Contraceptive preferences and adoption following female genital fistula surgery in Uganda: a mixed-methods study.
Contraceptive preferences and adoption following female genital fistula surgery in Uganda: a mixed-methods study.
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DOI：
10.1186/s12978-023-01663-3
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发表时间：
2023-08-19
影响因子：
3.4
通讯作者：
Harper, Cynthia C.
中科院分区：
文献类型：
--
作者：
El Ayadi, Alison M.;Nalubwama, Hadija;Painter, Caitlyn;Kakaire, Othman;Miller, Suellen;Barageine, Justus;Byamugisha, Josaphat;Obore, Susan;Korn, Abner;Harper, Cynthia C.
女性生殖器瘘主要是由于长期难产造成的，通过外科手术治疗。建议在修复后的最短时间内预防妊娠，以确保充分愈合并优化修复后的结果。我们研究了乌干达瘘管患者（n = 60）在生殖器瘘管手术后一年使用混合方法的避孕偏好和使用。术后12个月，每季度记录一次性活动、避孕药具使用和妊娠状况。有目的地选择的参与者（n = 30）进行深入访谈，探讨亲密关系，性经验，生殖意图，避孕药具的使用。参与者的中位年龄为28岁，近一半（48%）已婚或与伴侣生活在一起。向97%的参与者提供了推迟性交的咨询，但只有59%的人接受了避孕咨询。6个月后有32%的人报告了性活动，12个月后有50%的人报告了性活动。83%的人报告说没有尝试怀孕。在性活跃的参与者中，避孕措施的使用率在基线时较低（36%），但在12个月时增加到73%。6名（10%）女性怀孕，其中2名在修复后3个月内怀孕。那些希望立即生孩子的受访者都很年轻，孩子较少，在瘘管发展时经历过死产，并感受到来自伴侣的压力。妇女采取避孕措施是为了从瘘管手术中完全康复，避免不良后果。另一些人则干脆选择推迟生育。不采取避孕措施的原因包括对生育能力和避孕方法的误解，以及医疗保健提供者对其首选方法的建议不足或不明确。很大一部分患者没有得到医疗保健提供者的避孕咨询。在瘘管病手术时及手术后提供以病人为中心的全面避孕咨询，对于病人优化瘘管病的愈合和尽量减少复发以及满足他们自己的生殖偏好非常重要。女性生殖器瘘是一种在分娩过程中如果妇女得不到高质量护理可能发生的伤害。可以通过手术治疗。瘘管手术后，女性不应该马上怀孕，这样她们才能痊愈。为了帮助女性康复，我们需要了解患有瘘管病的女性对节育的想法和感受。我们收集了60名乌干达妇女瘘管手术后一年的数据，以了解手术后的性生活，避孕药具的使用和怀孕情况。我们与其中30人进行了交谈，以了解更多关于他们的关系，性经验，孩子的计划以及避孕措施的使用。大多数女性被告知不要马上发生性行为（97%），许多人被告知避孕措施（59%）。一些女性在手术后6个月（32%）有性生活，一半在12个月（50%）。大多数人不想怀孕（83%）。在12个月内发生性行为的人中，避孕药具的使用率上升到73%。那些想尽快怀孕的女性都很年轻，孩子较少，因为瘘管病失去了孩子，她们的伴侣也想要一个孩子。妇女们告诉我们，她们采取避孕措施是为了从手术中恢复过来，或者是因为她们不想马上要孩子。一些妇女告诉我们，她们不采取避孕措施，因为她们担心这会伤害她们。其他人对避孕知识了解不够。在瘘管手术中需要对患者进行避孕教育，以帮助患者愈合并实现其生育计划。
Female genital fistula, largely caused by prolonged obstructed labour, is treated by surgical repair. Preventing pregnancy for a minimum period post-repair is recommended to ensure adequate healing and optimize post-repair outcomes. We examined contraceptive preferences and use among Ugandan fistula patients (n = 60) in the year following genital fistula surgery using mixed-methods. Sexual activity, contraceptive use and pregnancy status were recorded quarterly for 12 months after surgery. In-depth interviews among purposively selected participants (n = 30) explored intimate relationships, sexual experiences, reproductive intentions, and contraceptive use. Median participant age was 28 years and almost half (48%) were married or living with partners. Counselling was provided to 97% of participants on delaying sexual intercourse, but only 59% received counselling on contraception. Sexual activity was reported by 32% after 6 months and 50% after 12 months. Eighty-three percent reported not trying for pregnancy. Among sexually active participants, contraceptive use was low at baseline (36%) but increased to 73% at 12 months. Six (10%) women became pregnant including two within 3 months post-repair. Interview participants who desired children immediately were young, had fewer children, experienced stillbirth at fistula development, and felt pressure from partners. Women adopted contraception to fully recover from fistula surgery and avoid adverse outcomes. Others simply preferred to delay childbearing. Reasons cited for not adopting contraception included misconceptions related to their fertility and to contraceptive methods and insufficient or unclear healthcare provider advice on their preferred methods. A high proportion of patients were not counselled by healthcare providers on contraception. Provision of comprehensive patient-centred contraceptive counselling at the time of fistula surgery and beyond is important for patients to optimize healing from fistula and minimize recurrence, as well as to meet their own reproductive preferences. Female genital fistula is an injury that can happen during childbirth if women do not get high-quality care. It can be treated by surgery. After fistula surgery, women should not get pregnant right away so they can heal. To help women heal, we need to know how women with fistula think and feel about birth control. We collected data from 60 Ugandan women for one year after fistula surgery to learn about sex after surgery, contraceptive use, and pregnancy. We talked with 30 of them to learn more about their relationships, experiences with sex, plans for children, and birth control use. Most women were told to not have sex right away (97%) and many were told about birth control (59%). Some women had sex by 6-months after surgery (32%) and half by 12-months (50%). Most did not want to get pregnant (83%). Contraceptive use rose to 73% among those having sex by 12-months. Women who wanted to get pregnant soon were young, had fewer children, had lost their baby at fistula, and their partners wanted a child. Women told us they used contraception so they could recover from surgery or because they did not want a child right away. Some women told us they did not use contraception because they were worried it would hurt them. Others did not know enough about contraception. Patient education on contraception is needed at fistula surgery to help patients heal and meet their plans for children.
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影响因子：
3.7
作者：
Sarnak DO;Wood SN;Zimmerman LA;Karp C;Makumbi F;Kibira SPS;Moreau C
通讯作者：
Moreau C
影响因子：
2.9
作者：
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通讯作者：
Atela, Martin
DOI：
10.1016/j.ijgo.2007.06.032
发表时间：
2007-11-01
影响因子：
3.8
作者：
de Bernis, L.
通讯作者：
de Bernis, L.
影响因子：
34.3
作者：
Maheu-Giroux, Mathieu;Filippi, Veronique;Kirakoya-Samadoulougou, Fati
通讯作者：
Kirakoya-Samadoulougou, Fati
影响因子：
3.7
作者：
Ahinkorah, Bright Opoku
通讯作者：
Ahinkorah, Bright Opoku