International Perspectives On Sexual And Reproductive Health[JOURNAL]
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200 papers
Changes in Morbidity and Abortion Care in Ethiopia After Legal Reform: National Results from 2008 and 2014.
Gebrehiwot Y, Fetters T, Gebreselassie H … +5 more , Moore A, Hailemariam M, Dibaba Y, Bankole A, Getachew Y
Int Perspect Sex Reprod Health · 2016 Sep · PMID 28825903 · Full text
CONTEXT: In Ethiopia, liberalization of the abortion law in 2005 led to changes in abortion services. It is important to examine how levels and types of abortion care-i.e., legal abortion and treatment of abortion compli...
CONTEXT: In Ethiopia, liberalization of the abortion law in 2005 led to changes in abortion services. It is important to examine how levels and types of abortion care-i.e., legal abortion and treatment of abortion complications-changed over time. METHODS: Between December 2013 and May 2014, data were collected on symptoms, procedures and treatment from 5,604 women who sought abortion care at a sample of 439 public and private health facilities; the sample did not include lower-level private facilities-some of which provide abortion care-to maintain comparability with the sample from a 2008 study. These data were combined with monitoring data from 105,806 women treated in 74 nongovernmental organization facilities in 2013. Descriptive analyses were conducted and annual estimates were calculated to compare the numbers and types of abortion care services provided in 2008 and 2014. RESULTS: The estimated annual number of women seeking a legal abortion in the types of facilities sampled increased from 158,000 in 2008 to 220,000 in 2014, and the estimated number presenting for postabortion care increased from 58,000 to 125,000. The proportion of abortion care provided in the public sector increased from 36% to 56% nationally. The proportion of women presenting for postabortion care who had severe complications rose from 7% to 11%, the share of all abortion procedures accounted for by medical abortion increased from 0% to 36%, and the proportion of abortion care provided by midlevel health workers increased from 48% to 83%. Most women received postabortion contraception. CONCLUSIONS: Ethiopia has made substantial progress in expanding comprehensive abortion care; however, eradication of morbidity from unsafe abortion has not yet been achieved.
The Estimated Incidence of Induced Abortion in Ethiopia, 2014: Changes in the Provision of Services Since 2008.
Moore AM, Gebrehiwot Y, Fetters T … +5 more , Wado YD, Bankole A, Singh S, Gebreselassie H, Getachew Y
Int Perspect Sex Reprod Health · 2016 Sep · PMID 28825902 · Full text
CONTEXT: In 2005, Ethiopia's parliament amended the penal code to expand the circumstances in which abortion is legal. Although the country has expanded access to abortion and postabortion care, the last estimates of abo...
CONTEXT: In 2005, Ethiopia's parliament amended the penal code to expand the circumstances in which abortion is legal. Although the country has expanded access to abortion and postabortion care, the last estimates of abortion incidence date from 2008. METHODS: Data were collected in 2014 from a nationally representative sample of 822 facilities that provide abortion or postabortion care, and from 82 key informants knowledgeable about abortion services in Ethiopia. The Abortion Incidence Complications Methodology and the Prospective Morbidity Methodology were used to estimate the incidence of abortion in Ethiopia and assess trends since 2008. RESULTS: An estimated 620,300 induced abortions were performed in Ethiopia in 2014. The annual abortion rate was 28 per 1,000 women aged 15-49, an increase from 22 per 1,000 in 2008, and was highest in urban regions (Addis Ababa, Dire Dawa and Harari). Between 2008 and 2014, the proportion of abortions occurring in facilities rose from 27% to 53%, and the number of such abortions increased substantially; nonetheless, an estimated 294,100 abortions occurred outside of health facilities in 2014. The number of women receiving treatment for complications from induced abortion nearly doubled between 2008 and 2014, from 52,600 to 103,600. Thirty-eight percent of pregnancies were unintended in 2014, a slight decline from 42% in 2008. CONCLUSIONS: Although the increases in the number of women obtaining legal abortions and postabortion care are consistent with improvements in women's access to health care, a substantial number of abortions continue to occur outside of health facilities, a reality that must be addressed.
Improper Use of Conscientious Objection to Abortion.
