Menstrual pattern, sexual behaviors, and contraceptive use among postpartum women in Nairobi Urban Slums

listen audio

Study Justification:
– The study aims to examine the patterns of menstrual resumption, sexual behaviors, and contraceptive use among postpartum women in Nairobi urban slums.
– This is important because the postpartum period can be challenging for poor women, and understanding their experiences can help inform interventions and policies to improve their reproductive health outcomes.
– The study specifically focuses on women in marginalized areas such as slums, who may face additional barriers to accessing healthcare and family planning services.
Study Highlights:
– The study found that sexual resumption occurs earlier than the resumption of menses and postpartum contraceptive use.
– Approximately 28% of postpartum months where women were at risk of another pregnancy were months where no contraceptive method was used.
– Menstrual resumption acts as a trigger for initiating contraceptive use, with a peak of contraceptive initiation occurring shortly after the first month when menses are reported.
– There was no variation in contraceptive method choice between women who initiated use before and after menstrual resumption.
– Overall, poor postpartum women in marginalized areas such as slums experience a significant risk of unintended pregnancy.
Recommendations for Lay Readers and Policy Makers:
– Increase access to family planning services for postpartum women in marginalized areas such as slums.
– Strengthen postnatal visits and other subsequent health system contacts to provide opportunities for reaching postpartum women with a need for family planning services.
– Improve education and awareness about contraceptive methods and their availability.
– Address the underlying social and economic factors that contribute to the challenges faced by postpartum women in marginalized areas.
Key Role Players Needed to Address Recommendations:
– Government health centers
– Private for-profit outlets
– Faith-based organizations
– Non-governmental organizations
– Not-for-profit healthcare providers
– Retail outlets selling over-the-counter medicines including contraceptives
Cost Items to Include in Planning the Recommendations:
– Training and capacity building for healthcare providers
– Infrastructure and equipment for healthcare facilities
– Outreach and awareness campaigns
– Contraceptive supplies and distribution
– Monitoring and evaluation of interventions

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study provides detailed information about the methodology, sample size, and data collection process. However, the abstract does not mention specific statistical analyses or results. To improve the evidence, the abstract could include a summary of the key findings and statistical significance, as well as any limitations or potential biases in the study design.

Postpartum months provide a challenging period for poor women. This study examined patterns of menstrual resumption, sexual behaviors and contraceptive use among urban poor postpartum women. Women were eligible for this study if they had a birth after the period September 2006 and were residents of two Nairobi slums of Korogocho and Viwandani. The two communities are under continuous demographic surveillance. A monthly calendar type questionnaire was administered retrospectively to cover the period since birth to the interview date and data on sexual behavior, menstrual resumption, breastfeeding patterns, and contraception were collected. The results show that sexual resumption occurs earlier than menses and postpartum contraceptive use. Out of all postpartum months where women were exposed to the risk of another pregnancy, about 28% were months where no contraceptive method was used. Menstrual resumption acts as a trigger for initiating contraceptive use with a peak of contraceptive initiation occurring shortly after the first month when menses are reported. There was no variation in contraceptive method choice between women who initiate use before and after menstrual resumption. Overall, poor postpartum women in marginalized areas such as slums experience an appreciable risk of unintended pregnancy. Postnatal visits and other subsequent health system contacts provide opportunities for reaching postpartum women with a need for family planning services. © 2011 The New York Academy of Medicine.

