Salway S, Nurani S
Centre for Population Studies, London School of Hygiene and Tropical Medicine, UK.
Soc Sci Med. 1998 Oct;47(7):899-909. doi: 10.1016/s0277-9536(98)00154-3.
In urban Bangladesh, as in many other settings, an immediate postpartum family planning strategy prevails, where providers seek to promote and provide contraception at 40-45 days following birth to women regardless of their breastfeeding or menstrual status. Despite such practices, the majority of women choose to delay the initiation of contraception until menses resumes, often several months after birth. The present paper seeks to explain this discrepancy by describing poor, urban women's understandings regarding the chances of conception and the risks associated with contraceptive use in the postpartum period. Findings from in-depth interviews reveal that the majority of women perceive no personal risk of pregnancy during amenorrhoea, though most do not recognise an association between this diminished risk of conception and breastfeeding. In addition, the data illustrate that women are primarily concerned with their own and their newly born child's health and well-being in the period following childbirth, both of which are perceived to be extremely vulnerable. These perceptions, plus an understanding that modern methods of contraception are "strong" and potentially damaging to the health, mean that the majority of women are reluctant to adopt family planning methods soon after birth, particularly during postpartum amenorrhoea. The paper advocates that, since breastfeeding affords good protection against pregnancy for six to nine months following birth, efforts should be made to actively incorporate lactational amenorrhoea into postpartum family planning strategies in Bangladesh. Recommendations are also made for ways in which women may be encouraged to adopt contraception during amenorrhoea beyond the period of high natural protection. The paper highlights the importance of taking the client's perspective into consideration in attempts to improve the quality and effectiveness of family planning programmes.
在孟加拉国城市，和许多其他地方一样，产后即时计划生育策略盛行，即医疗服务提供者试图在妇女产后40 - 45天向其推广并提供避孕措施，而不论其哺乳或月经状况如何。尽管有这些做法，但大多数妇女选择推迟开始避孕，直到月经恢复，通常是在产后几个月。本文试图通过描述贫困城市妇女对产后受孕几率以及避孕相关风险的理解来解释这种差异。深入访谈的结果显示，大多数妇女认为闭经期间自己没有怀孕的个人风险，尽管大多数人没有认识到受孕风险降低与母乳喂养之间的关联。此外，数据表明，妇女在产后主要关心自己和新生儿的健康与幸福，她们认为这两者都极其脆弱。这些观念，再加上认为现代避孕方法“强效”且可能损害健康的看法，意味着大多数妇女在产后不久，尤其是在产后闭经期间，不愿采用计划生育方法。本文主张，鉴于母乳喂养在产后六到九个月能有效防止怀孕，应努力将哺乳期闭经积极纳入孟加拉国的产后计划生育策略。文中还就如何鼓励妇女在自然高保护期之后的闭经期间采用避孕措施提出了建议。本文强调了在试图提高计划生育项目的质量和效果时考虑客户观点的重要性。
