#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Contraceptive methods used by women in the period before and after giving birth


Authors: P. Křepelka 1,2;  J. Hanáček 1;  D. Hrdlička 3
Authors‘ workplace: Ústav pro péči o matku a dítě, Praha, ředitel doc. MUDr. J. Feyereisl, CSc. 1;  Katedra gynekologie a porodnictví IPVZ, Praha, vedoucí doc. MUDr. J. Feyereisl, CSc. 2;  Cegedim, Strategic Data CZ, s. r. o., Praha, vedoucí ing. J. Krýza 3
Published in: Ceska Gynekol 2009; 74(3): 211-218

Overview

Goal of the study:
To provide information on the knowledge and practices involving the use of the contraceptive methods employed by women of a fertile age, especially in the period of lactation.

Design:
A cross-section, descriptive study.

Setting:
Institute for the Care of Mother and Child, Prague; Department of Gynaecology and Obstetrics at the Institute of Postgraduate Education in Healthcare, Prague; Cegedim Strategic Data CZ s.r.o., Prague.

Methodology:
The method involved a written questionnaire in a structured form. The investigation was undertaken in two phases; the first round took place directly after giving birth, while the second took place 6 months after giving birth. The group consisted of 4,535 women who gave birth at the Institute for the Care of Mother and Child in the period between 15. 11. 2006 – 15. 11. 2007.

Results:
2540 women (56.0%) answered the questions in the first round; 85% of them were in the 26-35 age group, 44.3% were secondary school graduates and 36.7% were university graduates. 61.3% were first-time mothers, 32.3% were second-time mothers and 5.4% were third–time mothers. Contraception used before current gravidity: (n = 2540) oral hormonal contraception 59.7%, a condom 11.1%, intrauterine contraception 1.0% and 20.6% of the women used no contraceptive method. The users of oral hormonal contraception (n = 1517) were most frequently prescribed (12.8% of the women) a preparation containing 20 μg ethinylestradiol and 150 μg desogestrel (Mercilon). The contraception used during the course of lactation after a birth in the group of mothers of more than one child (n = 982): oral hormonal contraception 19.6%, a condom 17.1%, intrauterine contraception 1.3%, no contraceptive method 54.5%. Breastfeeding users of oral hormonal contraception (n = 192) were most frequently prescribed (20.3% of women) a preparation containing 500 μg lynestrenol (Exluton) and a preparation containing 75 μg desogestrel (Cerazette) (16.1% of women). The contraceptive methods planned by women after birth (n = 2540): oral hormonal contraceptive 36.5%, a condom 18.8%, intrauterine contraception 18.8%, no method 20.1%. 1,440 women (56.7%) answered the questions in the second round; 83.5% of them were in the 26-35 age group, 45.0% were secondary school graduates and 37.0% were university graduates. 64.4% were first-time mothers, 30.6% were second time mothers and 4.2% were third-time mothers. 74.6% of women were still breastfeeding 6 months after giving birth. Contraception used by breastfeeding women (n = 1074): oral hormone contraception 27.6%, a condom 21.8%, an intrauterine system with levonorgestrel 2.8%, intrauterine contraception 2.4%, no method 39.5%. Contraception used by non-breastfeeding women (n = 366): oral hormonal contraception 42.1%, a condom 15.0%, an intrauterine system with levonorgestrel 2.7%, intrauterine contraception 2.7%, no method 31.4%. In both groups of women, the users of oral hormonal contraception were most frequently prescribed a preparation containing 75 μg desogestrel (Cerazette); this accounted for 99.3% of the breastfeeding women and 18.8% of those not breastfeeding. 40.0% of breastfeeding and 48.4% of non-breastfeeding women are planning to use hormonal contraception in the coming period. The self-evaluation of the knowledge of contraception methods (n = 2540): 61.6% of women evaluated their knowledge as good, but 77.6% of women did not know a suitable hormonal contraceptive for the period of lactation. According to 80.7% of the women, their main source of expert information in the area of family planning is their gynaecologist.

