Objectives: (To determine the level and consistency of condom use among family planning clients a... more Objectives: (To determine the level and consistency of condom use among family planning clients at three family planning clinics in Zimbabwe.) Design: A prospective cross sectional study. Setting: The study was carried out at three Zimbabwe National Family Planning Council clinics. Subjects: We interviewed 899 consecutive women seeking family planning services at these three clinics using a structured questionnaire. Main outcome measures: The prevalence of condom use among this population of family planning clients and the factors predicting condom use were the main outcome measures. We define dual method use (DMU) as the use of condoms in conjunction with another highly effective contraceptive and dual purpose use (DPU) as the use of condoms for both pregnancy and STI/HIV prevention. We measured self-reported condom use during the last 30 days prior to each interview. Results: The prevalence of condom use among this population of family planning clients was 38%. Of all the study participants, 32% were DMU clients while 5% were DPU clients. Fifty eight percent of the DMU clients and 89% of the DPU clients clients reported consistent condom use respectively. Logistic regression analysis showed that young age and reporting high risk sexual behaviour were predictors of condom use. Conclusions: The level of condom use among this population of family plannig clients is too low for a country with such a high HIV prevalence. Condom users were more likely to report DMU than DPU. Those reporting DPU were more likely to report consistent condom use.
The Central African journal of medicine, Sep 6, 2019
Background : Preterm birth has a worldwide incidence of 9.6% and contributes about 33.6% to globa... more Background : Preterm birth has a worldwide incidence of 9.6% and contributes about 33.6% to global perinatal mortality. Objectives : The objective of this study was to determine the prevalence and associated factors of preterm birth and associated perinatal outcomes. Design : A descriptive cross-sectional study. Settings : The maternity hospitals of the two tertiary institutions in Harare Zimbabwe; Harare Central and Parirenyatwa hospitals. Subjects : Consecutive pregnant women who delivered prematurely (24-36 weeks and 6 days gestation) between16 March and 23 May 2014 were recruited. Main Outcome Measures : The proportion rate of preterm birth, perinatal mortality rate and perinatal morbidity. Results : There were 3291 total deliveries and 262 babies were delivered preterm from 255 women giving a crude incidence of 8%.The perinatal mortality rate was 13.7% (9.5/1000 total births) and 60% of these occurred in the 28-32 weeks gestational period. Of the babies born between 28 and 32 weeks 34.6% died by day 7 of birth and their odds of dying was 24 (p < .001) compared to those born between 34 to 37 completed weeks. Conclusion : This study reports a proportion of preterm birth of 8%. There was a high perinatal mortality mainly affecting the 28 to 32 weeks gestational age category.
The Central African journal of medicine, Mar 1, 2006
To determine the acceptance of HIV testing by pregnant women referred to the antenatal clinic at ... more To determine the acceptance of HIV testing by pregnant women referred to the antenatal clinic at a tertiary training hospital. Women who accepted testing and were positive received nevirapine. Their babies also received nevirapine within 72 hours of birth. Doctors, nurses and pharmacists were equipped with counselling and management skills for prevention of mother to child HIV vertical transmission. Substudy of a prospective operational research. Harare Central Hospital, antenatal clinic. 863 women were given lectures in a group followed by individualised pre and post test HIV counselling; 767 accepted testing for HIV. Acceptance rates for HIV testing, number of mothers and babies who received nevirapine as well as the characteristics of HIV positive and negative women were analysed. 89% of the women accepted HIV testing; 44% were positive. Seventy percent of the women who tested positive and their babies received nevirapine. Acceptance rates increased when lectures were given to a group of pregnant women followed by individualised pre and post test counselling. The support and encouragement that the women gave each other may explain this observation. Nevirapine should be issued to pregnant women at the time that the HIV test results are available irrespective of the age of gestation, with instructions to take the drug at the onset of labour at their place of delivery. This practice will increase the uptake of the drug by pregnant women. Medical students, nursing and pharmacy students should be equipped with skills for initiating and managing a mother to child HIV prevention programme during their training followed by refresher courses after graduating.
