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  • Title: Postpartum tubal sterilisation: an international perspective on some programmatic issues.
    Author: Chi IC, Thapa S.
    Journal: J Biosoc Sci; 1993 Jan; 25(1):51-61. PubMed ID: 8425886.
    Abstract:
    The demand for postpartum sterilisation (performed within 42 days after delivery), is increasing both in developed and developing countries. The incidence of regret after postpartum sterilisation is important, but it could be minimised by carefully screening risk factors. Using trained paramedical personnel to perform postpartum sterilisation via minilaparotomy where physicians are in short supply appears to be safe and acceptable, under close medical supervision. Including postpartum sterilisation information in the antenatal counselling services effectively strengthens postpartum services and simultaneously helps to minimise subsequent regret. Family Health International reviews data from Demographic and Health Surveys (DHS) in 25 developing countries and the literature to identify programmatic issues of postpartum tubal sterilization and then makes recommendations based on the findings. More than 66% of all contraceptive users in Thailand undergo tubal sterilization within 3 months after their last delivery, indicating that Thailand likely leads the world in postpartum sterilization. The demand for postpartum sterilization (i.e., postpartum women not wanting anymore children) in developing countries ranges from 24% in Africa to 62% in Latin America and the Caribbean. It is safest when done within 7 days after delivery. Even though many studies indicate that postpartum sterilization has no adverse effects on lactation, others show that delayed postpartum sterilization does affect lactation, suggesting a need to promote early postpartum sterilization. Many studies indicate higher regret among women undergoing postpartum sterilization, especially after a Cesarean section, than among those undergoing interval sterilization. Careful screening for regret risk factors (e.g., decision for sterilization not made by the woman and changes in patient characteristics after sterilization, such as divorce or child death) would diminish regret. Health workers should also provide accurate information about postpartum sterilization during prenatal care visits. Some specialists assert that postpartum sterilization is likely more cost-effective than temporary methods (e.g., oral contraceptives and injectables), because they necessitate repeated stock. In many areas of developing countries, experienced physicians are not available to perform postpartum sterilizations, so trained paramedical personnel perform sterilizations via minilaparotomy. In Thailand, for example, trained nurse-midwives perform postpartum sterilizations with few complications, and women and physicians are satisfied with their performance.
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