International Perspectives On Sexual And Reproductive Health[JOURNAL]
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200 papers
Gender-based power and couples' HIV risk in Uttar Pradesh and Uttarakhand, north India.
Agrawal A, Bloom SS, Suchindran C … +2 more , Curtis S, Angeles G
Int Perspect Sex Reprod Health · 2014 Dec · PMID 25565347 · Full text
CONTEXT: Gender inequality is a long-recognized driver of the HIV epidemic. However, few studies have investigated the association between gender-based power and HIV risk in India, which has the world's third largest HIV...
CONTEXT: Gender inequality is a long-recognized driver of the HIV epidemic. However, few studies have investigated the association between gender-based power and HIV risk in India, which has the world's third largest HIV epidemic. METHODS: Population-based data collected in 2003 from 3,385 couples residing in Uttar Pradesh and Uttarakhand, North India, were used to examine associations between gender-based power (wife's autonomy and husband's inequitable gender attitudes) and indicators of couples' HIV risk (whether the husband had had premarital sex with someone other than his eventual spouse, extramarital sex in the past year or STI symptoms in the past year). Structural equation modeling was used to create composite variables for the gender-based power measures and test their associations with HIV risk measures. RESULTS: Twenty-four percent of husbands had had premarital sex, 7% had had extramarital sex in the past year and 6% had had STI symptoms in the past year. Structural equation models indicated that wives who reported higher levels of autonomy were less likely than other wives to have husbands who had had extramarital sex in the past year (direct association) or STI symptoms in the past year (indirect association). Moreover, husbands who endorsed more inequitable gender attitudes were more likely than others to report having had premarital sex with someone other than their spouse, which in turn was associated with having had extramarital sex and STI symptoms in the past year. CONCLUSIONS: If the associations identified in this study reflect a causal relationship between gender-based power and HIV risk behavior, then HIV prevention programs that successfully address inequitable gender roles may reduce HIV risks in North India.
Risk for coerced sex among female youth in Ghana: roles of family context, school enrollment and relationship experience.
Bingenheimer JB, Reed E
Int Perspect Sex Reprod Health · 2014 Dec · PMID 25565346 · Full text
CONTEXT: A better understanding is needed of the variables that may influence the risk of experiencing coerced sex among adolescent females in Sub-Saharan Africa. METHODS: Data were collected from 700 female respondents...
CONTEXT: A better understanding is needed of the variables that may influence the risk of experiencing coerced sex among adolescent females in Sub-Saharan Africa. METHODS: Data were collected from 700 female respondents who were interviewed in 2010 and 2012 waves of a longitudinal study of behavioral risk for HIV infection among youth aged 13-14 or 18-19 and living in two towns in southeastern Ghana. A series of logistic regression models examined the influences of household composition and wealth, four family process variables (behavioral control, relationship quality, financial support, conflict), school enrollment and relationship experience on females' risk of experiencing coerced sex. RESULTS: Eighteen percent of respondents reported having experienced coerced sex prior to Wave 1, and 13% experienced it between Waves 1 and 2. In both cross-sectional and prospective models, the variable with the strongest association with having experienced coerced sex was having ever had a boyfriend (fully adjusted odds ratios, 4.5 and 2.6, respectively). In cross-sectional analyses, parental behavioral control was negatively associated with risk for coerced sex, while parental conflict was positively associated; these associations were not significant in the prospective analyses. Having a boyfriend appears to be the primary predictor of coerced sex among young females, beyond any influence of family, school or other household variables. CONCLUSIONS: More research is needed to understand the context of females' relationships with boyfriends in an effort to reduce the risk of sexual coercion and to promote the prevention of sexual violence perpetrated by males within these relationships.
Young women's access to and use of contraceptives: the role of providers' restrictions in urban Senegal.
Sidze EM, Lardoux S, Speizer IS … +3 more , Faye CM, Mutua MM, Badji F
Int Perspect Sex Reprod Health · 2014 Dec · PMID 25565345 · Full text
CONTEXT: Contraceptive prevalence is very low in Senegal, particularly among young women. Greater knowledge is needed about the barriers young women face to using contraceptives, including barriers imposed by health prov...
