Your search found 27 Results

  1. 1
    Peer Reviewed

    Uptake and predictors of early postnatal follow-up care amongst mother-baby pairs in South Africa: Results from three population-based surveys, 2010-2013.

    Larsen A; Cheyip M; Aynalem G; Dinh TH; Jackson D; Ngandu N; Chirinda W; Mogashoa M; Kindra G; Lombard C; Goga A

    Journal of Global Health. 2017 Dec; 7(2):021001.

    Background: Achieving World Health Organization (WHO) recommendations for postnatal care (PNC) within the first few weeks of life is vital to eliminating early mother-to-child transmission of HIV (MTCT) and improving infant health. Almost half of the annual global deaths among children under five occur during the first six weeks of life. This study aims to identify uptake of three PNC visits within the first six weeks of life as recommended by WHO among South African mother-infant pairs, and factors associated with uptake. Methods: We analyzed data from three facility-based, nationally representative surveys (2010, 2011/12 and 2012/13) primarily designed to determine the effectiveness of the South African program to prevent MTCT. This analysis describes the proportion of infants achieving the WHO recommendation of at least 3 PNC visits. Interviews from 27 699 HIV-negative and HIV-positive mothers of infants aged 4-8 weeks receiving their six week immunization were included in analysis. Data were analyzed using STATA 13.0 and weighted for sample ascertainment and South African live births. We fitted a multivariable logistic regression model to estimate factors associated with early PNC uptake. Results: Over half (59.6%, 95% confidence interval (CI) = 59.0-60.3) of mother-infant pairs received the recommended three PNC visits during the first 6 weeks; uptake was 63.1% (95% CI = 61.9-64.3) amongst HIV exposed infants and 58.1% (95% CI = 57.3-58.9) amongst HIV unexposed infants. Uptake of early PNC improved significantly with each survey, but varied significantly by province. Multivariable analysis of the pooled data, controlling for survey year, demonstrated that number of antenatal visits (4+ vs <4 Adjusted odds ratio (aOR) = 1.13, 95% CI = 1.04-1.23), timing of initial antenatal visits (12 weeks, aOR = 1.13, 95% CI = 1.04-1.23), place of delivery (clinic vs hospital aOR = 1.5, 1.3-1.6), and infant HIV exposure (exposed vs unexposed aOR = 1.2, 95% CI = 1.1-1.2) were the key factors associated with receiving recommended PNC visits. Conclusions: Approximately 40% of neonates did not receive three or more postnatal care visits in the first 6 weeks of life from 2010-2013. To improve uptake of early PNC, early antenatal booking, more frequent antenatal care attendance, and attention to HIV negative women is needed.
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  2. 2
    Peer Reviewed

    Postnatal contraception discontinuation: different methods, same problem.

    Singata-Madliki M; Dekile-Yonto N; Hofmeyr GJ; Lawrie TA

    BMJ Sexual and Reproductive Health. 2018 Jan; 44(1):66-68.

    Following publication of the author's trial on the effects of postnatal depot medroxyprogesterone acetate (DMPA) compared with the copper intrauterine device (IUD) on postnatal depression in this journal in July 2016, they have sought to evaluate contraceptive discontinuation in our study sample. Postnatal contraception is promoted as part of the WHO strategy to reduce the unmet need for family planning in low- and middle-income countries (LMICs) and to reduce preventable maternal and child mortality. However, little is known about discontinuation rates associated with postnatal contraception use in these settings. From the trial, 75 of 242 participants were contactable two or more years after randomisation and 54 consented to a follow-up interview, which was conducted by a Masters student from the University of Fort Hare (NDY). Twenty-three women had received DMPA and 31 women an IUD. In the DMPA and IUD arms, respectively, 48% (11/23) and 42% (13/31) had discontinued their contraceptive methods by the time of the interview. All participants who discontinued did so within the first year, 10 within 3 months of allocation (DMPA=4, IUD=6), and 17 within 6 months (DMPA=7, IUD=10). Six of the participants allocated to DMPA (26%) and five allocated to the IUD (16%) became pregnant following discontinuation.
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  3. 3

    Updated WHO recommendation on tranexamic acid for the treatment of postpartum haemorrhage. Highlights and key messages from the World Health Organization's 2017 Global Recommendation.

