International Perspectives On Sexual And Reproductive Health[JOURNAL]
Sun
200 papers
Acceptability of Contraceptive Self-Injection with DMPA-SC Among Adolescents in Gulu District, Uganda.
Cover J, Lim J, Namagembe A … +3 more , Tumusiime J, Drake JK, Cox CM
Int Perspect Sex Reprod Health · 2017 Dec · PMID 29771679 · Publisher ↗
CONTEXT: In Uganda, an estimated one in four adolescent women have begun childbearing. Many adolescent pregnancies are unintended because of substantial barriers to contraceptive access. The injectable contraceptive is t...
CONTEXT: In Uganda, an estimated one in four adolescent women have begun childbearing. Many adolescent pregnancies are unintended because of substantial barriers to contraceptive access. The injectable contraceptive is the most commonly used method in Uganda, and a new subcutaneous version offers the possibility of reducing access barriers by offering a self-injection option. However, more information about adolescent attitudes toward and interest in self-injection is needed. METHODS: In 2015, in-depth interviews were conducted with a purposive sample of 46 adolescent women aged 15-19 from rural and urban areas of Gulu District. Respondents were asked about their demographic characteristics, experience with contraceptives and opinions about injectable contraception, then introduced to subcutaneous depot medroxyprogesterone acetate (DMPA-SC) and trained in how to give an injection using a model. They were then asked their opinion about contraceptive self-injection. The interviews were transcribed and analyzed qualitatively to identify key themes. RESULTS: Although the injectable was generally viewed favorably, some adolescents expressed reservations about the suitability of injectable contraception for adolescents. The most common concern was fear of infertility. The majority felt self-injection would be an appealing option to adolescents because of the time and money saved and the discreet nature of injecting at home. Barriers to self-injection included fear of needles, the potential of making a mistake and lack of privacy at home. CONCLUSIONS: Contraceptive self-injection has the potential to increase contraceptive access and use for adolescents in Uganda, and should be considered as a delivery modality in the context of adolescent-friendly contraceptive services.
A Deviance Approach to Understanding Use of Maternal Health Care Services in Bangladesh.
Goldenberg T, Stephenson R
Int Perspect Sex Reprod Health · 2017 Dec · PMID 29771678 · Publisher ↗
CONTEXT: Use of maternal health care can reduce maternal morbidity and mortality in countries like Bangladesh, where rates of these outcomes are high. Community characteristics are associated with use of maternal care se...
CONTEXT: Use of maternal health care can reduce maternal morbidity and mortality in countries like Bangladesh, where rates of these outcomes are high. Community characteristics are associated with use of maternal care services, but it is unclear whether deviation from community norms is associated with service use. METHODS: Data from the 2014 Bangladesh Demographic and Health Survey on 4,106 ever-married women aged 15-49 were used to examine relationships between women's deviation from their communities on socioeconomic, fertility and other characteristics and use of maternal health care (antenatal care, delivery care, postpartum care and a composite measure). Characteristics were examined at the individual and community levels and as deviance variables that indicated whether respondents differed from local norms in a positive way (e.g., being employed when others were not) or a negative way (being unemployed when others had jobs). Associations were identified using logistic regression. RESULTS: Sixty-three percent of women had had postpartum care; smaller proportions had had delivery care (40%), antenatal care (27%) or all three types (17%). Several deviance variables were associated with service use. Negative deviance on women's employment was associated with antenatal care (odds ratio, 1.3); positive deviance on violence justification, exposure to family planning messages and husband's employment was associated with delivery care (1.3-4.8); positive deviance on husband's employment was associated with not receiving postpartum care (0.7); and negative deviance on women's employment and positive deviance on age at marriage were associated with receipt of all three services (1.4-1.7). CONCLUSION: Understanding associations between deviation from community norms and receipt of maternal health care may provide deeper understanding of variation within communities regarding whether women use services.
Intimate Partner Violence and Uptake of Antenatal Care: A Scoping Review of Low- and Middle-Income Country Studies.