The study was conducted in two Nairobi slum settlements namely: Korogocho and Viwandani. The Nairobi Urban Health and Demographic Surveillance System (NUHDSS) has prospectively monitored about 60,000 individuals living in the two slums since 2002, with routine updates conducted every 4 months. The two informal settlements share common slum characteristics such as poor sanitation, high school dropout, congestion, crime, unemployment, high disease burden, and limited access to proper health facilities. The slums are served by some government health centers, together with several private for-profit outlets, faith-based organizations, nongovernmental organizations, not-for-profit health care providers, and retail outlets selling over-the-counter medicines including contraceptives. The current study uses data from the Maternal and Child Health (MCH) component of a 5-year Urbanization, Poverty, and Health Dynamics longitudinal study. This is an ongoing open cohort, where women are recruited into the study if they had a birth from September 2006 onwards and they were living in the Nairobi Urban Health and Demographic Surveillance area. The MCH study is nested into the NUHDSS and relies on previously collected rich sociodemographic data from all women resident in the study area. The first baseline round of the MCH component was conducted between February and April 2007 and since then additional waves of data collection have been conducted. A total of 2,994 women had been recruited into the study by the end of August 2008 (Table 1). Interviews were conducted in Swahili, the commonly spoken national language in the settlements. During every visit, trained fieldworkers recruit new mothers who form a new cohort and updates are conducted for those mothers previously recruited. Number of women recruited/interviewed for the study during the period 2007–2008 aThese two cohorts recorded relatively higher loss to follow-up/attrition rates mostly due to the political instability resulting from national elections that were conducted around this period and the resulting higher rate of changes of residences and outmigrations Details of reproductive events such as breastfeeding, postpartum abstinence, postpartum amenorrhea, sex, contraceptive use, and condom use are documented in a month-to-month calendar format since the birth of the index child. For the current analysis, data from four cohorts of women collected between February 2007 to August 2008 are utilized (Table 1). The fieldwork duration for the third wave was relatively long because data collection was disrupted by the presidential election campaigns that covered most of December 2007 and later resulted into post-election violence in the first few months of 2008. To assess the effect of loss to follow-up, we compared characteristics for women who were recruited initially and women who were successfully followed up during the subsequent updates/surveys (results not shown). The distributions of selected indicators such as parity, marital status, age of woman, location, etc. were generally comparable between women present at recruitment and those who were successfully re-interviewed during the first update which allowed on average a maximum of 12 months. The entire analysis is restricted to the first 12 postpartum months. Much of the analysis is performed in woman-months. A woman followed up for 1 year or more contributes 12 woman-months. Nearly all women in the early recruitment cohorts contributed a full 12 months of data. Women in cohort 4 contribute an average of 9 months of data. This censoring for a small minority of the sample is addressed by life-table methods and by data presentation in terms of ordinal months since birth. This approach allowed us to measure exposure to pregnancy and contraceptive use on a month-to-month basis and allowed us to assess the contribution of several event-states such as abstinence, amenorrhea, and contraception in the first 12 months of postpartum. Five women with missing information in one of the months of (retrospective) follow-up were excluded. In order to jointly assess the timing and interactions of menstrual and sexual resumption, the time since birth of the child was classified into ordinal months of mutually exclusive categories of protection and risk periods in relation to contraceptive use. For a specific woman-month: Descriptive statistics was used to assess patterns of postpartum infecundity (amenorrhea), contraceptive use, and sexual resumption as well as for summarizing study cohorts by selected characteristics such as age of women at recruitment, marital status, education, ethnicity, parity, fertility desires, and source of contraception. Survival analysis techniques were used to assess the time to event (resumption of menstrual flow and resumption of sexual activities and time to first contraceptive use).

Based on the provided information, here are some potential innovations that can be used to improve access to maternal health:

1. Mobile Health (mHealth) Applications: Develop mobile applications that provide information and reminders about menstrual patterns, sexual behaviors, and contraceptive use to postpartum women. These apps can also connect women to healthcare providers and facilitate access to family planning services.

2. Community Health Workers: Train and deploy community health workers in slum settlements to provide education and counseling on menstrual health, sexual behaviors, and contraceptive use. These workers can also distribute contraceptives and refer women to healthcare facilities for further support.

3. Telemedicine: Establish telemedicine services that allow postpartum women in slum settlements to consult with healthcare providers remotely. This can help overcome barriers to accessing healthcare facilities and provide timely advice on menstrual health, sexual behaviors, and contraceptive use.

4. Integrated Service Delivery: Integrate maternal health services with existing healthcare facilities in slum settlements. This can include incorporating family planning services into postnatal visits and other health system contacts, making it easier for postpartum women to access contraceptive methods and receive counseling.

5. Public-Private Partnerships: Foster collaborations between government health centers, private for-profit outlets, faith-based organizations, non-governmental organizations, not-for-profit healthcare providers, and retail outlets selling contraceptives. This can expand the availability and accessibility of family planning services in slum settlements.