    World Health Organization [WHO]. Department of Maternal, Newborn, Child and Adolescent Health

    Geneva, Switzerland, WHO, 2017 Oct. 5 p. (WHO/RHR/17.21)

    This summary brief highlights key messages from the updated World Health Organization’s recommendation on Tranexamic acid (TXA) for the treatment of postpartum haemorrhage (PPH), including policy and program implications for translating the TXA recommendation into action at the country level. In 2012, WHO published recommendations for the prevention and treatment of postpartum haemorrhage, including a recommendation on the use of tranexamic acid (TXA) for treatment of PPH. The 2017 updated WHO Recommendation on TXA is based on new evidence on use of TXA for treatment of PPH. Key messages include: 1) The World Health Organization (WHO) recommends early use of intravenous tranexamic acid (TXA) within 3 hours of birth in addition to standard care for women with clinically diagnosed postpartum haemorrhage (PPH) following vaginal birth or caesarean section; 2) Administration of TXA should be considered as part of the standard PPH treatment package and be administered as soon as possible after onset of bleeding and within 3 hours of birth. TXA for PPH treatment should not be initiated more than 3 hours after birth; 3) TXA should be used in all cases of PPH, regardless of whether the bleeding is due to genital tract trauma or other causes; 4) TXA should be administered at a fixed dose of 1 g in 10 mL (100 mg/mL) IV at 1 mL per minute (i.e., administered over 10 minutes), with a second dose of 1 g IV if bleeding continues after 30 minutes; and 5) TXA should be administered via an IV route only for treatment of PPH. Research on other routes of TXA administration is a priority.This summary brief is intended for policy-makers, programme managers, educators and providers.
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  4. 4

    Statement on maternal sepsis.

    World Health Organization [WHO]. Department of Reproductive Health and Research; World Health Organization [WHO]. Human Reproduction Programme [HRP]

    Geneva, Switzerland, WHO, 2017. 4 p. (WHO/RHR/17.02)

    Strategic approaches to reduce maternal mortality in the past 15 years have mainly focused on clinical interventions and health system strengthening. The greatest attention has been on postpartum haemorrhage and hypertensive disorders, the two leading direct causes of maternal mortality. Further reducing maternal deaths is a priority for achieving the Sustainable Development Goals, implementing the UN Global Strategy for Women’s, Children’s and Adolescents’ Health and critical for the Strategies toward Ending Preventable Maternal Mortality (EPMM). However, the third most common direct cause of maternal mortality, maternal sepsis, received less attention, research and programming. Undetected or poorly managed maternal infections can lead to sepsis, death or disability for the mother and increased likelihood of early neonatal infection and other adverse outcomes. Recognizing the need to foster new thinking and to catalyse greater action to address this important cause of maternal and newborn mortality and morbidity, the World Health Organization (WHO) and Jhpiego have launched the Global Maternal and Neonatal Sepsis Initiative, dedicated to focusing additional effort, energizing stakeholders and accelerating progress in the area of maternal and neonatal infection and sepsis. This statement defines maternal sepsis and operationalizes the definition.
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  5. 5

    Guideline: iron supplementation in postpartum women.

    World Health Organization [WHO]. Department of Nutrition for Health and Development

    2016; Geneva, Switzerland, WHO, 2016. 38 p.

    This guideline provides a global, evidence-informed recommendation on iron supplementation in postpartum women, as a public health intervention for the purpose of improving maternal and infant health outcomes. The guideline aims to help Member States and their partners in their efforts to make informed decisions on the appropriate nutrition actions to achieve the Sustainable Development Goals (SDGs), in particular, Goal 2: End hunger, achieve food security and improved nutrition and promote sustainable agriculture.
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  6. 6
    Peer Reviewed

    The WHO's medical eligibility criteria for contraceptive use: 20 years of global guidance.

    Altshuler AL; Gaffield ME; Kiarie JN

    Current Opinion In Obstetrics and Gynecology. 2015 Dec; 27(6):451-9.

    PURPOSE OF REVIEW: The purpose of this review is to revisit the inception of the WHO's medical eligibility criteria for contraceptive use (MEC), particularly its objectives and methodology, and to describe its impact over the last 20 years in the field of family planning. New recommendations are summarized from the newly released fifth edition of the guidance. RECENT FINDINGS: Fourteen topics, encompassing over 575 recommendations were reviewed for the MEC, fifth edition. New recommendations include: changes for combined hormonal contraceptive use among postpartum women; progestogen-only methods among breastfeeding women; and women at high risk for HIV infection, women living with HIV, and women living with HIV using antiretroviral therapy and hormonal contraception. New methods reviewed include subcutaneously administered depot medroxyprogesterone acetate, Sino-implant (II), ulipristal acetate, and progesterone-releasing vaginal ring. SUMMARY: Over the past 20 years, the MEC has become a remarkably influential document for practitioners and policy makers in family planning, as it provides up-to-date, evidence-based recommendations for contraceptive use for women with various medical conditions and medically relevant characteristics.
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  7. 7

    WHO recommendations for the prevention and treatment of postpartum haemorrhage.