Metheny N, Stephenson R
Int Perspect Sex Reprod Health · 2017 Dec · PMID 29596048 · Publisher ↗
CONTEXT: Intimate partner violence (IPV) is associated with negative physical and mental health outcomes. Antenatal care can act as a link to IPV services, but experiencing IPV may be associated with reduced uptake of an...
CONTEXT: Intimate partner violence (IPV) is associated with negative physical and mental health outcomes. Antenatal care can act as a link to IPV services, but experiencing IPV may be associated with reduced uptake of antenatal care, an issue that has received little attention from researchers. METHODS: A scoping review was conducted to synthesize quantitative research on IPV and uptake of antenatal care in low-resource settings. Keyword searches of PubMed and other databases and snowball searches of reference lists were conducted to identify articles published in 2005-2015 that measured one or more types of IPV (physical, sexual or emotional) or controlling behavior and assessed the relationship of such abuse with use of antenatal care. For each identified article, key characteristics and findings were abstracted, and study quality was assessed. RESULTS: Sixteen articles, representing 10 low- and middle-income countries, met the inclusion criteria. Most studies were of medium-to-high quality but low rigor, reflecting the abundance of cross-sectional studies in the literature. In all 16 studies, IPV was negatively associated with initiation of antenatal care, number of visits or use of a skilled provider. Analyses revealed reduced odds of antenatal care use among women who had experienced IPV (odds ratios, 0.5-0.8) and elevated odds of antenatal care use among women who had not experienced IPV or of nonuse among women who had experienced IPV (1.2-4.1). CONCLUSION: Women in low-resource settings who experience IPV have a reduced likelihood of obtaining optimal antenatal care and may benefit from interventions to mitigate barriers to care.
A Choice Without Information Is Not a Choice.
Int Perspect Sex Reprod Health · 2017 Sep · PMID 29553475 · Publisher ↗
Abstract loading — click title to view on PubMed.
Preventing Pregnancy in Kenya Through Distribution and Use of the CycleBeads Mobile Application.
Shelus V, Ashcroft N, Burgess S … +2 more , Giuffrida M, Jennings V
Int Perspect Sex Reprod Health · 2017 Sep · PMID 29553474 · Publisher ↗
CONTEXT: Given the proportion of Kenyan women not using hormonal contraceptives, the country appears to have a substantial need for a modern, natural family planning option. The CycleBeads® mobile phone application (app)...
CONTEXT: Given the proportion of Kenyan women not using hormonal contraceptives, the country appears to have a substantial need for a modern, natural family planning option. The CycleBeads® mobile phone application (app), a digital platform for the Standard Days Method® of family planning, could help address this issue. METHODS: After the CycleBeads app was promoted in Kenya in May-June 2015, a three-month pilot study was conducted to collect quantitative and qualitative data from 185 female app users. Chi-square testing, binary logistic regression and thematic content analysis were used to assess whether the app brought new users to family planning, to understand users' experiences and to assess how user experiences vary by distribution channel. RESULTS: Participants learned about the app through nongovernmental organizations (17%), via digital media (33%) or from family or friends (50%). Most used the app to track their periods (54%) or prevent pregnancy (37%); a few used it to plan a pregnancy (7%) or for other reasons (2%). The main reason for choosing the Standard Days Method was fear of side effects from hormonal methods (64%). The majority of women found the app and method easy to use (53%). Among those preventing pregnancy, 42% had never before used a method. By midline, all participants knew when fertile days occurred, and most (97%) knew the method's cycle-length requirements. Women reported high rates of condom use (88%), abstinence (68%) and withdrawal (46%) on fertile days. CONCLUSION: Offering the CycleBeads app to support women in use of the Standard Days Method may expand family planning options, reduce unmet need and make family planning more widely available.
Awareness and Perceptions of Emergency Contraceptive Pills Among Women in Kinshasa, Democratic Republic of the Congo.
Hernandez JH, Muanda M, Garcia M … +1 more , Matawa G
Int Perspect Sex Reprod Health · 2017 Sep · PMID 29553473 · Publisher ↗
CONTEXT: Despite the commitment of the Democratic Republic of the Congo (DRC) to expand the family planning method mix and increase access to services, awareness of emergency contraception is low among women, and the met...