CONTEXT: Contraceptive prevalence is very low in Senegal, particularly among young women. Greater knowledge is needed about the barriers young women face to using contraceptives, including barriers imposed by health providers. METHODS: Survey data collected in 2011 for the evaluation of the Urban Reproductive Health Initiative in Senegal were used to examine contraceptive use, method mix, unmet need and method sources among urban women aged 15-29 who were either currently married or unmarried but sexually active. Data from a sample of family planning providers were used to examine the prevalence of contraceptive eligibility restrictions based on age and marital status, and differences in such restrictions by method, facility type and provider characteristics. RESULTS: Modern contraceptive prevalence was 20% among young married women and 27% among young sexually active unmarried women; the levels of unmet need for contraception-mostly for spacing-were 19% and 11%, respectively. Providers were most likely to set minimum age restrictions for the pill and the injectable-two of the methods most often used by young women in urban Senegal. The median minimum age for contraceptive provision was typically 18. Restrictions based on marital status were less common than those based on age. CONCLUSIONS: Training and education programs for health providers should aim to remove unnecessary barriers to contraceptive access.
Fertility among orphans in rural Malawi: challenging common assumptions about risk and mechanisms.
Kidman R, Anglewicz P
Int Perspect Sex Reprod Health · 2014 Dec · PMID 25565344 · Full text
CONTEXT: Although a substantial literature suggests that orphans suffer disadvantage relative to nonorphaned peers, the nature of this disadvantage and the mechanisms driving it are poorly understood. Some evidence sugge...
CONTEXT: Although a substantial literature suggests that orphans suffer disadvantage relative to nonorphaned peers, the nature of this disadvantage and the mechanisms driving it are poorly understood. Some evidence suggests that orphans experience elevated fertility, perhaps because structural disadvantage leads them to engage in sexual risk-taking. An alternative explanation is that orphans intentionally become pregnant to achieve a sense of normality, acceptance and love. METHODS: Data from the 2006 wave of the Malawi Longitudinal Study of Families and Health on 1,033 young adults aged 15-25 were used to examine the relationship of maternal and paternal orphanhood with sexual risk indicators and desired and actual fertility. Regression analyses were used to adjust for covariates, including social and demographic characteristics and elapsed time since parental death. RESULTS: Twenty-six percent of respondents had lost their father and 15% their mother. Orphanhood was not associated with sexual risk-taking. However, respondents whose mother had died in the past five years desired more children than did those whose mother was still alive (risk differences, 0.52 among women and 0.97 among men). Actual fertility was elevated among women whose father had died more than five years earlier (0.31) and among men whose mother had died in the past five years (1.06) or more than five years earlier (0.47). CONCLUSION: The elevations in desired and actual fertility among orphans are consistent with the hypothesis that orphans intentionally become pregnant. Strategies that address personal desires for parenthood may need to be part of prevention programs aimed at orphaned youth.
Contraceptive method skew and shifts in method mix in low- and middle-income countries.
Bertrand JT, Sullivan TM, Knowles EA … +2 more , Zeeshan MF, Shelton JD
Int Perspect Sex Reprod Health · 2014 Sep · PMID 25271650 · Publisher ↗
CONTEXT: Method mix-the percentage distribution of contraceptive users in a given country, by method-is one measure that reflects the availability of a range of contraceptive methods. A skewed method mix-one in which 50%...
CONTEXT: Method mix-the percentage distribution of contraceptive users in a given country, by method-is one measure that reflects the availability of a range of contraceptive methods. A skewed method mix-one in which 50% or more of contraceptive users rely on a single method-could be cause for concern as a sign of insufficiency of alternative methods or provider bias. Shifts in method mix are important to individual countries, donors and scholars studying contraceptive dynamics. METHODS: To determine current patterns and recent changes in method mix, we examined 109 low- and middle-income countries. A variety of statistical methods were used to test four factors as correlates of skewed method mix: geographic region, family planning program effort index, modern contraceptive prevalence rate and human development index. An assessment of changes in reliance on female and male sterilization, the IUD, the implant and the injectable was conducted for countries with available data. RESULTS: Of the 109 countries included in this analysis, 30% had a skewed method mix-a modest decrease from 35% in a 2006 analysis. Only geographic region showed any correlation with method skew, but it was only marginally significant. The proportion of users relying on female sterilization, male sterilization or the IUD decreased in far more countries than it increased; the pattern was reversed for the injectable. CONCLUSION: Method mix skew is not a definitive indicator of lack of contraceptive choice or provider bias; it may instead reflect cultural preferences. In countries with a skewed method mix, investigation is warranted to identify the cause.
