International Perspectives On Sexual And Reproductive Health[JOURNAL]
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200 papers
What happens to contraceptive use after injectables are introduced? An analysis of 13 countries.
Sutherland EG, Otterness C, Janowitz B
Int Perspect Sex Reprod Health · 2011 Dec · PMID 22227627 · Publisher ↗
CONTEXT: Although the introduction of a new method is generally hailed as a boon to contraceptive prevalence, uptake of new methods can reduce the use of existing methods. It is important to examine changing patterns of...
CONTEXT: Although the introduction of a new method is generally hailed as a boon to contraceptive prevalence, uptake of new methods can reduce the use of existing methods. It is important to examine changing patterns of contraceptive use and method mix after the introduction of new methods. METHODS: Demographic and Health Survey data from 13 countries were used to analyze changes in method use and method mix after the introduction of the injectable in the early 1990s. Subgroup analyses were conducted among married women who reported wanting more children, but not in the next two years (spacers), and those who reported wanting no more children (limiters). RESULTS: Modern method use and injectable use rose for each study country. Increases in modern method use exceeded those in injectable use in all but three countries. Injectable use rose among spacers, as well as among limiters of all ages, particularly those younger than 35. In general, the increase in injectable use was partially offset by declines in use of other methods, especially long-acting or permanent methods. CONCLUSION: Family planning programs could face higher costs and women could experience more unintended pregnancies if limiters use injectables for long periods, rather than changing to longer acting and permanent methods, which provide greater contraceptive efficacy at lower cost, when they are sure they want no more children.
Clients' perceptions of the quality of care in Mexico city's public-sector legal abortion program.
Becker D, Díaz-Olavarrieta C, Juárez C … +3 more , García SG, Sanhueza P, Harper CC
Int Perspect Sex Reprod Health · 2011 Dec · PMID 22227626 · Full text
CONTEXT: In 2007, first-trimester abortion was legalized in Mexico City. Limited research has been conducted to understand clients' perceptions of the abortion services available in public-sector facilities. METHODS: Per...
CONTEXT: In 2007, first-trimester abortion was legalized in Mexico City. Limited research has been conducted to understand clients' perceptions of the abortion services available in public-sector facilities. METHODS: Perceptions of quality of care were measured among 402 women aged 18 or older who had obtained abortions at any of three public-sector sites in Mexico City in 2009. Six domains of quality of care (client-staff interaction, information provision, technical competence, postabortion contraceptive services, accessibility and the facility environment) were assessed, and ordinal logistic regression analysis was conducted to identify the domains that were important in women's overall evaluation of care. RESULTS: Clients gave overall services a high rating, with a mean of 8.8 out of 10. In multivariate analysis, overall ratings were higher among women who said the doctor made them feel comfortable (odds ratio, 3.3), the receptionist was respectful (1.7), the staff was very careful to protect their privacy (2.5), they had received sufficient information on self-care at home following the abortion and on postabortion emotions (1.9 and 2.0, respectively) and they felt confident in the doctor's technical skill (2.5). Rating site hours as very convenient (2.4), waiting time as acceptable (2.8) and the facility as very clean (1.9) were all associated with higher overall scores. Compared with women who had given birth, those who had not rated the services lower overall (0.6). CONCLUSION: Efforts to improve patient experiences with abortion services should focus on client-staff interaction, information provision, service accessibility, technical competence and the facility environment. The most highly significant factor appears to be whether a doctor makes a woman feel comfortable during her visit.
Do men and women report their sexual partnerships differently? Evidence from Kisumu, Kenya.
Clark S, Kabiru C, Zulu E
Int Perspect Sex Reprod Health · 2011 Dec · PMID 22227625 · Full text
CONTEXT: It is generally believed that men and women misreport their sexual behaviors, which undermines the ability of researchers, program designers and health care providers to assess whether these behaviors compromise...
