Integrated Maternal and Infant Health Care in the Postpartum Period in a Poor Neighborhood in Santiago, Chile

Abstract

An integrated postpartum health-care program was established by the Consultorio San Luis de Huechuraba (CSLH), a nongovernmental organization in a neighborhood of extreme poverty in Santiago, Chile. The main components were education, maternal and infant health care, support for the mothers, and active participation of women from the community served. The program was evaluated through indicators of contraceptive use, breastfeeding performance, infant growth and health, and a qualitative assessment of women's satisfaction. Controls were women of similar characteristics attending the nearby public clinic. Acceptability of contraceptive methods was similar but contraceptive options differed between clinics. The total number of pregnancies and of respondents lost to follow-up was significantly higher for the public clinic than for the CSLH. Breastfeeding duration was significantly longer and infant growth and health were found to be significantly better at the CSLH than at the public clinic. Women valued being treated with respect, receiving education and support, and being offered timesaving services and wider contraceptive choices at the CSLH. This study demonstrates that such interventions are possible for poor communities, providing significant advantages for women and children.

Meeting the Family Planning Needs of Postpartum Women

“…Their lack of understanding appeared to be unrelated to subsequent pregnancies, however (Kennedy et al 1998). Similar mixed results have been obtained regarding the role of LAM as a gateway to the use of modern methods; some studies find no greater use of contraceptives at 6 or at 12 months among some previous users of LAM than among those who did not use LAM or those who have used other methods (Hardy et al 1998;Alvarado et al 1999;Tazhibayev et al 2004;Bongiovanni et al 2005). In summary, although LAM is an effective clinical method, programs must find more efficacious strategies for training providers and counseling clients regarding the three conditions required to use it appropriately and effectively, and how to use LAM as a bridge to the adoption of modern methods.…”

“…Moreover, although half the women in intervention hospitals said that they planned to use LAM, significantly fewer knew the three essential elements of the method (Tazhibayev et al 2004). Similarly, in a study in Chile in which exclusive breastfeeding was promoted and LAM was systematically explained to all clients at one clinic but not to those of another, only 2.5 percent of women in the intervention clinic (and no women in the control clinic) used LAM in the postpartum period, whereas 74 percent and 10 percent, respectively, fully breastfed their children at six months (Alvarado et al 1999).…”

Outreach and integration programs to promote family planning in the extended postpartum period

“…The limitations of the identified studies on mother–infant integration programs included unclear time and method of outcome measurement [24,25] and significant loss to follow-up limiting the ability to measure outcomes [21,22]. In addition, the study by Huntington et al [23] was a combination of a time series survey and a retrospective review of service statistics, both of which have a high susceptibility to confounding and bias.…”

The Ethical Involvement of Women in HIV Vaccine Trials in Africa: Discussion Paper Developed for the African AIDS Vaccine Programme

“…Such research could be seen as integral to trial site development and as a component of preparatory social science and behavioural studies that precede vaccine trials. Ideally, such steps might initiate further social emancipations (Alvarado et al 1999) to supplement, in small local ways, the global development agenda (Labonte et al 2005) and offset the pernicious links between gender, low social class and infectious disease mortality. This process would ensure that HIV vaccine trials can be conducted ethically, and ultimately would bring increasing health and social benefits to this disproportionately affected population.…”