Int Perspect Sex Reprod Health · 2016 Dec · PMID 28825901 · Publisher ↗
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Male Involvement and Accommodation During Obstetric Emergencies in Rural Ghana: A Qualitative Analysis.
Story WT, Barrington C, Fordham C … +3 more , Sodzi-Tettey S, Barker PM, Singh K
Int Perspect Sex Reprod Health · 2016 Dec · PMID 28825900 · Full text
CONTEXT: Although men potentially play an important role in emergency obstetric care in Sub-Saharan Africa, few studies have examined the ways in which men are involved in such emergencies, the consequences of their invo...
CONTEXT: Although men potentially play an important role in emergency obstetric care in Sub-Saharan Africa, few studies have examined the ways in which men are involved in such emergencies, the consequences of their involvement or the degree to which health facilities accommodate men. METHODS: Qualitative interviews were conducted with 39 mothers and fathers in two districts in Northern and Central Ghana who had experienced obstetric emergencies, such as severe birth complications, to obtain narratives about those experiences. In addition, interviews with six health facility workers and eight focus group discussions with community members were conducted. Transcripts were analyzed using an inductive analytic approach. RESULTS: Although some men had not been involved at all during their partner's obstetric emergency, two-thirds had provided some combination of financial, emotional and instrumental support. On the other hand, several men had acted as gatekeepers, and their control of resources and decisions had resulted in care-seeking delays. Although many respondents reported that health facilities accommodated male partners (e.g., by providing an appropriate space for men during delivery), others found that facilities were not accommodating, in some cases ignoring or disrespecting men. A few respondents had encountered improper staff expectations, notably that men would accompany their partner to the facility, a requirement that limits women's autonomy and delays care. CONCLUSIONS: Policies and programs should promote supportive behavior by men during obstetric emergencies while empowering women. Health facility policies regarding accommodation of men during obstetric emergencies need to consider women's and men's preferences. Research should examine whether particular forms of support improve maternal and newborn health outcomes.
Abortion Incidence and Unintended Pregnancy in Nepal.
Puri M, Singh S, Sundaram A … +3 more , Hussain R, Tamang A, Crowell M
Int Perspect Sex Reprod Health · 2016 Dec · PMID 28825899 · Full text
CONTEXT: Although abortion has been legal under broad criteria in Nepal since 2002, a significant proportion of women continue to obtain illegal, unsafe abortions, and no national estimates exist of the incidence of safe...
CONTEXT: Although abortion has been legal under broad criteria in Nepal since 2002, a significant proportion of women continue to obtain illegal, unsafe abortions, and no national estimates exist of the incidence of safe and unsafe abortions. METHODS: Data were collected in 2014 from a nationally representative sample of 386 facilities that provide legal abortions or postabortion care and a survey of 134 health professionals knowledgeable about abortion service provision. Facility caseloads and indirect estimation techniques were used to calculate the national and regional incidence of legal and illegal abortion. National and regional levels of abortion complications and unintended pregnancy were also estimated. RESULTS: In 2014, women in Nepal had 323,100 abortions, of which 137,000 were legal, and 63,200 women were treated for abortion complications. The abortion rate was 42 per 1,000 women aged 15-49, and the abortion ratio was 56 per 100 live births. The abortion rate in the Central region (59 per 1,000) was substantially higher than the national average. Overall, 50% of pregnancies were unintended, and the unintended pregnancy rate was 68 per 1,000 women of reproductive age. CONCLUSIONS: Despite legalization of abortion and expansion of services in Nepal, unsafe abortion is still common and exacts a heavy toll on women. Programs and policies to reduce rates of unintended pregnancy and unsafe abortion, increase access to high-quality contraceptive care and expand safe abortion services are warranted.
Premarital Births and Union Formation in Rural South Africa.
Sennott C, Reniers G, Gómez-Olivé FX … +1 more , Menken J
Int Perspect Sex Reprod Health · 2016 Dec · PMID 28825898 · Full text
CONTEXT: In rural South Africa, women often delay union formation until they are in their late 20s, though premarital first births are common. METHODS: Longitudinal data from the Agincourt Health and Socio-Demographic Su...
