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Barriers to accessing voluntary postpartum female tubal sterilization among minority and low-income women
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Abstracts / Contraception 86 (2012) 173–186
A41 CANCER CERVIX SCREENING AND TREATMENT OF PRECANCER: POPULATION- VS. FACILITY-BASED APPROACH Sheth T Medical College, Baroda, Vadodara, Gujarat, India Gandhi S, Maitra N, Singh S, Kansara T Objectives: To compare population- and facility-based cancer cervix screening services using “Visual Inspection with Acetic acid” (VIA) followed by early treatment of precancerous lesions. Method: Population-based cancer cervix screening and treatment of precancer services are being implemented in administrative block with a population of 70,000 in Vadodara district as per the National Guidelines on Cancer Cervix Screening Programme. Women between 30 and 59 years of age are mobilized to the nearest primary health centre every Saturday for screening by trained auxiliary nurse midwives using VIA method. VIA-positive women are referred to Community Health Center (CHC) for diagnosis (colposcopy, punch biopsy) and treatment (cryotherapy) of precancerous lesions. The women who are not eligible for cryotherapy are reffered to district-level facilities for management using the loop electrosurgical excision procedure (LEEP). Treated women are followed up as per guideline. The Gynecology Department of Baroda Medical College provides facilitybased services on a “see and treat” approach to symptomatic women attending the outpatient department. Results: From August to December 2010, a total of 440 women were screened in population-based screening approach, of which 82 (19%) were VIA positive. Fifty-six of 82 VIA-positive women (70%) reached the CHC for colposcopy, where 16 underwent cryotherapy. At Baroda Medical College, 79 women were screened of which 20 were VIA positive (25%) and also had an abnormal colposcopy. Based on the biopsy results, one LEEP and one hysterectomy for invasive carcinoma were done. Conclusions: VIA positivity rate, though higher in the facility-based approch, had strong agreement with colposcopy results compared to the populationbased approach; however, the latter approach is accessible to larger number of women. A42 ASSOCIATION OF TNFΑ POLYMORPHISMS WITH ALTERED SPERM CONCENTRATION AND MOTILITY IN INFERTILE MEN OF AN INDIAN POPULATION Shukla KK Department of Biochemistry, C.S.M. Medical University, Lucknow-UttarPradesh, India Agnihotri S, Das M, Mahdi AA, Mishra V, Sankhwar SN Objectives: We conducted a cohort study to investigate the associations of single-nucleotide polymorphisms (SNPs) in candidate gene tumor necrosis factor-α (TNF-α) in the infertile subject with their correlations into hormones and cell death of sperm cells of Indian populations. Method: We undertook genotyping on a total of 780 individuals including well-characterized individuals, and the participants, aged 20–40 years, were selected from the C.S.M. Medical University, Lucknow, India. The total eligible cohort (n=780) was composed of normozoospermic (idiopathic unexplained; n=260), oligozoospermic (n=260) and asthenozoospermic (n=260) infertile subjects. We used allele-specific polymerase chain reaction (PCR) and PCR-RFLP (restriction fragment length polymorphism) to investigate the distribution of the guanine (G)-to-adenosine (A) substitution at position in the promoter region of the TNFa gene. Results: The frequency of combined mutant genotype (GA+AA) (13.8%) and mutant allele (A) (7.5%) of TNF-α gene was significantly (pb.01) less
frequently observed as compared to respective wild GG genotype and wild G allele in healthy fertile men (control). Additionally, we found significantly higher mutant genotype AA (2.7% vs. 1.2%) and mutant allele A (20.4% vs. 7.5%) frequency in asthenozoospermic infertile men as compared to healthy fertile men. Furthermore, we found increased apoptosis levels in oligozoospermic (pb.01) infertile subjects as well as increased necrosis only in asthenozoospermic subjects (pb.001), although reactive oxygen species and cell cycle were increased in oligozoospermic and asthenozoospermic subjects; however, we observed significantly decreased levels of testosterone and luteinizing hormone along with increased prolactin and follicle-stimulating hormones in infertile subjects. Conclusions: TNF-α (G-308A) substitution associated strongly with male infertility in Indian population. Allele and genotype meta-analysis also supported its strong correlation with male infertility, thus