Fertility decisions and contraceptive use at different stages of relationships: windows of risk among men and women in accra.
Osei IF, Mayhew SH, Biekro L … +2 more , Collumbien M, ECAF Team
Int Perspect Sex Reprod Health · 2014 Sep · PMID 25271649 · Publisher ↗
CONTEXT: Despite declining fertility in Ghana, modern contraceptive use-even in urban areas-is low for reasons that remain unclear. Few studies have explored what drives fertility decisions and contraceptive use among co...
CONTEXT: Despite declining fertility in Ghana, modern contraceptive use-even in urban areas-is low for reasons that remain unclear. Few studies have explored what drives fertility decisions and contraceptive use among contemporary urban residents within a relationship context. METHODS: In-depth contraceptive life history interviews were conducted among a purposive sample of 80 sexually active women and men living in Accra. RESULTS: Contraception is viewed favorably, although the timing and choice of method strongly depends on the type and stage of relationship. At sexual debut and at first sex with a new partner, sex is usually unprotected. Many women show agency in subsequently negotiating condom use; men also show motivation to practice contraception. As relationships stabilize, couples abandon condoms and adopt traditional methods, out of fear that modern methods could affect fertility. After a first birth, couples prefer modern contraceptives to space children, but side effects often lead women to switch methods or discontinue use; women in supportive relationships are more likely than those in unsupportive relationships to continue use of modern contraceptives despite side effects. After reproductive goals have been realized, couples revert to using traditional methods to avoid further exposure to "chemicals." CONCLUSIONS: Contraceptive programs may be more successful if they target messages according to stage of relationship, involve men and work with people's desires to use traditional methods at certain times to ensure that they can do so safely.
Repeat use of emergency contraceptive pills in urban Kenya and Nigeria.
Chin-Quee D, L'Engle K, Otterness C … +2 more , Mercer S, Chen M
Int Perspect Sex Reprod Health · 2014 Sep · PMID 25271648 · Publisher ↗
CONTEXT: Little is known about the frequency and patterns of use of emergency contraceptive pills among women in urban Kenya and Nigeria. METHODS: To recruit women who had used emergency contraceptive pills, individuals...
CONTEXT: Little is known about the frequency and patterns of use of emergency contraceptive pills among women in urban Kenya and Nigeria. METHODS: To recruit women who had used emergency contraceptive pills, individuals aged 18-49 were intercepted and interviewed at shopping venues in Nairobi, Kenya, and Lagos, Nigeria, in 2011. Information was collected on 539 Nairobi and 483 Lagos respondents' demographic and behavioral characteristics, attitudes toward the method, and frequency of use. Multinomial logistic regression analyses were used to identify associations between these characteristics and frequency of pill use. RESULTS: Eighteen percent of the women interviewed in Nairobi and 17% in Lagos had ever used emergency contraceptive pills. On average, these respondents had used the pills less than once per month, but greater use and acceptance were seen in Lagos. In multivariate analysis, women who had sex at least once in a typical week were generally more likely than others to have used the pills 2-5 times in the last six months, rather than once or never, or to have used them six or more times. Furthermore, Lagos respondents who said their main contraceptive method was the condom, the pill or injectable, or a natural method were generally less likely than those who did not report these methods to have used the emergency pills multiple times in the last six months. CONCLUSIONS: Repeated use of emergency contraceptive pills was not common in this sample.
Pregnancy termination in Matlab, Bangladesh: trends and correlates of use of safer and less-safe methods.
