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Attitudes about obtaining or not obtaining a postpartum sterilization at 6 months postdelivery: a qualitative study
Abstracts / Contraception 72 (2005) 229 –245
evaluating the initiation of oral contraceptive use. Hospitalizations during follow-up were elicited during the follow-up interviews. Medical records of the admissions for cholecystectomy and the most recent antecedent pregnancy were reviewed. Results: A total of 757 women enrolled at the University of Texas Southwestern Medical Center (UTSWMC) site and 959 at the Emory University and Mt. Sinai Medical Center. All eight cholecystectomies occurred at the UTSWMC, resulting in an observed rate of 25.28/1000 women-years (95% CI, 8.09/ 1000–42.47/1000). Compared with the American rate, the rate ratio is 6.01 (95% CI, 1.92 –10.11). The UTSWMC had a greater proportion of women who (1) were of Hispanic ethnicity (660 vs. 357; p b .01) and (2) identified themselves as postpartum at the time of enrollment (500 vs. 36; p b .01). Discussion: The women enrolled at the UTSWMC site had a sixfold increased rate of cholecystectomy compared with the American rate of 4.2/1000 women aged between 18 and 44 years. Conclusion: In our cohort, factors associated with cholecystectomy included being postpartum at the time of oral contraceptive initiation and being of Hispanic ethnicity. 20 ARE YOU WILLING? CHARACTERISTICS OF COLLEGE UNDERGRADUATES WILLING TO USE CONTRACEPTIVE VAGINAL RINGS Leboeuf M, Wuellner S, Gilliam ML. Introduction: Oakley, using electronic pill packets, demonstrated that an irregular daily schedule was associated with poor OC compliance. The objective of this study was to examine the association between lifestyle variables and acceptance of a nondaily method (Oakley D, Yu MY, Zhang YM, Zhu XL, Chen WH, Yao L. Combining qualitative with quantitative approaches to study contraceptive pill use. J Womens Health 1999;8(2): 249–57). Materials and Methods: We electronically surveyed a random sample of female undergraduates. Demographic and lifestyle variables (hours of sleep, class hours, employment, extracurricular activities), sexual and pregnancy history, contraceptive use and factors relevant to the choice of a contraceptive method were assessed. The association of these characteristics with the willingness to use a contraceptive ring was evaluated using a logistic regression model. Results: A total of 689 women answered the survey. Willingness to use the contraceptive ring was positively associated with willingness to use the contraceptive patch (OR, 2.13; 95% CI, 1.34 –3.40), being employed at least 20 hours a week (OR, 2.20; 95% CI, 1.25–3.85), acceptability of a monthly contraceptive (OR, 2.23; 95% CI, 1.62 –3.08), acceptability of self-insertion (OR, 1.74; 95% CI, 1.42 –2.13), acceptability of feeling ring during intercourse (OR, 1.44; 95% CI, 1.08–1.92) and concern over potential hormonal side effects (OR, 1.09; 95% CI, 1.02 –1.16). Willingness to use the contraceptive ring was negatively associated with current use of oral contraceptives (OR, 0.48; 95% CI, 0.28 – 0.83). Discussion: Busy lifestyle and acceptance of its characteristics were associated with willingness to use a contraceptive vaginal ring. Committed pill users were less likely to consider this option. Conclusion: Lifestyle and acceptability of its characteristics are important factors in the decision to use a contraceptive vaginal ring.