Progestin-only injectable contraceptives continue to gain in popularity, but uncertainty remains ... more Progestin-only injectable contraceptives continue to gain in popularity, but uncertainty remains about pregnancy risk among women late for reinjection. The World Health Organization (WHO) recommends a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;grace period&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; of 2 weeks after the scheduled 13-week reinjection. Beyond 2 weeks, however, many providers send late clients home to await menses. A prospective cohort study in Uganda, Zimbabwe and Thailand followed users of depot-medroxyprogesterone acetate (DMPA) for up to 24 months. Users were tested for pregnancy at every reinjection, allowing analysis of pregnancy risk among late comers. The analysis consists of 2290 participants contributing 13,608 DMPA intervals. The pregnancy risks per 100 women-years for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;on time&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; [0.6; 95% confidence interval (CI), 0.33-0.92], &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;2-week grace&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (0.0; 95% CI, 0.0-1.88) and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;4-week grace&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (0.4; 95% CI, 0.01-2.29) injections were low and virtually identical. Extending the current WHO grace period for DMPA reinjection from 2 to 4 weeks does not increase pregnancy risk and could increase contraceptive continuation.
Journal of traditional medicine & clinical naturopathy, Mar 24, 2020
Background: In Zimbabwe, elephant dung and Fadogia ancylantha are widely used in the third trimes... more Background: In Zimbabwe, elephant dung and Fadogia ancylantha are widely used in the third trimester of pregnancy. They are believed to facilitate childbirth because they open the birth canal during delivery. However, the effects of these medicines in pregnancy have not been investigated. This study aimed to determine the effects of elephant dung and F. ancylantha leaf extracts on isolated pregnant and non-pregnant uterine horns. Materials and Methods: Elephant dung and Fadogia ancylantha leaves were air-dried, macerated in water, filtered, evaporated and freeze dried. Uterine horns from 72 non-pregnant and 72 pregnant female Sprague-Dawley rats were used. The ‘test’ strips were separately exposed to elephant dung (20-640 mg/ml) or F. ancylantha (25-800 mg/ml) while the 'controls' received distilled water only. Effects of oxytocin on tissues exposed to these extracts were measured. Results: Elephant dung aqueous extract contracted the uterus in a dose-dependent manner whilst Fadogia ancylantha relaxed uterine tissue in a dose-dependent manner. The effects of both the Elephant dung and Fadogia ancylantha extracts were higher in pregnant uteri versus non-pregnant uteri. Oxytocin potentiated elephant dunginduced contraction, but only slightly shifted baseline upwards in tissues exposed to Fadogia ancylantha. Conclusion: Elephant dung possessed oxytoxic effects and contracted uteri in a dose-dependent manner. Fadogia ancylantha relaxed the uterus in a dose-dependent manner, suggesting that it might slow down labour progression since uterine contraction will not be occurring at a sufficient enough pace to facilitate labour and delivery. Pregnant women and health care workers need education to understand the possible effects of using these traditional medicines in pregnancy.
Objectives: The aim of this study was to determine the prevalence and types of traditional medici... more Objectives: The aim of this study was to determine the prevalence and types of traditional medicine used during pregnancy, at labour and for postpartum care by women in rural Zimbabwe. Research design: A cross-sectional survey was conducted on 398 women from two rural districts in Zimbabwe. Data on socio-demography, pregnancy related information as well as traditional medicine use patterns was collected using a structured interviewer administered questionnaire. Convenient sampling was used to recruit women of childbearing age who were either pregnant at the time of the study, or had previously given birth. Results: The prevalence of traditional medicine used during pregnancy and at labour was 69.9% and only 17.3% used these medicines for postpartum care. During pregnancy, 27.7% used soil from a mole hill, 21.6% used elephant dung, and 13.3% used Fadogia ancylantha. These medicines were mainly used to facilitate labour (43.5%), avoid tears/stitches (19.7%), make delivery easy and safe (18.3%) and to avoid prolonged labour (5%). Only 9% of the participants however reported to have experienced adverse effects from using traditional medicines. Conclusion: The use of traditional remedies in different forms during pregnancy and at labour was very common as confirmed by the high prevalence rate of 69.9%. Some of the women however used more than one type of traditional medicine during pregnancy, labour and for postpartum care. The exact effects of some of these medicines on both the mother and infant however, are not known, and there is therefore a need for them to be studied in greater detail.