DaVanzo J, Rahman M
Int Perspect Sex Reprod Health · 2014 Sep · PMID 25271647 · Publisher ↗
CONTEXT: Menstrual regulation (MR), a relatively safe form of pregnancy termination, is legal in Bangladesh during the early stages of pregnancy. However, little is known about the factors associated with whether women w...
CONTEXT: Menstrual regulation (MR), a relatively safe form of pregnancy termination, is legal in Bangladesh during the early stages of pregnancy. However, little is known about the factors associated with whether women who terminate pregnancies choose this method or a less-safe one. METHODS: Data from the Matlab Demographic Surveillance System on 122,691 pregnancies-5,221 (4.3%) of which were terminated-were used to examine trends between 1989 and 2008 in termination and in use of safer methods (MR or dilation and curettage) and less-safe (all other) methods of pregnancy termination. Logistic and multinomial logistic regressions were used to assess factors associated with whether women terminate pregnancies and whether they use safer methods. RESULTS: Sixty-seven percent of pregnancy terminations were by safer methods and 33% by less-safe means. The proportion of pregnancies that were terminated increased between 1989 and 2008; this increase was entirely due to increased use of safer methods. Women younger than 18 and those 25 or older were more likely than women aged 20-24 to terminate their pregnancies (odds ratios ranged from 1.5 among women aged 16-17 or 25-29 to 26.1 among those aged 45 or older). Among women who terminated their pregnancies, those aged 25-44 were more likely than those aged 20-24 to use a safer method. Compared with women who had no formal education, those with some education were more likely to terminate their pregnancies and to do so using safer methods. CONCLUSION: A growing proportion of pregnancies in Matlab are terminated, and these terminations are increasingly done using safer methods.
Pregnancy termination in Matlab, Bangladesh: maternal mortality risks associated with menstrual regulation and abortion.
Rahman M, DaVanzo J, Razzaque A
Int Perspect Sex Reprod Health · 2014 Sep · PMID 25271646 · Publisher ↗
CONTEXT: In Bangladesh, both menstrual regulation (MR), which is thought to be a relatively safe method, and abortion, which in this setting is often performed using unsafe methods, are used to terminate pregnancies (kno...
CONTEXT: In Bangladesh, both menstrual regulation (MR), which is thought to be a relatively safe method, and abortion, which in this setting is often performed using unsafe methods, are used to terminate pregnancies (known or suspected). However, little is known about changes over time in the use of these methods or their relative mortality risks. METHODS: Data from the Demographic Surveillance System in Matlab, Bangladesh, on 110,152 pregnancy outcomes between 1989 and 2008 were used to assess changes in mortality risks associated with MR (and a small number of dilation and curettage procedures), abortion and live birth. Tabulation and logistic regression analyses were used to compare outcomes in two areas of Matlab--the comparison area, which receives standard government health and family planning services, and the Maternal and Child Health-Family Planning (MCH-FP) area, which receives enhanced health and family planning services. RESULTS: In Matlab as a whole, the proportion of pregnancies ending in MR increased from 1.9% in 1989-1999 to 4.2% in 2000-2008, while the proportion ending in abortion decreased from 1.6% to 1.1%. The odds of mortality from MR were 4.1 times those from live birth in 1989-1999, but were no longer elevated in 2000-2008. The odds of mortality from abortion were 12.0 and 4.9 times those of live birth in 1989-1999 and 2000-2008, respectively. Reduction in mortality risk was greater in the MCH-FP area than the comparison area (90% vs. 75%). CONCLUSION: MR is no longer associated with higher mortality risk than live birth in Bangladesh, but abortion is.
Using mapping of service delivery sites to increase contraceptive availability in Kinshasa, Democratic Republic of the Congo.
Bertrand JT, Kayembe P, Dikamba N … +4 more , Mafuta E, Hernandez J, Hellen J, Binanga A
Int Perspect Sex Reprod Health · 2014 Jun · PMID 25051581 · Publisher ↗
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Traditional birthspacing practices and uptake of family planning during the postpartum period in Ouagadougou: qualitative results.
