A retained Graefenberg , ring intrauterine. contraceptive device which looked like a fractured Lippes loop on pelvic radiography is presented, and its management outlined.
A study of 300 Malaysian women who were fitted with the Copper-7 intrauterine device is presented. Two per cent of the acceptors were nulliparous. Insertion was easy in 97-7% of the cases and the side effects were minimal. In a study of over 4,634 women-months a low cumulative expulsion rate, at 12 and 24 months of use, of 3-1 and 3-6 respectively, was observed. However, relatively high cumulative rates of pregnancy of 4-3 and 9-2 occurred at 12 and 24 months of use respectively. Out of a total of 19 pregnancies, in 12 cases the device was found to have descended, a finding not commonly reported. One woman experienced translocation of the device five months after insertion, and in this instance, the device was removed by laparotomy. The findings in this study and their implications are discussed.
Over the past few years, the intrauterine contraceptive device (IUD) has overcome many of the problems that had initially made it unpopular. Today it is probably the most cost effective reversible form of contraception available.
PIP: Analysis of family planning clinic services offered by the FFPA and its state Family Planning Associations in Malaysia in 1978 has shown that oral contraceptives continued to be the most popular contraceptive method among family planning acceptors, but there had been notable increases in acceptance of the condom and the IUD. There was a marginal decrease from 1977 figures in the acceptance rate among the new and continuing acceptors of OCs in Peninsular Family Planning Associations. 77.1% of new acceptors chose OCs in 1978, compared with 85.3% in 1977. 15% of the new acceptors chose condoms in Peninsular Family Planning Associations last year, compared with 10.2% in 1977. The injectable contraceptive has been well received in Sawawak; 14,681 vials were dispensed in 1978.
A 45-year-old Malay housewife was seen at a health clinic with the chief complain of recurrent lower abdominal pain for 9 months. The pain was colicky in nature and occasionally it radiated to the back. There was no history of fever, vaginal discharge or any urinary or bowel symptoms. She had been using an intrauterine contraceptive device (IUCD Cu250) for the past 5 years. The last change of the IUCD was 2 years ago. Her annual pap smear results were normal. She had been to many primary care clinics and was reassured by the doctors that her symptom was due to her IUCD. She was prescribed mefenamic acid repeatedly for the past 9 months. However her symptoms worsen and she was worried because prior to this she did not have similar problems. Her physical examination was unremarkable. On pelvic examination, the IUCD string was visualised, indicating that her IUCD was still in-situ. Her cervix was pink and healthy. There was no abnormal vaginal discharge.
The objectives of this article are (1) review the contribution of traditional midwives to family planning communication in several Asian countries; (2) organize knowledge gathered from various studies into general guidelines for the most effective use of traditional midwives in family planning programs; and (3) present hypotheses for future research. In certain countries where pilot projects have tested the potential performance of traditional midwives in family planning programs, results have been encouraging. In other nations, more research is needed to determine the contribution traditional midwives can make to the family planning program.
PIP: Traditional midwives are found in almost every village and in many urban neighborhoods in the developing world, delivering the majority of births in these areas. Several Asian nations have begun to recognize the potential contribution of traditional midwives to modern family planning and health programs. A total of about 17,000 traditional midwives have been trained as family planning recruiters in Indonesia, Malaysia, the Philippines, and Thailand. Because traditional midwives deliver a large number of births in Asian nations, the potential is great for them to reach large numbers of women regarding family planning -- particularly poor, illiterate women. There is much to be learned from the traditional health system and governmental health and family planning programs should join hands with these older systems.
Evidence-based data confirm the relationship between an increased availability of effective contraception and reduction in induced abortion rate. In Malaysia, the contraception prevalence rate in 1966 was 8.8 per cent to 52 per cent in 1984, but has levelled off since then. In recent years there has been increasing report of babies ‘abandonment’ in Malaysia. The aim of this study is to determine the knowledge, attitudes and practices related to contraception among women and doctors in Kota Kinabalu the capital of Sabah, Malaysia. Descriptive and analytical community-based cross-sectional study was used. A total of 240 women and 60 doctors were selected from either private or public clinics. The instrument used was face-to-face interview for the women and self-administered questionnaires for doctors. Analysis was done using SPSS version 21. The doctors (80%) felt that contraception is extremely important, and routinely discuss (63%) with their patients. Oral contraceptive pill (97%) is the most common type of contraceptive available in their clinics. About 68% of doctors surprisingly cited that abstinence plays a major part in their contraceptive advice. The average correct answer by doctors on knowledge is 62%. The women surveyed (98.8%) have heard of contraception. The main reason for using is for spacing of pregnancy and many stopped or did not use because of fear of side effects. Women attending the public clinic appear to know more about female and male sterilization and intrauterine contraceptive device compared to those attending private clinic. Further research is needed to reinforce this study.
Study site: Klinik Kesihatan (maternal and child health clinics), private general practitioner clinics. Kota Kinabalu, Sabah, Malaysia
An Intrauterine contraceptive devices (IUCD) is commonly inserted by the primary health care physician. It can migrate into pelvic or abdominal organs. When a pregnancy occurs following an insertion of an IUCD, there should be a high suspicion of uterine perforation or possible migration. A radiograph can be done in the primary health care clinic to search for a missing IUCD. Early referral to the urology service is warranted when a patient presents with recurrent urinary tract infections. Removal of an intravesical IUCD can be managed with cystoscopy, laparoscopy or open surgery. Herein, we report a case of IUCD migration into the bladder. This case will highlight the importance of proper technique, careful insertion and the role of ultrasound.
