Birth intervals of at least two years are beneficial for the health and well-being of women and their children. However, little is known about the best time to provide pregnant or postpartum women with family planning counseling and methods to help them space their births. According to a study by Sowmya Rajan and colleagues among urban women in Uttar Pradesh, India, 46% reported using a modern contraceptive method in the 12 months following their last birth during the period studied. Of women who had delivered at a health facility, those who received family planning counseling while at the facility were twice as likely as those who did not to report postpartum use of a modern method. In addition, among postpartum women visited at home by a community health worker after their birth, those given information about family planning were 30% more likely than those not given such information to report modern method use. Provision of information during antenatal care visits was not associated with postpartum uptake of family planning methods.
Until 2002, when abortion was legalized in Nepal under broad criteria, the procedure was permitted only to save a woman’s life, and complications from clandestine abortions accounted for more than half of all maternal deaths that occurred in hospitals. More than a decade later, women’s access to safe abortion remains limited. According to Nepal’s first national study on the incidence of abortion, conducted in 2014, only 42% of abortions were obtained at government-approved facilities. Mahesh Puri and colleagues calculated an abortion rate of 42 per 1,000 women aged 15–49, an abortion ratio of 56 per 100 live births and a complication treatment rate of eight cases per 1,000 women. The study also found that half of all pregnancies nationwide were unintended, and that 62% of such pregnancies ended in abortion. The authors recommend expanding high-quality family planning services; increasing access to free or low-cost abortion services, especially in remote areas; and disseminating information on the legal status of abortion and on where legal services can be obtained.
Although men play an important role in decisions about women’s health care in Sub-Saharan Africa, few studies have explored the ways in which men are involved in obstetric emergencies or the consequences of their involvement. Using birth narratives from 39 mothers and fathers in Northern and Central Ghana who had experienced serious birth complications, William Story and colleagues found that two-thirds of men had provided their partner with some combination of financial, emotional and instrumental support. On the other hand, several men had withheld economic resources or approval for care, and their decisions had resulted in delays in obtaining care. The researchers note that it is critical to understand the implications of involving men in obstetric emergencies, given the vulnerability of the mother and child in such situations.
Premarital first births are common in rural South Africa, but such births may affect women’s chances of establishing a stable, committed relationship. Using longitudinal data on women aged 10–35 from the Agincourt Health and Socio-Demographic Surveillance System, Christie Sennott and colleagues found that overall, women who had had a premarital birth were less likely than other women to have entered a first union. However, those who had had a premarital birth in the past year were more likely than those without such a birth to have entered a union, while those whose premarital birth had occurred 1–2 years or more than five years earlier were less likely to have done so. Unions formed within two years of a premarital birth were more likely to be nonmarital partnerships than to be marriages.
People living with HIV may desire children, but often lack information about safer conception and pregnancy. To understand communication between patients and providers about childbearing and safer-conception guidelines for people living with HIV, Haneefa Saleem and colleagues conducted in-depth interviews with 30 providers of HIV-related services in seven health facilities in Iringa, Tanzania, and with 60 HIV-positive women and men attending the study facilities. According to providers, the training they had received on childbearing and safer conception was limited, and clinical guidance on the subject is poor in Tanzania. Many providers stated that HIV-positive people have the right to have children, but some patients reported that providers had discouraged them from doing so. Only a few patients said they had learned about safer-conception strategies through discussions with health providers. The authors recommend that national guidelines on safer-conception and safe-pregnancy counseling be updated, and that providers be trained on those topics so that they can help HIV-affected couples plan their pregnancies and receive the care they need to manage their health.