CONTEXT: Despite the commitment of the Democratic Republic of the Congo (DRC) to expand the family planning method mix and increase access to services, awareness of emergency contraception is low among women, and the method remains underused and poorly integrated in family planning programming. METHODS: Data from 15 focus group discussions conducted in 2016 among women aged 15-35 were used to examine awareness and perceptions of, and attitudes toward, emergency contraceptives. After facilitators explained emergency contraceptive pills' mechanism of action and other characteristics, participants were asked about the potential benefits and risks of making the method more widely available. Transcripts were analyzed using an iterative approach. RESULTS: Women reported employing a wide range of postcoital contraceptive behaviors, albeit often using inappropriate products, and generally agreed that emergency contraceptive pills seemed to be a potentially effective solution to their family planning needs. Perceived benefits and limitations of the method were almost always framed in reference to other, better-known contraceptives, and women expressed strong preferences for pharmacy-based provision that aligned with their usual behaviors for obtaining contraceptives. Participants were reluctant to see the method available for free. CONCLUSIONS: Emergency contraceptive pills have the potential to address gaps in the family planning method mix in the DRC. Assessing whether women have incomplete or erroneous information about family planning methods can provide better understanding of women's contraceptive choices in low-income countries.
Improving the Measurement of Fertility Regulation Practices: Findings from Qualitative Research in Ghana.
Marston C, Renedo A, Nyaaba GN … +3 more , Machiyama K, Tapsoba P, Cleland J
Int Perspect Sex Reprod Health · 2017 Sep · PMID 29553472 · Publisher ↗
CONTEXT: According to Demographic and Health Survey (DHS) data, highly educated urban women in some West African countries simultaneously have low rates of both contraceptive use and fertility-suggesting that the DHS may...
CONTEXT: According to Demographic and Health Survey (DHS) data, highly educated urban women in some West African countries simultaneously have low rates of both contraceptive use and fertility-suggesting that the DHS may not be capturing a complete picture of women's contraceptive practices. METHODS: Individual in-depth interviews and focus group discussions were conducted with a total of 48 women aged 18-49 in Accra, Ghana, who had at least a secondary education to explore their reproductive lives and relationships, and their views on and use of fertility regulation strategies. Data were analyzed using iterative thematic techniques. RESULTS: Women commonly reported using combinations of contraceptive methods, including "counting days" (using a calendar and the date of one's last menstrual period to estimate "unsafe" days-those on which the risk of conception is high), as well as withdrawal, condoms and frequent use of emergency contraceptive pills. Women described practicing "periodic contraception": for example, counting days to determine unsafe days and practicing contraception ad hoc on such days. Method use combinations varied from cycle to cycle-forming a "mosaic" of method use combinations over time. CONCLUSIONS: The fertility control strategies commonly reported by the study respondents-periodic contraception, and frequent use of traditional methods and emergency contraceptive pills-are likely not adequately captured in general surveys such as the DHS. Such surveys are also not well suited to measuring combinations of methods and mosaics of method combinations. New ways of capturing women's fertility regulation practices should be considered, including additional survey items, new question modules and specialist studies.
Son Preference and Family Limitation in Pakistan: A Parity- and Contraceptive Method-Specific Analysis.
Channon MD
Int Perspect Sex Reprod Health · 2017 Sep · PMID 29553471 · Publisher ↗
CONTEXT: Son preference exerts a strong influence over contraceptive and fertility decisions in many South Asian countries. In Pakistan, where fertility remains high and contraceptive use low, research on son preference...
