International Perspectives On Sexual And Reproductive Health[JOURNAL]
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200 papers
The Oportunidades conditional cash transfer program: effects on pregnancy and contraceptive use among young rural women in Mexico.
Darney BG, Weaver MR, Sosa-Rubi SG … +4 more , Walker D, Servan-Mori E, Prager S, Gakidou E
Int Perspect Sex Reprod Health · 2013 Dec · PMID 24393726 · Full text
CONTEXT: Oportunidades is a large conditional cash transfer program in Mexico. It is important to examine whether the program has any direct effect on pregnancy experience and contraceptive use among young rural women, a...
CONTEXT: Oportunidades is a large conditional cash transfer program in Mexico. It is important to examine whether the program has any direct effect on pregnancy experience and contraceptive use among young rural women, apart from those through education. METHODS: Data from the 1992, 2006 and 2009 waves of a nationally representative, population-based survey were used to describe trends in pregnancy experience, contraceptive use and education among rural adolescent (15-19) and young adult (20-24) women in Mexico. To examine differences in pregnancy experience and current modern contraceptive use among young women, multivariable logistic regression analyses were conducted between matched 2006 samples of women with and without exposure to Oportunidades, predicted probabilities were calculated and indirect effects were estimated. RESULTS: Over the three survey waves, the proportion of adolescent and young adult women reporting ever being pregnant stayed flat (33-36%) and contraceptive use increased steadily (from 13% in 1992 to 19% in 2009). Educational attainment rose dramatically: The proportion of women with a secondary education increased from 28% in 1992 to 46% in 2009. In multivariable analyses, exposure to Oportunidades was not associated with pregnancy experience among adolescents. Educational attainment, marital status, pregnancy experience and access to health insurance--but not exposure to Oportunidades--were positively associated with current modern contraceptive use among adolescent and young adult women. CONCLUSION: Through its effect on education, Oportunidades indirectly influences fertility among adolescents. It is important for Mexico to focus on strategies to increase contraceptive use among young rural nulliparous women, regardless of whether they are enrolled in Oportunidades.
Consumer perspectives on a pericoital contraceptive pill in India and Uganda.
Cover JK, Drake JK, Kyamwanga IT … +4 more , Turyakira E, Dargan T, Kumakech E, Harner-Jay C
Int Perspect Sex Reprod Health · 2013 Dec · PMID 24393725 · Publisher ↗
CONTEXT: Studies suggest that women in some countries have adopted emergency contraceptive pills as a routine method of family planning. This practice indicates there may be latent demand for a pericoital contraceptive p...
CONTEXT: Studies suggest that women in some countries have adopted emergency contraceptive pills as a routine method of family planning. This practice indicates there may be latent demand for a pericoital contraceptive pill taken only when a woman has sexual intercourse, and labeled and marketed for use as a regular contraceptive method. METHODS: To understand the appeal and potential market for a pericoital contraceptive pill, 39 focus groups and 23 in-depth interviews were conducted with women and men in Lucknow, Uttar Pradesh, India, and Kampala, Uganda. A total of 281 individuals participated in this qualitative study. RESULTS: In general, women embraced the idea of a female-controlled method that would be easier than taking a daily oral contraceptive pill and that could be taken either before or after sexual intercourse; in Uganda, especially, women approved of the fact that the method could be taken without a partner's knowledge. Although we do not yet know the extent of side effects for this method, women expressed some concerns about the level and nature of potential side effects. CONCLUSIONS: The results suggest that a pericoital contraceptive pill would be well-received by consumers in both country settings. If its efficacy and side effects are acceptable, a pericoital contraceptive pill could fill a gap for female-controlled, discreet, coitus-related contraception, particularly among women who do not have sex very frequently.
Understanding couples' relationship quality and contraceptive use in Kumasi, Ghana.
Cox CM, Hindin MJ, Otupiri E … +1 more , Larsen-Reindorf R
Int Perspect Sex Reprod Health · 2013 Dec · PMID 24393724 · Publisher ↗
CONTEXT: A wealth of data exist on knowledge, attitudes and practice related to contraceptive use; however, emotional aspects of relationships that may influence reproductive decision making are often overlooked. METHODS...