CONTEXT: In rural South Africa, women often delay union formation until they are in their late 20s, though premarital first births are common. METHODS: Longitudinal data from the Agincourt Health and Socio-Demographic Surveillance System in rural South Africa were used to examine the relationship between premarital birth and union entry among 55,158 nonmigrant women aged 10-35 who took part in at least one annual census from 1993 to 2012. Discrete-time event history models were used to determine whether the likelihood of union formation differed between women who had had a premarital first birth and those who had not. Associations between single motherhood and union type (marriages or nonmarital partnerships) were identified using logistic regression. RESULTS: Forty-five percent of women had had a premarital first birth and 25% had entered a first union. Women who had had a premarital first birth were less likely than other women to have entered a first union (odds ratio, 0.6). Women who had had a premarital birth in the past year were more likely than those without a premarital birth to have entered a union (1.5), but women had reduced odds of union formation if they had had a birth 1-2 years earlier (0.9) or at least five years earlier (0.8). Unions formed within two years of a premarital birth had an elevated likelihood of being nonmarital partnerships (1.2-1.4). CONCLUSIONS: Single motherhood is common in the Agincourt HDSS, and women with a premarital first birth face challenges in establishing committed unions with partners.
HIV Care Providers' Communication with Patients About Safer Conception for People Living with HIV in Tanzania.
Saleem HT, Surkan PJ, Kerrigan D … +1 more , Kennedy CE
Int Perspect Sex Reprod Health · 2016 Dec · PMID 28825897 · Publisher ↗
CONTEXT: People living with HIV may desire children, but often lack information about safer conception and pregnancy and face barriers to obtaining high-quality reproductive health services. To inform clinical guidance t...
CONTEXT: People living with HIV may desire children, but often lack information about safer conception and pregnancy and face barriers to obtaining high-quality reproductive health services. To inform clinical guidance that supports HIV-affected couples wanting to conceive, it is important to better understand communication between patients and providers about childbearing and safer-conception guidelines for people living with HIV. METHODS: In-depth interviews were conducted with 30 providers of HIV-related services in seven health facilities in Iringa, Tanzania, and with 60 HIV-positive women and men attending study facilities. The study followed an iterative research process and used thematic content analysis. RESULTS: Providers reported that they had received limited training on childbearing and safer conception for HIV-positive people, and that clinical guidance in Tanzania on the subject is poor. Although many providers mentioned that people living with HIV have the right to bear children, some HIV-positive patients reported having been discouraged by providers from having more children. Only a few HIV-positive patients reported having learned about safer-conception strategies for HIV-affected couples through discussions with health providers. CONCLUSIONS: Guidance on safer-conception and safe-pregnancy counseling for women and men living with HIV in Tanzania needs to be updated. It is critical that providers be trained in safe pregnancy and safer conception for HIV-affected couples, and that HIV and sexual and reproductive health services be integrated, so that HIV-positive patients and their partners are able to plan their pregnancies and to receive the care they need to manage their health and their pregnancies.
Counseling during Maternal and Infant Health Visits and Postpartum Contraceptive use in Uttar Pradesh, India.
Rajan S, Speizer IS, Calhoun LM … +1 more , Nanda P
Int Perspect Sex Reprod Health · 2016 Dec · PMID 28649295 · Full text
CONTEXT: Postpartum family planning is a compelling concern of global significance due to its salience to unplanned pregnancies, and to maternal and infant health in developing countries. Yet, women face the highest leve...
CONTEXT: Postpartum family planning is a compelling concern of global significance due to its salience to unplanned pregnancies, and to maternal and infant health in developing countries. Yet, women face the highest level of unmet need for contraception in the year following a birth. A cost-effective way to inform women about their risk of becoming pregnant after the birth of a child is to integrate family planning counseling and services with maternal and infant health services. METHODS: We use recently collected survey data from 2733 women from six cities in Uttar Pradesh, India who had a recent birth (since 2011) to examine the role of exposure to family planning information at maternal and infant health visits on (1) any contraceptive use in the postpartum period, and (2) choice of modern method in the postpartum period. We use discrete-time event history multinomial logit models to examine the duration to contraceptive use, and choice of modern method, in the 12 months following the last birth since 2011. RESULTS: We find that receiving counseling in an institution at the time of delivery has the strongest influence on women's subsequent uptake of modern contraception (female sterilization and IUD). Being visited by a CHW in the extended postpartum period was also strongly associated with subsequent uptake of modern contraception (IUD, condom and hormonal contraception). CONCLUSION: Providing postpartum family planning counseling at key junctures during maternal health visits has the potential to increase uptake of modern contraceptive method in urban Uttar Pradesh.