CONTEXT: Son preference exerts a strong influence over contraceptive and fertility decisions in many South Asian countries. In Pakistan, where fertility remains high and contraceptive use low, research on son preference has been limited. METHODS: Data from Pakistan Demographic and Health Surveys conducted in 1990-1991, 2006-2007 and 2012-2013 were used to examine potential indicators and outcomes of son preference. Descriptive analyses looked at sex composition preferences of men and women, as well as the sex ratio at last birth. Multivariate logistic regression analyses examined parity progression by birth order, while multinomial logistic regression was used to identify associations between sex composition and use of permanent, temporary and traditional contraceptive methods. RESULTS: Parity progression and choice of contraceptive method are increasingly associated with the sex composition of children. Many respondents wanted at least two sons, though most also wanted at least one daughter. Analyses suggest that the prevalence of modern contraceptive use among parous women would have been 19% higher in 2012-2013 in the absence of son preference. Permanent method use was extremely low among women with no sons and increased significantly with number of sons. The association between number of sons and use of temporary methods was weaker, while son preference had little relationship with traditional method use. CONCLUSIONS: The association of son preference with parity progression and modern contraceptive use has become stronger in Pakistan. Continuation of the fertility transition may be difficult unless the degrees of differential stopping behavior and differential contraceptive use decline.
Longitudinal Evaluation of the Tupange Urban Family Planning Program in Kenya.
Benson A, Calhoun LM, Corroon M … +5 more , Lance P, O'Hara R, Otsola J, Speizer IS, Winston J
Int Perspect Sex Reprod Health · 2017 Jun · PMID 29261507 · Full text
CONTEXT: Levels of fertility and contraceptive use have long fluctuated in Kenya. The multicomponent Tupange program, part of the Urban Reproductive Health Initiative, was initiated in 2011 to increase use of modern fami...
CONTEXT: Levels of fertility and contraceptive use have long fluctuated in Kenya. The multicomponent Tupange program, part of the Urban Reproductive Health Initiative, was initiated in 2011 to increase use of modern family planning methods. METHODS: Women aged 15-49 in the five Kenyan cities where Tupange was implemented were interviewed in 2010 and reinterviewed in 2014 to obtain information on their contraceptive use and exposure to components of the Tupange program. Fixed-effects models were estimated to identify associations between program exposure and use of modern family planning methods. Analyses were performed to determine the relative cost-effectiveness of program components. RESULTS: During the four-year follow-up period, the proportion of women using modern contraceptives increased from 45% to 52%, and the proportion of users who were using long-acting or permanent methods rose from 6% to 19%. The fixed-effects model indicated that modern method use was associated with having heard Tupange-related local radio programming and marginally associated with having discussed family planning with a community health worker (CHW); among women who were unmarried or did not give birth during the study period, modern method use was associated with living near program facilities. Local radio programming was the most cost-effective program component, followed by proximity to Tupange facilities and discussions with CHWs. CONCLUSIONS: Urban reproductive health programs seeking to increase use of modern family planning methods in Kenya and other Sub-Saharan African settings should consider multicomponent approaches that include CHW activities, local radio programming and improvements to the supply environment.
Men's Roles in Women's Abortion Trajectories in Urban Zambia.
Freeman E, Coast E, Murray SF
Int Perspect Sex Reprod Health · 2017 Jun · PMID 29261506 · Publisher ↗
CONTEXT: Given that maternal morbidity and mortality from unsafe abortion persist, especially in Africa, there is a pressing need to understand the abortion decision-making process. However, little is known about men's i...
CONTEXT: Given that maternal morbidity and mortality from unsafe abortion persist, especially in Africa, there is a pressing need to understand the abortion decision-making process. However, little is known about men's influence on and involvement in women's abortion decision making and care seeking. METHODS: A qualitative study was conducted at the largest public provider of abortion-related care in Zambia. Thematic framework analysis was used to categorize and synthesize data from in-depth interviews conducted in 2013 with 71 women who received a safe abortion and 41 who received care following an incomplete (unsafe) abortion. RESULTS: Men influenced whether women sought a safe or unsafe abortion; their actions, lack of action and anticipated actions-negative and positive-reflected broader gender inequities. Abandonment by men, and the desire to avoid disclosing pregnancy to men because of fear of their reactions or interference, were important influences on some women's decision to seek abortion, on the secrecy and urgency with which abortion was pursued and on the level of risk assumed. However, other women discussed men's positive influences on their abortion care seeking. In this setting of low awareness of the legality and availability of abortion, some men used their greater social and economic resources to facilitate safe abortion by providing information and paying for care. CONCLUSIONS: Increasing knowledge about the legality and availability of safe abortion is vital not only among sexually active women, but also among those they confide in, including men.
