title: Initiation of effective postpartum contraceptive use in public hospitals in Guatemala.
abstract: OBJECTIVE
  Low frequency of effective contraceptive use remains a challenging problem. This article examines the frequency of effective postpartum contraception and the methods used before discharge in public hospitals in Guatemala. It also discusses the need to implement best practices in providing family-planning and contraceptive services.
  
  
  METHODS
  In March 2006, a surveillance system was implemented to collect data on the initiation of effective contraceptive methods. Postpartum women were monitored in 34 public hospitals. Univariate and bivariate analyses were performed, and a chi-square test for linear trends was used to compare female surgical sterilization rates after vaginal delivery and cesarean section.
  
  
  RESULTS
  Between 1 March 2006 and 31 December 2008, of the 218 656 women who had a postpartum event, 31% received an effective contraceptive method before hospital discharge. The frequency of initiation of effective postpartum methods varied across hospitals. Hospital results were consistent with national data on women of reproductive age. Among women who underwent surgical sterilization, differences between those who had delivered vaginally and those who had a cesarean section were statistically significant.
  
  
  CONCLUSIONS
  The overall frequency of initiation of effective postpartum contraceptive use is low in public hospitals in Guatemala. It is higher, however, in hospitals at lower health care levels with strong community ties. Routine data collection revealed specific areas for improvement, particularly the need to enhance health providers' knowledge of medical eligibility criteria for effective contraceptive use postpartum. The priority is to promote the provision of high-quality family-planning and contraceptive services in Guatemala's public health system.
authors: Hospital General San Juan de Dios, Guatemala City, Guatemala. ekestler@ciesar.org.gt
authors: Edgar
authors: E
authors: Kestler
authors: Maria Del Rosario
authors: Mdel R
authors: Orozco
authors: Silvia
authors: S
authors: Palma
authors: Roberto
authors: R
authors: Flores
mesh_terms: D000328:Adult; D002585:Cesarean Section; D017280:Condoms / Q000706:statistics & numerical data; D003267:Contraception / Q000706:statistics & numerical data; D003268:Contraception Behavior / Q000706:statistics & numerical data; D003271:Contraceptive Agents, Female; D003277:Contraceptives, Oral, Combined; D036861:Delivery, Obstetric; D003906:Developing Countries; D005193:Family Planning Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D006166:Guatemala; D006297:Health Services Accessibility; D006779:Hospitals, Public / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007434:Intrauterine Devices / Q000706:statistics & numerical data; D017258:Medroxyprogesterone Acetate; D049590:Postpartum Period; D011247:Pregnancy; D013245:Sterilization, Reproductive / Q000706:statistics & numerical data
chemical_list: D003271:Contraceptive Agents, Female; D003277:Contraceptives, Oral, Combined; D017258:Medroxyprogesterone Acetate