CONTEXT: It is generally believed that men and women misreport their sexual behaviors, which undermines the ability of researchers, program designers and health care providers to assess whether these behaviors compromise individuals' sexual and reproductive health. METHODS: Data on 1,299 recent sexual partnerships were collected in a 2007 survey of 1,275 men and women aged 18-24 and living in Kisumu, Kenya. Chi-square and t tests were used to examine how sample selection bias and selective partnership reporting may result in gender differences in reported sexual behaviors. Correlation coefficients and kappa statistics were calculated in further analysis of a sample of 280 matched marital and nonmarital couples to assess agreement on reported behaviors. RESULTS: Even after adjustment for sample selection bias, men reported twice as many partnerships as women (0.5 vs. 0.2), as well as more casual partnerships. However, when selective reporting was controlled for, aggregate gender differences in sexual behaviors almost entirely disappeared. In the matched-couples sample, men and women exhibited moderate to substantial levels of agreement for most relationship characteristics and behaviors, including type of relationship, frequency of sex and condom use. Finally, men and women tended to agree about whether men had other nonmarital partners, but disagreed about women's nonmarital partners. CONCLUSIONS: Both sample selection bias and selective partnership reporting can influence the level of agreement between men's and women's reports of sexual behaviors. Although men report more casual partners than do women, accounts of sexual behavior within reported relationships are generally reliable.
Condom use before marriage and its correlates: evidence from India.
Santhya KG, Acharya R, Jejeebhoy SJ
Int Perspect Sex Reprod Health · 2011 Dec · PMID 22227624 · Publisher ↗
CONTEXT: Little evidence is available from India concerning young people's use of condoms in premarital relationships. METHODS: Data from a subnationally representative study of Indian youth conducted in 2006-2008 were u...
CONTEXT: Little evidence is available from India concerning young people's use of condoms in premarital relationships. METHODS: Data from a subnationally representative study of Indian youth conducted in 2006-2008 were used to assess condom use in premarital relationships. Analyses used survey data from 2,408 married or unmarried youth aged 15-24 who had had premarital sex, and qualitative data from 271 such youth who completed in-depth interviews. Logistic regression was used to identify characteristics associated with four measures of condom use (ever-use, consistent use, use at first sex and use at last sex). RESULTS: Only 7% of young women and 27% of young men who had had premarital sex had ever used condoms. Among both sexes, discomfort with approaching a provider or pharmacist for condoms was inversely correlated with most measures of condom use (odds ratios, 0.5), while having peers who had had premarital sex was generally positively correlated (1.6-2.9). Females who had had premarital sex only with nonromantic partners were less likely than those with only romantic partners to have used a condom at last sex (0.2), while males were generally more likely to use condoms with nonromantic than romantic partners (1.5-1.6). Among men, education level, age at sexual initiation and neighborhood economic status were positively associated with use. CONCLUSION: Programs that encourage condom use are needed. Service delivery structures should be modified to enable youth to obtain condoms easily and privately.
A woman cannot die from a pregnancy she does not have.
Diamond-Smith N, Potts M
Int Perspect Sex Reprod Health · 2011 Sep · PMID 21988792 · Publisher ↗
More than 99% of maternal deaths occur in low-resource settings; in parts of the developing world, as many as one in six women die of maternal causes. Currently, seven developing countries-Afghanistan, Angola, Malawi, Ni...
More than 99% of maternal deaths occur in low-resource settings; in parts of the developing world, as many as one in six women die of maternal causes. Currently, seven developing countries-Afghanistan, Angola, Malawi, Niger, Rwanda, Sierra Leone and Tanzania-have maternal mortality ratios of at least 1,400 maternal deaths per 100,000 live births.
Maximizing the effectiveness of sexual and reproductive health funding provided by seven European governments.
Seims S
Int Perspect Sex Reprod Health · 2011 Sep · PMID 21988791 · Publisher ↗
The landmark United Nations International Conference on Population and Development (ICPD) took place in Cairo almost 20 years ago. At that time, 180 nations made a commitment to work together and to pay for services to i...
The landmark United Nations International Conference on Population and Development (ICPD) took place in Cairo almost 20 years ago. At that time, 180 nations made a commitment to work together and to pay for services to improve the sexual and reproductive health and rights (SRHR) of women and men, particularly those living in the world's poorest countries.
Maternal health care utilization among HIV-positive female adolescents in Kenya.
Birungi H, Obare F, van der Kwaak A … +1 more , Namwebya JH
Int Perspect Sex Reprod Health · 2011 Sep · PMID 21988790 · Publisher ↗
CONTEXT: Given the health risks of HIV/AIDS and the risks of teenage pregnancy in general, pregnant HIV-positive adolescents in Kenya need maternal health care services that account for their HIV status. However, researc...