    World Health Organization [WHO]. Department of Reproductive Health and Research

    Geneva, Switzerland, WHO, 2012. 41 p.

    Postpartum haemorrhage (PPH) is a major cause of mortality, morbidity and long term disability related to pregnancy and childbirth. Effective interventions to prevent and treat PPH exist and can largely reduce the burden of this life-threatening condition. Given the availability of new scientific evidence related to the prevention and treatment of PPH, this document updates previous WHO recommendations and adds new recommendations for the prevention and treatment of PPH. The primary goal of this guideline is to provide a foundation for the implementation of interventions shown to have been effective in reducing the burden of PPH. Health professionals responsible for developing national and local health policies constitute the main target audience of this document. Obstetricians, midwives, general medical practitioners, health care managers and public health policy-makers, particularly in under-resourced settings are also targeted. This document establishes general principles of PPH care and it is intended to inform the development of clinical protocols and health policies related to PPH.
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  8. 8
    Peer Reviewed

    Post placental insertion of intrauterine contraceptive device.

    Suri V

    Indian Journal of Medical Research. 2012 Sep; 136(3):370-1.

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  9. 9
    Peer Reviewed

    Controversies in postpartum contraception: when is it safe to start oral contraceptives after childbirth?

    Jackson E

    Thrombosis Research. 2011; 127(Suppl 3):S35-S39.

    The timely initiation of contraception postpartum is an important consideration for breastfeeding and non-breastfeeding women; many women prefer oral contraceptive pills to other methods. In breastfeeding women, combined hormonal pills are not recommended prior to 6 weeks postpartum, due to effects on milk production. Although progestogen-only pills do not adversely affect milk, lack of data regarding possible effects on infants exposed to progestogens in breast milk renders timing of initiation of this method controversial. In non-breastfeeding women, elevated risk of venous thromboembolism restricts use of combined hormonal pills prior to 21 days postpartum. From 21 to 42 days, use of combined hormonal pills should be assessed based on a woman's personal venous thromboembolism risk profile; after 42 days postpartum there is no restriction in the use of combined hormonal pills for otherwise healthy women. Non-breastfeeding women may safely use progestogen-only pills at any time during the postpartum.
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  10. 10

    WHO Technical Consultation on Postpartum and Postnatal Care.

    Matthews M; Severin VX; Jelka Z

    Geneva, Switzerland, World Health Organization [WHO], Department of Making Pregnancy Safer, 2010. [65] p. (WHO/MPS/10.03)

    On October 29, 2008, WHO Technical Consultation on Postpartum and Postnatal Care was held in Geneva, Switzerland. This report reflects the discussions, proceedings and recommendations for follow-up. The World Health Organization (WHO) is in the process of revising and updating its guidance on postpartum and postnatal care delivered by skilled providers. The purposes of the revision are to encourage and support broader provision of care and to foster a new, woman-centred concept of care that promotes health and sustains attention to dangerous complications. This consultation report also discusses follow up activities after the revision of the WHO guidance.
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  11. 11
    Peer Reviewed

    An evidence-based approach to postpartum use of depot medroxyprogesterone acetate in breastfeeding women.

    Rodriguez MI; Kaunitz AM

    Contraception. 2009 Jul; 80(1):4-6.

    This article reviews the evidence and safety of immediate depot medroxyprogesterone acetate (DMPA) use in lactating postpartum women. It presents the benefits for mothers and infants, the concerns, the safety issues, and states that existing data are not sufficient to limit DMPA use postpartum in women at high risk for unintended pregnancy.
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  12. 12
    Peer Reviewed

    The effect of Baby Friendly Hospital Initiative and postnatal support on breastfeeding rates -- Croatian experience.

    Bosnjak AP; Batinica M; Hegedus-Jungvirth M; Grguric J; Bozikov J

    Collegium Antropologicum. 2004 Jun; 28(1):235-243.