PIP: Traditional midwives are active in most villages and many urban areas of Asia, Africa, and Latin America. They deliver babies, provide prenatal and postpartum care, teach folk methods of birth control, treat infertility, and enjoy the confidence of many women. Most official family planning programs make little or no use of these traditional midwives. Research should be conducted into the most effective ways of recruiting and rewarding midwives in family planning programs. They seem to function best when provided with adequate training, supervision, and incentives. Traditional midwives are participating in the national family planning programs in Pakistan, Indonesia, Malaysia, and the Philippines. Only in Iran do they participate in the medical aspects of family planning. Midwives in Iran do IUD insertions and their performance compares favorably with that of medical personnel.
PIP: The initial results of a study conducted to develop guidelines for the clinical management of family planning acceptors with regard to return of fertility following contraceptive use, are presented. 193 parous women attending an urban family planning clinic were interviewed regarding their last pregnancy conceived after stopping a method of contraception. The average interval to pregnancy was 3.9, 2.8 and 1.8 months for ex-users of oral pills, intrauterine devices and conventional methods of contraception, respectively, with median delays to conception of 1.9, 1 and within the 1st month for the 3 categories. In comparison, 149 women who had not used any method at all took 7.3 months before becoming pregnant. Selected variables including age and parity, duration of use and problems encountered, and outcome of pregnancy are further analysed. Follow-up investigations and treatment are recommended 12 months after stopping oral pills and 6 months after removal of intrauterine device for those who have not yet conceived.
Pregnant women with diabetes mellitus pose an increased risk of maternal and infant morbidity and mortality. In Perlis, for the year of 2016, only 3 (0.3%) out of 1,114 reproductive women with diabetes mellitus were using an intrauterine device (IUCD) as their main contraceptive measure. This project aims to improve the usage of IUCD to 10% among reproductive women with diabetes mellitus in nine health clinics of Perlis.
A retrospective contraception card review was undertaken to determine the baseline in providing IUCD services. Two sets of validated questionnaires were distributed to patients and healthcare providers in the pre and post-remedial period.
Customised training sessions were organised for both doctors and nurses’ group. A quick reference for IUCD was developed to guide the healthcare providers during counselling sessions. The Model of Good Care (MOGC) was integrated into the Maternal and Child Health State Plan of Action 2016 to ease the supervision of quality improvement.
Of the 244 diabetic women who had undergone counselling, 44 (18%) agreed to use IUCD and 38 (16%) of them inserted the IUCD within two weeks. Our project was able to increase the usage of IUCD among diabetic women in nine Perlis health clinics from 3 (0.3%) to 38 (3.4%) within six months. There was a gap reduction in achievable but not achieved (ABNA) from 9.7% to 6.6%. [ABNA = Achievable benefit not achieved]
Low usage of IUCD among diabetic women is a challenging issue and patient refusal to use IUCD, lack of husband support and comfortable with the previous contraception method were among the main contributing factors. However, providing continuous awareness and new process of effort in promoting the usage of IUCD among diabetic women do improve the uptake of the approach
PIP: Contraceptive prevalence was determined in the Kelantan region of Malaysia, an area with relatively poor health indices. 350 women attending health clinics on rubber and palm-oil estates and living in surrounding suburbs were surveyed by clinic workers or during home visits. The sample included 273 Malays, 64 Indians and 13 Chinese. This area of Peninsular Malaysia is noted for the highest infant mortality rate (17.7), second highest crude birth rate (35.2) and highest dependency ratio (88%) in the country. 44.9% practiced contraception, highest in Chinese and lowest in Indians. Methods used were pills by (55%), traditional methods (19%), tubal ligation (18%), safe period (14%), injections (5.5%), IUD (4.7%), and condom (2.3%). The Malaysian traditional methods are herbal preparations from tree bark or roots, herb pills, and exercises after coitus. 34% of the non contraceptors had used contraception before but stopped because of side effects, religious or spousal objections, or desire to conceive. 74% had married in their teens. 46% of the non-contraceptors were spacing their children by prolonged breastfeeding.
OBJECTIVE: Many forms of contraception are available on prescription only for example, the oral contraceptive pill (OCP) and long-acting reversible contraceptives (LARCs). In this analysis we aim to identify key determinants of prescription contraceptive use.
DESIGN: Cross-sectional population survey. Data on sociodemographic indices, concerns about the OCP and perceived barriers to access were collected.
SETTING: Data set constructed from a representative population-based telephone survey of community dwelling adults in the Republic of Ireland (RoI)
PARTICIPANTS: 1515 women aged between 18 and 45 years
MAIN OUTCOME MEASURE: Self-reported user of the OCP or LARCs (intrauterine contraception, contraceptive injections or subdermal contraceptive implants) in the previous 12 months.
RESULTS: For at least some of the previous year, 35% had used the OCP and 14% had used LARCs, while 3% had used two or more of these methods. OCP users were significantly younger, more likely to be unmarried and had higher income than non-users. Overall, 68% agreed with the statement 'that taking a break from long-term use of the contraceptive pill is a good idea' and 37% agreed with the statement that 'the OCP has dangerous side effects' and this was the strongest predictor variable of non-use of the OCP. Intrauterine contraception users were significantly older, more likely to be married and had lower income than non-users. Injections or subdermal contraceptive implant users were significantly younger, less likely to be married, had lower income and were less likely to agree that taking a break from long-term use of the pill is a good idea than non-users.
CONCLUSIONS: Prescription contraceptive use is sociodemographically patterned, with LARCs in particular being associated with lower incomes in the RoI. Concerns about the safety of the OCP remain prevalent and are important and modifiable determinants of contraceptive-related behaviour.