RamaRao Saumya, Ishaku Salisu, Liambila Wilson, Mane Babacar
Population Council, Reproductive Health Program, New York, NY, USA.
Population Council, Reproductive Health Program, Abuja, Nigeria.
Open Access J Contracept. 2015 Sep 18;6:117-123. doi: 10.2147/OAJC.S55033. eCollection 2015.
It is increasingly recognized that women who have just given birth have a high unmet need and require contraceptive protection in the first year postpartum. A majority of women in developing countries do breastfeed exclusively but for short durations, hence they may be sometimes unknowingly exposed to the risk of pregnancy if they are relying on nursing for contraceptive protection. The WHO's recommends the use of different contraceptives in the first year postpartum depending on whether the woman is nursing or not and the time since delivery. Some of the options available for breastfeeding women include implants, IUDs and injectables, which can be obtained only from a trained family planning provider. Since 2013, Population Council has been carrying out a study in Senegal, Nigeria, and Kenya to assess the acceptability of progesterone vaginal ring (PVR) as a new contraceptive option designed specifically for use by breastfeeding women to extend the period of lactational amenorrhea and promote birth spacing. Breastfeeding in sub-Saharan Africa is near universal with fairly long durations, a situation that increases the effectiveness of PVR. Each ring delivers a daily dose of 10 mg of progesterone and can be used continuously up to 3 months with a woman being able to continue with its use up to 1 year (four rings used consecutively). Preliminary results indicate that many women who had used the method found it acceptable and their partners supported its use. Activities aimed at having PVR registered and made available in focal countries are ongoing. Integration of family planning and immunization services for mothers and their newborns will be a key strategy in introducing PVR into targeted health care markets. Given that the use of PVR does not require extensive clinical training, it will be easier to integrate it at all levels of the health system from tertiary health facilities to community-based services. The PVR has been recently included in the WHO and the WHO's fifth edition of the which should facilitate its introduction into the public and private sectors.
人们越来越认识到，刚分娩的妇女有很大的未满足需求，在产后第一年需要避孕保护。发展中国家的大多数妇女确实进行纯母乳喂养，但持续时间较短，因此，如果她们依靠哺乳进行避孕保护，有时可能在不知不觉中面临怀孕风险。世界卫生组织建议，根据妇女是否哺乳以及分娩后的时间，在产后第一年使用不同的避孕药具。一些可供哺乳期妇女选择的避孕方法包括植入剂、宫内节育器和注射剂，这些只能从经过培训的计划生育服务提供者处获得。自2013年以来，人口理事会一直在塞内加尔、尼日利亚和肯尼亚开展一项研究，以评估孕酮阴道环（PVR）作为一种专门为哺乳期妇女设计的新型避孕选择的可接受性，该避孕环旨在延长哺乳期闭经时间并促进生育间隔。撒哈拉以南非洲地区的母乳喂养几乎普及且持续时间较长，这种情况提高了PVR的有效性。每个阴道环每天释放10毫克孕酮，可连续使用长达3个月，女性可以连续使用长达1年（连续使用四个阴道环）。初步结果表明，许多使用该方法的女性认为它是可以接受的，并且她们的伴侣也支持使用。旨在使PVR在重点国家注册并可供使用的活动正在进行中。将计划生育和免疫服务整合到母亲及其新生儿身上将是将PVR引入目标医疗保健市场的一项关键战略。鉴于使用PVR不需要广泛的临床培训，将其从三级卫生设施到社区服务等卫生系统的各个层面进行整合将更加容易。PVR最近已被列入世界卫生组织以及世界卫生组织的第五版《》，这应有助于将其引入公共和私营部门。
