conditions of labor and delivery that have short and long-term implications. Current efforts focus on reducing SMM during acute events. Very little research has examined whether postpartum healthcare may complement current efforts. Postpartum healthcare, which includes attending a postpartum visit and receiving contraception, is important for addressing health needs, connecting individuals to needed specialty care and other preventive care such as a well-woman visit, and helping individuals achieve an optimal inter-pregnancy interval. However, there is a dearth of literature on whether postpartum healthcare use differs by SMM-status, whether postpartum healthcare use is associated with reduced risk of subsequent SMM, and whether history of SMM is associated with a change postpartum healthcare use across two deliveries. This study included Michigan residents with at least one, and a subset of individuals with at least two sequential, Medicaid-paid deliveries between October 1, 2009 and September 30, 2015. Data were from maternally linked birth records and Medicaid billing claims. SMM was identified from delivery claims using International Classification of Diseases, 9th Revision, Clinical Modification codes for 16 diagnoses and 5 procedures recommended by the Centers for Disease Control and Prevention. Postpartum healthcare included postpartum visit attendance with or without receipt of most or moderately effective contraception identified in billing claims. Postpartum visit attendance used the Healthcare Effectiveness Data and Information Set’s performance measure. In analysis, either multinomial or binary logistic regression was conducted to calculate predicted margins to generate either risk or rate ratios and 95% confidence intervals. Multivariable models were built using LASSO. Almost half of individuals with at least one Medicaid-paid delivery did not attend a postpartum visit, and postpartum healthcare use did not differ by SMM during delivery. About one-third of individuals with at least two sequential Medicaid-paid deliveries did not attend a postpartum visit after either delivery. Repeat SMM including transfusion was associated with a significantly higher probability of not attending a postpartum visit after either delivery. However, postpartum healthcare use, more specifically attending a postpartum visit and receiving contraception, was associated with a lower rate of subsequent SMM

Learning from Graduate and Undergraduate Public Health Virtual Internship Experiences with State Title V Agencies During COVID-19, Summer 2020

Background: Since summer 2014, the National MCH Workforce Development Center has placed students from MCH public health graduate (Centers of Excellence and Catalyst) and undergraduate (MCH Pipeline) programs, all funded by the Maternal and Child Health Bureau, in summer internships with state and territorial Title V agencies. In 2020, due to the COVID-19 pandemic the Title V MCH Internship Program was offered virtually. Participants and methods: This manuscript includes quantitative and qualitative data from 2017 to 2020 generated by both Title V MCH Internship student interns (n = 76) and their preceptors (n = 40) with a focus on a comparison between the 2020 virtual year and the 2017-2019 years. Results: Evaluation data from the 2017 to 2020 Title V MCH Internship Program from both students and preceptors revealed the implementation of a robust and successful internship program in which students increased their confidence in a variety of team, mentorship, and leadership skills while gaining direct exposure to the daily work of state Title V agencies. However, students and preceptors identified more challenges during 2020 compared to previous years. Conclusions: The COVID-19 Pandemic was both a disruption and a catalyst for change in education. While there were clearly some challenges with the pivot to a virtual Title V MCH Internship Program in summer 2020, students were able to participate in meaningful internship experiences. This success can be attributed to the ability of the internship sponsor to engage in best practices, including extensive planning and provision of ongoing support to the students. Going forward, it is recognized that virtual internships may facilitate access to agencies in distant locales, eliminating issues related to housing and transportation. When both virtual and in-person relationships are available, those responsible for internship programs, including the Title V MCH Internship, will need to weigh these type of benefits against the potential missed opportunities students may have when not able to participate in on-site experiences