Approaches to Postpartum Family Planning.
Pfitzer A, Kenon C, Blanchard H
Int Perspect Sex Reprod Health · 2015 Dec · PMID 27295722
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Consistent Laws and Child Marriage.
Svanemyr J, Chandra-Mouli V
Int Perspect Sex Reprod Health · 2015 Dec · PMID 27295721 · Publisher ↗
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Levels, Trends and Correlates of Abortion in Tehran, Iran: 2009-2014.
Erfani A
Int Perspect Sex Reprod Health · 2016 Jun · PMID 28825910 · Publisher ↗
CONTEXT: Accurate, up-to-date information on abortion incidence is lacking for Iran, where abortion is illegal. METHODS: Data from 2,934 currently married women aged 15-49 who completed the 2009 Tehran Survey of Fertilit...
CONTEXT: Accurate, up-to-date information on abortion incidence is lacking for Iran, where abortion is illegal. METHODS: Data from 2,934 currently married women aged 15-49 who completed the 2009 Tehran Survey of Fertility (TSF) and 3,012 such women who completed the 2014 TSF were used to estimate levels of and trends in abortion and related measures. Analyses also examined characteristics of abortions, abortion recipients and providers, as well as trends in women's reasons for having an abortion. RESULTS: Between 2009 and 2014, the proportion of married women who reported having ever had an abortion decreased from 8.3% to 5.6%. Declines also occurred in the general abortion rate (from 6.6 to 5.4 abortions per 1,000 women), the total abortion rate (from 0.18 to 0.17 abortions per married woman) and the annual number of abortions (from 10,656 to 8,734); however, the proportion of pregnancies that were terminated was stable (8.7-8.8%). The proportion of terminations obtained for nonmedical reasons rose from 68% to 81%. In 2014, abortion rates were elevated among women who were more educated, wealthier, employed, urban migrants or not highly religious, and among those who had no more than one child. The most commonly used providers were midwives (40%) and obstetricians (32%). Half of abortions resulted from withdrawal failure, but only one-fourth of withdrawal users switched to a modern contraceptive method after an abortion. CONCLUSIONS: Some subgroups of women had an elevated risk of abortion and may benefit from measures that increase couples' effective use of contraceptives.
Mother, Daughter, Doctor: Medical Professionals and Mothers' Decision Making About Female Genital Cutting in Egypt.
Modrek S, Sieverding M
Int Perspect Sex Reprod Health · 2016 Jun · PMID 28825909 · Publisher ↗
CONTEXT: Although female genital cutting (FGC) is illegal in Egypt and rates are declining, medicalization of the practice has increased. However, little is known about why some mothers prefer that FGC be performed by me...
CONTEXT: Although female genital cutting (FGC) is illegal in Egypt and rates are declining, medicalization of the practice has increased. However, little is known about why some mothers prefer that FGC be performed by medical professionals or the degree to which such professionals may influence decisions about the practice. METHODS: Data collected in 2014 from a survey of 410 women with young daughters, and from in-depth interviews with 29 of those women, were used to examine the role of consultations with medical professionals in mothers' decisions about FGC. Women were asked about their experiences, perceptions, knowledge and intentions regarding FGC and their interactions with medical personnel. An open coding approach was used to analyze qualitative data, while multivariate regression was used to identify correlates of intending to consult a doctor and knowing that FGC is illegal. RESULTS: Medical professionals were the main providers of FGC to study participants. Mothers wanted FGC performed by doctors to mitigate the perceived risks of the procedure. About one-third of mothers planned to consult a doctor in deciding whether to have their daughters cut. Women reported that doctors performed physical examinations and subsequently recommended that daughters either be cut, not be cut or be re-examined in the future. Most respondents expressed high levels of trust in doctors. CONCLUSION: Since mothers appear to value their opinions, doctors could contribute to the abandonment of FGC if they consistently recommend against the practice. The ban on FGC is unlikely to be effective in the absence of broader social change.
