Family Planning And Maternal Health

Abstraction

Context: Family planning is built-in in carry throughing the Millennium Development Goals of bettering maternal wellness, cut downing child mortality and eliminating utmost poorness. Currently an estimated 215 million twosomes globally do non utilize preventives, despite desiring to infinite or bound childbirth. highDaisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Easmon ‘s editu04566312011-03-08T13:11:00

We had this in our concept paper: We hypothesize that the reported fright of side effects of contraceptive method will be a mix of existent and sensed hazards and that reported hazards will be greatest for hormonal contraceptive method. In add-on, we hypothesize that adult females are interested in deriving better information about side effects and will show an involvement in modern natural household planning methods.

We performed an appraisal to find household be aftering demands in communities near Kumasi, Ghana.

Methods: Eighty-five adult females between the ages of 15 and 49 in three communities were interviewed with a modified version of the 2008 Ghana Demographic and Health Survey related to household planningDaisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Easmon ‘s edit.

Consequences: We found that 27 % Daisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Sally: P intervals and Confidence Intervalsof adult females had misused norethisterone tablets ( Primolut-N or N tablets ) , a man-made Lipo-Lutin, as an exigency contraceptive method. Twenty per centum of adult females reported holding at least one abortion2011-02-26T19:40:00

Daniel: What do we intend by abortion in this context. Legal or illegal. Hospital supervised abortion etc in Daisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Daisy: We did n’t hold this item in our study – the inquiry merely asked “ Have you of all time had an abortion? ” If yes, “ how many ” the yesteryear. One-half of adult females who were at hazard for gestation were presently utilizing a household planning method, with unwritten preventives being the most popular method reported. Condoms were the most recognizable method, but merely 21 % had of all time had a spouse who had used one. Most adult females ( 86 % ) intended to utilize a method in the hereafter but they had a assortment of concerns when asked about their non-preferred method. Women cited a fright of side effects for hormonal methods, every bit good as strangeness and built-in qualities they did non like for most methods.

Decision: Further research is needed to understand the extent to which adult females are utilizing Primolut-N and the deductions this may hold on generative wellness in the area.2011-02-26T19:40:00

Daniel: Need to research into how they entree information on household planning. What are the options for us.Daisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Daisy: We had some inquiries on whether they had heard about household planning on the wireless, newspaper, and television. We besides asked if they had been visited by a household be aftering community wellness worker and if household planning was addressed when they went to the clinic ( for other grounds ) in the past twelvemonth. Possibly the Health Literacy Team this summer can inquire a more direct inquiry, such as, where do you entree information about household planning. While half of all past or current gestations were unintended, adult females had a high purpose rate to utilize household planning in the hereafter. u05510822011-02-26T19:40:00

Ty: I would province the high rate of unintended gestations foremost. Family be aftering plans could perchance turn to concerns about side effects by stressing methods with minimum side effects and presenting natural household planning methods.

Daisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Sally:

Tables should all travel at the terminal of the papers.

Need to do certain each tabular array is referenced in the text. – DONE

Endnote package may be helpful to cover with mentions

Could interrupt the communities down into hold a clinic and do n’t hold a clinic, you may necessitate to depict rural vs. periurban ( i.e. population and distance from Kumasi ) . Sometimes a tabular array with community demographics is helpful – DESCRIBED WHICH HAD A CLINIC, OTHER INFO NEEDED?

Further analysis as to why you found your findings may be helpfulaˆ¦do some multi/bivariate analyses on age, community, and instruction compared to your household planning determination and see if any statistically important tendencies pop out that might assist you explicate your findings further.

Background

Importance of Family Planning

Generative wellness, including household planning, is built-in in carry throughing the Millennium Development Goals of bettering maternal wellness, cut downing child mortality and eliminating utmost poorness ( Cleland et al. , 2006 ; United Nations Population Fund, 2004 ) . Family planning is critical to the overall wellness of the female parent and kid, diminishing baby and maternal morbidity and mortality. Family be aftering benefits communities socially, economically, and environmentally as Daisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Easmon: This statement appears to restrict FP to familieswomen and work forces are able to recognize their generative purposes, including forestalling unwanted gestations and accomplishing the figure and spacing of kids they desire. Currently an estimated 215 million twosomes who want to infinite or bound childbearing do non utilize preventives ( Guttmacher Institute/UNFPA, 2009u05510822011-02-26T19:40:00

Ty: Clarification: do all of those 215 million who do non utilize household planning besides desire to non hold kids? Possibly clearly saying this decision as a quantitative step of unmet need/desire for contraceptive method would be better. For illustration: “ Presently, 215 million twosomes who desire to infinite or bound childbearing do non hold entree to contraceptive method. ” ) . It is of import to understand why there is still an unmet demand for household planning and how maternal wellness services are utilized in Ghana.

