Bula Agatha, Kopp Dawn M, Maman Suzanne, Chinula Lameck, Tsidya Mercy, Tang Jennifer H
UNC Project-Malawi, Private Bag A-104, Lilongwe, Malawi.
2UNC Department of Obstetrics & Gynecology, Chapel Hill, NC USA.
Contracept Reprod Med. 2018 Oct 17;3:22. doi: 10.1186/s40834-018-0075-8. eCollection 2018.
Perinatal mortality is unacceptably high in low-income countries, including Malawi. Use of family planning to encourage birth spacing may optimize outcomes for subsequent pregnancies. However, the reproductive desires and family planning knowledge of women who have experienced a stillbirth or neonatal death in resource-poor settings are not well understood.
We examined family planning knowledge, contraceptive practices and barrier to contraceptive use among women who had experienced a poor obstetric outcome at Bwaila Hospital in Lilongwe, Malawi. We performed individual in-depth interviews or through focus group discussion with women who had experienced a stillbirth or early neonatal death, 4-8 weeks after their delivery. NVivo software was used to analyze data for recurrent patterns and themes, and central ideas were extracted to identify the data's core meanings.
We interviewed 46 women who had experienced a poor obstetric outcome. Overall, women were aware of both modern and traditional family planning methods, and the majority were in favour of modern versus traditional methods. They also had knowledge about risks for future complications if they have a short inter-pregnancy interval. However, they faced conflict about whether to use family planning methods for their health, as suggested by their relatives and friends, or to have another child to fulfil their husband's desire, especially among those with no living child. Some had fear about side effects, while others were concerned that use of family planning methods without involving the husband could bring misunderstandings within the family. A number of women had misconceptions about family planning methods, which also served as a barrier to their use.
Although women with a poor obstetric outcome are aware of modern family planning and its health benefits after their delivery, their decision to use a method is complicated by their own desire to protect their own health and the husband's desire for a child, particularly among those women with no living children coupled with fear of side effects and misconceptions. These findings suggest the importance of counselling both the affected woman and her husband about the benefits of family planning use, even after a poor obstetric outcome, to jointly choose the method they feel comfortable to use and dispel any misconceptions.
Clinicaltrials.gov NCT02674542.
在包括马拉维在内的低收入国家，围产期死亡率高得令人无法接受。使用计划生育来鼓励生育间隔可能会优化后续妊娠的结局。然而，在资源匮乏地区经历过死产或新生儿死亡的妇女的生育意愿和计划生育知识尚未得到充分了解。
我们调查了马拉维利隆圭市Bwaila医院产科结局不佳的妇女的计划生育知识、避孕措施及避孕使用障碍。我们在妇女分娩后4 - 8周，通过与经历过死产或早期新生儿死亡的妇女进行个人深度访谈或焦点小组讨论。使用NVivo软件分析数据中的重复模式和主题，并提取中心思想以确定数据的核心含义。
我们采访了46名产科结局不佳的妇女。总体而言，妇女们知晓现代和传统的计划生育方法，并且大多数人倾向于现代方法而非传统方法。她们也了解如果妊娠间隔短，未来出现并发症的风险。然而，她们在是否为了自身健康而采用计划生育方法，还是为了满足丈夫的愿望再要一个孩子（尤其是那些没有存活子女的妇女）这一问题上存在矛盾。一些人担心副作用，而另一些人则担心在未征得丈夫同意的情况下使用计划生育方法会在家庭中引发误解。许多妇女对计划生育方法存在误解，这也成为她们采用这些方法的障碍。
尽管产科结局不佳的妇女在分娩后知晓现代计划生育及其对健康的益处，但她们在决定是否采用某种方法时，会因自身保护健康的愿望和丈夫想要孩子的愿望而变得复杂，特别是对于那些没有存活子女且担心副作用和存在误解的妇女。这些发现表明，即使在产科结局不佳之后，为受影响的妇女及其丈夫提供关于使用计划生育益处的咨询，以共同选择他们觉得舒适的方法并消除任何误解是很重要的。
Clinicaltrials.gov NCT02674542