CONTEXT: A wealth of data exist on knowledge, attitudes and practice related to contraceptive use; however, emotional aspects of relationships that may influence reproductive decision making are often overlooked. METHODS: Data from the 2010 Family Health and Wealth Survey were used in bivariate and multinomial logistic regression analyses to identify associations between relationship quality and current contraceptive use among 698 married or cohabiting couples in Kumasi, Ghana. Four scales measuring commitment, trust, constructive communication and destructive communication, as well as a question about relationship satisfaction, were the indicators of relationship quality. Current contraceptive use was divided into three categories: no use, reliance on a method that can be used without the partner's awareness (the injectable, pill, IUD, implant and diaphragm) and use of a method that both partners are typically aware of (periodic abstinence, withdrawal, condoms and spermicide). RESULTS: Overall contraceptive use was low--22% of women said they were currently using any method. In general, respondents reported high levels of relationship quality. Women's relationship satisfaction scores were positively associated with use of awareness methods rather than nonuse (relative risk ratio, 1.2). Men's trust scores were positively associated with use of nonawareness methods rather than nonuse (1.1), and men's constructive communication scores were associated with use of both types of method rather than nonuse (1.1 for each). CONCLUSIONS: Couples' relationship quality appears to be an important element in their decision making regarding contraceptive use, and should be taken into consideration in the design and implementation of family planning programs and policy.
Documenting the individual- and household-level cost of unsafe abortion in Uganda.
Sundaram A, Vlassoff M, Mugisha F … +4 more , Bankole A, Singh S, Amanya L, Onda T
Int Perspect Sex Reprod Health · 2013 Dec · PMID 24393723 · Publisher ↗
CONTEXT: Although Uganda has a restrictive abortion law, illegal abortions performed under dangerous conditions are common. Data are lacking, however, on the economic impact of postabortion complications on women and the...
CONTEXT: Although Uganda has a restrictive abortion law, illegal abortions performed under dangerous conditions are common. Data are lacking, however, on the economic impact of postabortion complications on women and their households. METHODS: Data from a 2011-2012 survey of 1,338 women who received postabortion care at 27 Ugandan health facilities were used to assess the economic consequences of unsafe abortion and subsequent treatment. Information was obtained on treatment costs and on the impact of abortion complications on children in the household, on the productivity of the respondent and other household members, and on changes in their economic circumstances. RESULTS: Most women reported that their unsafe abortion had had one or more adverse effects, including loss of productivity (73%), negative consequences for their children (60%) and deterioration in economic circumstances (34%). Women who had spent one or more nights in a facility receiving postabortion care were more likely than those who had not needed an overnight stay to experience these three consequences (odds ratios, 1.6-2.8), and women who had incurred higher postabortion care expenses were more likely than those with lower expenses to report deterioration in economic circumstances (1.6). Wealthier women were less likely than the poorest women to report that their children had suffered negative consequences (0.4-0.5). CONCLUSIONS: The impact of complications of unsafe abortion and the expense of treating them are substantial for Ugandan women and their households. Strategies to reduce the number of unsafe procedures, such as by expanding access to contraceptives to prevent unintended pregnancies, are urgently needed.
Risk and protective correlates of young women's first sexual experiences in Rakai, Uganda.
Mmari KN, Kaggwa E, Wagman J … +3 more , Gray R, Wawer M, Nalugoda F
Int Perspect Sex Reprod Health · 2013 Sep · PMID 24135047 · Publisher ↗
CONTEXT: Sexually active young women bear the brunt of the HIV epidemic in Sub-Saharan Africa. Information is needed on risk and protective correlates at the family, partner and individual level for the design of program...