"The Fetus Is My Patient, Too": Attitudes Toward Abortion and Referral Among Physician Conscientious Objectors in Bogotá, Colombia.
Fink LR, Stanhope KK, Rochat RW … +1 more , Bernal OA
Int Perspect Sex Reprod Health · 2016 Jun · PMID 28825908 · Publisher ↗
CONTEXT: In 2006, the Colombian Constitutional Court partially decriminalized abortion. However, barriers to access, including improper use of conscientious objection, remain. METHODS: To explore conscientious objection...
CONTEXT: In 2006, the Colombian Constitutional Court partially decriminalized abortion. However, barriers to access, including improper use of conscientious objection, remain. METHODS: To explore conscientious objection from the objectors' perspectives, in-depth interviews were conducted in 2014 with 13 key informants and with 15 Colombian physicians who self-identified as conscientious objectors. Recruitment included snowball and purposive sampling techniques. Analysis was conducted in tandem with data collection and focused on objectors' attitudes, beliefs and behaviors related to abortion and referral. RESULTS: Objectors had varied perspectives. Three types of objectors were evident: extreme, moderate and partial. Extreme objectors refused to perform abortions or make referrals, and often lectured their patients; they also provided misleading or false medical and legal information, preventing women from accessing abortions to which they were legally entitled. Moderate objectors would not perform abortions, but respected their patients and viewed referral as a way to save "one out of two" lives. Partial objectors performed some abortions but refused to do others on the basis of gestational age or case-by-case circumstances. Across the typology, objectors linked conscientious objection with medical ethics, and many described a duty to protect the fetus, which they conceptualized as a patient. CONCLUSION: Conscientious objectors exhibit diverse opinions and behaviors. Potential areas for future investigation include identifying factors that lead objectors to refer and estimating the prevalence of each type of objector. Results suggest potential interventions that could reduce the role of conscientious objection as a barrier to care.
Postpartum Family Planning During Sociopolitical Transition: Findings from an Integrated Community-Based Program in Egypt.
Cooper CM, Charurat E, El-Adawi I … +4 more , Kim YM, Emerson MR, Zaki W, Schuster A
Int Perspect Sex Reprod Health · 2016 Jun · PMID 28825907 · Publisher ↗
CONTEXT: Limited information exists on postpartum family planning and implementation of integrated reproductive and maternal and child health programs in countries experiencing sociopolitical transition. METHODS: A quasi...
CONTEXT: Limited information exists on postpartum family planning and implementation of integrated reproductive and maternal and child health programs in countries experiencing sociopolitical transition. METHODS: A quasi-experimental evaluation of an integrated reproductive and maternal and child health program implemented in selected sites in Upper and Lower Egypt was conducted between 2012 and 2014. Preintervention and postintervention household surveys were conducted among 12,454 women in intervention sites and nonintervention comparison sites who at survey had a child younger than 24 months. Bivariate and multivariate analyses estimated the intervention's effects on postpartum family planning-related outcomes, including contraceptive use, knowledge of optimal birthspacing, reproductive intentions and decision making about contraceptive use. RESULTS: In Upper Egypt, modern contraceptive use decreased over the study period in both intervention and comparison sites (by six and 15 percentage points, respectively), and in Lower Egypt, contraceptive use remained unchanged in intervention sites and decreased slightly (by three points) in comparison sites; in both regions, the intervention was positively associated with the difference in differences between groups (odds ratios, 1.5 for Upper Egypt and 1.3 for Lower Egypt). The intervention appears to have had a positive effect on knowledge of optimal birthspacing in Upper Egypt, on wanting to delay the next pregnancy in Lower Egypt, and on pregnancy risk and joint decision making in both regions. DISCUSSION: Study findings demonstrate the feasibility and effectiveness of an integrated reproductive and maternal and child health program implemented in a changing sociopolitical context. Revitalized efforts to bolster family planning within the country are needed to avert further losses and spark a return to positive trends.