Family Planing in Ghana

In 2008, a Demographic and Health Survey ( DHS ) was performed countrywide in Ghana ( GSS, GHS & A ; ICF Macro, 2009 ) . The DHS provides up to day of the month epidemiologic information sing population, nutrition and wellness in a state. This study besides yielded information particular to maternal wellness. The entire birthrate rate is the mean figure of kids a adult female has in her life-time. In the Ashanti part, where the Barekese subdistrict is located, the entire birthrate rate is 3.6. Although greater than 99 per centum of married Ashanti adult females have heard of Daisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Sally: Most sorts of or X types ofat least one method to avoid gestation, merely 27 per centum presently use household planning, of which injectables and the beat method are most popular ( 5.9 and 5.4 per centum, severally ) . In all of Ghana, there has been a little addition in the consumption of household planning in the last 10 old ages, but this decreased somewhat from 2003 to 2008. When married adult females who were non presently utilizing contraceptive method were asked about the ground for non utilizing contraceptive method in the hereafter, 26 per centum cited fright of side effects, 8.1 per centum cited wellness concerns, and 3.7 per centum cited that contraceptive method interferes with the organic structure ‘s normal procedure. Merely 2.6 per centum of adult females reported that their husband/partner was opposed to contraceptive method and merely 1 per centum reported that they lacked entree to contraceptive method or that it was dearly-won. Furthermore, merely 3.5 per centum cited deficiency of cognition as a ground. Finally, more than a 3rd of married adult females ( 36.5 per centum ) have an unmet demand for household planning.

Barekuma Collaborative Community Development Project

The Barekuma Collaborative Community Development Project ( BCCDP ) is a collaborative attempt between Kwame Nkrumah University of Science and Technology ( KNUST ) , Komfo Anokye Teaching Hospital ( KATH ) , and the University of Utah to better the quality of life in communities in the Barekuma sub-district in Ghanau05510822011-02-26T19:40:00

Ty: I would cite the paper on the BCCDP CBPR foremost authored by Peter DeSwienitz here. ( Reference ) . Assorted appraisals and undertakings have been conducted since 2003. In 2010, cardinal confederates from Ghana identified household planning and maternal wellness as precedence countries for research Daisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Daniel ‘s editor with the position to supplying grounds for appropriate interventions.Daisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Easmon ‘s edit. A research squad from the University of Utah and translators from KNUST and the Barekese Family Planning and Maternal Health Daisy Samantha Krakowiak-Redd2011-02-28T17:46:00

Easmon: Did these research workers work with KNUST staff? It will be deemed unusual that research workers come to work independently in Ghana without local partnersClinic was formed to carry on an appraisal sing the cognition, attitudes and patterns of household planning and maternal health. ] Researchers from KATH and KNUST provided counsel on this procedure. The appraisal was done to make full the spreads in cognition of the 2008 Ghana DHS and to better understand the state of affairs in this local country. Importantly, this appraisal sought to bring out the grounds adult females would n’t utilize each method of household be aftering with open-ended inquiries. This paper discusses the household planning consequences. u05510822011-02-26T19:40:00

Ty: I agree that we need to apologize our research attempts better. Using a hypothesis-driven attack would work. It could travel like this: anectodal grounds suggested unmet household planning demands locally, confederates desired to research this subject in order to prioritise wellness betterment attempts, hypothesized that there is an umet demand for household planning due to a assortment of barriers ( economic, educational, hapless entree, etc ) , squad conducted survey to prove hypothesis/hypotheses..

2011-02-26T19:40:00

Daniel: I think I am losing the cardinal aims and particulars for this survey. The treatment should hence be linked to the aims. Can we province the aims and reflect it in the treatment Daisy Samantha Krakowiak-Redd2011-03-08T13:16:00

Daisy:

From my ain research, it seems that the grounds why adult females would n’t utilize household planning from the DHS was excessively obscure. It was a wide inquiry and should hold been asked individually of all the methods in an open-ended manner. For illustration, it was n’t known if side consequence frights were existent or rumours.

From our concept paper: We hypothesize that the reported fright of side effects of contraceptive method will be a mix of existent and sensed hazards and that reported hazards will be greatest for hormonal contraceptive method. In add-on, we hypothesize that adult females are interested in deriving better information about side effects and will show an involvement in modern natural household planning methods.