CONTEXT: Given the health risks of HIV/AIDS and the risks of teenage pregnancy in general, pregnant HIV-positive adolescents in Kenya need maternal health care services that account for their HIV status. However, research on their access to and use of these services is scant. METHODS: To examine maternal health care utilization, pregnancy history data collected in 2009 on 506 pregnancies among 393 HIV-positive female adolescents aged 15-19 enrolled in HIV/AIDS programs in Kenya were analyzed. Multilevel logit models were used to identify the variables associated with use of prenatal care, prevention of mother-to-child transmission (PMTCT) of HIV, skilled attendance at pregnancy outcomes and postnatal/postabortion care. RESULTS: Use of PMTCT services was less common than use of prenatal care services among HIV-positive female adolescents (67% of pregnancies vs. 84%). These adolescents made four or more prenatal care visits in only 45% of pregnancies. In addition, use of skilled care during or after abortion or miscarriage was low (20%). The odds of receiving PMTCT services and skilled assistance were higher in Nairobi than in other regions (odds ratios, 3.8 and 2.7, respectively). HIV-positive adolescents were less likely to use maternal health care services for higher-order pregnancies than for lower-order pregnancies (0.4-0.6). They were, however, more likely to receive prenatal care and PMTCT services when their husband rather than someone else was responsible for the pregnancy (3.7 and 4.9, respectively). CONCLUSION: Pregnant, HIV-positive adolescents need maternal health care services--including PMTCT care--that take into account parity, paternity dynamics and regional variations in use.
Induced abortion in Tehran, Iran: estimated rates and correlates.
Erfani A
Int Perspect Sex Reprod Health · 2011 Sep · PMID 21988789 · Publisher ↗
CONTEXT: Abortion is severely restricted in Iran, and many women with an unwanted pregnancy resort to clandes-tine, unsafe abortions. Accurate information on abortion incidence is needed to assess the extent to which wom...
CONTEXT: Abortion is severely restricted in Iran, and many women with an unwanted pregnancy resort to clandes-tine, unsafe abortions. Accurate information on abortion incidence is needed to assess the extent to which women ?experience unwanted pregnancies and to allocate resources for contraceptive services. METHODS: Data for analysis came from 2,934 married women aged 15-49 who completed the 2009 Tehran Survey of Fertility. Estimated abortion rates and proportions of known pregnancies that end in abortion were calculated for all women and for demographic and socioeconomic subgroups, and descriptive data were used to examine women's contraceptive use and reasons for having an abortion. RESULTS: Annually, married women in Tehran have about 11,500 abortions. In the year before the survey, the estimated total abortion rate was 0.16 abortions per woman, and the annual general abortion rate was 5.5 abortions per 1,000 women; the general abortion rate peaked at 11.7 abortions among those aged 30-34. An estimated 8.7 of every 100 known pregnancies ended in abortion. The abortion rate was elevated among women who were employed or had high levels of income or education, as well as among those who reported a low level of religiosity, had two children or wanted no more. Fertility-related and socioeconomic reasons were cited by seven in 10 women who obtained an abortion. More than two-thirds of pregnancies that were terminated resulted from method failures among women who had used withdrawal, the pill or a condom. CONCLUSIONS: Estimated abortion rates and their correlates can help policymakers and program planners identify subgroups of women who are in particular need of services and counseling to prevent unwanted pregnancy.
Trends in national family planning programs, 1999, 2004 and 2009.
Ross J, Smith E
Int Perspect Sex Reprod Health · 2011 Sep · PMID 21988788 · Publisher ↗
CONTEXT: National family planning programs in the developing world vary greatly in strength and coverage, and in the nature of their outreach. Periodic measures of their types and levels of effort have been conducted sin...
CONTEXT: National family planning programs in the developing world vary greatly in strength and coverage, and in the nature of their outreach. Periodic measures of their types and levels of effort have been conducted since 1972. METHODS: In 2009, expert observers in 81 developing countries completed a questionnaire that assessed 31 features of family planning program effort, as well as other program measures. Data were compared with those from similar surveys fielded in 1999 and 2004 to examine trends over the decade. RESULTS: On average, national family planning programs improved their effort levels slightly from 1999 to 2004, and again from 2004 to 2009. The average effort in 2009, however, was only about half of maximum; component scores for service measures and for measures of access to contraception did not reach 50% of maximum in 2009. Differences by region and by effort quartile emerged in subgroup analyses. Overall, improvement of women's health and avoidance of unwanted births were the most important program justifications, ranking higher than fertility reduction, economic development or reduction of childbearing among unmarried adolescents. The subgroups given the most emphasis were poor and rural populations, while unmarried youth and postabortion women received the least. Among external influences, changes in donor and domestic funding were seen as more unfavorable than the merging of family planning programs into broader health services. CONCLUSIONS: Average program effort levels have been sustained, although deficiencies remain. Countries have not yet ensured universal access to a variety of contraceptive choices, through various channels, for both short- and long-term methods.
