Browsing by Subject "Maternal healthcare"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Open Access
    A randomised controlled trial studying the effects of the copper intrauterine device and the injectable progestogen contraceptive on depression and sexual functioning of women in the Eastern Cape
    (2014) Singata-Madliki, Mandisa; Khalil, Doris; Hofmeyr, G J
    A lack of contraception use and contraceptive method discontinuation are common causes of unintended pregnancy in the Eastern Cape. The most common reason for method discontinuation among childbearing women is the unacceptable side effects of their contraceptive choices. Both depression and sexual dysfunction are given as side effects of contraceptive use; however, there is little evidence to support these effects. This randomised, single-blind controlled trial conducted in East London, South Africa, Investigated the effects of the initiation of a long-acting injectable contraceptive, Depot Medroxyprogesterone Acetate (DMP A), compared with the initiation of a copper Intrauterine Contraceptive Device (Cu-IUD) after childbirth on depression and sexual functioning. After counselling, 242consenting pregnant women were randomised to receive DMP A or a Cu IUD within 48 hours of childbirth, in a ratio of 1:1. Primary outcome measures were depression and sexual dysfunction evaluated by validated instruments. Questionnaires were administered at baseline, and telephonically at one month and three months after randomisation. The telephonic interviewer was blinded to the participants' group allocation. English and Xhosa versions of the Beck Depression Inventory and the Edinburgh Postnatal Depression Scale were used to assess depression. The Arizona Sexual Functioning Scale was used to assess sexual functioning. For these primary outcomes, median scores between the intervention groups were compared, as well as the number of events (dichotomous data) in each intervention group. There relative effects of these interventions were summarised by calculating risk ratios, with 95% confidence intervals. Statistical tests used included the Shapiro-Wilk test, T-test, and Wilcoxon test. There were not consistently statistically significant differences in the risk of depression or sexual dysfunction between the intervention groups in this study. However, there was a trend towards more depression in the DMPA group which was statistically significant for mean EPDS score at the one month and for the BDI score three month assessments compared with the IUD group. There was also a trend to more sexual dysfunction with DMPA, but the only statistically significant difference was that fewer women in the DMPA group resumed sexual intercourse within the first month of treatment than in the IUD group. The author's recommendations from the study are that, firstly, family planning providers should inform women during contraceptive counselling that there is no certainty that DMPA causes depression and/or sexual dysfunction; however, it may do so in the postpartum period. Secondly, contraceptive users can continue to use DMPA with confidence as a convenient and effective method of preventing unintended pregnancy. Thirdly, the trend towards postpartum depression and sexual dysfunction in the DMPA group of this study justifies further research with a larger sample size, to include women from various social settings, and for a longer period of follow-up. Lastly, the Cu-IUD is a good alternative to DMPA in women who experience intolerable effects with the latter.
  • Thumbnail Image
    Item
    Open Access
    'What men don't know can hurt women's health': a qualitative study of the barriers to and opportunities for men's involvement in maternal healthcare in Ghana
    (Biomed Central Ltd, 2015) Ganle, John; Dery, Isaac
    BACKGROUND:The importance of men's involvement in facilitating women's access to skilled maternal healthcare in patriarchal societies such as Ghana is increasingly being recognised. However, few studies have been conducted to examine men's involvement in issues of maternal healthcare, the barriers to men's involvement, and how best to actively involve men. The purpose of this paper is to explore the barriers to and opportunities for men's involvement in maternal healthcare in the Upper West Region of Ghana. METHODS: Qualitative focus group discussions, in-depth interviews and key informant interviews were conducted with adult men and women aged 20-50 in a total of seven communities in two geographic districts and across urban and rural areas in the Upper West Region of Ghana. Attride-Stirling's thematic network analysis framework was used to analyse and present the qualitative data. RESULTS: Findings suggest that although many men recognise the importance of skilled care during pregnancy and childbirth, and the benefits of their involvement, most did not actively involve themselves in issues of maternal healthcare unless complications set in during pregnancy or labour. Less than a quarter of male participants had ever accompanied their wives for antenatal care or postnatal care in a health facility. Four main barriers to men's involvement were identified: perceptions that pregnancy care is a female role while men are family providers; negative cultural beliefs such as the belief that men who accompany their wives to receive ANC services are being dominated by their wives; health services factors such as unfavourable opening hours of services, poor attitudes of healthcare providers such as maltreatment of women and their spouses and lack of space to accommodate male partners in health facilities; and the high cost associated with accompanying women to seek maternity care. Suggestions for addressing these barriers include community mobilisation programmes to promote greater male involvement, health education, effective leadership, and respectful and patient-centred care training for healthcare providers. CONCLUSIONS: The findings in this paper highlight the need to address the barriers to men's involvement, engage men and women on issues of maternal health, and improve the healthcare systems - both in terms of facilities and attitudes of health staff - so that couples who wish to be together when accessing care can truly do so.