Methods

Study Design

The Family Planning and Maternal Health Assessment ( FPMHA ) was conducted as a cross-sectional survey with a qualitative survey design. Convenience trying Daisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Easmon: Why convenience sampling, why 85? Daisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Daisy: Convenience sampling because no counsel was given about how to make random in this location, and 85 because that ‘s all the clip we had.was used to choose 85 adult females between the ages of 16 and 48 in the Barekuma Collaborative Community Development Project ( BCCDP ) were attained July 21-30, 2010. To be eligible, adult females had to be 15 -49 old ages of age. Eligibility was non restricted in any other manner. Three communities, a little peri-urban community ( n=25 ) , a medium peri-urban community ( n=27 ) and a rural community ( n=33 ) were chosen as mark communities in the country. The medium periurban community has a household planning and maternal wellness clinic, but the other two communities do notDaisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Daisies: Should we depict the communities further ( population size and distance from Kumasi? ) as Sally suggested? Daisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Easmon: You need to supply definitions for these categorizations. .

2011-02-26T19:40:00

Daniel: If we want to subject to a local diary we can maintain the deleted points below, I think once we are aiming a international diary we can cancel this aspect.Daisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Sally: add medically trained interpreterDaisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Daisy: non ever medically trained Participants were found in adult females ‘s families or at their topographic point of work. Daisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Sally: some referees may desire more item here on how you selected participants-convenience sample, did you make all adult females in the community, cover the parts of the community evenlyDaisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Daisy: It was already described above that it was a convenience samplingThe survey was briefly introduced to each possible participant and eligibility was ascertained. Participants were so invited to take part in the survey. Upon credence, the research squad obtained informed consent. Each participant was given a Participant Information Leaflet and Consent Form with a phone figure to name if they had of all time had any inquiries or concerns about their engagement in the appraisal. In add-on, the signifier was explained to them verbally through an translator before subscribing or giving their thumbprint. For participants under the age of 18, consent was besides obtained from one parent or defender.

Participants were interviewed with a sawed-off and modified Demographic and Health Survey ( DHS ) tool that was used in Ghana in 2008. Questions sing reproduction history, household planning use and acknowledgment, maternal wellness, and birthrate penchants were included, among others. A peculiar focal point was directed toward sensed hazards for specific types of household planning, since these inside informations were excluded in the DHS. The interview took about one hr to finish for each participant.

One half twenty-four hours was spent at the Barekese Family Planning and Maternal Health Clinic, where four nurses were asked to take part in a 45 minute interview sing their clinic, including their cognition about household planning and preventive options. u05510822011-02-26T19:40:00

Ty: Since the nurses were besides participants I suggest we clarify that these interviews were different in range than the interviews with generative age adult females. In other words, the qualitative consequences obtained from the nurse interviews is a different informations set.u04566312011-03-08T13:37:00

Daisies: Should we take it out wholly? The research squad used an interview usher, but was able to inquire in-depth inquiries every bit good as follow-up inquiries. The cognition attained gave the research squad a better position about household planning service proviso in the country, but are non included in this paper.

The Internal Review Boards at the University of Utah and KNUST reviewed and approved this survey ( protocol # XXXX ) prior to induction. slcole2011-02-26T19:40:00

Sally: diaries nowadays typically wo n’t print documents without a statement in them about the IRB approval.Microsoft Excel 2007 ( metropolis, province ) was used for informations entry and storage. For open-ended responses, informations was coded and categorized. STATA v.10 ( metropolis, province ) was used to table the data.. 2011-02-26T19:40:00

Daniel: We need to give some more inside informations on the analysis that was done.Daisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Daisy: I imported the information from Excel ( after informations look intoing and cleaning ) , ran STATA to table the information. I am non certain what more item can be given.

Consequences

Demographics

We interviewed 85 adult females aged 16-48 old ages in the Barekuma Collaborative Community Development Project ( BCCDP ) country, 25 of which were occupants of a little peri-urban community, 26 a medium peri-urban community, and 33 a rural community. Table 1 describes the demographics of adult females in our appraisal. The average age of respondents was 28.7 yearsDaisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Easmon: supply the Standard Deviation. The bulk of adult females ( 55 per centum ) had completed all or some secondary instruction. Of our sample, 77 per centum presently had a spouse. The bulk of our population belonged to a Christian based faith ( 87 per centum ) and the staying 13 per centum were Moslem. The demographics of our participants were similar to adult females interviewed in the 2008 Ghana DHS.Daisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Sally: Put in the P values for the comparing statistics in the tabular array below. Most of them will be non-significant and will back up this statement.