Induced abortion in Colombia: new estimates and change between 1989 and 2008.
Prada E, Biddlecom A, Singh S
Int Perspect Sex Reprod Health · 2011 Sep · PMID 21988787 · Publisher ↗
CONTEXT: Although abortion was made legal in Colombia under selected circumstances in 2006, no national studies have examined whether the incidence of the procedure has changed since the previous estimate in 1989. METHOD...
CONTEXT: Although abortion was made legal in Colombia under selected circumstances in 2006, no national studies have examined whether the incidence of the procedure has changed since the previous estimate in 1989. METHODS: Data on the number of women treated for abortion complications were obtained from a nationally representative survey of 300 public and private health facilities, and estimates of the likelihood that women obtaining abortions experience complications and receive treatment at a facility were obtained from a survey of 102 knowledgeable professionals. Indirect estimation techniques were used to calculate national and regional abortion measures for 2008, which were compared with previously published 1989 estimates. Numbers and rates of unintended pregnancy were also calculated. RESULTS: In 2008, an estimated 93,300 women were treated for induced abortion complications in public and private health facilities. An estimated 400,400 induced abortions were performed, which translates to a rate of 39 per 1,000 women aged 15-44, a slight increase from 1989 (36 per 1,000). Rates varied widely across regions, from 66 in Bogotá to 18 in Oriental. Despite the new abortion law, only 322 legal abortions were performed in 2008. Between 1989 and 2008, the proportion of pregnancies ending in induced abortion increased from 22% to 29%, and the proportion of pregnancies that were unintended rose from 52% to 67%. CONCLUSION: Improvements in provision of and access to contraceptive and legal abortion services are needed to meet the increased demand among women and couples to prevent unintended pregnancy and unsafe abortion.
Niger: too little, too late.
Potts M, Gidi V, Campbell M … +1 more , Zureick S
Int Perspect Sex Reprod Health · 2011 Jun · PMID 21757424 · Publisher ↗
Abstract loading — click title to view on PubMed.
Legal abortion worldwide in 2008: levels and recent trends.
Sedgh G, Singh S, Henshaw SK … +1 more , Bankole A
Int Perspect Sex Reprod Health · 2011 Jun · PMID 21757423 · Publisher ↗
CONTEXT: Periodic assessments of abortion incidence are essential for monitoring trends in unintended pregnancy and gaps in contraceptive services and use. METHODS: Statistics and estimates of legal induced abortions in...
CONTEXT: Periodic assessments of abortion incidence are essential for monitoring trends in unintended pregnancy and gaps in contraceptive services and use. METHODS: Statistics and estimates of legal induced abortions in 2008 were compiled for 64 of the 77 countries in which legal abortion is generally available; these 64 are home to 98% of women aged 15-44 who live in the countries eligible for inclusion. Data sources included reports or completed questionnaires from national statistical offices and nationally representative surveys. The completeness of official figures was assessed by in-country and regional experts. Trends since 1996 and 2003 were examined. RESULTS: Of the 77 countries with liberal abortion laws, 36 are in the developing world. In 2008, abortion rates in the 25 countries with complete records-all of which were developed-ranged from seven (Germany and Switzerland) to 30 (Estonia) per 1,000 women aged 15-44. Abortion rates declined in most of the 20 countries with consistently reliable information on trends between 1996 and 2008; declines were generally steeper than increases, although the pace of decline slowed after 2003. The highest observed abortion rates were in developing countries with incomplete estimates. For most developing countries that had liberal laws, the reported abortion rates were incomplete and varied widely. CONCLUSIONS: High abortion rates in some countries, and small increases in rates in others, indicate a great need for more effective family planning services for these populations. Reliable data collection systems, needed to ensure that trends can be effectively monitored, are lacking in many countries.