Malaria causes over 10000 maternal and 200000 neonatal deaths a year globally. Fifty million preg... more Malaria causes over 10000 maternal and 200000 neonatal deaths a year globally. Fifty million pregnant women are at risk of acquiring malaria of which half of them are in Sub-Saharan Africa. It is caused by the plasmodium parasite, which is transmitted by the vector female Anopheles mosquito. Plasmodium falciparum is the most prevalent and virulent. Pregnant women are more susceptible to malaria and malaria runs a more fulminant course in pregnancy. Primigravidae and to a lesser degree the secundigravidae are more susceptible to malaria infection than the higher parities. Women in endemic areas have greater premonition (a host response that protects against high numbers of parasite and illness without eliminating the infection) to malaria though they become anaemic and have placental parasitisation that disturbs fetal growth leading to poor perinatal outcomes. Women in epidemic areas have lower premunition to malaria resulting in severe infections and higher mortality. WHO (World Health Organization) advocates for the use of Insecticide treated nets, chemoprophylaxis and effective case management to reduce mortality in pregnant women.
The Central African journal of medicine, Dec 8, 2010
The purpose of post natal care for the mother is to avert or alleviate significant mortality and ... more The purpose of post natal care for the mother is to avert or alleviate significant mortality and morbidity. During the immediate post partum period, the emphasis will be on monitoring to detect complications and assisting the mother to initiate care of the newborn, especially breastfeeding. In the latter post partum period, the aim is to confirm involution and healing of the genital tract, confirm continued good newborn care by the mother and offer protection against pregnancy to the couple.
Objectives: (To determine the level and consistency of condom use among family planning clients a... more Objectives: (To determine the level and consistency of condom use among family planning clients at three family planning clinics in Zimbabwe.) Design: A prospective cross sectional study. Setting: The study was carried out at three Zimbabwe National Family Planning Council clinics. Subjects: We interviewed 899 consecutive women seeking family planning services at these three clinics using a structured questionnaire. Main outcome measures: The prevalence of condom use among this population of family planning clients and the factors predicting condom use were the main outcome measures. We define dual method use (DMU) as the use of condoms in conjunction with another highly effective contraceptive and dual purpose use (DPU) as the use of condoms for both pregnancy and STI/HIV prevention. We measured self-reported condom use during the last 30 days prior to each interview. Results: The prevalence of condom use among this population of family planning clients was 38%. Of all the study participants, 32% were DMU clients while 5% were DPU clients. Fifty eight percent of the DMU clients and 89% of the DPU clients clients reported consistent condom use respectively. Logistic regression analysis showed that young age and reporting high risk sexual behaviour were predictors of condom use. Conclusions: The level of condom use among this population of family plannig clients is too low for a country with such a high HIV prevalence. Condom users were more likely to report DMU than DPU. Those reporting DPU were more likely to report consistent condom use.
The Central African journal of medicine, Sep 6, 2019
Background : Preterm birth has a worldwide incidence of 9.6% and contributes about 33.6% to globa... more Background : Preterm birth has a worldwide incidence of 9.6% and contributes about 33.6% to global perinatal mortality. Objectives : The objective of this study was to determine the prevalence and associated factors of preterm birth and associated perinatal outcomes. Design : A descriptive cross-sectional study. Settings : The maternity hospitals of the two tertiary institutions in Harare Zimbabwe; Harare Central and Parirenyatwa hospitals. Subjects : Consecutive pregnant women who delivered prematurely (24-36 weeks and 6 days gestation) between16 March and 23 May 2014 were recruited. Main Outcome Measures : The proportion rate of preterm birth, perinatal mortality rate and perinatal morbidity. Results : There were 3291 total deliveries and 262 babies were delivered preterm from 255 women giving a crude incidence of 8%.The perinatal mortality rate was 13.7% (9.5/1000 total births) and 60% of these occurred in the 28-32 weeks gestational period. Of the babies born between 28 and 32 weeks 34.6% died by day 7 of birth and their odds of dying was 24 (p < .001) compared to those born between 34 to 37 completed weeks. Conclusion : This study reports a proportion of preterm birth of 8%. There was a high perinatal mortality mainly affecting the 28 to 32 weeks gestational age category.
