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Long-acting reversible contraception is an underutilized method in low-resource areas. Our study aims to: (a) assess knowledge and attitudes around contraception; (b) identify barriers to intrauterine device (IUD) uptake; and (c) develop interventions to address this gap in contraceptive care. We conducted focus group discussions with pregnant, postpartum, and reproductive-aged women, males, and health care workers in rural Ghana. Lack of IUD-specific knowledge, provider discomfort with insertion, and incomplete contraceptive counseling contribute to lack of IUD use. Participant- and provider-related barriers contribute to poor uptake of IUDs within the community. Targeted interventions are necessary to improve IUD use.

Objective To report on a rigorous distribution and monitoring plan to track misoprostol for community-based distribution to reduce postpartum haemorrhage (PPH) in rural Ghana. Design Operations research.Setting Rural Ghana.Sample Women in third trimester of pregnancy presenting to primary health centres (PHCs) for antenatal care (ANC).Methods Ghana Health Service (GHS), Millennium Village Projects, and the University of Illinois at Chicago conducted an operations research study designed to assess the safety, feasibility, and acceptability of community-based distribution of misoprostol to prevent PPH at home deliveries in rural Ghana. One thousand doses (3000 tablets, 200 lg each) were obtained from the Family Health Division of GHS. Three 200-lg tablets of misoprostol (600 lg) in foil packets were packaged together in secured transparent plastic packets labelled with pictorial messages and distributed to midwives at seven PHCs for distribution to pregnant women.Main outcome measures Correct use of misoprostol in home deliveries and retrieval of unused misoprostol doses, PPH rates and maternal mortality.Results Of the 999 doses distributed to midwives, 982 (98.3%) were successfully tracked, with a 1.7% lost to follow-up rate. Midwives distributed 654 doses to women at third-trimester ANC visits. Of women who had misoprostol to use at home, 81% had an institutional delivery and were able to return the misoprostol safely to the midwife. Of the women that used misoprostol, 99% used the misoprostol correctly.Conclusions This study clearly demonstrates that misoprostol distributed antenatally to pregnant women can be used accurately and reliably by rural Ghanaian women, and should be considered for policy implementation across Ghana and other countries with high home birth rates and maternal mortality ratios.

Community-based distribution of misoprostol for prevention of postpartum hemorrhage (PPH) in resource-poor settings has been shown to be safe and effective. However, global recommendations for prenatal distribution and monitoring within a community setting are not yet available. In order to successfully translate misoprostol and PPH research into policy and practice, several critical points must be considered. A focus on engaging the community, emphasizing the safe nature of community-based misoprostol distribution, supply chain management, effective distribution, coverage, and monitoring plans are essential elements to community-based misoprostol program introduction, expansion, or scale-up.

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Postpartum haemorrhage (PPH) is an obstetric emergency caused by excessive blood loss after delivery, which is the leading cause of maternal mortality worldwide. PPH can lead to volume depletion, hypovolemic shock, anaemia and ultimately death. The prevalence of PPH is disproportionately higher in low resource settings where there is limited access to skilled medical care and safe blood supplies. Current management strategies target both prevention and treatment of PPH however no alternatives currently exist to address the lack of safe blood supplies which are considered essential in emergency obstetrical care. Autotransfusion is used to salvage blood loss in a variety of clinical settings but has never been used in the context of vaginal delivery. We describe the development and testing of a novel device for the collection, filtration and autotransfusion of blood lost due to PPH. The prototype device is inexpensive and easily operated so that it may be practically deployed in low resource settings. The device is comprised of a blood collection drape, a pump apparatus, three leukocyte reduction filters and a reservoir for filtered blood. Preliminary testing demonstrates efficacy of microbial load reduction of up to 97.3%. To reduce cost and improve safety, the device is modular in design such that the drape, tubing, filters and transfusion bag may be stored sterile, used once and discarded; while the pump apparatus may be used indefinitely without the need for sterilisation. Preliminary results indicate the device confers a low cost and potentially effective means of collecting, pumping, filtering and returning blood to a patient following PPH in settings that lack safe blood supplies. This device shows promise as a method of stabilising patients suffering of PPH in low resource settings until definitive treatment is rendered with the ultimate goal of reducing maternal mortality globally.

INTRODUCTION: Perinatal depression affects one in seven women, and is associated with significant morbidity. Limited data suggest depression rates to be twice as high among low-income, minority women. This study aimed to identify associations between race/ethnicity and perinatal depression in a medically and psychosocially at-risk population. METHODS: Study data were collected from interviews conducted from December 2013 through August 2016 by Community Health Workers as part of the initial obstetric assessment. Depression was scored on the Center for Epidemiologic Studies Depression (CES-D) Scale, with depression defined as a score of greater than 16 for clinical symptoms. Race and ethnicity were self-reported. Chi-square analyses were performed. RESULTS: A total of 3,214 women were included in the study. Analyses revealed that a larger proportion of African American women (26.2%) met criteria for depression than their White (20.1%), Asian (5.2%) and Mixed Race counterparts (2.6%; chi-square less than .01, P greater than .001). Analyses involving ethnicity revealed that women who identified as Hispanic/Latina (27.1%) were less likely than non-Hispanic women (38.5%) to meet CES-D depression criteria (chi-square=44, P less than .001). CONCLUSION: Race and ethnicity were significantly associated with perinatal depression. A higher proportion was seen among African American women, while a lower proportion seen among Hispanic/Latinas. Implications for practice include increasing mental health support and a referral network to access during pregnancy and postpartum. Future research might include examination of protective factors for depressive symptoms in pregnant women of different ethnic/racial backgrounds. Screening tools for other mental health conditions may account for other ethnic/racial differences.

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