How often and under which circumstances do Mexican pharmacy vendors recommend misoprostol to induce an abortion?
Lara D, García SG, Wilson KS … +1 more , Paz F
Int Perspect Sex Reprod Health · 2011 Jun · PMID 21757422 · Publisher ↗
CONTEXT: Misoprostol was used by women across Mexico to induce abortion even before 2007, when first-trimester abortion was legalized in Mexico City. Pharmacy vendors' misoprostol recommendation practices across subregio...
CONTEXT: Misoprostol was used by women across Mexico to induce abortion even before 2007, when first-trimester abortion was legalized in Mexico City. Pharmacy vendors' misoprostol recommendation practices across subregions of Mexico after abortion legalization warrant examination. METHODS: Overall, 192 pharmacies in four regions of Mexico were randomly selected and visited by simulated clients presenting three scenarios (a young woman, an adult woman and a male partner). Bivariate and multivariate analyses were used to explore associations between pharmacy, vendor and client characteristics and drug access. RESULTS: In 558 encounters with simulated clients, 78% of vendors provided information about misoprostol-18% recommended it spontaneously and 60% recommended it only after the client asked specifically for the drug. Fifteen percent of vendors recommended a potentially effective misoprostol dosing regimen. Mexico City-based pharmacies and those in the Central region were significantly less likely than those in the North region to require a prescription to sell misoprostol (odds ratios, 0.2 and 0.3, respectively). Independent pharmacies and those from low-?income areas were significantly more likely to sell misoprostol by the pill than chain pharmacies and those in medium-income areas (3.2 and 2.7, respectively). CONCLUSIONS: Access to misoprostol is influenced by neighborhood socioeconomic level, pharmacy location and pharmacy type. The frequently inaccurate and incomplete information provided to clients about using misoprostol for abortion suggests the need to improve pharmacy vendor training in medication abortion options and to develop ways to directly inform women about misoprostol use.
Emergency contraceptive pills: knowledge and attitudes of pharmacy personnel in Managua, Nicaragua.
Ehrle N, Sarker M
Int Perspect Sex Reprod Health · 2011 Jun · PMID 21757421 · Publisher ↗
CONTEXT: As abortion is illegal in Nicaragua, postcoital contraception is an important option for preventing pregnancy. Emergency contraceptive pills are available in Nicaraguan pharmacies over the counter, but pharmacy...
CONTEXT: As abortion is illegal in Nicaragua, postcoital contraception is an important option for preventing pregnancy. Emergency contraceptive pills are available in Nicaraguan pharmacies over the counter, but pharmacy personnel's knowledge and attitudes about this method can affect access. METHODS: A cross-sectional survey was conducted in Managua, Nicaragua's capital. Interviewers administered a semistructured questionnaire to 93 pharmacy employees to determine their knowledge of and attitudes toward emergency contraceptive pills. Descriptive statistics and cross-tabulations were used to examine responses of and differences between male and female employees. RESULTS: All participants knew about emergency contraceptive pills and reported experience selling them. The majority sold them at least once a week (92%), usually without a prescription (97%). Of participants who were aware that emergency contraceptive pills should be taken only after sexual intercourse, 45% knew that the pills can be taken up to three days afterward; none knew that the pills are effective up to five days afterward. More than one-third of all respondents (39%) thought the pills can induce abortion, and most overestimated contraindications and side effects. Large majorities believed the availability of emergency contraceptive pills discourages use of ongoing methods (75%), encourages sexual risk-taking (82%) and increases transmission of HIV and other STIs (76%). Sixty-three participants (68%) thought emergency contraceptive pills are necessary to reduce unwanted and unplanned pregnancy; 65% were willing to provide them to all women in need, although only 13% would provide them to minors. CONCLUSIONS: Managuan pharmacy personnel frequently dispense emergency contraceptive pills, but need additional education to accurately counsel women about the method.
Contraceptive discontinuation and unintended pregnancy: an imperfect relationship.
Curtis S, Evens E, Sambisa W
Int Perspect Sex Reprod Health · 2011 Jun · PMID 21757420 · Full text
CONTEXT: Contraceptive discontinuation is a common event that may be associated with low motivation to avoid pregnancy. If this is the case, a substantial proportion of pregnancies that follow discontinuation will be rep...
