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Objectives Complications of pregnancy such as gestational diabetes mellitus (GDM) forewarn future chronic illness and disability, and demonstrate the need for a life course approach to prevention. Our study had two aims: (1) to elucidate how experiences reported by patients and providers converge to facilitate or impede follow-up care after GDM, and (2) to elicit recommendations for system-level changes to enhance prevention across key care transitions. Methods We conducted in-depth interviews with 30 GDM patients and 29 providers of maternity, specialty and primary care in an urban safety hospital network, and used a three-tiered thematic analysis to interpret their narratives. Results Findings reveal that a 'perfect storm' gathers on the path to prevention across stages of care. At diagnosis, patients feel profound anxiety about the debilitating effects of type 2 diabetes mellitus in their communities, providers choose reassurance over risk communication, and both focus primarily on the birth of a healthy baby. Providers report that clinical teams often lack coordination, and confuse patients with a barrage of often-inconsistent advice. In the postpartum period, providers juggle competing clinical priorities and mothers juggle overwhelming demands; for both, the recommended 2-h oral glucose tolerance test is too arduous for women and providers to do as prescribed. Finally, the transition from maternity to primary care is complicated by communication barriers between clinicians and patients, and between maternity and primary care providers. Conclusions for Practice Respondents propose systems innovations to open communication between provider specialties in order to bridge the chasm between reproductive care and life course prevention., Author(s): Lois McCloskey [sup.1] , Marlena L. Sherman [sup.1] , Meryl St. John [sup.1] , Hannah Siegel [sup.1] , Julie Whyte [sup.1] , Ronald Iverson [sup.2] , Aviva Lee-Parritz [sup.2] [...]

Purpose With the rise of opioid use disorder (OUD) among women of childbearing age, effective care models must address the complex needs of pregnant and postpartum women with OUD. This paper describes promising practices and implementation challenges from the Collaborative Outreach and Adaptable Care at Hallmark Health (COACHH) program, which utilizes a collaborative care team to coordinate outpatient care for pregnant and postpartum women with OUD. Description Semi-structured interviews were conducted with members of the COACHH team to discuss program logistics and takeaways. Interviews were coded to analyze themes. Assessment The COACHH team identified the need for specialized, time-intensive care coordination to address the unique needs of pregnant and postpartum women with OUD. First, the team prioritizes forming trusting relationships with patients to holistically understand patients' needs, improve patient engagement, and connect patients with resources. Second, the wide range of patient needs necessitates a team with diverse professional skills, whose members share an understanding of addiction and pregnancy. Third, finding the right quantitative outcome measurements is difficult; instead, success is measured in qualitative terms, stressing relationships and engagement as signals of change. Finally, the team encounters challenges with low referral rates, lack of provider awareness, and fragmented services. Conclusion We identified care delivery and program design considerations that may inform others who wish to coordinate care for pregnant and postpartum women with OUD. The program continues to face challenges enrolling patients and measuring outcomes, reflecting the need for tailored approaches and metrics for this population., Author(s): Fran E. Hodgins [sup.1] , Jessica M. Lang [sup.1] , Gabriel G. Malseptic [sup.1] , Lauren H. Melby [sup.1] , Kathleen A. Connolly [sup.1] Author Affiliations: (Aff1) Massachusetts Health [...]