CONTEXT: Sexually active young women bear the brunt of the HIV epidemic in Sub-Saharan Africa. Information is needed on risk and protective correlates at the family, partner and individual level for the design of programs to encourage safer sexual behaviors and reduce HIV risk among young women. METHODS: The study was conducted among 1,675 sexually experienced women aged 15-24 living in Rakai, Uganda. The sample was taken from an ongoing community cohort study initiated in 1994 in 56 villages by the Rakai Health Sciences Program. Contextual variabless at the family, partner and individual levels were analyzed in relation to three outcome variables: sex before the age of 15, coerced first sex and condom use at first sex. RESULTS: At the family level, young females who did not live with both parents were more likely than those who did to have had sex before the age of 15 and to have experienced sexual coercion at first sex. Those whose mothers had some secondary education and whose female caregiver did not consume alcohol had elevated odds of using a condom at first sex. Having initiated sex at age 15 or older was the strongest individual-level characteristic associated with having used a condom at first sex. CONCLUSIONS: Reproductive health interventions should target adolescents and their parents to delay the onset of sexual activity, prevent sexual coercion and encourage condom use. Both adolescents and their parents should be educated about the risks associated with different types of sexual partnerships.
Effectiveness of a behavior change communication intervention to improve knowledge and perceptions about abortion in Bihar and Jharkhand, India.
Banerjee SK, Andersen KL, Warvadekar J … +1 more , Pearson E
Int Perspect Sex Reprod Health · 2013 Sep · PMID 24135046 · Publisher ↗
CONTEXT: Although abortion became legal in India in 1971, many women are unaware of the law. Behavior change communication interventions may be an effective way to promote awareness of the law and change knowledge of and...
CONTEXT: Although abortion became legal in India in 1971, many women are unaware of the law. Behavior change communication interventions may be an effective way to promote awareness of the law and change knowledge of and perceptions about abortion, particularly in settings in which abortion is stigmatized. METHODS: To evaluate the effectiveness of a behavior change communication intervention to improve women's knowledge about India's abortion law and their perceptions about abortion, a quasi-experimental study was conducted in intervention and comparison districts in Bihar and Jharkhand. Household surveys were administered at baseline in 2008 and at follow-up in 2010 to independent, randomly selected cross-sectional samples of rural married women aged 15-49. Logistic regression difference-in-differences models were used to assess program effectiveness. RESULTS: Analysis demonstrated program effectiveness in improving awareness and perceptions about abortion. The changes in the odds of knowing that abortion is legal and where to obtain safe abortion services were larger between baseline and follow-up in the intervention districts than the changes in odds observed in the comparison districts (odds ratios, 16.1 and 1.9, respectively). Similarly, the increase in women's perception of greater social support for abortion within their families and the increase in perceived self-efficacy with respect to family planning and abortion between baseline and follow-up was greater in the intervention districts than in the comparison districts (coefficients, 0.17 and 0.18, respectively). CONCLUSIONS: Behavior change communication interventions can be effective in improving knowledge of and perceptions about abortion in settings in which lack of accurate knowledge hinders women's access to safe abortion services. Multiple approaches should be used when attempting to improve knowledge and perceptions about stigmatized health issues such as abortion.
Reducing unmet need by supporting women with met need.
Jain AK, Obare F, RamaRao S … +1 more , Askew I
Int Perspect Sex Reprod Health · 2013 Sep · PMID 24135045 · Publisher ↗
CONTEXT: The 2012 London Summit on family planning set a goal of providing modern contraceptives to 120 million women with unmet need by 2020. Reducing the high rate of contraceptive discontinuation by facilitating switc...
CONTEXT: The 2012 London Summit on family planning set a goal of providing modern contraceptives to 120 million women with unmet need by 2020. Reducing the high rate of contraceptive discontinuation by facilitating switching among methods will play a critical role in meeting that goal. METHODS: Data collected from married women in Demographic and Health Surveys conducted in 34 countries between 2005 and 2010 were used to estimate the potential contribution of contraceptive discontinuation to current and future unmet need. An indicator of relevant discontinuation was created by calculating the proportion of past users with an unmet need for modern methods among ever-users. Regression analyses identified associations between this indicator and access to and composition of methods. RESULTS: Women who had discontinued method use and subsequently had unmet need at the survey accounted for 38% of the total estimated unmet need. These past users represented 19% of women who had ever used modern methods. Both the access to and composition of available methods were associated with a reduction in the relevant discontinuation rate. The level of discontinuation in Sub-Saharan Africa was significantly higher than in other regions, in part due to differences in method availability. CONCLUSIONS: High contraceptive discontinuation in the past has contributed tens of millions of cases of unmet need, and discontinuation among current users will contribute even more cases in the future. Enabling past users with unmet need to resume use and encouraging current users to continue use of the same or another method could be an effective strategy to reduce future unmet need.