establishing it as a risk factor. A43 BARRIERS TO ACCESSING VOLUNTARY POSTPARTUM FEMALE TUBAL STERILIZATION AMONG MINORITY AND LOW-INCOME WOMEN Siddiqui A Columbia University, New York, NY, USA Westhoff C Objectives: Over 10 million American women rely on sterilization for contraception. Half of female sterilizations are done immediately postpartum. Increasing evidence shows an unmet demand for sterilization disproportionately among minority and low-income women. This study aims to identify the patient- and system-level barriers and enablers to obtaining a postpartum bilateral tubal ligation (PPBTL). Method: Prospective cohort study of pregnant women seeking PPBTL (N=175) at a large medical center and four affiliated prenatal care clinics in a predominately Latina, low-income neighborhood of New York City. A chart abstraction tool was used to collect data regarding patient- and system-level barriers and enablers to PPBTL from electronic records during antenatal care, obstetric hospitalization and postpartum visits. Descriptive statistics, and univariable and multivariable logistic regression analyses of predictors of unfulfilled requests for PPBTL are presented. Results: Ninety-five (54.3%) women seeking PPBTL did not obtain the procedure. The patient declining the procedure (37.9%) and a busy labour and delivery unit (16.8%) were the most frequent reasons for not obtaining a PPBTL. Most women documented as “declining” the procedure delivered during the night or on a weekend (80.6%). Delivering via cesarean section [odds ratio (OR) 16.02, 95% confidence interval (CI) 6.69–38.35], during the daytime (OR 2.65, 95% CI 0.96–7.31) and on a weekday (OR 2.60, 95% CI 1.09–6.22) were associated with obtaining a desired PPBTL in the adjusted multivariable model. Conclusions: System-level barriers to obtaining PPBTL are identified. Future investigations should focus on provision of expeditious PPBTL even when the labour and delivery unit is busy, regardless of the delivery type or time. A44 REVITALIZATION OF POSTPARTUM IUCD (PPIUCD) SERVICES: EXPERIENCE FROM INDIA Sood B Jhpiego/India, New Delhi, India Asif R, Charurat E, Das S, Kumar S, McKaig C, Rath M, Saha S, Sethi R, Srivastava V, Yadav V Objectives: Describe programmatic results of introducing postpartum intrauterine contraceptive device (PPIUCD) services in India and assess the postinsertion outcomes of clients.
Abstracts / Contraception 86 (2012) 173–186
A41 CANCER CERVIX SCREENING AND TREATMENT OF PRECANCER: POPULATION- VS. FACILITY-BASED APPROACH Sheth T Medical College, Baroda, Vadodara, Gujarat, India Gandhi S, Maitra N, Singh S, Kansara T Objectives: To compare population- and facility-based cancer cervix screening services using “Visual Inspection with Acetic acid” (VIA) followed by early treatment of precancerous lesions. Method: Population-based cancer cervix screening and treatment of precancer services are being implemented in administrative block with a population of 70,000 in Vadodara district as per the National Guidelines on Cancer Cervix Screening Programme. Women between 30 and 59 years of age are mobilized to the nearest primary health centre every Saturday for screening by trained auxiliary nurse midwives using VIA method. VIA-positive women are referred to Community Health Center (CHC) for diagnosis (colposcopy, punch biopsy) and treatment (cryotherapy) of precancerous lesions. The women who are not eligible for cryotherapy are reffered to district-level facilities for management using the loop electrosurgical excision procedure (LEEP). Treated women are followed up as per guideline. The Gynecology Department of Baroda Medical College provides facilitybased services on a “see and treat” approach to symptomatic women attending the outpatient department. Results: From August to December 2010, a total of 440 women were screened in population-based screening approach, of which 82 (19%) were VIA positive. Fifty-six of 82 VIA-positive women (70%) reached the CHC for colposcopy, where 16 underwent cryotherapy. At Baroda Medical College, 79 women were screened of which 20 were VIA positive (25%) and also had an abnormal colposcopy. Based on the biopsy results, one LEEP and one hysterectomy for invasive carcinoma were done. Conclusions: VIA positivity rate, though higher in the facility-based approch, had strong agreement with colposcopy results compared to the populationbased approach; however, the latter approach is accessible to larger number of women. A42 ASSOCIATION OF TNFΑ POLYMORPHISMS WITH ALTERED SPERM CONCENTRATION AND MOTILITY IN INFERTILE MEN