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21 ATTITUDES ABOUT OBTAINING OR NOT OBTAINING A POSTPARTUM STERILIZATION AT 6 MONTHS POSTDELIVERY: A QUALITATIVE STUDY Zite N, Gilliam ML. Introduction: During prenatal care, many women express a desire for a postpartum sterilization but only some undergo the procedure. The purpose of this study was to compare longitudinally women who do with those who do not undergo sterilization. Materials and Methods: Interviews were conducted immediately postpartum with women who requested postpartum sterilization. Women were interviewed again at 6 weeks and 6 months to assess attitudes toward sterilization. Results: We recruited 72 women who requested postpartum sterilization; 38 of these women underwent the procedure whereas 34 did not. Most of the women who underwent the procedure were satisfied with their care and decision. When these women voiced a concern, it involved fear of failure or side effects but not regret. Attitudes held by women who did not undergo the procedure were closely related to the reason for procedure cancellation. Women who deferred the procedure due to poor neonatal outcome expressed relief. Women who desired more children also felt satisfaction. Women who had their procedure cancelled for maternal medical reasons were fearful of consequences of future pregnancy. Those who had their procedure cancelled due to logistics of labor and delivery expressed anger. Women who feared spinal anesthesia or pain remained ambivalent about sterilization. Discussion: Women who felt that it was their decision to be sterilized or not were satisfied at follow-up. Women who expressed fear about the nature of the surgery remained ambivalent. Women who were prevented from having the procedure remained frustrated. Conclusion: Women’s attitudes toward sterilization at follow-up reflected their thoughts immediately postpartum. 22 AVAILABILITY AND KNOWLEDGE OF EMERGENCY CONTRACEPTION AND MISOPROSTOL IN MORELOS, MEXICO Cwiak C, Torres P, Walker D. Introduction: The objectives of the study were to (1) determine the availability of emergency contraception (EC) and misoprostol and (2) measure knowledge regarding EC and misoprostol in Mexico. Materials and Methods: A survey was conducted in pharmacies and health centers in Morelos, Central Mexico. Subjects were asked about the availability of and their knowledge regarding EC and misoprostol. Results: Subjects from 33 pharmacies and 32 health centers were interviewed. Of the subjects who had knowledge of EC (n = 53), 39 (73.6%) dispensed oral contraceptives for use as EC. Of the 41 subjects (77.4%) who said that they knew how to use EC, only 20 (48.8%) knew the correct time of administration and 13 (31.7%) knew the correct number of doses. Availability or knowledge of EC did not significantly differ between site types (p N .05). Fourteen (26.4%) subjects had misoprostol available. Twenty-two (41.5%) knew of its abortive properties. Subjects from pharmacies were significantly more likely to have misoprostol available and know of its abortifacient properties (p b .05). Overall, knowledge of effective regimens of misoprostol was extremely limited.
evaluating the initiation of oral contraceptive use. Hospitalizations during follow-up were elicited during the follow-up interviews. Medical records of the admissions for cholecystectomy and the most recent antecedent pregnancy were reviewed. Results: A total of 757 women enrolled at the University of Texas Southwestern Medical Center (UTSWMC) site and 959 at the Emory University and Mt. Sinai Medical Center. All eight cholecystectomies occurred at the UTSWMC, resulting in an observed rate of 25.28/1000 women-years (95% CI, 8.09/ 1000–42.47/1000). Compared with the American rate, the rate ratio is 6.01 (95% CI, 1.92 –10.11). The UTSWMC had a greater proportion of women who (1) were of Hispanic ethnicity (660 vs. 357; p b .01) and (2) identified themselves as postpartum at the time of enrollment (500 vs. 36; p b .01). Discussion: The women enrolled at the UTSWMC site had a sixfold increased rate of cholecystectomy compared with the American rate of 4.2/1000 women aged between 18 and 44 years. Conclusion: In our cohort, factors associated with cholecystectomy included being postpartum at the time of oral contraceptive initiation and being of Hispanic ethnicity. 