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Improved access increases postpartum uptake of contraceptive implants among HIV-positive women in Rwanda

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Abstract
Background : Long-acting reversible contraceptives (LARCs) and sterilisation are the most cost-effective methods of contraception but are rarely used in sub-Saharan Africa partly due to limited access. Study design : HIV-positive pregnant women attending two urban clinics in Rwanda were followed prospectively in a perinatal HIV transmission cohort study. Women attending one clinic were referred to public family planning (FP) services for all contraceptive methods (Site A) and women attending the other clinic (Site B) were offered implants and intrauterine devices (IUDs) on-site. Results : Fifty three percent of the pregnant women reported an intention to use a LARC or to be sterilised after delivery. The uptake of implants was significantly higher at Site B (38%) than at Site A (6%). The IUD uptake was extremely low at both sites (2%). Twenty-eight of the 39 women at Site B who had intended to start using a LARC actually did so as compared to only one of 23 at Site A. Conclusion : When access to LARC was provided, a substantial number of HIV-positive women started using hormonal implants, but not IUDs, in the postpartum period. HIV and FP services should consider improving access to implants to reduce the number of unintended pregnancies.
Keywords
Unmet need, Postpartum, Family planning, Access, Rwanda, PREGNANCY, Long-acting reversible contraceptives (LARCs), TRANSMISSION, HIV infection, Sterilisation

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MLA
Dhont, Nathalie et al. “Improved Access Increases Postpartum Uptake of Contraceptive Implants Among HIV-positive Women in Rwanda.” EUROPEAN JOURNAL OF CONTRACEPTION AND REPRODUCTIVE HEALTH CARE 14.6 (2009): 420–425. Print.
APA
Dhont, N., Ndayisaba, G. F., Peltier, C. A., Nzabonimpa, A., Temmerman, M., & van de Wijgert, J. (2009). Improved access increases postpartum uptake of contraceptive implants among HIV-positive women in Rwanda. EUROPEAN JOURNAL OF CONTRACEPTION AND REPRODUCTIVE HEALTH CARE, 14(6), 420–425.
Chicago author-date
Dhont, Nathalie, Gilles François Ndayisaba, Cécile Alexandra Peltier, Aniceth Nzabonimpa, Marleen Temmerman, and Janneke van de Wijgert. 2009. “Improved Access Increases Postpartum Uptake of Contraceptive Implants Among HIV-positive Women in Rwanda.” European Journal of Contraception and Reproductive Health Care 14 (6): 420–425.
Chicago author-date (all authors)
Dhont, Nathalie, Gilles François Ndayisaba, Cécile Alexandra Peltier, Aniceth Nzabonimpa, Marleen Temmerman, and Janneke van de Wijgert. 2009. “Improved Access Increases Postpartum Uptake of Contraceptive Implants Among HIV-positive Women in Rwanda.” European Journal of Contraception and Reproductive Health Care 14 (6): 420–425.
Vancouver
1.
Dhont N, Ndayisaba GF, Peltier CA, Nzabonimpa A, Temmerman M, van de Wijgert J. Improved access increases postpartum uptake of contraceptive implants among HIV-positive women in Rwanda. EUROPEAN JOURNAL OF CONTRACEPTION AND REPRODUCTIVE HEALTH CARE. 2009;14(6):420–5.
IEEE
[1]
N. Dhont, G. F. Ndayisaba, C. A. Peltier, A. Nzabonimpa, M. Temmerman, and J. van de Wijgert, “Improved access increases postpartum uptake of contraceptive implants among HIV-positive women in Rwanda,” EUROPEAN JOURNAL OF CONTRACEPTION AND REPRODUCTIVE HEALTH CARE, vol. 14, no. 6, pp. 420–425, 2009.
@article{852743,
  abstract     = {Background : Long-acting reversible contraceptives (LARCs) and sterilisation are the most cost-effective methods of contraception but are rarely used in sub-Saharan Africa partly due to limited access.
Study design : HIV-positive pregnant women attending two urban clinics in Rwanda were followed prospectively in a perinatal HIV transmission cohort study. Women attending one clinic were referred to public family planning (FP) services for all contraceptive methods (Site A) and women attending the other clinic (Site B) were offered implants and intrauterine devices (IUDs) on-site.
Results : Fifty three percent of the pregnant women reported an intention to use a LARC or to be sterilised after delivery. The uptake of implants was significantly higher at Site B (38%) than at Site A (6%). The IUD uptake was extremely low at both sites (2%). Twenty-eight of the 39 women at Site B who had intended to start using a LARC actually did so as compared to only one of 23 at Site A.
Conclusion : When access to LARC was provided, a substantial number of HIV-positive women started using hormonal implants, but not IUDs, in the postpartum period. HIV and FP services should consider improving access to implants to reduce the number of unintended pregnancies.},
  author       = {Dhont, Nathalie and Ndayisaba, Gilles François and Peltier, Cécile Alexandra and Nzabonimpa, Aniceth and Temmerman, Marleen and van de Wijgert, Janneke},
  issn         = {1362-5187},
  journal      = {EUROPEAN JOURNAL OF CONTRACEPTION AND REPRODUCTIVE HEALTH CARE},
  keywords     = {Unmet need,Postpartum,Family planning,Access,Rwanda,PREGNANCY,Long-acting reversible contraceptives (LARCs),TRANSMISSION,HIV infection,Sterilisation},
  language     = {eng},
  number       = {6},
  pages        = {420--425},
  title        = {Improved access increases postpartum uptake of contraceptive implants among HIV-positive women in Rwanda},
  url          = {http://dx.doi.org/10.3109/13625180903340584},
  volume       = {14},
  year         = {2009},
}

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