    The effects of implementation WHO/UNICEF Breastfeeding Hospital Initiative (BFHI) and community postnatal support on breastfeeding rates were examined during and after the breastfeeding promotion campaign in one county of Croatia. Comparison with a control group indicated increase of breastfeeding prevalence in a period of BFHI implementation 11994-1998) - 68% us. 87% at infant age 1 ma., 30% us. 54% at 3 mo., 11.5% vs. 28% at 6 mo., and 2% us. 3.5% at infant age 11-12 mo. (chi-square test, p < 0.05). More considerable increase has been noticed in period 1999-2000 which is characterized by breastfeeding support groups activity: 68% us. 87% at infant age I no., 30% us. 66% at 3 mo., 11.5% us. 49% at 6 mo., and 2% vs. 23% at infant age 11-12 ;TO. (chi-square test, p < 0.05). Our conclusion is that activities aiming to promote breastfeeding in maternity hospitals have had limited success. They have resulted in satisfactory increase of breastfeeding prevalence in early infant's period, but for far-reaching effect postnatal support is also required. (author's)
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  13. 13
    Peer Reviewed

    Hormonal contraception during lactation: systematic review of randomized controlled trials.

    Truitt ST; Fraser AB; Grimes DA; Gallo MF; Schulz KF

    Contraception. 2003 Oct; 68(4):233-238.

    Contraception choices may be limited for lactating women due to concerns about hormonal effects on quality and quantity of milk, passage of hormones to the infant and infant growth. We conducted a systematic review of randomized controlled trials to determine the effect of hormonal contraception on lactation. We sought all randomized controlled trials, reported in any language, that included any form of hormonal contraception compared with another form of hormonal contraception, nonhormonal contraception or placebo during lactation. Seven reports from five randomized controlled trials met the inclusion criteria. Most of the five trials did not specify their method used to generate a random sequence, method of allocation concealment, blinding of treatments or use of an intention-to-treat analysis. Additionally, high loss-to-follow-up rates invalidated at least two trials. The findings from two trials comparing oral contraceptives to placebo during lactation were conflicting. Another trial found no inhibitory effects on lactation from progestin-only contraceptives. Finally, the World Health Organization trial found a statistically significant decline in breast milk volume in women using combined oral contraceptives compared to women using progestin-only pills. However, infant growth for the two groups did not differ. The limited evidence from randomized controlled trials on the effect of hormonal contraceptives during lactation is of poor quality and insufficient to establish an effect of hormonal contraception, if any, on milk quality and quantity. At least one properly conducted randomized controlled trial of adequate size is urgently needed to make recommendations regarding hormonal contraceptive use for lactating women. (author's)
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  14. 14
    Peer Reviewed

    WHO multicentre randomised trial of misoprostol in the management of the third stage of labour. [Estudio clínico multicéntrico aleatorizado de la OMS sobre misoprostol en el manejo del alumbramiento]

    Gulmezoglu AM; Villar J; Nguyen Thi Nhu Ngoc; Piaggio G; Carroli G

    Lancet. 2001 Sep 1; 358(9283):689-95.

    Postpartum hemorrhage is a leading cause of maternal morbidity and mortality. Active management of the third stage of labor, including use of uterotonic agent, has been shown to reduce blood loss. Misoprostol (a prostaglandin E1 analogue) has been suggested for this purpose because it has strong uterotonic effects, can be given orally, is inexpensive, and does not need refrigeration for storage. The authors did a multicenter, double- blind, randomized controlled trial to determine whether oral misoprostol is as effective as oxytocin during the third stage of labor. In hospitals in Argentina, China, Egypt, Ireland, Nigeria, South Africa, Switzerland, Thailand, and Vietnam, the authors randomly assigned women about to deliver vaginally to receive 600 mcg misoprostol orally or 10 IU oxytocin intravenously or intramuscularly, according to routine practice, plus corresponding identical placebos. The medications were administered immediately after delivery as part of the active management of the third stage of labor. The primary outcomes were measured postpartum blood loss of 1000 ml or more, and the use of additional uterotonics without an unacceptable level of side-effects. The authors chose an upper limit of a 35% increase in the risk of blood loss of 1000 ml or more as the margin of clinical equivalence, which was assessed by the confidence interval of the relative risk. Analysis was by intention to treat. 9264 women were assigned misoprostol and 9266 oxytocin. 37 women in the misoprostol group and 34 in the oxytocin group had emergency caesarean sections and were excluded. 366 (4%) of women on misoprostol had a measured blood loss of 1000 ml or more, compared with 263 (3%) of those on oxytocin (relative risk 1.39 [95% confidence interval 1.19-1.63], p < 0.0001). 1398 (15%) women in the misoprostol group and 1002 (11%) in the oxytocin group required additional uterotonics (1.40 [1.29-1.51], p < 0.0001). Misoprostol use was also associated with a significantly higher incidence of shivering (3.48 [3.15- 3.84]) and raised body temperature (7.17 [5.67-9.07]) in the first hour after delivery. 10 IU oxytocin (intravenous or intramuscular) is preferable to 600 mcg oral misoprostol in the active management of the third stage of labor in hospital settings where active management is the norm. (author's)
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  15. 15