Conclusion:
The prevalence of breastfeeding women 6 months after giving birth is high in the monitored group. Oral hormonal contraceptives are the most frequently used contraceptive method in general, including during the lactation period when women prefer a preparation containing 75 μg desogestrel regardless of whether or not they are breastfeeding. The women’s knowledge of suitable methods of contraception during the period of lactation is unsatisfactory and represents a challenge for healthcare providers to improve the amount of information available to women in this area

Key words:
family planning, hormonal contraception, lactation, breastfeeding.


Sources

1. Alerany Pardo, C., Bassons Boncompte, MT., Font Pous, M. Drugs and lactation. Farm Clin, 1986, 3, 6, p. 594-606.

1. Antoniou, E., Daglas, M., Iatrakis, G., et al. Factors associated with initiation and duration of breastfeeding in Greece. Clin Exp Obstet Gynecol, 2005, 32, 1, p. 37-40.

2. Cibula, D. Women’s contraceptive practices and sexual behaviour in Europe. Eur J Contracept Reprod Health Care, 2008, 13, 4, p. 362-375.

3. Conde-Agudelo, A., Rosas-Bermúdez, A., Kafury-Goeta, AC. Effects of birth spacing on maternal health: a systematic review. Am J Obstet Gynecol, 2007, 196, 4, p. 297-308.

4. McNeilly, AS. Lactational amenorrhea. Endocrinol Metab Clin North Am, 1993, 22, 1, p. 59-73.

5. Grimmes, D., Schultz, K., Van Vliet, H. Immediate post-partum insertion of intrauterine devices. Cochrane Databáze Syst Rev, 2003, 1, CD003036.

6. King, J. Contraception and lactation. J Midwifery Womens Health, 2007, 52, 6, p. 614-620.

7. Mosher, WD., Martinez,GM., Chandra, A., et al. Use of contraception and use of family planning services in the United States: 1982–2002. Advance Data from Vital and Health Statistics.

8. Nabukera, SK., Wingate, MS., Kirby, RS., et al. Interpregnancy interval and subsequent perinatal outcomes among women delaying initiation of childbearing. J Obstet Gynaecol Res, 2008, 34, 6, p. 941-947.

9. Ryan, AS., Zhou, W., Gaston, MH. Regional and sociodemographic variation of breastfeeding in the United States, 2002. Clin Pediatr, 2004, 43, 9, p. 815-824.

10. Saamash, AH., Sayed, GH., Hussain, MM. A comparative study of the levonorgestrel-releasing intrauterine system Mirena versus the Copper T380A intrauterine device during lactation: breast-feeding performance, infant growth and infant development. Contraception, 2005, 72, 5, p. 346-351.

11. Sandes, AR., Nascimento, C., Figueira, J., et al. Breastfeeding: prevalence and determinant factors. Acta Med Port, 2007, 20, 3, p. 193-200.

12. Shenfield, GM., Griffin, JM. Clinical pharmacokinetics of contraceptive steroids. An update. Clin Pharmacokinet, 1991, 20, 1, p. 15-37.

13. Shikary, ZK., Betrabet, SS., Patel, ZM., et al. ICMR task force study on hormonal contraception. Transfer of levonorgestrel (LNG) administered through different drug delivery systems from the maternal circulation into the newborn infant’s circulation via breast milk. Contraception, 1987, 35, 5, p. 477-486.

14. Skouby, SO. Contraceptive use and behavior in the 21st century: a comprehensive study across five European countries. Eur J Contracept Reprod Health Care, 2004, 9, 2, s. 57-68.

15. Truitt, ST., Fraser, AB., Grimas, DA., et al. Combined hormonal versus nonhromonal versus progestin-only contraception in lactation. Cochrane Databáze Syst Rev, 2003, 2, CD003988.

16. ÚZIS ČR. Činnost oboru gynekologie a péče o ženy v roce 2007, Aktuální informace č. 26/2008, s. 1-4.

Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine

Article was published in

Czech Gynaecology

Issue 3

2009 Issue 3

Most read in this issue
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#