Importance We need a systematic approach to understanding health service utilization behavior in women with pelvic floor symptoms in the United States.Objectives The aim of this study was to determine the prevalence of pelvic floor care utilization and identify its barriers and promotors using Andersen's model, which theorizes care-seeking behavior with individual care needs, resources, predispositions, and macrostructures. Design This was a systematic search of studies on care-seeking patterns in women with symptomatic pelvic floor disorders, which included pelvic organ prolapse, lower urinary tract symptoms, and anal incontinence. We then performed meta-analyses with random-effects models and descriptive analysis to determine utilization rate and the impact of each identified determinant. Results The pooled utilization rate was 37% (95% confidence interval [CI], 30%-45%). Determinants were identified across all domains except at the macrostructure level. For individual care needs, increased symptom severity or duration and a history of depression (odds ratio [OR], 1.27; 95% CI, 1.07-1.51) were associated with higher utilization. In the resources domain, having social support and established primary/secondary care were promotors, whereas higher income and employed status trended as barriers. Under predispositions, age ≥50years (OR, 1.29; 95% CI, 1.05-1.60), and pelvic floor awareness were associated with utilization, whereas Asian (OR, 0.60; 95% CI, 0.51-0.72) and Black (OR, 0.77; 95% CI, 0.55-1.08) women as well as women experiencing fear, misinformation, or normalization of pelvic floor disorders had decreased utilization. Conclusions This review identified a low utilization rate for pelvic floor care and revealed multilayered, actionable items affecting care-seeking behavior. It highlights the need for more inclusive and multifaceted approaches in future pelvic floor disparity research and equity interventions.
Less than 2% of Malawian women use long-acting reversible contraception (LARC). We describe experiences of Malawian family planning providers, focusing on LARC. We conducted a mixed-methods study using questionnaires and focus group discussions with providers in Lilongwe. Data were analyzed separately and triangulated. Most (58%) participants saw over 30 patients daily. Only 19% had ever inserted IUC. Qualitative data were complementary; participants noted that LARC provision was important, though hindered by lack of experienced providers, work burden, and low demand. Future efforts to improve LARC access in Lilongwe must address both supply and demand-side barriers. (Afr J Reprod Health 2016; 20[2]: 62-71).Keywords: Family planning, long-acting reversible contraception, Malawi. RésuméMoins de 2% des femmes malawiennes utilisent la contraception de longue durée d'action réversible (CLDR). Nous décrivons les expériences des prestataires de planification familiale malawienne, en nous concentrant sur CLDR. Nous avons effectué une étude des méthodes mixtes à l'aide des questionnaires et des discussions de groupes cibles avec les fournisseurs à Lilongwe. Les données ont été analysées séparément et ont été triangulées. La plupart (58%) des participants ont vu plus de 30 patientes par jour. Seulement 19% avaient déjà inséré DIU. Les données qualitatives etaient complémentaires; les participants ont noté que la provision de la CLDR était importante, quoique entravée par le manque de fournisseurs expérimentés, la charge de travail, et la faible demande. Les futurs efforts pour améliorer l'accès à la CLDR à Lilongwe doit s'occuper des deux barrières de coté de l'offre et de la demande. (Afr J Reprod Health 2016; 20[2]: 62-71).Mots-clés: planification familiale, contraception de longue durée d'action réversible, Malawi.
The objectives of this study were to describe the most recent pregnancy intentions and family planning preferences of HIV-infected and HIV-uninfected postpartum Malawian women, and to assess whether HIV status is associated with fertility desire and knowledge of intrauterine contraception (IUC) and the subdermal contraceptive implant. We conducted a cross-sectional analysis of the baseline characteristics of Malawian women enrolled in a prospective cohort study assessing postpartum contraceptive uptake and continuation. Women at a government hospital completed a baseline survey assessing reproductive history, family planning preferences, and knowledge of IUC and the implant. We used Pearson's chi-square tests to compare these parameters between HIV-infected and HIV-uninfected women. Modified Poisson regression was performed to assess the association between HIV status and fertility desire and knowledge about IUC and the implant. Of 634 postpartum women surveyed, HIV-infected women were more likely to report their most recent pregnancy was unintended (49% versus 37%, p=0.004). Nearly all women (97%) did not want a child in the next two years but HIV-infected women were more likely to desire no more children (adjusted PR: 1.59; 95% CI: 1.33, 1.89). HIV-infected women were also less likely to know that IUC (adjusted PR 0.72; 95% CI: 0.61, 0.84) and the implant (adjusted PR 0.83; 95% CI: 0.75, 0.92) are safe during breastfeeding. Postpartum women strongly desire family spacing and many HIV-infected postpartum women desire no more children, suggesting an important role for these long-acting methods. Education about the efficacy and safety of IUC and the implant particularly during breastfeeding may facilitate postpartum use.
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