Understanding Early Marriage and Transactional Sex In the Context of Armed Conflict: Protection at a Price.
Hutchinson A, Waterhouse P, March-McDonald J … +2 more , Neal S, Ingham R
Int Perspect Sex Reprod Health · 2016 Mar · PMID 28825914 · Publisher ↗
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Global Trends in Family Planning Programs, 1999-2014.
Kuang B, Brodsky I
Int Perspect Sex Reprod Health · 2016 Mar · PMID 28825913 · Publisher ↗
CONTEXT: Since 1972, the Family Planning Effort Index has measured national family planning program activities in developing countries and provided a longitudinal perspective on a standardized set of program characterist...
CONTEXT: Since 1972, the Family Planning Effort Index has measured national family planning program activities in developing countries and provided a longitudinal perspective on a standardized set of program characteristics. METHODS: In 2014, experts in 90 developing countries assessed national family planning program effort in four main component areas-policies, services, monitoring and evaluation mechanisms, and access to methods-using a standardized questionnaire. Results were compared with previous years' data. RESULTS: Globally, family planning program effort has progressed in all four main component areas. The service component, historically the weakest, was rated lowest of all components in 2014, at 47% of the maximum effort, despite a marked improvement of 7.6 percentage points since 1999. Policies, generally the strongest component, remained the strongest in 2014, with 55% of the maximum score and a 6.7 percentage-point improvement since 1999. Monitoring and evaluation improved the most, by 7.8 percentage points, from 45% to 53%, while access improved more modestly, by 2.7 points, from 49% to 52%. Family planning efforts were generally strongest in Asia and Oceania and generally weakest in Central Asia and Eastern Europe. CONCLUSIONS: Global family planning programs have improved consistently over the last few decades, although there is room for further development in all regions.
Understanding Female Condom Use and Negotiation Among Young Women in Cape Town, South Africa.
Martin J, de Lora P, Rochat R … +1 more , Andes KL
Int Perspect Sex Reprod Health · 2016 Mar · PMID 28825912 · Publisher ↗
CONTEXT: In most countries, female condoms are not widely available and uptake has been slow. More information is needed on how women and men successfully negotiate female condom use. METHODS: In-depth interviews were co...
CONTEXT: In most countries, female condoms are not widely available and uptake has been slow. More information is needed on how women and men successfully negotiate female condom use. METHODS: In-depth interviews were conducted at two sites in Cape Town, South Africa, with 14 women and 13 men who had used female condoms. A structured interview guide was used to elicit information on how women negotiate female condom use, and how male partners negotiate or respond to negotiations of female condom use. Thematic analysis was used to identify key patterns in the data. RESULTS: Participants reported that female condoms are easier for women to negotiate than male condoms, largely because the method is understood to be under a woman's control. The main barrier to use was lack of familiarity with the method; strong negative reactions from partners were not a major barrier. Personal comfort and tensions with partners usually improved after first use. Some male respondents preferred the method because it shifts responsibility for condom use from men to women. CONCLUSIONS: Findings suggest that female condoms empower women to initiate barrier method use, and that programs designed to educate potential users about female condoms and familiarize them with the method may be useful. That some men preferred female condoms because they wanted women to take responsibility for condom use is cause for concern, and suggests that counseling efforts should be directed toward men as well as women, and should include a discussion of gender dynamics and responsibility that emphasizes condom use as a choice that couples make together.
The Relationship Context of Adolescent Fertility in Southeastern Ghana.
Bingenheimer JB, Stoebenau K
Int Perspect Sex Reprod Health · 2016 Mar · PMID 28825911 · Publisher ↗
CONTEXT: Little is known about relationship types and processes linked to adolescent pregnancy and childbearing in Sub-Saharan Africa. A greater understanding of the role of relationships could help in the design of inte...