Table 1. Demographics of Women in the Family Planning and Maternal Health Assessment ( FPMHA ) ( n=85Daisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Easmon: Could we do farther analyses ( qis square for tendency ) by comparing the demographics by community? )

Ghana

DHS

A

A

N

%

%

Community

A

A

A

Small periurban

25

29 %

A

Medium periurban

27

32 %

A

Rural

33

39 %

Age

( Mean=28.7, Median=28, Range=16-48 )

A

A

A

15-24

34

40 %

39 %

A

25-34

25

29 %

30 %

A

35-49

26

31 %

31 %

Highest degree of instruction

A

A

None

9

11 %

21 %

A

Primary

21

25 %

20 %

A

Middle-Secondary

47

55 %

55 %

A

Higher

8

9 %

4 %

Has a partner*

A

A

A

Yes

65

77 %

59 %

A

No

19

23 %

41 %

Religion

A

A

A

Christian

74

87 %

78 %

A

Muslim

11

13 %

15 %

Other

0

0 %

7 %

*Sample size of 84. Defined in FPMHA as “ Is presently married, populating with a adult male or has a sexual spouse ” ; defined in Ghana DHS “ Is presently married or populating with a adult male ”

Abortion, Pregnancy Intentions and Family Planning PerceptionsDaisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Sally: should we hold assurance intervals around the per centums?

Twenty per centum of adult females had at least one abortion ( see Table 2 ) . Fortyfive per centum were seeking to acquire pregnant at that clip, 36 per centum wanted to wait until subsequently, and 14 per centum of adult females did non desire any more kids. The average figure of unrecorded births was 2.6. The mean coveted figure of entire kids was 3.9.

Sixty-five per centum of adult females stated they know where to obtain a household planning method, but merely 18 per centum have been visited by a fieldworker in the last 12 months. Sixty per centum of adult females agreed with the statement that adult females who use contraceptive method may go promiscuous and 40 per centum of adult females agreed that contraceptive method is a adult female ‘s concern, non a adult male ‘s. However, about all adult females agreed that holding excessively many kids may be unsafe for a adult female, that it is better non to hold more kids than they can afford, and that kids in smaller households are more likely to win.

Table 2. Abortion, Pregnancy Intention and Family Planning Perceptions among Women in the Family Planning and Maternal Health Assessment ( FPMHA )

Daisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Sally: Break down and compare communities and age

n Daisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Sally: n=yes?

Entire N

%

Womans who have had an abortion

17

85

20 %

Last or current gestation intention*

A

A

A

Wanted to go pregnant so

31

69 Daisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Easmon: How come we have 69 as ‘n ‘ here? Daisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Explained by the asterisk * now

45 %

Wanted to wait until subsequently

25

69

36 %

Did non desire any more kids

9

69

13 %

Missing informations

4

69

6 %

Family be aftering perceptual experiences

Contraception is a adult female ‘s concern and a adult male should n’t hold to worry about it

34

85

40 %

Womans who use contraceptive method may go promiscuous

51

85

60 %

Having excessively many kids may be unsafe for a

Woman**

77

84

92 %

It is better non to hold any more kids than we can afford**

81

84

96 %

Children in smaller households are more likely to succeed**

82

84

98 %

*Sixty-nine adult females had a old gestation or were presently pregnant. Sixteen adult females had non had a gestation before.

**Missing informations for one adult female.

Family Planing

Table 3 describes household planning acknowledgment, of all time use, current usage and future penchant by method among adult females in our assessment.Virtually all adult females recognized at least one household planning method, and three-fourthss of them had of all time used a method. The bulk of adult females recognized male rubbers ( 95 per centum ) , female sterilisation ( 88 per centum ) , and injectables ( 89 per centum ) . Daily unwritten preventives ( 29 per centum ) , exigency contraceptive method ( 27 per centum ) , and the rhythm/calendar method ( 21 per centum ) were the most widely of all time used methods. Barrier methods, IUDs, implants and sterilisation had the lowest rates of of all time and current methods used.

Even though 65 adult females had a spouse, 5 of them were non presently sexually active. In entire, 25 adult females ( 29 per centum ) were at generative potency but presently non sexually active, 7 adult females ( 8 per centum ) were pregnant at the clip of survey, and 2 adult females ( 2 per centum ) reported they were in climacteric. Therefore, 51 adult females ( 65 per centum of adult females ) were susceptible to gestation at the clip of the interview. Fifty-five per centum of those adult females were presently utilizing a method to detain or avoid gestation. The most popular current method among adult females at hazard for gestation was unwritten preventives ( 25 per centum ) . The 2nd most popular method was exigency contraceptive method ( 8 per centum ) . The usage of exigency contraceptive method was higher than expected, and after farther probe we found that adult females were utilizing misapplying Primolut-N tablets as an exigency preventive ( see treatment subdivision ) .