Rossier C, Hellen J
Int Perspect Sex Reprod Health · 2014 Jun · PMID 25051580 · Publisher ↗
CONTEXT: In many low-income countries, postpartum women typically start contraception after the resumption of sexual intercourse or menstruation. Postpartum breast-feeding and abstinence delay these events. Information i...
CONTEXT: In many low-income countries, postpartum women typically start contraception after the resumption of sexual intercourse or menstruation. Postpartum breast-feeding and abstinence delay these events. Information is needed on women's motivations to rely on these traditional birthspacing practices and their difficulties in starting a contraceptive method after a birth in urban West Africa. METHODS: In 2012, provider-client interactions and service delivery were observed for a week in seven health facilities in Ouagadougou, Burkina Faso, and semistructured interviews were conducted with 33 women and 12 men with infants younger than 24 months. Existing postpartum family planning services and women's transition from traditional practices to a family planning method are described. RESULTS: Family planning is scheduled to be delivered at the six-week postpartum checkup, which women rarely attend. No women viewed amenorrhea as protective against pregnancy, and all had started or planned to start a method just before or when they resumed sexual activity. Half of the women abstained for six or more months, and some then either adopted a method they used incorrectly or did not adopt one at all. The main difficulties included providers' requirements for amenorrheic women seeking contraceptives and husbands' refusal to refrain from unprotected sex. CONCLUSION: The initial postpartum family planning visit should occur right after delivery. Integration of family planning into immunization programs would provide opportunities to reach women who did not adopt a method early in the postpartum period. Provider barriers for amenorrheic women should be ended. Men should be involved in the postpartum family planning consultation.
Knowledge and use of emergency contraception: a multicountry analysis.
Palermo T, Bleck J, Westley E
Int Perspect Sex Reprod Health · 2014 Jun · PMID 25051579 · Publisher ↗
CONTEXT: Globally, evidence on knowledge and use of emergency contraception from population-based data is limited, though such information would be helpful in increasing access to the method. We examined knowledge and us...
CONTEXT: Globally, evidence on knowledge and use of emergency contraception from population-based data is limited, though such information would be helpful in increasing access to the method. We examined knowledge and use of emergency contraception in 45 countries using population-based survey data. METHODS: Demographic and Health Survey (DHS) data on women aged 15-49 were analyzed by country in logistic regressions to identify associations between women's characteristics and their having heard of emergency contraception or having ever used it. Trends were examined, by region and globally, according to individual, household and community descriptors, including women's age, education, marital status, socioeconomic status, and urban or rural location. RESULTS: The proportion of women who had heard of emergency contraception ranged from 2% in Chad to 66% in Colombia, and the proportion of sexually experienced women who had used it ranged from less than 0.1% in Chad to 12% in Colombia. The odds of having heard of or used the method generally increased with wealth, and although the relationship between marital status and knowing of the method varied by region, never-married women were more likely than married women to have used emergency contraception in countries where significant differences existed. In some countries, urban residence was associated with having heard of the method, but in only three countries were women from urban areas more likely to have used it. CONCLUSIONS: Our findings support the need for broader dissemination of information on emergency contraception, particularly among low-income individuals. Variations in use and knowledge within regions suggest a need for programs to be tailored to country-level characteristics.
Individual- and community-level influences on the timing of sexual debut among youth in Nyanza, Kenya.
Tenkorang EY, Maticka-Tyndale E
Int Perspect Sex Reprod Health · 2014 Jun · PMID 25051578 · Publisher ↗
CONTEXT: Delaying sexual debut is an important HIV prevention strategy, yet few studies have examined associations between both community- and individual-level characteristics and sexual debut among youth in Sub-Saharan...