    Long-acting systemic agents for fertility regulation.

    d'Arcangues C

    In: Annual technical report, 1992, [of the] World Health Organization [WHO]. Special Programme of Research, Development and Research Training in Human Reproduction. Geneva, Switzerland, WHO, 1993. 23-36. (WHO/HRP/ATR/92/93)

    This 1992 annual report of the Task Force on Long-acting Systemic Agents for Fertility Regulation of the World Health Organization's Special Programme of Research, Development, and Research Training in Human Reproduction states that the main objectives of the Task Force are the development of new compounds and/or delivery systems which are superior to existing methods and which are easily delivered by family planning programs. Projects completed in 1992 include a major Phase III clinical trial comparing the once-a-month injectables (which induce regular monthly estrogen-withdrawal bleeding) Mesigyna and Cyclofem in 12 centers in Egypt, a Phase III clinical trial comparing these agents with the Chinese Injectable No. 1 in China, a multicenter study of the effects of Mesigyna and Cyclofem on lipid metabolism and on coagulation and fibrinolysis, and a study in Mexico of the return of fertility after discontinuation of the injectables. Also completed in 1992 were two studies on the pharmacokinetics of the injectables depot medroxyprogesterone acetate and norethisterone enanthate (NET) and a multicenter Phase II study comparing levonorgestrel butanoate (HRP002) to NET. Because of the favorable results of this last study, pharmacokinetic studies of an improved formulation of HRP002 are ongoing. A Phase III clinical trial of the vaginal rings in the UK revealed that a number of users developed vaginal lesions. This development will be given priority in further tests. Other ongoing and planned activities of the Task Force revolve around attempts to develop hormonal postpartum contraception which prevents exposure of breast-fed infants to synthetic steroids and attempts to deal with the problem of unpredictable endometrial bleeding associated with progestogen-only methods.
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  16. 16

    Training health care workers to counsel breastfeeding mothers.

    Savage F; Daelmans B

    DIALOGUE ON DIARRHOEA. 1995 Feb; (59):2.

    WHO and UNICEF have designed a 40-hour counseling course for maternal-child health workers that aims to impart the skills needed to assist mothers to breast feed their infant. Course participants receive training in the following communication and counseling techniques: accepting what a mother feels as valid, recognizing and praising things a mother is doing right, giving practical guidance, using simple language, making suggestions rather than commands, and limiting the information provided so as not to overwhelm the mother. In addition, health workers are trained on the attachment and positioning techniques that promote successful breast feeding. Such techniques include having the infant's chin touch the breast, more areola exposed above than below the infant's mouth, close contact with the mother's body, and arrangement of the baby's head and body in a straight line. Common concerns, such as mothers' fears that they are not producing enough milk, sore nipples, and breast feeding practices when an infant is sick, are addressed. At the conclusion of the training, health workers apply the skills they have learned in maternity wards and maternal-child health clinics.
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  17. 17
    Peer Reviewed

    Progesterone-releasing vaginal rings for use in postpartum contraception. I. In vitro release rates of progesterone from core-loaded rings.

    Matlin SA; Belenguer A; Hall PE

    CONTRACEPTION. 1992 Apr; 45(4):329-41.

    Chemists from London, England and a chemist from WHO in Geneva, Switzerland compared release rates of progesterone from vaginal rings with cores of different diameters (4, 5, 6, 6.7, and 7.24 mm). The manufacturer loaded each core with 25% w/w progesterone. The technique used to dissolve the progesterone from the silicone rubber core consisted of placing the rings in continuously flowing baths of isotonic saline at 37 degrees Celsius. The learned that a membrane diffusion controlled process, modified by the development of a gradually increasing zone of depletion at the core surface, did indeed release the progesterone. The used the UV absorption method to measure the amount of progesterone released in 24 hour periods for as much as 128 days. The vaginal ring with the 6 mm core released 3.6-5.5 mg progesterone/day in a 90 day period. The daily range of maximum and minimum values for each set of rings demonstrated good reproducibility. Progesterone release was inversely related to diffusion distance (between core surface and ring surface) for each day. Since, in their clinical trials in postpartum women, WHO wanted to use vaginal rings which initially released 5 mg progesterone/day and declines by about 0.5 mg/month under conditions of membrane limited diffusion as the depletion zone grew thicker, the study showed that the rings with a 6 mm core met the criteria. The chemists found that these rings and 4 sterile batches of these rings have highly consistent and reproducible rates in vitro drug delivery. They also compared the vaginal rings with a 6 mm core with rings with at homogeneous dispersion of progesterone throughout the polymer. The homogenous rings 1st released much progesterone then fell quickly from 10->20 mg/day during the 1st week to a gradual release of about 6 mg/day during the end of the 90 days.
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  18. 18

    The breastmilk controversy.