86 per centum of respondents stated they intend to utilize some signifier of household planning, with unwritten preventives ( 35 per centum ) , injectables ( 20 per centum ) and rhythm/calendar methods ( 18 per centum ) being the most popular preferable hereafter methods.

Table 3. Recognition, Ever Use, Current Use and Future Preferences of Family Planning Methods among Women in the Family Planning and Maternal Health Assessment ( FPMHA ) ( n=85 )

A

Recognizes

Ever Used

Current Use*****

Future Preferences

Method

N

%

N

%

N

%

N

%

Female Sterilization

75

88 %

0

0 % A

0

0 % A

14

16 %

Male Sterilization

17

20 %

1

1 %

0

0 %

1

1 %

Pill

71

84 %

25

29 %

13

25 %

30

35 %

IUD*

48

57 %

0A

0 % A

0

0 % A

0

0 %

Injectables

76

89 %

13

15 %

2

4 %

17

20 %

Implants

64

75 %

3

4 %

1

2 %

4

5 %

Condom

81

95 %

15

18 %

2

4 %

11

13 %

Female Condom

59

69 %

0A

0 % A

0

0 % A

0

0 %

Diaphragm

14

16 %

0A

0 %

0

0 %

1

1 %

Foam or Jelly

20

24 %

2

2 %

0

0 %

3

4 %

Rhythm/Calendar

61

72 %

18

21 %

2

4 %

15

18 %

Withdrawal

56

66 %

17

20 %

3

6 %

7

8 %

Getaway

35

41 %

9

11 %

3

6 %

4

5 %

Emergency

Contraception**

63

74 %

23

27 %

4

8 %

10

12 %

Sum

84

99 %

63

74 %

28***

55 %

73****

86 % Bernard Arhin2011-03-11T14:24:00

The per centums and values represents which variables? It seems non add up

*Missing one value for IUD acknowledgment. Percentage reported is out of 84.

**Primolut-N tablets

***Two participants reported utilizing 2 methods together. Therefore, the entire figure for presently utilizing is 28, non 30.

****Many participants reported 2 or more preferable methods. Seventy-three participants stated that they think they will utilize a prophylactic method to detain or avoid gestation at any clip in the hereafter.

*****Percent reported is out of 51 adult females who are at hazard for gestation. Twenty-five adult females in our

sample were non presently sexually active, 7 adult females were pregnant, and 2 were in climacteric.

Table 4. Top Reasons Why Women Would Not Use Family Planning Methods in the Family Planning and Maternal Health Assessment ( FPMHA ) ( n=85 )

Method

Top Reason

N

( % )

2nd Reason

N

( % )

3rd Reason

N

( %

)

Female Sterilization

Privations more kids

44

52 %

But would see when household finish

22

26 %

May autumn sick with operation

9

11 % Bernard Arhin2011-03-14T09:35:00

The per centum does non add up can we hold a 2nd expression at the information set? was the difference due losing values or non-responses?

Male Sterilization

Man ‘s determination or adult male against

32

38 %

Privations more kids

30

35 %

But would see when household finish

8

9 % Bernard Arhin2011-03-14T09:35:00

The per centum does non add up can we hold a 2nd expression at the information set? was the difference due losing values or non-responses?

Pill

Fear of side effects

27

32 %

Have to take everyday

14

17 %

Unfamiliar

6

7 % Bernard Arhin2011-03-14T09:36:00

The per centum does non add up can we hold a 2nd expression at the information set? was the difference due losing values or non-responses?

hold a 2nd expression at the information set was? was difference due losing values or non-responses?

Intrauterine device

Fear of side effects

26

31 %

Unfamiliar

24

28 %

Afraid of interpolation and/or does n’t desire it inside her

11

13 % Bernard Arhin2011-03-14T10:05:00

The per centum does non add up can we hold a 2nd expression at the information set? was the difference due losing values or non-responses?

Injectables

Fear of side effects

24

28 %

Afraid of acerate leafs

16

19 %

Unfamiliar

10

12 % Bernard Arhin2011-03-14T09:59:00

The per centum does non add up can we hold a 2nd expression at the information set? was the difference due losing values or non-responses?

Implants

Fear of side effects

24

28 %

Unfamiliar

15

18 %

Lost in organic structure and/or does n’t desire under tegument

14

16 % Bernard Arhin2011-03-14T09:59:00

The per centum does non add up can we hold a 2nd expression at the information set? was the difference due losing values or non-responses?

Condom

Can tear/burst

28

33 %

Man ‘s determination or adult male against

15

18 %

Sexual activity non as gratifying

11

13 % Bernard Arhin2011-03-14T09:59:00

The per centum does non add up can we hold a 2nd expression at the information set? was the difference due losing values or non-responses?

