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Title : Annotated Bibliography - Selected Researches on Family Planning in Indonesia 2005-2015
Author :

Dr. dr. Prima Dhewi Ratrikaningtyas, M.Biotech. (1)

Date : 2016
Keyword : RCT, Progestin-only pills, breastmilk,maternal lipid profile,maternal blood glucose RCT, Progestin-only pills, breastmilk,maternal lipid profile,maternal blood glucose
Abstract : Background Breast milk is the most ideal food, both physiologically and biologically, to be given to infants during the first six months of their lives. However, in Indonesia exclusive breastfeeding is universally practiced by no more than 40% women, far below the national target of 80%. Feeding infants alternative foods too early, including foods that are designed to complement breastfeeding, can shorten the duration of amenorrhea during lactation, and thus postpartum ovulation resumes sooner. The risk of unintended pregnancy during this period between childbirth and the resumption of ovulation is high for the majority of Indonesian women, as postpartum contraceptive use was still relatively low (14 %) among Indonesian women. Postpartum contraception is critical to improving the health of mothers and infants by extending the space between births. There are a number of postpartum family planning options available to Indonesian women that do not adversely interfere with breast milk quality or maternal health, however awareness of the benefits of postpartum is not widespread and the available methods have not been socialized well. The purpose of this study was to determine the effect of the use of progestin-only pills (POPs), one of the suitable postpartum family planning methods, on breast milk quality, maternal lipid profile and blood glucose. Methodology The study was a non-randomized controlled trial. The study was conducted in a/several community health center/s, and data was collected by Certified Professional Midwives located in the Sleman and Yogyakarta City districts of the Special Region of Yogyakarta, Indonesia. The research was conducted from June 2012 to July 2013. The study population was women of reproductive age who were six to eight weeks postpartum and breastfeeding and were seekingto delay or space their next pregnancy by usinghormonal birth control pills (POPs)or the non-hormonal copper IUD. Each subject was observed for 6 months. The total number of samples was 90, divided into two groups: the treatment group received POPs and the control group received the copper IUD. The independent variables are hormonal contraceptive use and non-hormonal contraceptive use, and the dependent variables are breast milk quality, maternal lipid profile and fasting blood glucose. Data was collected through interviews using questionnaires, breast milk samples were taken to investigate the quality of breast milk i.e. lactose, casein, calcium and fat content. Blood tests were conducted to determine maternal fasting blood glucose and lipid profile i.e. cholesterol, triglyceride, HDL and LDL. Laboratory testing was undertaken twice, at baseline (admission) and endline (after 6 months follow up). Data analysis was performed using t-test to determine the relationships between independent variables and dependent variables. Result Altogether, 107 postpartum women participated in the study, 19 was excluded from statistical analysis (lost to follow up 17.8%). At endline there were 88 remaining subjects; 59 subjects in the intervention group (using POPs) and 29 subjects in the control group (using IUD). It was found that the values of breast milk and blood indicators before and after the intervention were in a normal range. There were no significant difference between the breast milk quality of the two groups with regard to the different means of casein 0.17 gram (95% CI -0.09-0.44), lactose 0.22 gram (95% CI -0.71-0.26), fat 0.02 gram (95% CI -0.84-0.80) and calcium 1.64 gram (95% CI -11.86-8.58). There were no significant differences between maternal lipid profile of the two groups with regards to the mean of triglyceride 1.50 gr/dL (95% CI -5.09-2.09)and cholesterol 1.58 gr/dL (95% CI -9.75-6.60). There were statistically significant differences between lipid profile of the two groups with regard to the different mean of LDL 6.54 gr/dL (95% CI -13.04-(-0.05), HDL 18.55 gr/dL (95% CI -33.34-(-3.76) and also fasting blood glucose 0.98 gr/dL (95% CI 0.12 -1.84), but the values after intervention were within a normal range. Clinically, the overall difference was not significant. In conclusion, the study found that POPs do not have any harmful effects on breast milk quality, maternal lipid profile and blood glucose when used during the first 6 month postpartum. Knowledge contribution This study strengthens previous evidence on the safety of POPs to postpartum women especially in terms of maternal lipid profile, blood glucose and breast milk quality. Contraceptive pills containing only progestin can thus be considered as a safe option by postpartum women because it did not affect the breast milk quality or maternal lipid profile. Thus POPs can be offered as a safe family planning method for patients who are at risk for cardiovascular disease and diabetes . This study supports the potential for POPs as a postpartum contraceptive option for Indonesian women to prevent unplanned pregnancy. It should be noted that POPs are currently not produced domestically in Indonesia nor included in the government-funded family planning program. Thus there is potential for POPs to be manufactured generically to and incorporated into the national family planning program to improve quality of care by expanding method choice available to postpartum women. However, further study with longer follow up period is required to investigate the long-term effect of POPs use on breast milk quality and maternal health. In case of a future study, participant retention strategies will need to be considered to reduce the number of lost to follow up subjects in order to increase the quality of the study.
Group of Knowledge :
Level : Internasional
Status :
Published
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