Objective To determine whether an intervention to involve the male partners of pregnant women in maternity care influenced care-seeking, healthy breastfeeding and contraceptive practices after childbirth in urban Burkina Faso. Methods In a non-blinded, multicentre, parallel-group, superiority trial, 1144 women were assigned by simple randomization to two study arms: 583 entered the intervention arm and 561 entered the control arm. All women were cohabiting with a male partner and had a low-risk pregnancy. Recruitment took place at 20 to 36 weeks'gestation at five primary health centres in Bobo-Dioulasso.The intervention comprised three educational sessions: (i) an interactive group session during pregnancy with male partners only, to discuss their role; (ii) a counselling session during pregnancy for individual couples; and (Iii) a postnatal couple counselling session. The control group received routine care only. We followed up participants at 3 and 8 months postpartum. Findings The follow-up rate was over 96% at both times. In the intervention arm, 74% (432/583) of couples or men attended at least two study sessions. Attendance at two or more outpatient postnatal care consultations was more frequent in the intervention than the control group (risk difference, RD: 11.7%; 95% confidence interval, CI: 6.0 to 17.5), as was exclusive breastfeeding 3 months postpartum (RD: 11.4%; 95% CI: 5.8 to 17.2) and effective modern contraception use 8 months postpartum (RD: 6.4%; 95% CI: 0.5 to 12.3). Conclusion Involving men as supportive partners in maternity care was associated with better adherence to recommended healthy practices after childbirth. Objectif Determiner si une intervention visant a faire participer le compagnon des femmes enceintes aux soins de maternite a permis d'influencer le recours aux soins, l'allaitement et les pratiques contraceptives apres l'accouchement dans une ville du Burkina Faso. Methodes Dans le cadre d'un essai de superiorite en groupes paralleles, multicentrique, non aveugle, 1144 femmes ont ete reparties par randomisation simple en deux groupes d'etude: 583 dans le groupe experimental et 561 dans le groupe temoin.Toutes les femmes vivaient avec un compagnon et avalent une grossesse a faible risque. Leur recrutement a eu lieu entre 20 et 36 semaines de grossesse dans cinq centres de soins primaires de Bobo-Dioulasso. L'intervention comprenait trois seances pedagogiques: (i) une seance de groupe interactive pendant la grossesse, avec les compagnons uniquement, afin de discuter de leur role; (ii) une seance de conseil pendant la grossesse pour les couples; et (iii) une seance de conseil postnatale pour les couples. Le groupe temoin a beneficie uniquement de la prise en charge habituelle. Nous avons suivi les participants a 3 et 8 mois apres l'accouchement. Resultats Le taux de suivi etait superieur a 96% aux deux visites de suivi. Dans le groupe experimental, 74% (432/583) des couples ou des hommes avaient assiste a au moins deux des seances prevues. La presence a deux consultations postnatales externes ou plus etait plus frequente dans le groupe experimental que dans le groupe temoin (difference de risques, DR: 11,7%; intervalle de confiance de 95%, IC: 6,0 a 17,5), comme l'allaitement exclusif 3 mois apres l'accouchement (DR: 11,4%; IC 95%: 5,8 a 17,2) et l'utilisation de moyens de contraception modernes efficaces 8 mois apres l'accouchement (DR: 6,4%; IC 95%: 0,5 a 12,3). Conclusion La participation et l'accompagnement des hommes aux soins de maternite etaient associes a un meilleur suivi des pratiques recommandees apres l'accouchement. Objetivo Determinar si una Intervencion para involucrar a las parejas masculinas de las mujeres embarazadas en la atencion de la maternidad influyo en la busqueda de atencion, la lactancia materna saludable y las practicas anticonceptivas despues del parto en una zona urbana de Burkina Faso. Metodos En un ensayo preponderado, no cegado, multicentrico, de grupos paralelos, se asigno a 1144 mujeres aleatorias a dos grupos del estudio: 583 entraron en el grupo de intervencion y 561 entraron en el grupo de control. Todas las mujeres convivian con una pareja masculina y tenian un embarazo de bajo riesgo. La seleccion tuvo lugar entre las semanas 20 y 36 de gestacion en cinco centros de salud primarios en Bobo-Dioulasso. La intervencion conto con tres sesiones educativas: (i) una sesion grupai interactiva durante el embarazo solo con las parejas masculinas, para hablar sobre su papel; (ii) una sesion de asesoramiento durante el embarazo para parejas individuales; y (iii) una sesion de consejeria posnatal en pareja. El grupo de control recibio solo atencion rutinaria. Seguimos a los participantes a los 3 y 8 meses despues del parto. Resultados La tasa de seguimiento fue superior al 96% en dos visitas. En el grupo de Intervencion, el 74% (432/583) de. parejas u hombres asistieron al menos a dos sesiones de estudio. La asistencia a dos o mas consultas de atencion posnatal para pacientes ambulatorios fue mas frecuente en el grupo de intervencion que el grupo de control (diferencia de riesgo, RD: De 1,7% a 95% en el intervalo de confianza, IC: De 6,0 a 17,5), en la lactancia materna exclusiva 3 meses despues del parto (RD: De 11,4% a 95% IC: De 5,8 a 17,2) en anticonceptivos modernos efectivos 8 meses despues del parto (RD: De 6,4% a 95% IC: De 0,5 a 12,3). Conclusion Involucrar a los hombres como apoyo en la atencion de maternidad se asocio con una mejor adherencia a las practicas recomendadas de salud despues del parto., [phrase omitted] Introduction Ending preventable maternal and perinatal mortality necessarily involves engaging with families and communities. (1) Male partners, in particular, exert a considerable influence on women's use of reproductive [...]