Female Condom

Unfamiliar

30

35 %

Can rupture

17

20 %

Sexual activity non as gratifying or rubber is excessively large

14

16 % Bernard Arhin2011-03-14T10:00:00

The per centum does non add up can we hold a 2nd expression at the information set? was the difference due losing values or non-responses?

Diaphragm

Unfamiliar

42

49 %

Difficult to put precisely

9

11 %

Can acquire lost indoors

4

5 % Bernard Arhin2011-03-14T10:00:00

The per centum does non add up can we hold a 2nd expression at the information set? was the difference due losing values or non-responses?

Foam or Jelly

Unfamiliar

35

41 %

Slippery and/or work forces do n’t wish it

14

16 %

Does n’t desire it inside her and/or may impact vagina

8

9 % Bernard Arhin2011-03-14T10:00:00

The per centum does non add up can we hold a 2nd expression at the information set? was the difference due losing values or non-responses?

Rhythm/Calendar

Not confident in ability to number

34

40 %

Unfamiliar

15

12 %

Not effectual

5

6 % Bernard Arhin2011-03-14T10:00:00

The per centum does non add up can we hold a 2nd expression at the information set? was the difference due losing values or non-responses?

Withdrawal

Man ‘s determination or adult male against

15

18 %

Unfamiliar

11

13 %

Not effectual

10

12 % Bernard Arhin2011-03-14T10:00:00

The per centum does non add up can we hold a 2nd expression at the information set? was the difference due losing values or non-responses?

Getaway

Unfamiliar

40

47 %

Does n’t see amenorrhoea or entirely breastfeed postpartum

13

15 %

Not effectual

10

12 % Bernard Arhin2011-03-14T10:00:00

The per centum does non add up can we hold a 2nd expression at the information set? was the difference due losing values or non-responses?

Emergency Contraception*

Not effectual

15

18 %

Unfamiliar

13

15 %

Fear of side effects

8

9 % Bernard Arhin2011-03-14T10:00:00

The per centum does non add up can we hold a 2nd expression at the information set? was the difference due losing values or non-responses?

*Primolut-N tablets

Reasons for Not Desiring to Use Family Planning Methods

We besides asked adult females with open-ended inquiries why they would non utilize household be aftering methods that were non their hereafter penchant. Table 4 summarizes the top grounds adult females why adult females would n’t utilize a peculiar method. The top ground stated for adult females non desiring to utilize hormonal methods was a fright of side effects ; about a 3rd of adult females cited side effects as a ground they would n’t utilize unwritten preventives, IUD, injectables, or implants. Womans were peculiarly afraid of bosom palpitations. Other side effects adult females cited were that hormonal methods would impact catamenial rhythms, would do giddiness, weight gain/loss, and IUDs and implants being painful. Most adult females described what specific side effects they feared, but some adult females merely commented that they would fall ill. A few side effects mentioned were that IUDs, implants and stop would be lost inside the organic structure and that hormonal methods would do lasting asepsis. u05510822011-02-26T19:40:00

Ty: Move any readings of informations consequences to discussion

Womans besides mentioned built-in qualities they did non like for most methods that were non their penchant. For female sterilisation, 55 per centum stated they would wish more kids ( but 26 per centum would see when their household is complete ) . With pills, 17 per centum of adult females were worried in their ability to retrieve to take a pill every twenty-four hours. For injectables, 19 per centum of adult females were afraid of acerate leafs. With rubbers, 13 per centum of adult females cited that sex would non be as gratifying. With IUDs, implants, stop, and spermatocides, adult females were uncomfortable with the thought of holding something inside of them.

Non-literate adult females were concerned about their ability to utilize u05510822011-02-26T19:40:00

Ty: Is this the respondents ‘ concern or our concern? Please clarifyaˆ¦.Daisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Sally: may be interesting to stratify by instruction and see if there are any statistically important differences harmonizing to method selected or cognition of contraceptivethe rhythm/calendar method ; 40 per centum of adult females stated that they would non be able to number the yearss right with a calendar. About half of adult females would n’t utilize lactational amenorrhoea because they were unfamiliar with it. For all traditional methods, 6-12 per centum of adult females cited that they were non effectual in forestalling gestation.

Womans mentioned that it would be the adult male ‘s determination or that the adult male was opposed tothree methods: male sterilisation ( 38 per centum ) , rubbers ( 18 per centum ) and backdown ( 18 per centum ) . u05510822011-02-26T19:40:00

Ty: Revise sentence. Not clear.Interestingly, a 3rd of adult females were afraid of rubbers rupturing or even bursting.