The Central African journal of medicine, Mar 1, 2006
To determine the acceptance of HIV testing by pregnant women referred to the antenatal clinic at ... more To determine the acceptance of HIV testing by pregnant women referred to the antenatal clinic at a tertiary training hospital. Women who accepted testing and were positive received nevirapine. Their babies also received nevirapine within 72 hours of birth. Doctors, nurses and pharmacists were equipped with counselling and management skills for prevention of mother to child HIV vertical transmission. Substudy of a prospective operational research. Harare Central Hospital, antenatal clinic. 863 women were given lectures in a group followed by individualised pre and post test HIV counselling; 767 accepted testing for HIV. Acceptance rates for HIV testing, number of mothers and babies who received nevirapine as well as the characteristics of HIV positive and negative women were analysed. 89% of the women accepted HIV testing; 44% were positive. Seventy percent of the women who tested positive and their babies received nevirapine. Acceptance rates increased when lectures were given to a group of pregnant women followed by individualised pre and post test counselling. The support and encouragement that the women gave each other may explain this observation. Nevirapine should be issued to pregnant women at the time that the HIV test results are available irrespective of the age of gestation, with instructions to take the drug at the onset of labour at their place of delivery. This practice will increase the uptake of the drug by pregnant women. Medical students, nursing and pharmacy students should be equipped with skills for initiating and managing a mother to child HIV prevention programme during their training followed by refresher courses after graduating.
Progestin-only injectable contraceptives continue to gain in popularity, but uncertainty remains ... more Progestin-only injectable contraceptives continue to gain in popularity, but uncertainty remains about pregnancy risk among women late for reinjection. The World Health Organization (WHO) recommends a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;grace period&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; of 2 weeks after the scheduled 13-week reinjection. Beyond 2 weeks, however, many providers send late clients home to await menses. A prospective cohort study in Uganda, Zimbabwe and Thailand followed users of depot-medroxyprogesterone acetate (DMPA) for up to 24 months. Users were tested for pregnancy at every reinjection, allowing analysis of pregnancy risk among late comers. The analysis consists of 2290 participants contributing 13,608 DMPA intervals. The pregnancy risks per 100 women-years for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;on time&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; [0.6; 95% confidence interval (CI), 0.33-0.92], &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;2-week grace&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (0.0; 95% CI, 0.0-1.88) and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;4-week grace&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (0.4; 95% CI, 0.01-2.29) injections were low and virtually identical. Extending the current WHO grace period for DMPA reinjection from 2 to 4 weeks does not increase pregnancy risk and could increase contraceptive continuation.
