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

Česká verzia

Authors: P. Křepelka ^1,2; J. Hanáček ¹; D. Hrdlička ³
Authors place of work: 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 the journal: Ceska Gynekol 2009; 74(3): 211-218

Summary

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.

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