Objectives A two-part review was undertaken to: (1) summarize current guidelines on the timing and frequency of postpartum follow-up care for generally healthy, non-high risk postpartum women and to delineate the evidence on which these guidelines are based; and, (2) summarize the results of intervention studies focused on increasing utilization of the postpartum visit for generally healthy, non-high risk postpartum women. Methods A review of guidelines from high and upper middle income countries published between 2000 and 2016 in English related to non-high risk postpartum follow-up visits was conducted in 2014-2016 using four databases and additional sources. In addition, articles published between 1990 and 2016 which evaluated interventions from high to upper middle income countries related to increasing attendance at the postpartum visit were gathered using three databases. Results This review located eight guidelines, all of which relied on expert opinion/group consensus as the evidence for their recommendations regarding the timing of the postpartum visit. The review located 19 intervention studies focused on increasing use of the postpartum visit; in 12 there was statistically significant evidence that these approaches improved utilization. However, no intervention strategy was evaluated more than a few times and many of the evaluations were relatively dated. Conclusions Guidelines for the timing of the postpartum visit are variable and are typically based on weak evidence; however, there is support for increased flexibility to meet women's needs. Additionally, while there is a diverse set of promising interventions to increase utilization of the postpartum visit, there is limited evaluative information. Future initiatives should focus on more rigorous evaluation., Author(s): Katrina Stumbras[sup.1] , Kristin Rankin[sup.2] , Rachel Caskey[sup.3] , Sadia Haider[sup.4] , Arden Handler[sup.5] Author Affiliations: (1) UIC College of Medicine, 808 S Wood, 60612, Chicago, ILUSA (2) Department [...]

Purpose To showcase several current national initiatives that focus on reducing maternal mortality and severe maternal morbidity and promote postpartum health and wellness for all women. Description Maternal injuries and deaths are a serious public health concern with tremendous impact on families, communities, and healthcare providers. Over the past two decades, it has become apparent that the timing of serious maternal complications has shifted, with more than half of deaths occurring in the immediate postpartum period up to 1 year following birth. Many of these reported deaths could have been prevented, and the number of 'near misses' of maternal morbidity cases continues to grow exponentially. In addition, postpartum women experience substantial unmet health needs, compromising their wellbeing. Assessment The American College of Obstetricians and Gynecologists and the Association of Women's Health, Obstetric, and Neonatal Nurses have thoroughly assessed the significance of the rising trends in maternal morbidity/mortality and are leading efforts to reduce these rates and improve overall health and wellbeing for all women during the postpartum period. Conclusion Developing national initiatives to improve postpartum health are vital to increasing the effectiveness of postpartum discharge education, and improving the participation in and the quality of postpartum care. Hopefully, evidence-based practice and widespread dissemination of these efforts will lead to a reduction in preventable post-birth maternal morbidity and mortality., Author(s): Lisa Kleppel[sup.1] , Patricia D. Suplee[sup.2] , Alison M. Stuebe[sup.3] , Debra Bingham[sup.4] Author Affiliations: (1) Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN), 1800 M Street NW, [...]

Objectives To assess low-income mothers' perceptions of their postpartum information needs; describe their information seeking behavior; explore their use of mobile technology to address those needs; and to contribute to the sparse literature on postpartum health and wellness. Methods Exploratory community-based qualitative approach. Interviewees were recruited among clients of community partners and had children aged 48 months and under. A survey assessing demographics was used to identify low-income mothers. 10 low-income mothers were recruited from survey participants to complete in-depth interviews regarding postpartum information needs, information seeking, and technology use. Interviews were transcribed verbatim and coded by three researchers independently. Narratives were analyzed along predetermined (etic) and emergent (emic) categories. Results Establishing breastfeeding and solving breastfeeding problems were central postpartum concerns leading to information seeking. Interviewees reported almost exclusive use of mobile phones to access the Internet. Mobile applications were widely used during pregnancy, but were not valuable postpartum. Face-to-face information from medical professionals was found to be repetitive. Online information seeking was mediated by default mobile phone search engines, and occurred over short, fragmented time periods. College graduates reported searching for authoritative knowledge sources; non-graduates preferred forums. Conclusions for Practice Low-income postpartum women rely on their smartphones to find online infant care and self-care health information. Websites replace pregnancy-related mobile applications and complement face-to-face information. Changes in searching behavior and multitasking mean information must be easily accessible and readily understood. Knowledge of page-rank systems and use of current and emergent social media will allow health-related organizations to better engage with low-income mothers online and promote evidence-based information., Author(s): Lucia Guerra-Reyes[sup.1] , Vanessa M. Christie[sup.3] , Annu Prabhakar[sup.2] , Asia L. Harris[sup.1] , Katie A. Siek[sup.2] Author Affiliations: (1) Department of Applied Health Science, School of Public Health, [...]