    Panos Institute

    WORLDAIDS. 1992 Jan; (19):11.

    In 1991, researchers followed 212 mothers and infants who tested HIV-1 negative at delivery in Rwanda. Later 8 infants tested HIV positive. Both the infants and mothers became infected simultaneously. They ruled out other routes of infection and concluded that the colostrum and breast milk were possibly the route of infection for 4 infants and positively the route for 4 infants. They postulated that when one 1st becomes infected with HIV, one may have high levels of HIV in the blood and thus be more infectious in the time period between 1st contracting HIV and development of HIV antibodies. All the mothers were vulnerable to sexual exploitation because they were either unmarried or widowed or had absent husbands and unstable sexual partnerships. Thus the risk factor of economic and social instability enhanced their vulnerability to exposure to HIV. The researchers suggested that heal professionals should counsel HIV negative mothers who are at high risk about the possibility of transmitting HIV via breast milk if they happen to seroconvert. In some developing countries like Rwanda, no alternatives to breast feeding exist so the researchers advocated intervention studies to assess the efficacy and feasibility of alternative nutritional practices, such as wet nursing, for mothers at high risk of acquiring HIV after delivery. They did not conclude that already HIV infected mothers should not breast feed since research had not yet proved that infants acquire HIV from breast milk of infected mothers. In fact, other research showed that HIV positive infants who are breast fed live longer than bottle fed HIV infants. After publication of this study, WHO continued its commitment to promote, protect, and support breast feeding no matter what the HIV prevalence of a country is.
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  19. 19

    New IPPF statement on breastfeeding, fertility and post-partum contraception.

    International Planned Parenthood Federation [IPPF]. International Medical Advisory Panel [IMAP]

    IPPF MEDICAL BULLETIN. 1990 Apr; 24(2):2-4.

    The International Planned Parenthood Federation International Medical Advisory Panel drew up the following statement in November, 1989. Breastfeeding is good for the infant. Antibodies passed to it from the mother protect it from infection. Patterns of breastfeeding are changing. Therefore, the risk of pregnancy is increased. Postpartum amenorrhea plays a major role in natural fertility regulation. Studies from around the world show a positive correlation between the length of breastfeeding and the length of lactational amenorrhea. Amenorrhea lasts longer in those who breastfeed more often at night and during the day. There is controversy over the effect of nutrition on postpartum infertility. Pregnancy and the puerperium are a good time for counseling on maternal nutrition, child spacing, breastfeeding, and contraceptive methods. Counseling nursing mothers about potential fertility during lactation should be based on local information. All women should be advised to fully breastfeed. Family planning programs should cooperate with maternity services in providing counseling and education for postpartum women who need contraception, for providing referral services, for producing educational resources, and in training health personnel. Postpartum contraception should be included in the training of traditional birth attendants. Women who do not breastfeed can select any contraceptive method. Mothers who nurse must not hurt success of lactation or the infant's health. Nonhormonal contraception should be the 1st choice for lactating women. IUDs do not harm infant growth or lactation. Postpartum insertions are appropriate, though care must be taken. Female sterilization can be conveniently done at this time. Barrier methods are reliable when used regularly. The failure rate should be lower when used after delivery. Progestagen-only contraception consists of progestagen-only pills, injectables, and Norplant. These do not affect quality and quantity of breast milk or length of lactation. They are suitable for those who do not wish nonhormonal methods. There are possible consequences, however, of the transfer of the steroid to breast milk. Hormonal methods should not be used earlier than 6 weeks postpartum. High and low dose oral contraceptives adversely affect the quality and quantity of breast milk. They also reduce duration of lactation. They should be withheld until 6 weeks after delivery, or until the infant is weaned--whichever comes first. The efficacy or periodic abstinence in nursing women requires further analysis.
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  20. 20
    Peer Reviewed

    An initiative on vesicovaginal fistula.

    Tahzib F

    Lancet. 1989 Jun 10; 1(8650):1316-7.

