Harrison Margo S, Goldenberg Robert L
Columbia University Medical Center, New York, NY USA.
622 W 168th St, PH 16-29, New York, NY 10032 USA.
Matern Health Neonatol Perinatol. 2017 Dec 22;3:24. doi: 10.1186/s40748-017-0063-z. eCollection 2017.
Globally, data show that many women of reproductive age desire to use modern family planning methods. Many of these women do not have access to modern contraceptives, which is termed their 'unmet need' for contraception. In low- and middle-income countries where total fertility rates can be high and many women have undesired fertility, or wish to increase their inter-pregnancy intervals, access to modern contraceptives is often inadequate. The puerperium is a unique time for interventions to offer modern contraceptive methods. Having just given birth, women may desire contraceptives to prevent short-interval pregnancy, or further pregnancy, altogether. In high-, middle-, and low-income countries there has been an increased interest in the placement of long-acting reversible contraceptives at or immediately after delivery, regardless of delivery mode. These methods can provide women with highly effective contraception for years, can be manufactured at low cost, are generally well tolerated with a good safety profile, and do not require the user to remember to take them. Oral contraceptives and injectable medications require the patient to present to the clinic during a specific timeframe for follow-up care or a refill, and the clinic may not be proximate, affordable, or have the desired contraceptive in stock. This document will review the currently published literature on the use of immediate postpartum long-acting reversible contraceptives (placed within two days of delivery) in low- and middle-income countries to report on the prevalence of use and satisfaction rates, and note the lack of data on cost and economic implications. We will also explore data on how future maternal, neonatal, and infant outcomes may be influenced by increased peripartum long-term contraceptive use.
全球数据显示，许多育龄妇女希望使用现代计划生育方法。这些妇女中的许多人无法获得现代避孕药具，这被称为她们对避孕的“未满足需求”。在总生育率可能较高且许多妇女有意外生育或希望延长两次怀孕间隔时间的低收入和中等收入国家，现代避孕药具的可及性往往不足。产褥期是提供现代避孕方法干预措施的独特时机。刚分娩的妇女可能希望使用避孕药具来预防短间隔怀孕或完全避免再次怀孕。在高收入、中等收入和低收入国家，无论分娩方式如何，人们对在分娩时或分娩后立即放置长效可逆避孕方法的兴趣都有所增加。这些方法可为妇女提供数年的高效避孕，生产成本低，通常耐受性良好且安全性高，而且不需要使用者记住服用。口服避孕药和注射药物要求患者在特定时间段到诊所进行后续护理或取药补充，但诊所可能距离较远、费用高昂或没有所需的避孕药具库存。本文将回顾目前已发表的关于低收入和中等收入国家产后立即放置长效可逆避孕方法（在分娩后两天内放置）的文献，报告其使用 prevalence 和满意度，并指出缺乏关于成本和经济影响的数据。我们还将探讨增加围产期长期避孕使用对未来孕产妇、新生儿和婴儿结局可能产生何种影响的数据。
