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Breast-feeding: An International and Historical Review
Published in Frank Falkner, Infant and Child Nutrition Worldwide:, 2021
Some appreciation of the global importance of breast-feeding and fertility, and its effectiveness as a contraceptive, may be obtained from a report prepared by a multidisciplinary group of researchers convened by the WHO and the Rockefeller Foundation at Bellagio, Italy, in 1988 (Kennedy et al., 1989). They concluded that, “The consensus of the group was that the maximum birth spacing effect of breastfeeding is achieved when a mother ‘fully’ or nearly fully breastfeeds and remains amenorrheic. When these two conditions are fulfilled, breastfeeding provides more than 98% protection from pregnancy in the first six months.” (Kennedy et al., 1989, emphasis added)
The Cardio-Obstetric Team
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
A triad solution (Figure 2.3) including patient education, cardiovascular screening, and the multidisciplinary team has been proposed to address maternal mortality and morbidity associated with cardiovascular disease of pregnancy [7]. Preconception counseling for all women with known heart disease is recommended. Review of their reproductive goals and an understanding of their disease and potential physiologic cardiac changes in a future pregnancy is recommended [8,9]. A contraceptive plan is essential to optimize pregnancy planning and birth spacing [10]. This counseling can be done in a multidisciplinary setting whereby a cardiologist and MFM subspecialist can assess the patient's options together. The third aspect of the triad is a cardiovascular screening toolkit that has been proposed by the California Maternal Quality Care Collaborative based on a retrospective review of peripartum cardiomyopathy case deaths [11]. This screening tool is used to identify pregnant and postpartum patients at risk for cardiovascular disease who therefore need to be referred to the maternal cardiology team. It is well established that many symptoms of pregnancy overlap common symptoms of heart disease. The challenge of distinguishing between the two has been proposed in Table 6.1 of the Practice Bulletin on Pregnancy and Heart Disease, ACOG [12]; see Chapter 6 of this book.
Interpregnancy Intervals and Birth Spacing
Published in Crystal D. Karakochuk, Kyly C. Whitfield, Tim J. Green, Klaus Kraemer, The Biology of the First 1,000 Days, 2017
Amanda Wendt, Usha Ramakrishnan
There are many studies examining the relationship of birth spacing to stillbirth and early neonatal death. However, only three studies on stillbirth and three for early neonatal death were included in a recent meta-analysis, as many poor-quality studies were excluded, such as those that did not consider any confounding variables or define IPI as <12 months or a subset of this group. The meta-analysis found an overall random-effects OR of 1.35 (95% CI: 1.07, 1.71) for stillbirth among pregnancies following an IPI of <7 months (or a subset) with “unexposed” groups’ IPI between 12 and 50 months (or a subset) [5]. Stillbirth was defined as fetal death ≥20 weeks of gestation in one included study [47] and as ≥28 weeks in the other two [48,49]. The meta-analysis on early neonatal death (death in the first week of life) resulted in an OR of 1.29 (95% CI: 1.02, 1.64), with similar IPI categorizations. Evidence for the association of both outcomes and short IPIs was assessed to be of “moderate” quality [5]. A 2006 review did not create pooled estimates on these outcomes; however, they created meta-regression curves, which appeared to show higher risks for both outcomes in IPIs <6 months or >50 months [6].
Rural-Urban Differences in Unintended Pregnancies, Contraceptive Nonuse, and Terminated Pregnancies in Latin America and the Caribbean
Published in Women's Reproductive Health, 2022
Living in rural areas, as compared to urban areas, is associated with 25% lower odds (1–odds ratio) of experiencing a pregnancy termination, after controlling for geographic, socioeconomic, individual, and reproductive factors (p ≤ 0.001). In the case of pregnancy terminations, the interaction of rural residence and wealth does not provide statistically significant protection against pregnancy terminations (p > 0.05). In general, respondents with more education; employed in managerial, clerical, sales, domestic and other services, and manual labor; older in age; married/living together; with higher birth parity; and with higher birth spacing have a higher risk of experiencing a pregnancy termination due to a miscarriage, abortion, or still-birth. Respondents employed in agriculture and younger at-first-birth have a lower risk of experiencing a pregnancy termination due to a miscarriage, abortion, or still-birth.
Community-based postpartum contraceptive counselling in rural Nepal: a mixed-methods evaluation
Published in Sexual and Reproductive Health Matters, 2020
Wan-Ju Wu, Aparna Tiwari, Nandini Choudhury, Indira Basnett, Rita Bhatt, David Citrin, Scott Halliday, Lal Kunwar, Duncan Maru, Isha Nirola, Sachit Pandey, Hari Jung Rayamazi, Sabitri Sapkota, Sita Saud, Aradhana Thapa, Alisa Goldberg, Sheela Maru
The World Health Organization (WHO) recommends 24 months of spacing between births, as shorter pregnancy intervals are associated with adverse maternal and child health outcomes.1–3 Despite the benefits of birth spacing, there continues to be significant unmet need for postpartum contraception worldwide.4 Access to modern contraceptive methods facilitates a woman’s ability to decide freely and for herself whether, when, and how many children she wants to have.5 Universal health coverage for women, girls, and adolescents, a cornerstone of the Sustainable Development Goals, requires the expansion of sexual and reproductive health services.6,7 Expanding access to postpartum contraception, especially in remote areas, will be one critical component towards this end.
After obstetric fistula repair; willingness of women in Northern Nigeria to use family planning
Published in Journal of Obstetrics and Gynaecology, 2019
Obioma Uchendu, Hadizah Adeoti, Oluwapelumi Adeyera, Olayide Olabumuyi
An effective means of delaying pregnancy in a woman and allowing her to achieve adequate birth spacing while still being sexually active is through the use of modern family planning methods (Lindberg et al. 2006; Caro et al. 2013). Family planning reduces the incidence of maternal and child morbidity and mortality thereby improving the health outcomes for children, women, and their families (Lindberg et al. 2006; Caro et al. 2013). However, contraceptive utilisation is low in Sub-Saharan Africa and even lower in Nigeria where a contraceptive utilisation rate of 19% and 18.1% have been reported, respectively (Pacqué-Margolis et al. 2013; Center for Research Evaluation Resources and Development and Bayero University Kano 2016). The low utilisation of contraceptives in developing countries has been attributed to the cultural value placed on children, misconceptions about family planning and the poor access to contraceptives (Abiodun and Balogun 2009; National Population Commission (NPC) Nigeria and ICF Macro 2013).