    Vesicovaginal fistula (VVF), commonly caused by prolonged obstructed labor, is one of the worst complications of childbirth. Afflicted women continuously leak urine and sometimes feces, excoriating their mutilated vulvas and vaginas and often becoming social outcasts. Until the early part of this century, VVF was common in the United States and European countries, but today it is rarely encountered in developed countries. It is still, however, a major problem in many developing countries, where it is generally caused by neglect and mismanagement in labor. As many as 300 women suffering from VVF come to gynecology clinics for treatment every month in some areas of northern Nigeria. But many doctors do not wish to deal with VVF and their Western training does not equip them to perform needed surgery. The major thrust of research and development of services must be in prevention of VVF. But much can be learned about the disorder through treatment of its victims, and their suffering in and of itself demands a major treatment effort. This will require establishment of specialized centers, including hostel accommodations. International and national teams of medical experts would go periodically to needy areas to train local surgeons, advise on difficult cases, and help reduce patient backlogs. Such a program can only be set in motion through funds provided by international organizations. A WHO working group on VVF recently recommended urgent measures to prevent the disorder and to clear the backlog of patients waiting for operations. And an organization known as the VVF Initiative has been established in Nigeria and is in need of practical and financial assistance.
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  21. 21

    Breastfeeding effects on birth interval components: a prospective child health study in Gaza.

    Anderson JE; Becker S; Guinena AH; McCarthy BJ

    Studies in Family Planning. 1986 May-Jun; 17(3):153-60.

    Data from a prospective child health study conducted in Gaza by the WHO was used to examine the relationship between infant feeding and subsequent fertility. The study group consisted of 769 women living in 2 refugee camps in Gaza who gave birth in a 2-month period in 1978, and their index children, followed up for 23 months with monthly visits. Women who became pregnant within the 23 months were followed up until the end of their pregnancy. Women who practiced contraception after the birth of the index child were excluded. Life table analyses demonstrate a strong relationship between breastfeeding and 2 components of birth intervals, the postpartum anovulatory period and the waiting time from the end of the anovulatory period to conception. Duration of breastfeeding in this population averaged 12 months. Once menses have resumed, main factors related to waiting time to conception are age, husbands education, and measures of breastfeeding intensity and duration. Women who are breastfeeding when menstruation resumes and continue to do so are less likely to conceive than other women.
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  22. 22

    Protection of working mothers: an ILO global survey (1964-84).

    International Labour Office [ILO]

    Women At Work. 1984; (2):1-71.

    This document describes the current status of maternity protection legislation in developed and developing countries and is based primarily on the findings of the International Labor Organization's (ILO's) global assessment of laws and regulations concerning working women before and after pregnancy. The global survey collected information from 18 Asian and Pacific countries, 36 African nations, 28 North and South American countries, 14 Middle Eastern countries, 19 European market economy countries, and 11 European socialist countries. Articles in 2 ILO conventions provide standards for maternity protection. According to the operative clauses of these conventions working women are entitled to 1) 12 weeks of maternity leave, 2) cash benefits during maternity leaves, 3) nursing breaks during the work day, and 4) protection against dismissal during maternity. Most countries have some qualifying conditions for granting maternity leaves. These conditions either state that a worker must be employed for a certain period of time or contributed to an insurance plan over a defined period of time before a maternity leave will be granted. About 1/2 of the countries in the Asia and Pacific region, the Americas, Africa, and in the Europe market economy group provide maternity leaves of 12 or more weeks. In all European socialist countries, women are entitled to at least 12 weeks maternity leave and in many leaves are considerably longer than 12 months. In the Middle East all but 3 countries provide leaves of less than 12 weeks. Most countries which provide maternity leaves also provide cash benefits, which are usually equivalent to 50%-100% of the worker's wages, and job protection during maternity leaves. Some countries extend job protection beyond the maternity leave. For example, in Czechoslovakia women receive job protection during pregnancy and for 3 years following the birth, if the woman is caring for the child. Nursing breaks are allowed in 5 of the Asian and Pacific countries, 30 of African countries, 18 of the countries in the Americas, 9 of the Middle East countries, 16 of European market economy countries, and in all of the European socialist countries. Several new trends in maternity protection were observed in the survey. A number of countries grant child rearing leaves following maternity leaves. In some countries these leaves can be granted to either the husband or the wife. Some countries have regulations which allow parents to work part time while rearing their children and some permit parents to take time off to care for sick children. In most of the countries, the maternity protection laws and regulations are applied to government workers and in many countries they are also applied to workers in the industrial sector. A list of the countries which have ratified the articles in the ILO convenants concerning maternity benefits is included.
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  23. 23

    Post partum return of fertility: ovulation method initiated after childbirth. Preliminary report.

    Perez A

    [Unpublished] 1980. Presented at the Second International Congress of the International Federation for Family Life Promotion, Navan, Ireland, September 24-October 1, 1980. 13 p.