CONTEXT: Delaying sexual debut is an important HIV prevention strategy, yet few studies have examined associations between both community- and individual-level characteristics and sexual debut among youth in Sub-Saharan Africa. METHODS: Cross-sectional survey data collected from 8,183 youth aged 11-17 in 160 schools in Nyanza, Kenya, were used to examine the relationships between individual and community measures and the timing of sexual debut. Multilevel discrete-time hazard models were used to identify bivariate and multivariate associations. RESULTS: At the individual level, youth were more likely to have initiated sex (or had done so at an earlier age) if they had felt pressure to engage in sex from a greater number of sources (odds ratios, 1.3-1.8); perceived that they had a small or (among females) moderate chance, rather than no chance, of contracting HIV (1.2-1.3); or endorsed a greater number of HIV transmission myths (1.1 for both sexes). In addition, males with higher abstinence selfefficacy had a reduced risk of sexual debut (0.95). At the community level, males and females had a reduced risk of sexual debut if they lived in a community where AIDS deaths were publicly acknowledged (0.6-0.8) or the Primary School Action for Better Health program had been implemented (0.8-0.95); risk was also reduced among young men who lived in communities where HIV was discussed at a greater number of parent-teacher association meetings (0.9) or where abstinence was the primary AIDS prevention message conveyed to youth (0.9). CONCLUSION: Community-level variables are frequently associated with sexual debut and should be included in future research.
Evaluation of a communication campaign to improve continuation among first-time injectable contraceptive users in Nyando District, Kenya.
McClain Burke H, Ambasa-Shisanya C
Int Perspect Sex Reprod Health · 2014 Jun · PMID 25051577 · Publisher ↗
CONTEXT: Communication campaigns might be a viable means of improving contraceptive continuation; however, few such interventions aimed at reducing contraceptive discontinuation have been evaluated. METHODS: Data were co...
CONTEXT: Communication campaigns might be a viable means of improving contraceptive continuation; however, few such interventions aimed at reducing contraceptive discontinuation have been evaluated. METHODS: Data were collected from independent samples of new injectable users in Nyando District, Kenya-site of a communication campaign to increase contraceptive continuation-and in a comparison district, nine months before and nine months after intervention implementation. Survival analysis was used to compare the intervention and comparison groups with respect to the distribution of time until first discontinuation of modern method use among women still in need of family planning. RESULTS: Exposure to family planning information was high in both the treatment and the comparison district before (97% and 85%, respectively) and after the intervention (99% and 78%). Postintervention, 5% of women in the comparison district discontinued by 98 days, 8% by 196 days and 23% by 294 days; the proportions in the treatment district were 4%, 6% and 16%, respectively. No significant difference between the districts was found in the ninemonth postintervention contraceptive continuation rates. Having method-related side effects or health concerns was the reason most consistently associated with discontinuation. Other factors associated with discontinuation differed between the districts. CONCLUSIONS: Addressing method-related side effects and health concerns will be critical in improving continuation of the injectable.
Is age difference between partners associated with contraceptive use among married couples in Nigeria?
Ibisomi L
Int Perspect Sex Reprod Health · 2014 Mar · PMID 24733060 · Publisher ↗
CONTEXT: The likelihood that women use contraceptives may be reduced when they are considerably younger than their husband, because such age differences are often accompanied by disparities in social position, resources...
CONTEXT: The likelihood that women use contraceptives may be reduced when they are considerably younger than their husband, because such age differences are often accompanied by disparities in social position, resources and life experiences, which may make marital relationships inherently unequal. METHODS: Data from the 2008 Nigeria Demographic and Health Survey on 6,552 married couples in which the woman was aged 15-49 and the man was aged 15-59 were used to examine associations between partners' age difference and current contraceptive use. Associations were explored using multinomial logistic regression models that adjusted for women's and couples' characteristics. Separate analyses were conducted for couple methods (condoms, withdrawal and abstinence) and non-couple methods. RESULTS: Ninety-eight percent of women were younger than their partner, and two-fifths were younger by 10 or more years. In bivariate analyses, women who were less than five years younger than their partner or were 5-9 years younger were more likely than those who were at least 10 years younger to be using a couple or non-couple contraceptive method (relative risk ratios, 1.4-2.2). However, these associations were no longer significant after adjustment for other characteristics. The measures that were most consistently related to use of couple and non-couple methods were education level, fertility intentions and household wealth. CONCLUSION: Age differences between married partners are not associated with women's contraceptive use in Nigeria after adjustment for covariates. Further study is needed to understand this finding.
Differences in unintended pregnancy, contraceptive use and abortion by HIV status among women in Nigeria and Zambia.