Last, the figure one ground for which adult females would non utilize exigency contraceptive method was because they stated it was non effectual. Many of the adult females who cited this had experienced Primolut-N ‘s ineffectualness themselves, which resulted in an abortion or unwanted gestation u05510822011-02-26T19:40:00

Ty: Do we hold information to endorse up the claim that “ adult females seem to be larning from experienceaˆ¦.. ” ? HoweverDaisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Sally: Did they province why? Continued gestation, cramping and abdominal hurting, important hemorrhage? , 15 per centum were still unfamiliar with the method. Merely a few adult females were afraid of possible side effects.

It is besides of import to see that strangeness was one of the top three grounds for which adult females would non utilize 11 of the 14 methods.

Interest in Possible Family Planning Interventions

Womans were besides asked inquiries about their involvement in possible household intercessions ( see Table 5 ) . About all adult females were interested in larning more about preventives including their side effects and would be interested in a toll-free figure they could name to seek advice on preventives. Three-fourthss of adult females were besides interested in larning more about new methods of natural household be aftering including utilizing beads on a twine to number yearss of birthrate and sterility ( CycleBeadsA® ) and acknowledging their organic structure ‘s marks for birthrate and sterility.

Table 5. Interest in Possible Family Planning Interventions among Women in the Family Planning and Maternal Health Assessment ( FPMHA ) ( n=84 )

A

A

N

( % )

Would you be interested in

A

A

A

Deriving better information about preventives, including their side effects?

78

93 %

In a toll-free phone figure for advice on preventives

78

93 %

A

In acquisition and utilizing a method to avoid gestation that helps you count the yearss of birthrate and sterility with beads on a twine

64

76 %

A

In acquisition and utilizing a method to avoid gestation that teaches you how to acknowledge the organic structure ‘s marks of birthrate and sterility

63

75 %

A

In an injectable preventive that you could give to yourself

30

36 %

A

Discussion2011-02-26T19:40:00

Daniel: I think we will necessitate more local/African surveies and international mentions to compare our work to and discuss.Daisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Daisy: Agreed – Easmon has said he has good local mentions

The end of the Family Planning and Maternal Health Assessment ( FPMHA ) is to better understand household planning and maternal wellness in the Barekese subdistrict in order to inform future household planning activities.

One of the major findings u05510822011-02-26T19:40:00

Ty: I would propose that our primary determination is a big unmet demand for household planning in the country since it affects the bulk of our respondents. Daisy Samantha Krakowiak-Redd2011-03-08T13:39:00

Daisy: Yes, there is unmet need like most topographic points, but the usage of Primolut-N is alone and stands outwas the usage of exigency preventives as a primary method of household planning, as opposed to being used for instances of exigency, such as failure of the primary method or colza. The chief exigency preventive is Primolut N-tablets ( a synthetic Lipo-Lutin called norethisterone ) , which are being used even though there are no published surveies that validate it for usage as exigency contraceptive method Daisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Sally: Expression at the WHO guidelines and some of the other 1s on approved/recommended exigency contraceptive method methods. You could state that this method is non consistent with those guidelines.or household planningDaisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Daisy:

“ The WHO-recommended regimen for exigency contraceptive method is: 1.5 milligram of levonorgestrel as a individual dosage. ”

“ Emergency preventive pills are for exigency usage merely and non allow for regular usage as an on-going preventive method because of the higher possibility of failure compared to modern preventives. In add-on, frequent usage of exigency contraceptive method would consequences in more side-effects, such as catamenial abnormalities. However, their repeated usage poses no known wellness hazards. ”

hypertext transfer protocol: //www.who.int/mediacentre/factsheets/fs244/en/index.html and it is non a WHO-recommended regimen for exigency contraceptive method ( ref ) . In a literature reappraisal, we merely found one unpublished paper ( Ellertson et al. , 2000 ) that described the usage of ethinyl estradiol and norethisterone together as an exigency preventive method but it was less effectual than the usage of ethinyl estradiol and levonorgestrel together ( called the Yuzpe regimen ) orlevonorgestrel merely ( Plan B or the forenoon after pill ) . To our cognition, no survey has been conducted to find the effectivity of utilizing a norethisterone-only pill for exigency contraceptive method. Furthermore, as noted on the maker cusp found online, Primolut N-tablets are meant to be used to modulate catamenial rhythms, for painful periods and adenomyosis and should non be taken when a adult females suspects that she is pregnant ( New Zealand Medicines and Medical Devices Safety Authority, 2008 ) . These tablets are being dispensed at unregulated chemical stores or drug shops with inconsistent instructions on how to take them. Some adult females noted these tablets were uneffective for them, ensuing in unwanted gestations and in some instances abortion. Twenty per centum of adult females had at least one abortion in their life-time. The usage of exigency contraceptive method and abortion are indexs of an unmet demand for household planning in the country.