These innovations aim to address the challenges faced by poor postpartum women in slum settlements by improving access to information, healthcare services, and contraceptive methods.
AI Innovations Description
Based on the study “Menstrual pattern, sexual behaviors, and contraceptive use among postpartum women in Nairobi Urban Slums,” the following recommendation can be developed into an innovation to improve access to maternal health:

1. Strengthen postnatal care: Postnatal visits and subsequent health system contacts provide opportunities to reach postpartum women with a need for family planning services. Innovations can be developed to enhance the quality and accessibility of postnatal care, ensuring that women receive comprehensive reproductive health services, including counseling on contraceptive use.

2. Community-based interventions: Given the unique challenges faced by poor postpartum women in marginalized areas such as slums, community-based interventions can be developed to improve access to maternal health services. This can involve training community health workers to provide education, counseling, and distribution of contraceptives within the community.

3. Integration of services: Innovations can focus on integrating maternal health services with other existing healthcare services, such as immunization programs or antenatal care. This can help ensure that women receive comprehensive care throughout the continuum of pregnancy, childbirth, and postpartum period.

4. Mobile health (mHealth) solutions: Leveraging technology, mHealth solutions can be developed to provide information, reminders, and support to postpartum women regarding menstrual patterns, contraceptive use, and sexual behaviors. This can be done through mobile applications, SMS reminders, or interactive voice response systems.

5. Empowerment and education: Innovations can focus on empowering postpartum women through education and awareness programs. This can include providing information on menstrual health, contraceptive options, and the importance of spacing pregnancies for maternal and child health.

By implementing these recommendations and developing innovative solutions, access to maternal health can be improved, leading to better reproductive health outcomes for postpartum women in marginalized areas.
AI Innovations Methodology
To improve access to maternal health based on the findings of the study, here are some potential recommendations:

1. Increase awareness and education: Implement targeted educational campaigns to raise awareness about the importance of postpartum contraception and the risks of unintended pregnancies. This can be done through community health workers, local clinics, and outreach programs.

2. Strengthen postnatal care services: Enhance postnatal care services to include comprehensive family planning counseling and provision of contraceptive methods. This can be done by training healthcare providers on postpartum contraception and ensuring that contraceptive methods are readily available in postnatal care settings.

3. Improve access to contraceptives: Address barriers to accessing contraceptives by ensuring a consistent supply of a variety of contraceptive methods in both public and private healthcare facilities. This can be achieved through partnerships with pharmaceutical companies, NGOs, and government agencies.

4. Engage men in family planning: Involve men in family planning discussions and decision-making processes. This can be done through community-based interventions that promote male involvement in reproductive health and family planning.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the target population: Identify the specific population group that will be impacted by the recommendations, such as postpartum women in Nairobi slums.

2. Collect baseline data: Gather data on the current access to maternal health services, including contraceptive use, menstrual resumption patterns, and sexual behaviors among postpartum women in the target population. This can be done through surveys, interviews, or existing data sources.

3. Develop a simulation model: Create a mathematical or statistical model that simulates the impact of the recommendations on access to maternal health. This model should consider factors such as population size, contraceptive availability, education campaigns, and healthcare infrastructure.

4. Input data and parameters: Input the baseline data and parameters into the simulation model. This includes information on the current levels of contraceptive use, menstrual resumption patterns, and sexual behaviors, as well as the expected impact of the recommendations.

5. Run simulations: Run the simulation model to project the potential impact of the recommendations on improving access to maternal health. This can include estimating changes in contraceptive use rates, reduction in unintended pregnancies, and improvements in overall maternal health outcomes.

6. Analyze results: Analyze the results of the simulations to understand the potential impact of the recommendations. This can involve comparing the projected outcomes with the baseline data and identifying key areas of improvement.

7. Refine and validate the model: Refine the simulation model based on feedback and validation from experts in the field. This can include adjusting parameters, incorporating additional data sources, or modifying the model structure.

8. Communicate findings: Present the findings of the simulation study to relevant stakeholders, such as policymakers, healthcare providers, and community organizations. This can help inform decision-making and guide the implementation of interventions to improve access to maternal health.

It is important to note that the methodology for simulating the impact of recommendations may vary depending on the specific context and available data.

Yabelana ngalokhu:
Facebook
Twitter
LinkedIn
WhatsApp
Email