Objectives We sought to determine rates and correlates of accessing health care in the 2 years following delivery among women at an urban academic medical center. Methods We used electronic medical records, discharge, and billing data to determine the occurrence of primary care, other non-primary outpatient care, emergency department visits, and inpatient admissions among women delivering at a single medical center who had a known primary care affiliation to that medical center over a 5 year period. We explored sociodemographic, clinical, and health care-related factors as correlates of care, using bivariate and multivariable modeling. Results Of 6216 women studied, most (91 %) had had at least one health care visit in the window between 2 months and 2 years postpartum (the 'late postpartum period'). The majority (81 %) had had a primary care visit. Factors associated with use of health care in this period included a chronic medical condition diagnosed prior to pregnancy (adjusted odds ratio (AOR) 1.42, 95 % CI [1.19, 1.71]), prenatal care received in an urban community health center (AOR 1.35 [1.06, 1.73]), having received obstetric (AOR 1.90 [1.51, 2.37]), primary (AOR 2.30 [1.68, 3.23]), or other non-primary outpatient care (AOR 2.35 [1.72, 3.39]) in the first 2 months postpartum, and living closer to the hospital [AOR for residence >17.8 miles from the medical center (AOR 0.74 [0.61, 0.90])]. Having had an obstetrical complication did not increase the likelihood of receipt of care during this window. Conclusions for Practice Among women already enrolled in a primary care practice at our medical center, health care utilization in the late postpartum period is high, but not universal. Understanding the characteristics of women who return for health care during this window, and where they are seen, can improve transitions of care across the life course and can provide opportunities for important and consistent interconception and well-woman messaging., Author(s): Allison Bryant[sup.1] , Tiffany Blake-Lamb[sup.1] , Ida Hatoum[sup.2] , Milton Kotelchuck[sup.1] [sup.3] Author Affiliations: (1) Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit Street, 02114, Boston, [...]

Objectives This study aimed to measure the incidence and identify predictors of postpartum visit non-attendance, using medical records of women who received prenatal care and went on to deliver live births at Montefiore Hospital in 2013. Methods Pearson's Chi square tests were used to assess the association between maternal demographics, insurance status, and delivery information with non-attendance of a postpartum visit. Logistic regression and modified Poisson regression models were then used to identify statistically significant predictors of postpartum visit non-attendance. Results We found that one-third of all women who attended a prenatal visit at Montefiore Hospital did not return for a postpartum visit. Variables significantly associated with non-attendance include having Medicaid or no insurance (RR 1.4, 95 % CI 1.2-1.6), being Hispanic or Latino (RR 1.2, 95 % CI 1.1-1.3), having a vaginal delivery (RR 1.2, 95 % CI 1.1-1.4), and age, Author(s): Annemieke Wilcox[sup.1] , Erika E. Levi[sup.2] , Joanne M. Garrett[sup.3] Author Affiliations: (1) Albert Einstein College of Medicine, 1945 Eastchester Rd, Apt 28G, 10461, Bronx, NYUSA (2) Division of [...]

Introduction The first 3 months after giving birth can be a challenging time for many women. The Postpartum Health and Wellness special issue explores this period, one that is often overlooked and under-researched. Methods This issue is designed to bring greater focus to the need for woman-centered care during the postpartum period. Articles in this issue focus on four key areas: (1) the postpartum visit and access to care, (2) the content of postpartum care and postpartum health concerns, (3) interconception care including contraception, and (4) policy, systems, and measurement. Results The submissions highlight deficits in the provision of comprehensive care and services during a critical period in women's lives. The research highlighted in this issue supports the recommendation that Maternal and Child Health leaders collaborate to create woman-centered postpartum services that are part of a coordinated system of care. Conclusion In order to achieve optimal health care in the postpartum period it is becoming more apparent that increased flexibility of services, cross-training of providers, a 'no wrong door' approach, new insurance and work-place policy strategies, improved communication, and effective coordinated support within a system that values all women and families is required., Author(s): Sarah Verbiest[sup.1] [sup.2] , Erin Bonzon[sup.3] , Arden Handler[sup.4] Author Affiliations: (1) School of Social Work, University of North Carolina at Chapel Hill, Campus Box 3550, 27599-3550, Chapel Hill, [...]