Journal of traditional medicine & clinical naturopathy, Mar 24, 2020
Background: In Zimbabwe, elephant dung and Fadogia ancylantha are widely used in the third trimes... more Background: In Zimbabwe, elephant dung and Fadogia ancylantha are widely used in the third trimester of pregnancy. They are believed to facilitate childbirth because they open the birth canal during delivery. However, the effects of these medicines in pregnancy have not been investigated. This study aimed to determine the effects of elephant dung and F. ancylantha leaf extracts on isolated pregnant and non-pregnant uterine horns. Materials and Methods: Elephant dung and Fadogia ancylantha leaves were air-dried, macerated in water, filtered, evaporated and freeze dried. Uterine horns from 72 non-pregnant and 72 pregnant female Sprague-Dawley rats were used. The ‘test’ strips were separately exposed to elephant dung (20-640 mg/ml) or F. ancylantha (25-800 mg/ml) while the 'controls' received distilled water only. Effects of oxytocin on tissues exposed to these extracts were measured. Results: Elephant dung aqueous extract contracted the uterus in a dose-dependent manner whilst Fadogia ancylantha relaxed uterine tissue in a dose-dependent manner. The effects of both the Elephant dung and Fadogia ancylantha extracts were higher in pregnant uteri versus non-pregnant uteri. Oxytocin potentiated elephant dunginduced contraction, but only slightly shifted baseline upwards in tissues exposed to Fadogia ancylantha. Conclusion: Elephant dung possessed oxytoxic effects and contracted uteri in a dose-dependent manner. Fadogia ancylantha relaxed the uterus in a dose-dependent manner, suggesting that it might slow down labour progression since uterine contraction will not be occurring at a sufficient enough pace to facilitate labour and delivery. Pregnant women and health care workers need education to understand the possible effects of using these traditional medicines in pregnancy.
Objectives: The aim of this study was to determine the prevalence and types of traditional medici... more Objectives: The aim of this study was to determine the prevalence and types of traditional medicine used during pregnancy, at labour and for postpartum care by women in rural Zimbabwe. Research design: A cross-sectional survey was conducted on 398 women from two rural districts in Zimbabwe. Data on socio-demography, pregnancy related information as well as traditional medicine use patterns was collected using a structured interviewer administered questionnaire. Convenient sampling was used to recruit women of childbearing age who were either pregnant at the time of the study, or had previously given birth. Results: The prevalence of traditional medicine used during pregnancy and at labour was 69.9% and only 17.3% used these medicines for postpartum care. During pregnancy, 27.7% used soil from a mole hill, 21.6% used elephant dung, and 13.3% used Fadogia ancylantha. These medicines were mainly used to facilitate labour (43.5%), avoid tears/stitches (19.7%), make delivery easy and safe (18.3%) and to avoid prolonged labour (5%). Only 9% of the participants however reported to have experienced adverse effects from using traditional medicines. Conclusion: The use of traditional remedies in different forms during pregnancy and at labour was very common as confirmed by the high prevalence rate of 69.9%. Some of the women however used more than one type of traditional medicine during pregnancy, labour and for postpartum care. The exact effects of some of these medicines on both the mother and infant however, are not known, and there is therefore a need for them to be studied in greater detail.
Malaria causes over 10000 maternal and 200000 neonatal deaths a year globally. Fifty million preg... more Malaria causes over 10000 maternal and 200000 neonatal deaths a year globally. Fifty million pregnant women are at risk of acquiring malaria of which half of them are in Sub-Saharan Africa. It is caused by the plasmodium parasite, which is transmitted by the vector female Anopheles mosquito. Plasmodium falciparum is the most prevalent and virulent. Pregnant women are more susceptible to malaria and malaria runs a more fulminant course in pregnancy. Primigravidae and to a lesser degree the secundigravidae are more susceptible to malaria infection than the higher parities. Women in endemic areas have greater premonition (a host response that protects against high numbers of parasite and illness without eliminating the infection) to malaria though they become anaemic and have placental parasitisation that disturbs fetal growth leading to poor perinatal outcomes. Women in epidemic areas have lower premunition to malaria resulting in severe infections and higher mortality. WHO (World Health Organization) advocates for the use of Insecticide treated nets, chemoprophylaxis and effective case management to reduce mortality in pregnant women.
The Central African journal of medicine, Dec 8, 2010
The purpose of post natal care for the mother is to avert or alleviate significant mortality and ... more The purpose of post natal care for the mother is to avert or alleviate significant mortality and morbidity. During the immediate post partum period, the emphasis will be on monitoring to detect complications and assisting the mother to initiate care of the newborn, especially breastfeeding. In the latter post partum period, the aim is to confirm involution and healing of the genital tract, confirm continued good newborn care by the mother and offer protection against pregnancy to the couple.
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