OF AN INDIAN POPULATION Shukla KK Department of Biochemistry, C.S.M. Medical University, Lucknow-UttarPradesh, India Agnihotri S, Das M, Mahdi AA, Mishra V, Sankhwar SN Objectives: We conducted a cohort study to investigate the associations of single-nucleotide polymorphisms (SNPs) in candidate gene tumor necrosis factor-α (TNF-α) in the infertile subject with their correlations into hormones and cell death of sperm cells of Indian populations. Method: We undertook genotyping on a total of 780 individuals including well-characterized individuals, and the participants, aged 20–40 years, were selected from the C.S.M. Medical University, Lucknow, India. The total eligible cohort (n=780) was composed of normozoospermic (idiopathic unexplained; n=260), oligozoospermic (n=260) and asthenozoospermic (n=260) infertile subjects. We used allele-specific polymerase chain reaction (PCR) and PCR-RFLP (restriction fragment length polymorphism) to investigate the distribution of the guanine (G)-to-adenosine (A) substitution at position in the promoter region of the TNFa gene. Results: The frequency of combined mutant genotype (GA+AA) (13.8%) and mutant allele (A) (7.5%) of TNF-α gene was significantly (pb.01) less
frequently observed as compared to respective wild GG genotype and wild G allele in healthy fertile men (control). Additionally, we found significantly higher mutant genotype AA (2.7% vs. 1.2%) and mutant allele A (20.4% vs. 7.5%) frequency in asthenozoospermic infertile men as compared to healthy fertile men. Furthermore, we found increased apoptosis levels in oligozoospermic (pb.01) infertile subjects as well as increased necrosis only in asthenozoospermic subjects (pb.001), although reactive oxygen species and cell cycle were increased in oligozoospermic and asthenozoospermic subjects; however, we observed significantly decreased levels of testosterone and luteinizing hormone along with increased prolactin and follicle-stimulating hormones in infertile subjects. Conclusions: TNF-α (G-308A) substitution associated strongly with male infertility in Indian population. Allele and genotype meta-analysis also supported its strong correlation with male infertility, thus establishing it as a risk factor. A43 BARRIERS TO ACCESSING VOLUNTARY POSTPARTUM FEMALE TUBAL STERILIZATION AMONG MINORITY AND LOW-INCOME WOMEN Siddiqui A Columbia University, New York, NY, USA Westhoff C Objectives: Over 10 million American women rely on sterilization for contraception. Half of female sterilizations are done immediately postpartum. Increasing evidence shows an unmet demand for sterilization disproportionately among minority and low-income women. This study aims to identify the patient- and system-level barriers and enablers to obtaining a postpartum bilateral tubal ligation (PPBTL). Method: Prospective cohort study of pregnant women seeking PPBTL (N=175) at a large medical center and four affiliated prenatal care clinics in a predominately Latina, low-income neighborhood of New York City. A chart abstraction tool was used to collect data regarding patient- and system-level barriers and enablers to PPBTL from electronic records during antenatal care, obstetric hospitalization and postpartum visits. Descriptive statistics, and univariable and multivariable logistic regression analyses of predictors of unfulfilled requests for PPBTL are presented. Results: Ninety-five (54.3%) women seeking PPBTL did not obtain the procedure. The patient declining the procedure (37.9%) and a busy labour and delivery unit (16.8%) were the most frequent reasons for not obtaining a PPBTL. Most women documented as “declining” the procedure delivered during the night or on a weekend (80.6%). Delivering via cesarean section [odds ratio (OR) 16.02, 95% confidence interval (CI) 6.69–38.35], during the daytime (OR 2.65, 95% CI 0.96–7.31) and on a weekday (OR 2.60, 95% CI 1.09–6.22) were associated with obtaining a desired PPBTL in the adjusted multivariable model. Conclusions: System-level barriers to obtaining PPBTL are identified. Future investigations should focus on provision of expeditious PPBTL even when the labour and delivery unit is busy, regardless of the delivery type or time. A44 REVITALIZATION OF POSTPARTUM IUCD (PPIUCD) SERVICES: EXPERIENCE FROM INDIA Sood B Jhpiego/India, New Delhi, India Asif R, Charurat E, Das S, Kumar S, McKaig C, Rath M, Saha S, Sethi R, Srivastava V, Yadav V Objectives: Describe programmatic results of introducing postpartum intrauterine contraceptive device (PPIUCD) services in India and assess the postinsertion outcomes of clients.