Objectives Young parents may be particularly vulnerable to poor mental health during the postpartum period. Little research exists, however, to adequately describe trajectories of depressive symptoms during their transition to parenthood, particularly among young fathers. Therefore, we aim to explore trajectories of depressive symptoms from pregnancy through 1 year postpartum among young expectant mothers and their partners. Methods Data are derived from a longitudinal cohort of pregnant adolescent females (ages 14-21; n = 220) and their male partners (n = 190). Multilevel regression models examined the impact of time on depressive symptoms, and generalized linear regression models examined predictors of experiencing elevated depressive symptoms. Results Depressive symptoms significantly decreased from pregnancy through 1 year postpartum among young females. Overall, depressive symptoms did not significantly change over time among young males. Predictors of elevated depressive symptoms common across genders included social support and relationship satisfaction. Marijuana use resulted in almost twice the odds of experiencing elevated depressive symptoms among young fathers (OR 1.82; 95 % CI 1.04, 3.20). Conclusion for Practice Providing strategies for strengthening social support networks among young parents may be an effective way to improve mental health among young parents, particularly during this period of potential social isolation. Additionally, providing tools to strengthen relationships between partners may also be effective for both young mothers and fathers. Substance use may be a marker for depressive symptoms among young fathers and thus screening for substance use could be important to improving their mental health. Future research is needed to better understand how IPV affects mental health, particularly among young fathers., Author(s): Heather L. Sipsma[sup.1] [sup.2] , Tamora Callands[sup.3] , Alethea Desrosiers[sup.4] , Urania Magriples[sup.5] , Krista Jones[sup.6] , Tashuna Albritton[sup.7] , Trace Kershaw[sup.8] Author Affiliations: (1) Department of Women, Children [...]

Objectives Participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has been associated with lower breastfeeding initiation and duration. This study examines breastfeeding-related factors among WIC participants and nonparticipants that might explain these previous findings. Methods Respondents to the 2007 Infant Feeding Practices Study II who were income-eligible for WIC were categorized as follows: no WIC participation (No-WIC); prenatal participation and infant entry while [greater than or equal to]60 % breastfeeding (WIC BF-high); prenatal participation and infant entry while, Author(s): Emily F. Gregory[sup.1] [sup.4] , Susan M. Gross[sup.2] , Trang Q. Nguyen[sup.3] , Arlene M. Butz[sup.1] , Sara B. Johnson[sup.1] [sup.2] Author Affiliations: (1) General Pediatrics and Adolescent Medicine, [...]

This study examined the effect of a job aidsfocused intervention on quality of facility-based postnatal counseling, and whether increased communication improved in-hospital newborn care and maternal knowledge of home practices and danger signs requiring urgent care. Ensuring mothers and newborns receive essential postnatal services, including health counseling, is integral to their survival. Yet, quality of clinic-based postnatal services is often low, and evidence on effective improvement strategies is scarce. Using a pre-post randomized design, data were drawn from direct observations and interviews with 411 mother-newborn pairs. Multi-level regression models with difference-in-differences analyses estimated the intervention's relative effect, adjusting for changes in the comparison arm. The mean percent of recommended messages provided to recently-delivered women significantly improved in the intervention arm as compared to the control (difference-in-differences [[[DELTA].sub.i] - [[DELTA].sub.c]] +30.9, 95% confidence interval (CI) 19.3, 42.5), and the proportion of newborns thermally protected within the first hour ([[DELTA].sub.i] - [[DELTA].sub.c] +33.7, 95% CI 19.0, 48.4) and delayed for bathing ([[DELTA].sub.i] - [[DELTA].sub.c] +23.9, 95% CI 9.4, 38.4) significantly increased. No significant changes were observed in early breastfeeding ([[DELTA].sub.i] - [[DELTA].sub.c] +6.8, 95% CI -2.8, 16.4) which was nearly universal. Omitting traditional umbilical cord substances rose slightly, but was insignificant ([[DELTA].sub.i] - [[DELTA].sub.c] +8.5, 95% CI -2.8, 19.9). The proportion of mothers with correct knowledge of maternal ([[DELTA].sub.i] - [[DELTA].sub.c] +27.8, 95% CI 11.0, 44.6) and newborn ([[DELTA].sub.i] - [[DELTA].sub.c] +40.3, 95% CI 22.2, 58.4) danger signs grew substantially, as did awareness of several home-care practices ([[DELTA].sub.i] - [[DELTA].sub.c] +26.0, 95% CI 7.7, 44.3). Counseling job aids can improve the quality of postnatal services. However, achieving reduction goals in maternal and neonatal mortality will likely require more comprehensive approaches to link enhanced facility services with community-based initiatives. Keywords Postnatal care * Job aids * Counseling * Maternal * Newborn * Quality improvement, Introduction The postnatal period, or the time immediately after birth up to the first 6 weeks of life, is a time of high mortality risk for women and newborns. Each [...]