The Role of Public-Sector Family Planning Programs in Meeting the Demand for Contraception in Sub-Saharan Africa.
Bongaarts J, Hardee K
Int Perspect Sex Reprod Health · 2017 Jun · PMID 29261505 · Publisher ↗
CONTEXT: Commonly used indicators of contraceptive behavior in a population-modern contraceptive prevalence (mCPR), unmet need for contraception, demand for contraception and demand satisfied-are not well-suited for eval...
CONTEXT: Commonly used indicators of contraceptive behavior in a population-modern contraceptive prevalence (mCPR), unmet need for contraception, demand for contraception and demand satisfied-are not well-suited for evaluating the progress made by government family planning programs in helping women and men achieve their reproductive goals. METHODS: Trends in these measures in 26 Sub-Saharan African countries between 1990 and 2014 were examined. Trends in a proposed new indicator, the public-sector family planning program impact score (PFPI), and its relationship to mCPR and the family planning effort score were also assessed. Case studies were used to review public family planning program development and implementation in four countries (Nigeria, Ethiopia, Rwanda and Kenya). RESULTS: The four commonly used indicators capture the extent to which women use family planning and to which demand is satisfied, but shed no direct light on the role of family planning programs. PFPI provides evidence that can be used to hold governments accountable for meeting the demand for family planning, and was closely related to policy developments in the four case-study countries. CONCLUSIONS: PFPI provides a useful addition to the indicators currently used to assess progress in reproductive health and family planning programs.
Service Delivery Correlates of Choosing Short-Acting Contraceptives at the Time of Uterine Evacuation in Bangladesh.
Pearson E, Biswas KK, Chowdhury R … +5 more , Andersen KL, Sultana S, Shahidullah SM, Moreau C, Decker MR
Int Perspect Sex Reprod Health · 2017 Jun · PMID 29261504 · Publisher ↗
CONTEXT: The World Health Organization recommends that contraceptives be offered on the day of a uterine evacuation procedure (i.e., induced abortion or postabortion care for an incomplete abortion). Short-acting methods...
CONTEXT: The World Health Organization recommends that contraceptives be offered on the day of a uterine evacuation procedure (i.e., induced abortion or postabortion care for an incomplete abortion). Short-acting methods can be initiated on the day of the uterine evacuation, regardless of procedure type. METHODS: Survey data from a facility-based sample of 479 Bangladeshi women aged 18-49 who did not intend to become pregnant in the four months following their uterine evacuation were used to examine women's choice of short-acting contraceptive methods (pill, condoms or injectable). Service delivery correlates of contraceptive choice were identified using sequential logistic regression models. RESULTS: Seventy-three percent of women chose a short-acting contraceptive method on the day of their uterine evacuation. The odds that a woman chose a short-acting method, rather than no method, were lower among those who had had a medication abortion (odds ratio, 0.1) or dilatation and curettage (0.3) than among those who had had a vacuum aspiration. The likelihood that a woman chose a specific type of short-acting method varied according to the type of uterine evacuation she had had, the facility level and the governmental or nongovernmental entity that managed the facility. CONCLUSIONS: Uterine evacuation service delivery characteristics may act as barriers to women's choosing a contraceptive method following an abortion. Training and monitoring providers may help ensure that all uterine evacuation clients have access to the full range of contraceptive information and services and that their choices, rather than service delivery factors, drive postabortion contraceptive use.
Impact of Family Planning and Business Trainings on Private-Sector Health Care Providers in Nigeria.
Ugaz J, Leegwater A, Chatterji M … +4 more , Johnson D, Baruwa S, Toriola M, Kinnan C
Int Perspect Sex Reprod Health · 2017 Jun · PMID 29261503 · Publisher ↗
CONTEXT: Private health care providers are an important source of modern contraceptives in Sub-Saharan Africa, yet they face many challenges that might be addressed through targeted training. METHODS: This study measures...