Bankole A, Keogh S, Akinyemi O … +3 more , Dzekedzeke K, Awolude O, Adewole I
Int Perspect Sex Reprod Health · 2014 Mar · PMID 24733059 · Publisher ↗
CONTEXT: Sub-Saharan Africa is burdened by high rates of unintended pregnancy and HIV. Yet little is known about the relationship between these two health risks in the region. Understanding the associations between HIV s...
CONTEXT: Sub-Saharan Africa is burdened by high rates of unintended pregnancy and HIV. Yet little is known about the relationship between these two health risks in the region. Understanding the associations between HIV status and pregnancy decision making may benefit strategies to reduce unintended pregnancy. METHODS: In 2009-2010, household-based surveys of 1,256 women in Nigeria and 1,280 women in Zambia collected information on social and demographic characteristics, unintended pregnancy, contraceptive use, abortion and self-reported HIV status. Multivariate models were used to examine the association of reported HIV status with unintended pregnancy and abortion in the five years preceding the survey and with contraceptive use at the time of conception. RESULTS: HIV-positive and HIV-negative women did not differ in their odds of unintended pregnancy or of having an abortion. However, HIV-positive women were more likely than HIV-negative women to have been using a contraceptive at the time their unintended pregnancy was conceived (odds ratio, 3.2). Women who did not know their HIV status were less likely than HIV-negative women to report an unintended pregnancy (0.6). However, they were also less likely than HIV-negative women to have been using a contraceptive at the time of conception (0.5). CONCLUSION: HIV-positive women may be making greater efforts than HIV-negative women to prevent unintended pregnancy, but with less success. Efforts should be made to improve access to effective contraceptive methods and counseling for all women, and for HIV-positive women in particular.
Injectable contraceptive sales at licensed chemical seller shops in ghana: access and reported use in rural and periurban communities.
Lebetkin E, Orr T, Dzasi K … +5 more , Keyes E, Shelus V, Mensah S, Nagai H, Stanback J
Int Perspect Sex Reprod Health · 2014 Mar · PMID 24733058 · Publisher ↗
CONTEXT: Most women in Ghana obtain oral contraceptives and condoms from shops run by licensed chemical sellers, but such shops are not legally permitted to sell the country's most widely used method, the injectable. All...
CONTEXT: Most women in Ghana obtain oral contraceptives and condoms from shops run by licensed chemical sellers, but such shops are not legally permitted to sell the country's most widely used method, the injectable. Allowing shops to sell the injectable could increase access to and use of the method. METHODS: In 2012-2013, semistructured telephone interviews were conducted among convenience samples of 94 licensed chemical seller shop operators in two districts who were trained to sell the injectable and of 298 women who purchased the method from these shops. Follow-up interviews were conducted with 92 clients approximately three months after their initial injectable purchase. RESULTS: Ninety-seven percent of shop operators reported selling the injectable, and 94% felt sufficiently trained to provide family planning methods and services. Virtually all sellers (99%) referred clients to a hospital or health facility for injection; none provided injections themselves. Fifty-six percent of injectable clients were new family planning users. Of those who completed a follow-up interview, 79% had purchased the injectable again from a shop. Virtually all clients (97%) reported getting their injection at the health facility to which they were referred by the seller. Women cited trust, convenience and commodities being in stock as key reasons for purchasing from a shop. CONCLUSION: Licensed chemical seller shop operators can safely sell the injectable and refer clients to health facilities for screening, counseling and injection.
Relationship characteristics and contraceptive use among couples in urban kenya.
Irani L, Speizer IS, Fotso JC
Int Perspect Sex Reprod Health · 2014 Mar · PMID 24733057 · Full text
CONTEXT: Few studies have used couple data to identify associations between individual- and relationship-level characteristics and contraceptive use in urban areas. METHODS: Population-based survey data collected in 2010...