CONTEXT: Contraceptive discontinuation is a common event that may be associated with low motivation to avoid pregnancy. If this is the case, a substantial proportion of pregnancies that follow discontinuation will be reported as intended. METHODS: Demographic and Health Survey data from six countries (Bangladesh, the Dominican Republic, Kazakhstan, Kenya, the Philippines and Zimbabwe) over the period 1999-2003 were used to explore the proportions of pregnancies women reported as intended or unintended following various contraceptive behaviors. Multivariate logistic regression analysis was used to examine the characteristics of women who reported births as intended when they followed contraceptive failure or discontinuation for reasons other than a desire for pregnancy. RESULTS: The proportion of births reported as intended following contraceptive failure ranged from 16% in Bangladesh to 54% in Kazakhstan, and the proportion reported as intended following discontinuation for reasons other than a desire for pregnancy ranged from 37% in Kenya to 51% in Kazakhstan. In at least half the countries, associations were found between selected women's characteristics and their reports that births following either contraceptive failure or discontinuation were intended: Factors that were positively associated were women's age and the time elapsed between contraceptive discontinuation and the index conception; factors that were negatively associated were increasing number of living children and reporting method failure as opposed to method discontinuation. CONCLUSION: These findings suggest that underlying variation in the motivation to avoid pregnancy is an important factor in contraceptive discontinuation.
Postabortion care: going to scale.
RamaRao S, Townsend JW, Diop N … +1 more , Raifman S
Int Perspect Sex Reprod Health · 2011 Mar · PMID 21478087 · Publisher ↗
Abstract loading — click title to view on PubMed.
Associations between family factors and premarital heterosexual relationships among female college students in Tehran.
Farahani FK, Cleland J, Mehryar AH
Int Perspect Sex Reprod Health · 2011 Mar · PMID 21478086 · Publisher ↗
CONTEXT: Although premarital heterosexual relationships, especially those involving sexual contact, are discouraged in Iran, particularly for females, a considerable minority of young people are involved in such relation...
CONTEXT: Although premarital heterosexual relationships, especially those involving sexual contact, are discouraged in Iran, particularly for females, a considerable minority of young people are involved in such relationships. However, the determinants of such relationships have not been identified, especially those pertaining to family. METHODS: In 2005-2006, a random sample of 1,378 unmarried female college students from four universities in Tehran completed anonymous, self-administered surveys that asked whether the respondent had ever had a premarital heterosexual relationship. Bivariate and multivariate regression analyses were conducted to examine associations between such relationships and family factors, including socioeconomic measures, parent-child communication and closeness, family values and atmosphere, and parental control. RESULTS: Having had a boyfriend was positively associated with paternal income (odds ratio, 1.3), maternal educational attainment (1.3) and more liberal family values (1.3), and negatively associated with parent-child closeness (0.6). Very strict and very relaxed parental control during adolescence were both associated with having had a boyfriend, but only the former was associated with having had premarital sex. In addition, respondents were more likely to have had premarital intercourse if they did not live with both parents (2.0) or if their family had more liberal values (1.3); they had reduced odds of having had sex if they had a closer relationship with their parents (0.7). CONCLUSION: Good family relationships may reduce the likelihood that youth will engage in premarital sex, possibly by fostering parent-child closeness. Moderate parental control may discourage premarital relationships more effectively than lesser or greater degrees of control.
Injected with controversy: sales and administration of injectable contraceptives in drug shops in Uganda.
Stanback J, Otterness C, Bekiita M … +2 more , Nakayiza O, Mbonye AK
Int Perspect Sex Reprod Health · 2011 Mar · PMID 21478085 · Publisher ↗
CONTEXT: Informal drug shops are the first line of health care in many poor countries. In Uganda, these facilities commonly sell and administer the injectable contraceptive depot medroxyprogesterone acetate (DMPA), even...