Approximately half of the most recent or current gestations were unwanted, but merely 55 per centum of sexually active adult females were presently utilizing a household planning method. This is an unmet demand for household planning that can be attributed to fear of side effects every bit good as built-in qualities adult females did non like about methods ( i.e. needle injection, something under their tegument or womb, sex non being as gratifying, fright of burying to take a pill everyday, fright of interpolation of IUD or implants, etc. ) . Some side effects mentioned, such as bosom palpitations, giddiness, and weight addition, are existent but are non every bit common as adult females perceived them to be. The ground why bosom palpitations were a common ground that adult females cited is non known, but it could be that adult females are non being suitably screened for high blood force per unit area before having a hormonal preventive and hence really sing higher rates of this side consequence. It besides could be that a few adult females may hold experienced bosom palpitations and the narrative has been magnified as it has been passed along ; adult females frequently cited that she heard that person had taken a method and had experienced a side consequence and hence did non desire to take it herself. Other side effects mentioned were misconceptions or rumours, but were less cited than expected. For most methods, deficiency of cognition was cited as one of the top 3 grounds for adult females non desiring to utilize in the hereafter. We besides found that wrong information was being passed along from people distributing methods or educating adult females about household planning methods.

Another major determination is the low rates of rubber usage and the deficiency of cognition about male sterilisation even as cognition of female sterilisation was high. The figure one ground for non desiring to utilize rubbers is fright of rubber failure ( interrupting ) , which may propose better instruction as how to right utilize rubbers. The 2nd most cited ground was that rubber use was the determination of the male spouse. After depicting what male sterilisation was to adult females, male decision-making was the figure one ground why adult females cited they would n’t utilize male sterilizationu05510822011-02-26T19:40:00

Ty: See local handiness of vasectomy. Is it available? . WhileDaisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Daisy: I believe it is available at the infirmaries ( non the clinics ) but it ‘s pretty clear it is non really good promoted- Daniel, Easmon, more ideas on this? our survey did non include work forces due to clip restraints, we recognize that more work forces need to be included in household planning instruction and outreach plans.

For the calendar method, most adult females were non confident in their ability to cipher the yearss of birthrate and sterility. However, they preferred to utilize it as a future household planning method because of the deficiency of side effects. A possible intercession could include CycleBeadsA® , which can be used by adult females with regular rhythms to track her yearss of birthrate and sterility by traveling a pealing down a twine of color-coded beads and is 95 per centum effectual if used right. When asked if they would be interested in such a method, 76 per centum of adult females expressed an involvement.

An overpowering bulk of adult females besides expressed an involvement in deriving better information about preventives, including their side effects. In peculiar, adult females were interested in being able to name a toll-free phone figure to seek advice on household planning.

The restrictions to our survey include merely being able to obtain a convenience sample and a comparatively little sample size that may non be wholly representative of the communities. In add-on, we found that it was hard for translators to interpret the exact significance of inquiries and replies from English to Twi and vice-versa. AnotherDaisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Easmon: This should hold been dealt with at the preparation and pretesting sessionsDaisy Samantha Krakowiak-Redd2011-03-08T13:41:00

Daisy: Agreed, unluckily, we did non hold every bit much homework clip with our translators major restriction was that we were non able to insulate adult females for private interviews ; a considerable figure of interviews were conducted with other people nearby, listening in and sometimes even come ining.

However, our survey had several strengths. The bulk of our inquiries came from the validated Demographic and Health Survey that was used in Ghana in 2008. The study besides included in-depth and open-ended inquiries. We besides were accepted by the community to carry on our research, which resulted in really high engagement rates.

In decision, our survey found an unmet demand Daisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Easmon: Would be interesting to utilize one of the recognized methods ( Bongaarts ) for ciphering unmet needfor household planning in the Barekese subdistrict that should be addressed with a future intercession. This unmet demand could be met with regulation and implementing the right usage of Primolut N-tablets, better preparation of community wellness nurses to chase away rumours and address existent side consequence frights, proper instruction of household planning, an addition in household planning outreach activities, including work forces in household planning, debut of new methods such as CycleBeadsA® , and an execution of a toll-free phone figure that adult females could utilize to seek advice on household planning. In the hereafter, we hope that our attempts will increase household planning usage and cognition among adult females in the subdistrict.

Daisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Easmon: There is the demand to make a more extended literature hunt related to the specific aims so that we can hold a more vivacious treatment of our consequences in comparing with the literatureDaisy Samantha Krakowiak-Redd2011-02-26T19:40:00

Daisy: Agree