Abstract
Goal of the study: To provide information on the knowledge and practices involving the use of the contraceptive methods employed by women of a fertile age, especially in the period of lactation. Design: A cross-section, descriptive study.
Setting: Institute for the Care of Mother and Child, Prague; Department of Gynaecology and Obstetrics at the Institute of Postgraduate Education in Healthcare, Prague; Cegedim Strategic Data CZ s.r.o., Prague. Methodology: The method involved a written questionnaire in a structured form.
The investigation was undertaken in two phases; the first round took place directly after giving birth, while the second took place 6 months after giving birth. The group consisted of 4,535 women who gave birth at the Institute for the Care of Mother and Child in the period between 15. 11. 2006- 15. 11. 2007.
Results: 2540 women (56.0%) answered the questions in the first round; 85% of them were in the 26- 35 age group, 44.3% were secondary school graduates and 36.7% were university graduates. 61.3% were first-time mothers, 32.3% were second-time mothers and 5.4% were third-time mothers. Contraception used before current gravidity: (n = 2540) oral hormonal contraception 59.7%, a condom 11.1%, intrauterine contraception 1.0% and 20.6% of the women used no contraceptive method.
The users of oral hormonal contraception (n = 1517) were most frequently prescribed (12.8% of the women) a preparation containing 20 sg ethinylestradiol and 150 .tg desogestrel (Mercilon). The contraception used during the course of lactation after a birth in the group of mothers of more than one child (n = 982): oral hormonal contraception 19.6%, a condom 17.1%, intrauterine contraception 1.3%, no contraceptive method 54.5%.
Breastfeeding users of oral hormonal contraception (n = 192) were most frequently prescribed (20.3% of women) a preparation containing 500 sg lynestrenol (Exluton) and a preparation containing 75 sg desogestrel (Cerazette) (16.1% of women). The contraceptive methods planned by women after birth (n = 2540): oral hormonal contraceptive 36.5%, a condom 18.8%, intrauterine contraception 18.8%, no method 20.1%. 1,440 women (56.7%) answered the questions in the second round; 83.5% of them were in the 26-35 age group, 45.0% were secondary school graduates and 37.0% were university graduates. 64.4% were first-time mothers, 30.6% were second time mothers and 4.2% were third-time mothers. 74.6% of women were still breastfeeding 6 months after giving birth.
Contraception used by breastfeeding women (n = 1074): oral hormone contraception 27.6%, a condom 21.8%, an intrauterine system with levonorgestrel 2.8%, intrauterine contraception 2.4%, no method 39.5%. Contraception used by non-breastfeeding women (n = 366): oral hormonal contraception 42.1%, a condom 15.0%, an intrauterine system with levonorgestrel 2.7%, intrauterine contraception 2.7%, no method 31.4%.
In both groups of women, the users of oral hormonal contraception were most frequently prescribed a preparation containing 75 tg desogestrel (Cerazette); this accounted for 99.3% of the breastfeeding women and 18.8% of those not breastfeeding. 40.0% of breastfeeding and 48.4% of non-breastfeeding women are planning to use hormonal contraception in the coming period. The self-evaluation of the knowledge of contraception methods (a = 2540): 61.6% of women evaluated their knowledge as good, but 77.6% of women did not know a suitable hormonal contraceptive for the period of lactation.
According to 80.7% of the women, their main source of expert information in the area of family planning is their gynaecologist. Conclusion: The prevalence of breastfeeding women 6 months after giving birth is high in the monitored group.
Oral hormonal contraceptives are the most frequently used contraceptive method in general, including during the lactation period when women prefer a preparation containing 75 g desogestrel regardless of whether or not they are breastfeeding. The women's knowledge of suitable methods of contraception during the period of lactation is unsatisfactory and represents a challenge for healthcare providers to improve the amount of information available to women in this area.