CONTEXT: Few studies have used couple data to identify associations between individual- and relationship-level characteristics and contraceptive use in urban areas. METHODS: Population-based survey data collected in 2010 in three Kenyan cities-Nairobi, Mombasa and Kisumu-were used to identify 883 couples. Bivariate and multivariate analyses were conducted to examine associations between relationship-level characteristics (i.e., desire for another child, and communication about desired number of children and family planning use) and contraceptive use among couples currently using contraceptives; additional analyses investigated intention to use contraceptives among couples currently not practicing contraception. RESULTS: Sixty percent of couples reported current use of contraceptives. In multivariate analyses, couples who desired another child were less likely to use contraceptives than couples who wanted no more children (odds ratio, 0.5). Couples in which both partners reported spousal communication about family planning in the past six months had greater odds of contraceptive use than couples that reported no spousal communication on the subject (3.8). Results from analyses examining associations between relationship-level characteristics and intention to use contraceptives among current nonusers resembled those from analyses of current contraceptive users. CONCLUSION: In this study, relationship-level characteristics were associated with current contraceptive use and intention to use contraceptives among couples in urban Kenya. Family planning programs that promote spousal communication about family planning and desired number of children may improve contraceptive use among urban couples.
Unmet need, intention to use contraceptives and unwanted pregnancy in rural bangladesh.
Callahan R, Becker S
Int Perspect Sex Reprod Health · 2014 Mar · PMID 24733056 · Publisher ↗
CONTEXT: Unmet need for contraception has become a central concept in the family planning field and one of the most important indicators for program planning and evaluation. The measure has faced criticism, however, for...
CONTEXT: Unmet need for contraception has become a central concept in the family planning field and one of the most important indicators for program planning and evaluation. The measure has faced criticism, however, for not taking into account women's stated intention to use contraceptives. METHODS: Using longitudinal data on more than 2,500 rural Bangladeshi women in 128 villages, this study links women's contraceptive adoption and experience of unwanted pregnancy between 2006 and 2009 to their unmet need status and their stated intention to use contraceptives in 2006. RESULTS: Intention to use a method was predictive of subsequent use for both women with and without an unmet need. Three-quarters of the unintended pregnancies reported between 2006 and 2009 occurred among women without an unmet need in 2006. In addition, nearly half of women without an unmet need who were pregnant or postpartum in 2006 had experienced an unwanted pregnancy, compared with 30% of all women classified as having an unmet need. CONCLUSION: To adequately meet population family planning needs, programs must look beyond unmet need and focus on the total demand for acceptable and effective methods.
Reproduction, functional autonomy and changing experiences of intimate partner violence within marriage in rural India.
Bourey C, Stephenson R, Hindin MJ
Int Perspect Sex Reprod Health · 2013 Dec · PMID 24393727 · Publisher ↗
CONTEXT: The literature on intimate partner violence in resource-poor contexts relies primarily on cross-sectional studies. Because changes in women's status and empowerment are hypothesized to influence violence vulnera...
CONTEXT: The literature on intimate partner violence in resource-poor contexts relies primarily on cross-sectional studies. Because changes in women's status and empowerment are hypothesized to influence violence vulnerability, longitudinal studies are needed to determine the potential benefits and harms associated with such changes. METHODS: Data were collected prospectively from a representative cohort of 4,749 married women in rural areas of four socially and demographically diverse states in India in 1998-1999 and 2002-2003. A multinomial regression model including social and demographic characteristics and intersurvey changes and events related to functional autonomy and reproduction was fitted to a categorical outcome measuring the absence (reference), initiation, cessation and continuation of intimate partner violence. RESULTS: Continued freedom of movement, increased freedom of movement and continued financial autonomy between baseline and follow-up were associated with a lower risk of violence initiation rather than no violence (relative risk ratio, 0.7 for each). Having a first child was associated with lower risk of violence initiation and continuation rather than no violence (0.6 and 0.2, respectively). Women who reported that their relative economic contribution to the household decreased or increased and women who experienced an unwanted pregnancy had a higher risk of violence continuation rather than no violence (1.8, 1.8 and 1.5, respectively). The death of a child was associated with higher risk of violence initiation rather than no violence (1.4). CONCLUSION: Future research to inform interventions to reduce intimate partner violence should consider how changes in women's reproductive experiences and functional autonomy may be linked to changes in intimate partner violence.
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