CONTEXT: Private health care providers are an important source of modern contraceptives in Sub-Saharan Africa, yet they face many challenges that might be addressed through targeted training. METHODS: This study measures the impact of a package of trainings and supportive supervision activities targeted to private health care providers in Lagos State, Nigeria, on outcomes including range of contraceptive methods offered, providers' knowledge and quality of counseling, recordkeeping practices, access to credit and revenue. A total of 965 health care facilities were randomly assigned to treatment and control groups. Facilities in the treatment group-but not those in the control group-were offered a training package that included a contraceptive technology update and interventions to improve counseling and clinical skills and business practices. Multivariate regression analysis of data collected through facility and mystery client surveys was used to estimate effects. RESULTS: The training program had a positive effect on the range of contraceptive methods offered, with facilities in the treatment group providing more methods than facilities in the control group. The training program also had a positive impact on the quality of counseling services, especially on the range of contraceptive methods discussed by providers, their interpersonal skills and overall knowledge. Facilities in the treatment group were more likely than facilities in the control group to have good recordkeeping practices and to have obtained loans. No effect was found on revenue generation. CONCLUSION: Targeted training programs can be effective tools to improve the provision of family planning services through private providers.
The Relationship Between Ambivalent and Indifferent Pregnancy Desires and Contraceptive Use Among Malawian Women.
Huber S, Esber A, Garver S … +2 more , Banda V, Norris A
Int Perspect Sex Reprod Health · 2017 Jul · PMID 28930624 · Publisher ↗
CONTEXT: Pregnancy ambivalence and pregnancy indifference are thought to be associated with nonuse of contraceptives, but their conceptualization and measurement vary, and their relationship to contraceptive use in devel...
CONTEXT: Pregnancy ambivalence and pregnancy indifference are thought to be associated with nonuse of contraceptives, but their conceptualization and measurement vary, and their relationship to contraceptive use in developing countries is poorly understood. METHODS: Data from the Umoyo wa Thanzi research program in rural Lilongwe, Malawi, were used to classify the pregnancy desires of 592 women aged 15-39 as antinatal, pronatal, ambivalent or indifferent, according to both the women's desire to conceive and their desire to avoid pregnancy. Logistic regression was used to assess the relationship between each of the four pregnancy desire categories and use of modern contraceptives. RESULTS: Overall, 12% of women were classified as ambivalent, 32% as indifferent, 44% as antinatal and 12% as pronatal. In the logistic regression analysis, the odds of contraceptive use among women with indifferent pregnancy desires (having both a desire not to avoid pregnancy and a desire not to conceive) were twice those of women with pronatal desires (odds ratio, 2.2) and were similar to those among women with antinatal desires (2.7). In contrast, the odds of contraceptive use among women with ambivalent pregnancy desires (having both a desire to avoid pregnancy and a desire to conceive) did not differ from those of women who had pronatal desires. CONCLUSIONS: Ambivalent and indifferent pregnancy desires are common in Malawi and are associated with modern contraceptive use in different ways. Understanding the complex nature of pregnancy desires may be valuable in improving family planning programs.
Multipartner Fertility in Nicaragua: Complex Family Formation in a Low-Income Setting.
Schmeer KK, Hays J
Int Perspect Sex Reprod Health · 2017 Mar · PMID 28930623 · Full text
CONTEXT: Multipartner fertility (having children with more than one partner) is an important topic in demographic research, but little is known about its incidence and correlates in low-income settings, where rates may b...