20 ARE YOU WILLING? CHARACTERISTICS OF COLLEGE UNDERGRADUATES WILLING TO USE CONTRACEPTIVE VAGINAL RINGS Leboeuf M, Wuellner S, Gilliam ML. Introduction: Oakley, using electronic pill packets, demonstrated that an irregular daily schedule was associated with poor OC compliance. The objective of this study was to examine the association between lifestyle variables and acceptance of a nondaily method (Oakley D, Yu MY, Zhang YM, Zhu XL, Chen WH, Yao L. Combining qualitative with quantitative approaches to study contraceptive pill use. J Womens Health 1999;8(2): 249–57). Materials and Methods: We electronically surveyed a random sample of female undergraduates. Demographic and lifestyle variables (hours of sleep, class hours, employment, extracurricular activities), sexual and pregnancy history, contraceptive use and factors relevant to the choice of a contraceptive method were assessed. The association of these characteristics with the willingness to use a contraceptive ring was evaluated using a logistic regression model. Results: A total of 689 women answered the survey. Willingness to use the contraceptive ring was positively associated with willingness to use the contraceptive patch (OR, 2.13; 95% CI, 1.34 –3.40), being employed at least 20 hours a week (OR, 2.20; 95% CI, 1.25–3.85), acceptability of a monthly contraceptive (OR, 2.23; 95% CI, 1.62 –3.08), acceptability of self-insertion (OR, 1.74; 95% CI, 1.42 –2.13), acceptability of feeling ring during intercourse (OR, 1.44; 95% CI, 1.08–1.92) and concern over potential hormonal side effects (OR, 1.09; 95% CI, 1.02 –1.16). Willingness to use the contraceptive ring was negatively associated with current use of oral contraceptives (OR, 0.48; 95% CI, 0.28 – 0.83). Discussion: Busy lifestyle and acceptance of its characteristics were associated with willingness to use a contraceptive vaginal ring. Committed pill users were less likely to consider this option. Conclusion: Lifestyle and acceptability of its characteristics are important factors in the decision to use a contraceptive vaginal ring.
235
21 ATTITUDES ABOUT OBTAINING OR NOT OBTAINING A POSTPARTUM STERILIZATION AT 6 MONTHS POSTDELIVERY: A QUALITATIVE STUDY Zite N, Gilliam ML. Introduction: During prenatal care, many women express a desire for a postpartum sterilization but only some undergo the procedure. The purpose of this study was to compare longitudinally women who do with those who do not undergo sterilization. Materials and Methods: Interviews were conducted immediately postpartum with women who requested postpartum sterilization. Women were interviewed again at 6 weeks and 6 months to assess attitudes toward sterilization. Results: We recruited 72 women who requested postpartum sterilization; 38 of these women underwent the procedure whereas 34 did not. Most of the women who underwent the procedure were satisfied with their care and decision. When these women voiced a concern, it involved fear of failure or side effects but not regret. Attitudes held by women who did not undergo the procedure were closely related to the reason for procedure cancellation. Women who deferred the procedure due to poor neonatal outcome expressed relief. Women who desired more children also felt satisfaction. Women who had their procedure cancelled for maternal medical reasons were fearful of consequences of future pregnancy. Those who had their procedure cancelled due to logistics of labor and delivery expressed anger. Women who feared spinal anesthesia or pain remained ambivalent about sterilization. Discussion: Women who felt that it was their decision to be sterilized or not were satisfied at follow-up. Women who expressed fear about the nature of the surgery remained ambivalent. Women who were prevented from having the procedure remained frustrated. Conclusion: Women’s attitudes toward sterilization at follow-up reflected their thoughts immediately postpartum. 22 AVAILABILITY AND KNOWLEDGE OF EMERGENCY CONTRACEPTION AND MISOPROSTOL IN MORELOS, MEXICO Cwiak C, Torres P, Walker D. Introduction: The objectives of the study were to (1) determine the availability of emergency contraception (EC) and misoprostol and (2) measure knowledge regarding EC and misoprostol in Mexico. Materials and Methods: A survey was conducted in pharmacies and health centers in Morelos, Central Mexico. Subjects were asked about the availability of and their knowledge regarding EC and misoprostol. Results: Subjects from 33 pharmacies and 32 health centers were interviewed. Of the subjects who had knowledge of EC (n = 53), 39 (73.6%) dispensed oral contraceptives for use as EC. Of the 41 subjects (77.4%) who said that they knew how to use EC, only 20 (48.8%) knew the correct time of administration and 13 (31.7%) knew the correct number of doses. Availability or knowledge of EC did not significantly differ between site types (p N .05). Fourteen (26.4%) subjects had misoprostol available. Twenty-two (41.5%) knew of its abortive properties. Subjects from pharmacies were significantly more likely to have misoprostol available and know of its abortifacient properties (p b .05). Overall, knowledge of effective regimens of misoprostol was extremely limited.