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Traditional contraceptive methods are used by 55 million women in developing countries. This study analysed over 80 national surveys to compare traditional with modern method users, by type, region, socio-demographic characteristics, strength of family planning programmes and discontinuation rates. The advance of modern methods has greatly reduced the share held by traditional methods, but the actual prevalence of their use has declined little. Young, sexually active unmarried women use traditional contraception much more than their married counterparts. Discontinuation rates are somewhat lower for traditional methods than for the resupply methods of the pill, injectable and condom; among users of all of these methods, more than a quarter stop use in the first year to switch to alternative methods. Traditional method use is firmly entrenched in many countries, as the initial method tried, a bridge method to modern contraception and even the primary method where other methods are not easily available.

Background: Public health measures that prevent the spread of COVID-19, such as social distancing, may increase the risk for suicide among American Indians due to decreased social connectedness that is crucial to wellbeing. Telehealth represents a potential solution, but barriers to effective suicide prevention may exist. Materials and Methods: In collaboration with Tribal and Urban Indian Health Center providers, this study measured suicide prevention practices during COVID-19. A 44-item Likert-type, web-based survey was distributed to Montana-based professionals who directly provide suicide prevention services to American Indians at risk for suicide. Descriptive statistics were calculated for survey items, and Mann-Whitney U tests examined the differences in telehealth use, training, skills among Montana geographic areas, and barriers between providers and their clients/patients. Results: Among the 80 respondents, two-thirds agreed or strongly agreed that American Indians experienced greater social disconnection since the COVID-19 pandemic began. Almost 98% agreed that telehealth was needed, and 93% were willing to use telehealth for suicide prevention services. Among current users, 75% agreed telehealth was effective for suicide prevention. Over one-third of respondents reported using telehealth for the first time during COVID-19 pandemic, and 30% use telehealth at least "usually" since the COVID-19 pandemic began, up from 6.3%. Compared with their own experiences, providers perceive their American Indian client/patients as experiencing greater barriers to telehealth. Discussion: Telehealth was increasingly utilized for suicide prevention during the COVID-19 pandemic. Opportunities to improve telehealth access should be explored, including investments in telehealth technologies for American Indians at risk for suicide.

The Democratic Republic of the Congo (DRC) decriminalized abortion under certain circumstances in 2018 through the Maputo Protocol. However, little is known about the readiness of the country's health facilities to provide comprehensive abortion care.Data on 1,380 health facilities from the 2017-2018 DRC Service Provision Assessment (SPA) inventory survey were used to assess readiness to provide abortion care in four domains: termination of pregnancy, basic treatment of postabortion complications, comprehensive treatment of postabortion complications and postabortion contraceptive care. Analyses used a modified application of the emergency obstetric care signal function approach; criteria for readiness were based on World Health Organization guidelines.Thirty-one percent of DRC facilities met the criteria for readiness to provide abortions. The proportion of facilities classified as ready was higher among urban facilities than rural ones (50% vs. 26%), and among hospitals than health centers or reference health centers (72% vs. 25% and 45%, respectively). Few facilities were ready to provide either basic or comprehensive treatment of postabortion complications (4% and 1%); readiness to provide these services was greatest among hospitals (14% and 11%). Only a third of facilities displayed readiness to provide postabortion contraceptive care. Inadequate supplies of medication (e.g., misoprostol, antibiotics, contraceptives) and equipment were the greatest barrier to readiness.Most DRC facilities were not ready to provide comprehensive abortion care. Improving supplies of vital health commodities will improve readiness, and has the potential to reduce the prevalence of unplanned pregnancies and future demand for abortions.RESUMEN Contexto: En 2018, la República Democrática del Congo (RDC) despenalizó el aborto bajo ciertas circunstancias a través del Protocolo de Maputo. Sin embargo, poco se sabe sobre la disposición de las instituciones de salud del país para proveer servicios integrales de aborto. Métodos: Se utilizaron datos de 1,380 instituciones de salud a partir de la Encuesta Inventario sobre la Evaluación de la Prestación de Servicios (EPS) con el fin de evaluar la disposición para proveer servicios de aborto en cuatro dominios: terminación del embarazo, tratamiento básico de complicaciones postaborto, tratamiento integral de complicaciones postaborto y servicios anticonceptivos postaborto. Los análisis utilizaron una aplicación modificada del enfoque de función de señales de atención obstétrica de emergencia; los criterios para disposición se basaron en las pautas de la Organización Mundial de la Salud. Resultados: Treinta y un porciento de las instituciones de salud de la RDC cumplieron con los criterios de disposición para la provisión de servicios de aborto. La proporción de instituciones clasificadas como preparadas fue mayor en los centros urbanos que en los rurales (50% vs. 26%) y en hospitales respecto de centros de salud o centros de salud de referencia (72% vs. 25% y 45%, respectivamente). Pocas instituciones de salud estuvieron preparadas para proveer ya fueran servicios básicos o tratamiento integral para complicaciones postaborto (4% y 1%); la mayor preparación para proveer esos servicios se presentó en los hospitales (14% y 11%). Solamente un tercio de las instituciones de salud mostró estar preparado para proveer servicios anticonceptivos postaborto. La inadecuada disponibilidad de medicamentos (ej., misoprostol, antibióticos, anticonceptivos) y de equipo fueron las más grandes barreras para la preparación. Conclusiones: La mayoría de las instituciones de salud de la RDC no estuvieron preparadas para proveer servicios integrales de aborto. Mejorar la disponibilidad de productos vitales para la salud aumentará la preparación y tiene el potencial de reducir la prevalencia de embarazos no planeados y la demanda futura de servicios de aborto.RÉSUMÉ Contexte: La République démocratique du Congo (RDC) a décriminalisé l'avortement dans certaines circonstances en 2018, du fait du Protocole de Maputo. La préparation des formations sanitaires du pays à assumer des soins d'avortement complets n'est cependant guère documentée. Méthodes: Les données relatives à 1 380 formations sanitaires comprises dans l'enquête d‘évaluation de la prestation des services de soins de santé (EPSS) ont servi à évaluer l‘état de préparation à offrir et assurer des soins d'avortement sur quatre plans: l'interruption de grossesse, le traitement de base des complications après avortement, le traitement complet des complications après avortement et les soins de contraception après avortement. Les analyses reposent sur une application modifiée de l'approche des fonctions fondamentales des soins obstétricaux d'urgence; les critères de préparation, sur les directives de l'Organisation mondiale de la Santé. Résultats: Trente-et-un pour cent des formations sanitaires de RDC répondaient aux critères de préparation à la prestation de l'avortement. La proportion qualifiée de prête était plus grande parmi les formations urbaines que rurales (50% contre 26%) et parmi les hôpitaux que dans les centres de santé ou de référence (72% contre 25% et 45%, respectivement). Peu de formations étaient prêtes à traiter, selon une approche de base ou complète, les complications après avortement (4% et 1%). Cette préparation était supérieure dans les hôpitaux (14% et 11%). Un tiers seulement des formations sanitaires étaient prêtes à offrir des soins contraceptifs après avortement. La disponibilité inadéquate de médicaments (par ex., misoprostol, antibiotiques, contraceptifs) et d'équipements était le plus grand obstacle à la préparation. Conclusions: La plupart des formations sanitaires en RDC n‘étaient pas prêtes à assumer les soins complets de l'avortement. L'amélioration de l'approvisionnement en produits de santé vitaux renforcera l‘état de préparation tout en offrant le potentiel de réduire la prévalence des grossesses non planifiées et la demande future d'avortements.