Women's sexual health and contraceptive needs after a severe obstetric complication ("near-miss"): a cohort study in Burkina Faso.
BACKGROUND
Little is known about the reproductive health of women who survive obstetric complications in poor countries. Our aim was to determine how severe obstetric complications in Burkina Faso affect reproductive events in the first year postpartum.


METHODS
Data were collected from a prospective cohort of women who either experienced life threatening (near-miss) pregnancy-related complications or an uncomplicated childbirth, followed from the end of pregnancy to one year postpartum or post-abortum. Documented outcomes include menses resumption, sexual activity resumption, dyspareunia, uptake of contraceptives, unmet needs for contraception and women's reproductive intentions.Participants were recruited in seven hospitals between December 2004 and March 2005 in six towns in Burkina Faso.


RESULTS
Reproductive events were associated with pregnancy outcome. The frequency of contraceptive use was low in all groups and the method used varied according to the presence or not of a live baby. The proportion with unmet need for contraception was high and varied according to the time since end of pregnancy. Desire for another pregnancy was highest among near-miss women with perinatal death or natural abortion. Women in the near-miss group with induced abortion, perinatal death and natural abortion had significantly higher odds of subsequent pregnancy. Unintended pregnancies were observed mainly in women in the near-miss group with live birth and the uncomplicated delivery group.


CONCLUSIONS
Considering the potential deleterious impact (on health and socio-economic life) of new pregnancies in near-miss women, it is important to ensure family planning coverage includes those who survive a severe complication.
Ganaba
Rasmané
R
Agence de Formation, de Recherche et d'Expertise en Santé pour l'Afrique (AFRICSanté), 01 BP 298 Bobo-Dioulasso, Burkina Faso. rganaba.muraz@fasonet.bf.
Marshall
Tom
T
Sombié
Issiaka
I
Baggaley
Rebecca F
RF
Ouédraogo
Thomas W
TW
Filippi
Véronique
V
Bull World Health Organ. 2000;78(5):593-602
10859853
BJOG. 2003 Feb;110(2):128-33
12618155
J Health Popul Nutr. 2003 Mar;21(1):55-66
12751675
Lancet. 2007 Oct 13;370(9595):1329-37
17933647
Int Fam Plan Perspect. 2006 Dec;32(4):185-91
17237015
Br J Psychiatry. 2001 Jun;178:556-60
11388974
Reprod Health. 2010 May 10;7:5
20459754
Trop Med Int Health. 2004 Mar;9(3):399-405
14996370
Stud Fam Plann. 1997 Sep;28(3):203-14
9322336
Hum Reprod. 2006 May;21(5):1279-84
16410331
Adv Contracept. 1996 Mar;12(1):53-61
8739516
East Afr Med J. 2003 Mar;80(3):144-9
12762430
J Biosoc Sci. 2007 Jul;39(4):493-515
16959060
Trop Med Int Health. 2010 Jun;15(6):733-42
20406426
Reprod Health Matters. 2005 May;13(25):155-63
16035609
Soc Sci Med. 2008 Feb;66(3):545-57
18061325
Stud Fam Plann. 2006 Jun;37(2):87-98
16832983
Soc Sci Med. 2004 Oct;59(7):1379-95
15246168
Eur J Obstet Gynecol Reprod Biol. 2002 May 10;102(2):173-8
11950486
Eur J Contracept Reprod Health Care. 2005 Dec;10(4):229-34
16448949
Afr J Reprod Health. 1998 Apr;2(1):10-9
10214424
BMJ. 1999 Jun 26;318(7200):1721-4
10381705
Afr Health Sci. 2003 Dec;3(3):117-23
14676716
Demography. 2001 Nov;38(4):467-79
11723945
Afr J Reprod Health. 2004 Aug;8(2):124-36
15623127
Contraception. 2008 Jul;78(1):73-8
18555821
BJOG. 2006 Mar;113(3):276-83
16487198
Demography. 1995 May;32(2):139-57
7664957
J Obstet Gynaecol. 2005 Jul;25(5):500-3
16183590
Int J Gynaecol Obstet. 2002 Sep;78(3):249-50
12384272
J Psychosom Res. 1999 Jul;47(1):27-49
10511419
Eur J Obstet Gynecol Reprod Biol. 2002 Apr 10;102(1):6-10
12039082
Stud Fam Plann. 2000 Dec;31(4):309-24
11198068
Int J Gynaecol Obstet. 1995 Jun;48 Suppl:S53-66
7672175