    Results of a research program on puerperium physiology are discussed in terms of their relationship to return of fertility during the postpartum period and possible applications to natural family planning (NFP) during this period. Correlation between nursing and first postpartum menstruation has been found. Of especial importance is the finding of the probability of ovulation occurring during the first 10 postpartum weeks being practically nil (=.0008) and chances of ovulation increasing after 12th week postpartum if full nursing is maintained (=.047). Therefore, in terms of Billings' method, nonnursing mothers or those nursing for less than 28 days must wait until first postpartum menstruation (40-80 days) before learning the method, if abstinence is maintained during the postpartum. Mothers in full nursing can reinitiate intercourse between 25-30 days postpartum. A WHO-sponsored training program of teachers of the Ovulation method in Santiago, Chile, trained 70 couples, and use-effectiveness postpartum was particularly studied. 82 couples were recruited as students. The women were all white and of low socioeconomic class. 51 were fully nursing, 25 partially, and 6 had suspended nursing upon entrance to the program. 82 couples completed 655 months of use during the 16-month study. 4 pregnancies occurred, and 2 couples changed methods. Pearl Index was 7.3/100 years of use. When 130 postpartum amenorrheic months were subtracted, Pearl Index was 9.1. 1 pregnancy was in a user under nonovulatory conditions; 2 were method failures; and 1 was the result of faulty teaching. All of the couples are continuing with NFP, and 97.8% were considered to have learned to recognize mucus patterns during postpartum period.
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  24. 24

    Studies on lactation and contraception in WHO's research programme.

    Bernard RM

    JOURNAL OF BIOSOCIAL SCIENCE. 1977; (Suppl 4):113-20.

    WHO (World Health Organization) is planning to undertake 3 different studies concerning lactation and contraception. These studies will attempt 1) to determine the effects, if any, of steroid contraceptives on lactation; 2) to identify and quantify any forms of steriods which may appear in the breast milk of mothers who use steroid contraceptives; and 3) to identify parameters which would help nursing mothers pinpoint ovulation onset. There is considerable controversy among scientists concerning the affects of steroid contraceptives on lactation. WHO proposes to undertake a prospective study assessing the effect of various typis of combined and progestogen only oral steroids as well as injectable preparation on lactation among matched control groups in a number of countries. An effort will be made to minimize an many extraneous variables as possible and to employ uniform procedures and methods in all the countries. In reference to the 2nd study, there is considerable controversy concerning the possible transfer of steroids to maternal breast milk and about the subsequent effect of these steroids on infants who ingest the milk. The WHO study will seek to determine if steroids or their metabolites are present in the breast milk of nursing mothers who take steroid contraceptives. In reference to the 3rd study, if reliable indicators of ovulation resumption among postpartum women can be identified, efforts will be made to develop test kits for home use by nursing mothers.
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  25. 25

    International fertility research program sponsors effort in 43 lands to develop new, safer methods.

    International Family Planning Perspectives. 1979 Sep; 5(3):127-9.

    The International Fertility Research Program (IFRP) is sponsoring research in 30 developing countries and 13 developed nations in an effort to develop more effective contraceptive methods. Particular emphasis is being placed on developing contraceptives for women in developing countries where nutritional, health, and sanitation conditions make current methods either difficult or less effective to use. Trials of a pill regimen including vitamin supplementation are underway in Sri Lanka, and a progestogen-only pill for use by lactating women is being tested in Egypt and India. Progestogens apparently do not modify the content of maternal milk. Another study involves the testing of a Lippes loop which releases Trasylol, a bleeding suppressant, in an effort to overcome bleeding problems associated with IUD use. The IFRP has developed and is testing biodegradable appendages which can be attached to IUDs to help retain the device in postpartum women during the period when the uterus is enlarged. Other efforts are being directed toward improving and simplifying sterilization procedures. In Chile, pellets of quinacrine have been inserted into the upper area of the uterus. As the pellets dissolve the quinacrine enters the tubes and produces scar tissue which eventually closes the tube. This research may pave the way toward the development of a non-surgical sterilization method. Animal studies of a reversible sterilization procedure in which a condom-like device is fitted over the ends of the tubes are in progress. In another project a modified laparoscope, called the Laprocator, is being evaluated. The device does not use electricity and is particularly suitable for use in areas in which electricity is lacking or the source is unstable. The device is used in a procedure called suprapubic endoscopy in which only a small incision is needed. Insufflation of the abdomen is unnecessary, and elastic rings are used to close the tubes. IFRP will undertake an innovative motivational project in the Middle East during the coming religious holidays.
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