OBJECTIVE. We sought to identify characteristics of pediatricians that were associated with identification or management (referral and/or treatment) of mothers with depression. METHODS. A cross-sectional survey was mailed to a random sample of 1600 of the 50 818 US nonretired members of the American Academy of Pediatrics. Overall, 832 responded, with 745 responses from nontrainee members. The 662 fellow nontrainee members who engaged in direct patient care and completed information on identifying, referring, and treating maternal depression were included in the analyses. RESULTS. A total of 511 of 662 respondents reported identifying maternal depression; of those who reported identifying maternal depression, 421 indicated they referred and 29 that they treated maternal depression in their practices. Pediatricians who are older, work in practices that provide child mental health services, see primarily ([greater than or equal to] 75 %) white patients, use [greater than or equal to] 1 method to address maternal depression, agree that pediatricians should be responsible for identifying maternal depression, think that maternal depression has an extreme effect on children's mental health, and are attitudinally more inclined to identify or manage maternal depression had significantly higher odds of reporting identification of maternal depression. Positive correlates of identification and management of maternal depression included practicing in the Midwest, using [greater than or equal to] 1 method to address maternal depression, working in a practice that provides child mental health services, thinking that caregiving problems attributable to maternal health have an extreme effect on children's physical health, having attitudes that are more inclined to identify and to manage maternal depression, and usually inquiring about symptoms routinely to identify maternal depression. CONCLUSIONS. Pediatricians' practice characteristics and attitudes are associated with their identification and management of mothers with depression., MATERNAL DEPRESSION, A global term encompassing a range of depressive symptoms and syndromes, may affect women immediately after childbirth or later in the child-rearing years. (1,2) For women 15 to [...]

Many women who are at high risk for human immunodeficiency virus (HIV) infection never have received HIV-related information or been offered counseling and testing. Statistics show that in March 1992, […]

A Perinatal HIV/AIDS Reduction and Education Demonstration Activity (PHREDA) project's model of care is described. A sub-sample of women who received four or fewer prenatal visits and known as the 'no prenatal' group were considered by history and demographic characteristics to be at high risk for HIV infection and unintended pregnancy. A team approach was developed utilizing a certified nurse-midwife as die designated care provider. The first postpartum appointment was scheduled for two weeks after each woman delivered. Subsequent postpartum visits were to occur at six weeks, three months, six months, one year and eighteen months. Pregnancy planning services delivered in a caring, supportive environment help assure accessibility and continuity of contraceptive services to this high risk group.

Measuring Obstetric and Newborn Functionality of Health Facilities Skilled delivery care providers working in the right environment can prevent, detect, and treat complications, thus contributing to a reduction in stillbirths [...]

The use of contraceptive in postpartum programs is discussed with regard to studies showing that it helps manage women's need for contraception during the first year after childbirth, leading to better health in mothers and lower morbidity rate for unwanted pregnancy. The need for such programs in Latin, America, the Caribbean, Asia and sub-Saharan Africa is presented.

'I COULD not walk out of the bedroom with the baby on my right hip because I was utterly convinced I would drop him over the banisters,' says Pru. 'I [...]

An even higher proportion had to wait at least a month for treatment, while one in ten had to wait more than a year. Mind said all women requiring admission [...]