CONTEXT: Informal drug shops are the first line of health care in many poor countries. In Uganda, these facilities commonly sell and administer the injectable contraceptive depot medroxyprogesterone acetate (DMPA), even though they are prohibited by law from selling any injectable drugs. It is important to understand drug shop operators' current practices and their potential to provide DMPA to hard-to-reach populations. METHODS: Between November 2007 and January 2008, 157 drug shops were identified in three rural districts of Uganda, and the operators of the 124 facilities that sold DMPA were surveyed. Data were analyzed with descriptive methods. RESULTS: Only 35% of operators reported that the facility in which they worked was a licensed drug shop and another 9% reported that the facility was a private clinic; all claimed to have some nursing, midwifery, or other health or medical qualification. Ninety-six percent administered DMPA in the shop. Operators gave a mean of 10 injections (including three of DMPA) per week. Forty-three percent of those who administered DMPA reported disposing of used syringes in sharps containers; in the previous 12 months, 24% had had a needle-stick injury and 17% had had a patient with an injection-related abscess. Eleven percent said they had ever reused a disposable syringe. Overall, contraceptive knowledge was low, and attitudes toward family planning reflected common traditional biases. CONCLUSION: Provision of DMPA is common in rural drug shops, but needs to be made safer. Absent stronger regulation and accreditation, drug shop operators can be trained as community-based providers to help meet the extensive unmet demand for family planning in rural areas.
What differentiates method stoppers from switchers? Contraceptive discontinuation and switching among Honduran women.
Barden-O'Fallon J, Speizer I
Int Perspect Sex Reprod Health · 2011 Mar · PMID 21478084 · Full text
CONTEXT: Contraceptive discontinuation contributes to unplanned pregnancy and unwanted births, as well as increased maternal, neonatal and infant morbidity and mortality. Information on differences between women who stop...
CONTEXT: Contraceptive discontinuation contributes to unplanned pregnancy and unwanted births, as well as increased maternal, neonatal and infant morbidity and mortality. Information on differences between women who stop using contraceptives and those who switch to another method would be useful for programs aimed at preventing unplanned pregnancies and their consequences. METHODS: Data come from two rounds of interviews with women aged 15-44 (800 interviewed at baseline and 671 reinterviewed one year later) who were new or continuing users of injectable or oral contraceptives or an IUD. Bivariate analysis examined associations between attitudes and behaviors of women who discontinued their baseline method and side effects they experienced. Multivariate logistic regression assessed differences between women who switched methods immediately or within one month of discontinuation and those who stopped contraceptive use for one month or more. RESULTS: Of the 671 women who were reinterviewed, 41% (273) discontinued use of their baseline contraceptive method within the one-year follow-up; of those, 43% (117) switched to a new method, and 57% (156) stopped for one month or more. Seeking help with side effects from a health worker, urban residence, talking to a partner about the decision to discontinue, and new and recent method adoption were associated with increased odds of switching methods (odds ratios, 2.0-3.5). CONCLUSION: Access to high-quality family planning services and encouraging discussion with partners and families before stopping contraceptive use is important for women who experience side effects from contraceptive methods and are at risk of discontinuation.
Prevalence and correlates of sexual risk behaviors among Jamaican adolescents.
Ishida K, Stupp P, McDonald O
Int Perspect Sex Reprod Health · 2011 Mar · PMID 21478083 · Publisher ↗
CONTEXT: Despite high levels of sexual activity and risk behaviors among Jamaican youth, few population-based studies have examined their prevalence or correlates. METHODS: The prevalence of three sexual risk behaviors w...
CONTEXT: Despite high levels of sexual activity and risk behaviors among Jamaican youth, few population-based studies have examined their prevalence or correlates. METHODS: The prevalence of three sexual risk behaviors was assessed using data from the 2008-2009 Jamaican ?Reproductive Health Survey on a subsample of adolescents aged 15-19 who neither were in a union nor had a child. Factors associated with the risk behaviors were examined separately for females and males, using bivariate analysis and multivariate logistic regression. RESULTS: In the year prior to the survey, 32% of females and 54% of males had had sexual intercourse; of those, 12% and 52%, respectively, had had more than one sexual partner, and 49% and 46% had used condoms ?inconsistently or not at all. School enrollment was protective against females being sexually active and males having multiple partners. Females who were enrolled in an age-appropriate or higher grade had decreased odds of using condoms inconsistently or not at all, and males who were enrolled in a lower than age-appropriate grade had a decreased risk of being sexually active. Males in the lowest wealth tercile were less likely than those in the highest tercile to have been sexually active or to have had multiple partners. Weekly attendance at religious services was protective against all three risk behaviors for both genders, with the exception of inconsistent or no condom use among males. CONCLUSIONS: Future reproductive health programs should continue to target adolescents in venues other than schools and churches, and should also address the varying needs of females and males.
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