CONTEXT: Multipartner fertility (having children with more than one partner) is an important topic in demographic research, but little is known about its incidence and correlates in low-income settings, where rates may be high because of poverty, union instability and early childbearing. METHODS: Data from the 2011-2012 Encuesta Nicaragüense de Demografía y Salud were used to calculate the prevalence of multipartner fertility among 8,320 mothers and 2,141 fathers with two or more children. Logistic and multinomial regression were used to identify individual and family characteristics associated with multipartner fertility. RESULTS: Among those with multiple children, 33% of mothers and 41% of fathers had had children with more than one partner. The prevalence of multipartner fertility was elevated among less-educated women, nonreligious men, and women and men who had grown up in urban areas (odds ratios, 1.3-1.6). Multipartner fertility was associated with lower current household wealth among mothers, and with increased risk of single parenthood and higher fertility among mothers and fathers. Fathers who had had multiple fertility partners were six times as likely as fathers with one fertility partner to report not providing financial support to, or sharing their surname with, at least one of their biological children. CONCLUSION: Multipartner fertility is a critical demographic and social phenomenon that may contribute to and reflect important gender and family structure inequalities in Nicaragua. Mothers with multipartner fertility may be at especially high risk of raising children without the children's fathers and with low levels of economic support.
Awareness of and Knowledge About STIs Among Nonmedical Students in Iran.
Karamouzian M, Shahesmaeili A, Khajehkazemi R … +4 more , Hooshyar SH, Fallahi H, Haghdoost AA, Sharifi H
Int Perspect Sex Reprod Health · 2017 Jul · PMID 28930622 · Publisher ↗
CONTEXT: Evidence on STI knowledge among Iranian nonmedical university students is limited. Information is needed to inform research and policies to improve the sexual health of university students in Iran. METHODS: A co...
CONTEXT: Evidence on STI knowledge among Iranian nonmedical university students is limited. Information is needed to inform research and policies to improve the sexual health of university students in Iran. METHODS: A convenience sample of 742 male and female undergraduate and graduate students was recruited from five nonmedical public and private universities in Iran in 2014. Respondents' awareness of and knowledge about STIs were assessed using a validated questionnaire. Chi-square tests, student t tests and one-way analysis of variance were used to compare the percentage of respondents giving correct responses across subgroups of students. RESULTS: Half of the respondents had ever heard of STIs, but most could not correctly identify STIs in a list of diseases. A total of 49%, 42% and 9% of the respondents had low, moderate and high STI knowledge scores, respectively. Respondents reported online sources (62%) and friends (32%) as their main sources of information about STIs, and those who were older, ever-married or more educated were more knowledgeable than other respondents. CONCLUSIONS: Given that the Internet was students' main source of information, increasing the accessibility and visibility of credible Internet sites about sexual health is warranted. Also, key individuals in students' networks (e.g., parents, teachers, peers) should be equipped with required training and knowledge on STI-related topics and be actively involved in sexual health education efforts.
The Incidence of Menstrual Regulation Procedures and Abortion in Bangladesh, 2014.
Singh S, Hossain A, Maddow-Zimet I … +3 more , Vlassoff M, Bhuiyan HU, Ingerick M
Int Perspect Sex Reprod Health · 2017 Mar · PMID 28930621 · Publisher ↗
CONTEXT: Menstrual regulation (MR) has been part of the Bangladesh family planning program since 1979. However, clandestine abortion remains a serious health problem in Bangladesh, and anecdotal reports indicate that cla...
CONTEXT: Menstrual regulation (MR) has been part of the Bangladesh family planning program since 1979. However, clandestine abortion remains a serious health problem in Bangladesh, and anecdotal reports indicate that clandestine use of misoprostol has increased since the most recent estimates (for 2010). Because of this, it is important to assess changes in the use of MR services and the incidence of clandestine abortion since 2010. METHODS: A survey of a nationally representative sample of 829 health facilities that provide MR or postabortion care services and a survey of 322 professionals knowledgeable about these services were conducted in 2014. Direct and indirect methods were applied to calculate the incidence of MR and induced abortion. RESULTS: In 2014, an estimated 1,194,000 induced abortions were performed in Bangladesh (29 per 1,000 women aged 15-49), and 257,000 women were treated for complications of such abortions (a rate of 6 per 1,000 women aged 15-49). Among women with complications, the proportion presenting with hemorrhage increased significantly, from 27% to 48%. An estimated 430,000 MR procedures (using MVA or medication) were performed in health facilities nationwide, a decline of about 40% in the MR rate-from 17 to 10 per 1,000 women aged 15-49-from 2010 to 2014. CONCLUSIONS: Given declines in MR provision, more attention needs to be paid to building capacity, including hiring and training more providers of MR. Harm-reduction approaches should be pursued to increase the safety of clandestine use of misoprostol in Bangladesh.
