Nance Nerissa, Ralph Lauren, Padian Nancy, Cowan Frances, Buzdugan Raluca, Mushavi Angela, Mahomva Agnes, McCoy Sandra I
University of California, Berkeley School of Public Health, Berkeley, USA.
Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, USA.
BMC Womens Health. 2018 Nov 26;18(1):193. doi: 10.1186/s12905-018-0668-z.
The postpartum period is an opportune time for contraception adoption, as women have extended interaction with the reproductive healthcare system and therefore more opportunity to learn about and adopt contraceptive methods. This may be especially true for women who experience unintended pregnancy, a key target population for contraceptive programs and programs to eliminate mother-to-child HIV transmission. Among women in Zimbabwe surveyed in 2014, we examined the relationship between pregnancy intention associated with a woman's most recent pregnancy, and her subsequent postpartum contraceptive use.
In our analysis we utilized a dataset from a random selection of catchment areas in Zimbabwe to examine the association between pregnancy intention of most recent pregnancy and subsequent postpartum contraceptive use using multinomial logistic regression models. We also explored whether this association differed by women's HIV status. Finally, we examined the association between pregnancy intention and changes in contraception from the pre- to postpartum periods.
Findings suggest that women who reported that their pregnancy was unintended adopted less modern (all non-traditional) contraceptive methods overall, but adopted long-acting reversible contraception (LARC) more frequently than women reporting an intended pregnancy (OR 1.41; CI 1.18, 1.68). Among HIV-positive women, this relationship was particularly strong (OR 3.12; CI 1.96, 4.97). However, when examining changes in contraceptive use from the pre-pregnancy to the postpartum period, women who had an unintended pregnancy had lower odds of changing to a more effective method postpartum overall (OR 0.71; CI 0.64, 0.79).
We did not find evidence of higher modern method adoption in the postpartum period among women with an unintended pregnancy. However, women who were already on a method in the pre-pregnancy period were catalyzed to move to more effective methods (such as LARC) postpartum. This study provides evidence of low modern (non-traditional) method adoption in general in the postpartum period among a vulnerable sub-population in Zimbabwe (women who experience unintended pregnancy). Simultaneously, however, it shows a relatively greater portion specifically of LARC use among women with an unintended pregnancy. Further research is needed to more closely examine the motivations behind these contraceptive decisions in order to better inform distribution and counseling programs.
产后时期是采用避孕措施的适宜时机，因为女性与生殖健康保健系统有更多接触，因此有更多机会了解并采用避孕方法。对于意外怀孕的女性而言可能尤其如此，她们是避孕项目以及消除母婴艾滋病毒传播项目的关键目标人群。在2014年接受调查的津巴布韦女性中，我们研究了与女性最近一次怀孕相关的怀孕意愿和其随后产后避孕措施使用之间的关系。
在我们的分析中，我们利用了从津巴布韦随机选取的集水区的数据，使用多项逻辑回归模型来研究最近一次怀孕的怀孕意愿与随后产后避孕措施使用之间的关联。我们还探讨了这种关联是否因女性的艾滋病毒感染状况而异。最后，我们研究了怀孕意愿与从孕前到产后期间避孕措施变化之间的关联。
研究结果表明，报告意外怀孕的女性总体上采用的现代（所有非传统）避孕方法较少，但与报告有意怀孕的女性相比，更频繁地采用长效可逆避孕法（LARC）（比值比1.41；置信区间1.18，1.68）。在艾滋病毒呈阳性的女性中，这种关系尤为明显（比值比3.12；置信区间1.96，4.97）。然而，在研究从孕前到产后期间避孕措施使用的变化时，意外怀孕的女性产后改用更有效方法的几率总体较低（比值比0.71；置信区间0.64，0.79）。
我们没有发现证据表明意外怀孕的女性在产后时期采用现代方法的比例更高。然而，孕前已采用某种避孕方法的女性在产后会被促使改用更有效的方法（如长效可逆避孕法）。本研究提供了证据，表明在津巴布韦的一个脆弱亚人群体（经历意外怀孕的女性）中，产后总体上采用现代（非传统）方法的比例较低。然而，与此同时，它表明意外怀孕的女性中长效可逆避孕法的使用比例相对较高。需要进一步研究，以更密切地审视这些避孕决策背后的动机，以便更好地为分发和咨询项目提供信息。
