Browsing by Author "Crede, Sarah"

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    Open Access
    Expanding contraceptive options for PMTCT clients: a mixed methods implementation study in Cape Town, South Africa
    (2014-01-10) Hoke, Theresa; Harries, Jane; Crede, Sarah; Green, Mackenzie; Constant, Deborah; Petruney, Tricia; Moodley, Jennifer
    Abstract Background Clients of prevention of mother-to-child transmission (PMTCT) services in South Africa who use contraception following childbirth rely primarily on short-acting methods like condoms, pills, and injectables, even when they desire no future pregnancies. Evidence is needed on strategies for expanding contraceptive options for postpartum PMTCT clients to include long-acting and permanent methods. Methods We examined the process of expanding contraceptive options in five health centers in Cape Town providing services to HIV-positive women. Maternal/child health service providers received training and coaching to strengthen contraceptive counseling for postpartum women, including PMTCT clients. Training and supplies were introduced to strengthen intrauterine device (IUD) services, and referral mechanisms for female sterilization were reinforced. We conducted interviews with separate samples of postpartum PMTCT clients (265 pre-intervention and 266 post-intervention) to assess knowledge and behaviors regarding postpartum contraception. The process of implementing the intervention was evaluated through systematic documentation and interpretation using an intervention tracking tool. In-depth interviews with providers who participated in study-sponsored training were conducted to assess their attitudes toward and experiences with promoting voluntary contraceptive services to HIV-positive clients. Results Following the intervention, 6% of interviewed PMTCT clients had the desired knowledge about the IUD and 23% had the desired knowledge about female sterilization. At both pre- and post-intervention, 7% of clients were sterilized and IUD use was negligible; by comparison, 75% of clients used injectables. Intervention tracking and in-depth interviews with providers revealed intervention shortcomings and health system constraints explaining the failure to produce intended effects. Conclusions The intervention failed to improve PMTCT clients’ knowledge about the IUD and sterilization or to increase use of those methods. To address the family planning needs of postpartum PMTCT clients in a way that is consistent with their fertility desires, services must expand the range of contraceptive options to include long-acting and permanent methods. In turn, to ensure consistent access to high quality family planning services that are effectively linked to HIV services, attention must also be focused on resolving underlying health system constraints weakening health service delivery more generally.
  • Thumbnail Image
    Item
    Open Access
    Is 'planning' missing from our family planning services?
    (2010) Crede, Sarah; Harries, Jane; Constant, Deborah; Hoke, Theresa Hatzell; Green, Mackenzie; Moodley, Jennifer
    The role of family planning in achieving the Millennium Development Goals is well recognised. The benefits of family planning, in developing countries in particular, extend beyond decreasing fertility and include poverty reduction, improved health for both mother and child, the promotion of gender equality by increasing women's opportunities beyond reproductive and domestic activities, and environmental sustainability. In addition, prevention of undesired pregnancies among HIV-positive women by eliminating unmet need for contraception is a highly cost-effective means of preventing mother-to-child transmission. In South Africa, free contraceptives are available at public sector health care facilities, and contraception use is high: an estimated 65% of sexually active women use a method.3 The method mix comprises predominantly short-acting methods - primarily injectable contraceptives. Long-acting contraceptives, such as the intra-uterine device (IUD), are highly effective among typical users owing to consistency of function, yet are underutilised in South Africa's public sector facilities. Of importance, especially in South Africa's high HIVprevalent setting, is that the IUD can be safely used on clinically well HIV-positive women. The 2004 Demographic and Health Survey showed that 10% of sexually active women were sterilised, while less than 1% of women were using the IUD. In preparation for an intervention aimed at improving contraceptive options, including long-acting and permanent methods (LAPM), for all postpartum women, we assessed women's knowledge and attitudes to LAPM. We report on findings from our baseline survey, which have prompted the question: Where is the 'planning' in family planning services?
  • Thumbnail Image
    Item
    Open Access
    The utilization of health care services by children with Foetal Alcohol Syndrome in the Western Cape, South Africa
    (2010) Crede, Sarah; London, Leslie; Sinanovic, Edina
    Foetal Alcohol Syndrome (FAS) is a serious public health concern in the Western Cape. However, the burden that this condition places on the health care systems in this region is poorly understood. The research proposed here will evaluate the utilization of health care services by children with FAS and Partial Foetal Alcohol Spectrum Disorders (PFAS) in Cape Town. In addition this study will identify factors that are correlated with increased utilization of health care.