Establishing a Referral System for Safe and Legal Abortion Care: A Pilot Project on the Thailand-Burma Border.
Foster AM, Arnott G, Hobstetter M … +4 more , Zaw H, Maung C, Sietstra C, Walsh M
Int Perspect Sex Reprod Health · 2016 Sep · PMID 28825906 · Publisher ↗
Abstract loading — click title to view on PubMed.
The Experience and Impact of Contraceptive Stockouts Among Women, Providers and Policymakers in Two Districts of Uganda.
Grindlay K, Turyakira E, Kyamwanga IT … +2 more , Nickerson A, Blanchard K
Int Perspect Sex Reprod Health · 2016 Sep · PMID 28825905 · Publisher ↗
CONTEXT: Little is known about the impact of contraceptive stockouts on women and health care providers, or how policymakers perceive and handle such stockouts. METHODS: In May-July 2015, a qualitative study on experienc...
CONTEXT: Little is known about the impact of contraceptive stockouts on women and health care providers, or how policymakers perceive and handle such stockouts. METHODS: In May-July 2015, a qualitative study on experiences of contraceptive stockouts was conducted in two districts of Uganda. It comprised three data collection components: eight focus groups with 50 women, 24 individual in-depth interviews with family planning service providers and facility managers, and 11 in-depth interviews with district-level policymakers and decision makers. Data analysis followed the content analysis approach. RESULTS: Contraceptive stockouts were common, particularly for long-term methods and oral contraceptives. For women, the consequences included stress, increased costs, domestic conflict, and unwanted or unplanned pregnancies. Providers reported emotional distress, blame from clients, deterioration of skills and lower demand for their services as a result of stockouts; they also felt unable to address stockouts under current supply systems. Despite the widespread prevalence and adverse impact of stockouts, policymakers reported being unaware of the scope of the problem. CONCLUSIONS: The findings suggest there is a critical need to raise awareness of the issue, reduce stockouts and mitigate their negative consequences. Efforts to eliminate stockouts should include addressing supply chain issues. Raising community awareness and engaging with men on family planning may be ways to deal with the consequences of stockouts.
Examining Progress and Equity in Information Received by Women Using a Modern Method in 25 Developing Countries.
Jain AK
Int Perspect Sex Reprod Health · 2016 Sep · PMID 28825904 · Publisher ↗
CONTEXT: The information exchanged during a contraceptive visit is important because providers need to understand clients' reproductive intentions and clients need to receive adequate information about methods and possib...
CONTEXT: The information exchanged during a contraceptive visit is important because providers need to understand clients' reproductive intentions and clients need to receive adequate information about methods and possible method-related side effects and problems. Little is known about how information exchange has changed over time and how it might vary across countries or subgroups within a country. METHODS: Demographic and Health Survey data from 25 developing countries were used to calculate the Method Information Index (MII), a Family Planning 2020 indicator that reflects some aspects of contraceptive information exchanged between providers and clients. For each country, the MII was calculated from each of two surveys about five years apart to examine change in the indicator over time. In addition, the MII was examined for all countries combined and by region. RESULTS: The average MII for all 25 countries increased from 34% at the earlier survey time to 39% at the later survey time; the index values of individual countries ranged from 19% to 64% at survey time 1 and from 13% to 65% at survey time 2. The MII increased over time in 15 countries and declined in 10. In analyses by contraceptive method type, the MII tended to be highest among implant users and lowest among women relying on sterilization. The index was generally higher among women living in urban areas than among those in rural areas, and tended to rise with increases in women's education and household wealth. CONCLUSIONS: On the basis of the MII, developing countries have room to improve information exchange between providers and clients. Such improvements would require concerted efforts by programs and donors.
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