KNOWLEDGE, ASSESSMENT AND PRACTICE OF USE OF CONTRACEPTIVES IN MARRIED FEMALE POPULATION IN CENTRAL MAHARASHTRA

*Rishiraj Ashokkumar Sinha, Dr. Suhas Shinde and Dr. Urmila Shinde

ABSTRACT

In 2005, there were more adults and children living with HIV, more new HIV infections, and more AIDS-related deaths in sub-Saharan Africa than in any other region of the world.[1] Of the estimated 2.3 million children living with HIV worldwide at the end of 2005,[2] million (nearly 90%) were living in sub-Saharan Africa, along with more than 12 million orphans on the continent.[1] These high levels of HIV prevalence exist in countries that also often have high levels of fertility and low contraceptive use. Comprehensive HIV/AIDS prevention programs must also address the prevention of unplanned pregnancies among couples living with HIV, while also providing couples with services and support to manage their fertility desires. There is a lack of systematic research on family size preferences and contraceptive use among HIVpositive women in Africa, and although many studies have examined the determinants of contraceptive adoption in African countries,[4] few studies have examined the intersection between HIV and contraceptive use. Studies on the fertility preferences of HIV-positive women in the United States have shown poor family planning uptake; however, women in these cohorts were often intravenous drug users and are in many ways not comparable to African women.[3] Acceptance of contraception among HIV-positive African women may well depend on a number of social, cultural and economic factors, and the mechanisms through which family planning and VCT services are integrated and delivered. Previous studies show that despite initial uptake of contraception after counseling, contraceptive use among HIV-positive women often declines with time, as pre-sero-conversion fertility desires return in the context of an environment of low contraceptive use and cultural constructs that support high fertility.[5,6] Thus, although some attention has been paid to the contraceptive needs of HIV-positive women,[7,8] and to the influence of knowledge of sero-status on contraceptive use,[9] there is a lack of information on the knowledge and concerns surrounding family planning among those living with HIV. Birth control, also known as contraception and fertility control, is a method or device used to prevent pregnancy.[1] Birth control has been used since ancient times, but effective and safe methods of birth control only became available in the 20th century.[2] Planning, making available, and using birth control is called family planning.[3][4] Some cultures limit or discourage access to birth control because they consider it to be morally, religiously, or politically undesirable. [2] The most effective methods of birth control are sterilization by means of vasectomy in males and tubal ligation in females, intrauterine devices (IUDs), and implantable birth control.[5] This is followed by a number of hormone-based methods including oral pills, patches, vaginal rings, and injections.[5] Less effective methods include physical barrierssuch as condoms, diaphragms and birth control sponges and fertility awareness methods.[5] The least effective methods are spermicides and withdrawal by the male before ejaculation.[5] Sterilization, while highly effective, is not usually reversible; all other methods are reversible, most immediately upon stopping them.[5] Safe sex practices, such as with the use of male or female condoms, can also help prevent sexually transmitted infections.[6] Other methods of birth control do not protect against sexually transmitted diseases.[7] Emergency birth control can prevent pregnancy if taken within the 72 to 120 hours after unprotected sex.[8,9] Some argue not having sex as a form of birth control, but abstinence-only sex education may increase teenage pregnancies if offered without birth control education, due to non-compliance.[10,11] In teenagers, pregnancies are at greater risk of poor outcomes.[12] Comprehensive sex education and access to birth control decreases the rate of unwanted pregnancies in this age group.[12,13] While all forms of birth control can generally be used by young people,[14] long-acting reversible birth control such as implants, IUDs, or vaginal rings are more successful in reducing rates of teenage pregnancy.[13] After the delivery of a child, a woman who is not exclusively breastfeeding may become pregnant again after as few as four to six weeks.[14] Some methods of birth control can be started immediately following the birth, while others require a delay of up to six months.[14] In women who are breastfeeding, progestin-only methods are preferred over combined oral birth control pills.[14] In women who have reached menopause, it is recommended that birth control be continued for one year after the last period.[14]

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