CONTEXT: Little is known about relationship types and processes linked to adolescent pregnancy and childbearing in Sub-Saharan Africa. A greater understanding of the role of relationships could help in the design of interventions to reduce adolescent fertility. METHODS: Data on 365 romantic and sexual relationships were collected from 298 adolescent female participants of a survey conducted in two towns in southeastern Ghana. Bivariate and multivariate analyses examined associations between adolescent fertility (i.e., pregnancy and childbearing) within a relationship and selected independent variables, such as the age difference between a woman and her partner, the partner's provision of basic and auxiliary financial support, the power disparity within the relationship, and cohabitation or marriage. RESULTS: Adolescent fertility occurred in 17% of relationships. Across model specifications, the strongest predictors of adolescent fertility were the partner's provision of basic financial support, and cohabitation or marriage. Increasing power disparity was associated with greater odds of adolescent fertility in some models. Being in a relationship with a partner five or more years older was associated with adolescent fertility in bivariate, but not multivariate, analyses. CONCLUSION: Adolescent pregnancy and childbearing in southeastern Ghana may be best understood as an aspect of relationship solidification and family formation along a gendered pathway to adulthood. Interventions that help young women avoid relying on sexual relationships as a source of financial support could be helpful in reducing adolescent fertility.
Place, Time and Experience: Barriers to Universalization Of Institutional Child Delivery in Rural Mozambique.
Agadjanian V, Yao J, Hayford SR
Int Perspect Sex Reprod Health · 2016 Mar · PMID 28770025 · Full text
CONTEXT: Although institutional coverage of childbirth is increasing in the developing world, a substantial minority of births in rural Mozambique still occur outside of health facilities. Identifying the remaining barri...
CONTEXT: Although institutional coverage of childbirth is increasing in the developing world, a substantial minority of births in rural Mozambique still occur outside of health facilities. Identifying the remaining barriers to safe professional delivery services can aid in achieving universal coverage. METHODS: Survey data collected in 2009 from 1,373 women in Gaza, Mozambique, were used in combination with spatial, meteorological and health facility data to examine patterns in place of delivery. Geographic information system-based visualization and mapping and exploratory spatial data analysis were used to outline the spatial distribution of home deliveries. Multilevel logistic regression models were constructed to identify associations between individual, spatial and other characteristics and whether women's most recent delivery took place at home. RESULTS: Spatial analysis revealed high- and low-prevalence clusters of home births. In multivariate analyses, women with a higher number of clinics within 10 kilometers of their home had a reduced likelihood of home delivery, but those living closer to urban centers had an increased likelihood. Giving birth during the rainy, high agricultural season was positively associated with home delivery, while household wealth was negatively associated with home birth. No associations were evident for measures of exposure to and experience with health institutions. CONCLUSIONS: The results suggest the need for a comprehensive approach to expansion of professional delivery services. Such an approach should complement measures facilitating physical access to health institutions for residents of harder-to-reach areas with community-based interventions aimed at improving rural women's living conditions and opportunities, while also taking into account seasonal and other variables.
How Reliable Are Reports of Early Adolescent Reproductive and Sexual Health Events in Demographic and Health Surveys?
Neal SE, Hosegood V
Int Perspect Sex Reprod Health · 2015 Dec · PMID 26871729 · Publisher ↗
CONTEXT: Age at sexual debut, age at first marriage or first union and age at first birth are among the most widely used indicators of health and well-being for female adolescents. However, the accuracy of estimates for...
CONTEXT: Age at sexual debut, age at first marriage or first union and age at first birth are among the most widely used indicators of health and well-being for female adolescents. However, the accuracy of estimates for these indicators, particularly for younger adolescents, is poorly understood. METHODS: For each of nine countries in Africa and Latin America, Demographic and Health Survey (DHS) data from two surveys conducted five years apart were used to examine women's reports of age at sexual debut, marriage or first union, and first birth. The consistency of estimates between surveys and across birth cohorts is described, focusing particularly on the reporting of events occurring before age 15 and age 16. RESULTS: Marked differences in estimates for very early first births and marriage were found. Women aged 15-19 were much less likely to report marriages and first births before age 15 than were women from the same birth cohort when asked five years later at ages 20-24. Early sexual debut was reported more consistently in consecutive surveys than early marriages or births. CONCLUSIONS: Caution should be exercised when inferring changes in early adolescent sexual and reproductive health on the basis of estimates from the DHS. Greater effort should be made to develop data collection instruments that reduce misreporting of self-reported data from women sampled in household surveys.
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