Contraception and abortion in a low-fertility setting: the role of seasonal migration.
Sevoyan A, Agadjanian V
Int Perspect Sex Reprod Health · 2013 Sep · PMID 24135044 · Publisher ↗
CONTEXT: Seasonal labor migration is common among men in many former Soviet republics. Little research has examined contraceptive use and induced abortion among women in such low-fertility, high-migration settings, accor...
CONTEXT: Seasonal labor migration is common among men in many former Soviet republics. Little research has examined contraceptive use and induced abortion among women in such low-fertility, high-migration settings, according to husband's migration status. METHODS: Combined data from 2,280 respondents of two surveys of married women aged 18-45 in rural Armenia-one conducted in 2005 and one in 2007-were used. Logistic regression analyses examined whether a husband's migration status was associated with his wife's current use of the pill or the IUD, or with the probability that she had had a pregnancy that ended in induced abortion. Additional analyses were conducted to determine whether relationships were moderated by household wealth. RESULTS: Women with a migrant husband were less likely than those with a nonmigrant husband to be currently using the pill or the IUD (odds ratio, 0.6); with increased household wealth, the likelihood of method use increased among women with a nonmigrant husband, but decreased slightly among women with a migrant husband. Overall, the probability that a pregnancy ended in abortion did not differ by migration status; however, the likelihood of abortion increased with wealth among women married to a nonmigrant, but not among those married to a migrant. CONCLUSIONS: Despite their husband's absence, women married to a migrant may have an unwanted pregnancy rate similar to that of women married to a nonmigrant. Improved access to modern contraceptive methods is likely to be positively associated with contraceptive use among women with a nonmigrant husband, but not among those with a migrant husband.
The cost of postabortion care and legal abortion in Colombia.
Prada E, Maddow-Zimet I, Juarez F
Int Perspect Sex Reprod Health · 2013 Sep · PMID 24135043 · Publisher ↗
CONTEXT: Although Colombia partially liberalized its abortion law in 2006, many abortions continue to occur outside the law and result in complications. Assessing the costs to the health care system of safe, legal aborti...
CONTEXT: Although Colombia partially liberalized its abortion law in 2006, many abortions continue to occur outside the law and result in complications. Assessing the costs to the health care system of safe, legal abortions and of treating complications of unsafe, illegal abortions has important policy implications. METHODS: The Post-Abortion Care Costing Methodology was used to produce estimates of direct and indirect costs of postabortion care and direct costs of legal abortions in Colombia. Data on estimated costs were obtained through structured interviews with key informants at a randomly selected sample of facilities that provide abortion-related care, including 25 public and private secondary and tertiary facilities and five primary-level private facilities that provide specialized reproductive health services. RESULTS: The median direct cost of treating a woman with abortion complications ranged from $44 to $141 (in U.S. dollars), representing an annual direct cost to the health system of about $14 million per year. A legal abortion at a secondary or tertiary facility was costly (medians, $213 and $189, respectively), in part because of the use of dilation and curettage, as well as because of administrative barriers. At specialized facilities, where manual vacuum aspiration and medication abortion are used, the median cost of provision was much lower ($45). CONCLUSIONS: Provision of postabortion care and legal abortion services at higher-level facilities results in unnecessarily high health care costs. These costs can be reduced significantly by providing services in a timely fashion at primary-level facilities and by using safe, noninvasive and less costly abortion methods.
The mystery of missing female children in the Caucasus: an analysis of sex ratios by birth order.
Michael M, King L, Guo L … +3 more , McKee M, Richardson E, Stuckler D
Int Perspect Sex Reprod Health · 2013 Jun · PMID 23895886 · Publisher ↗
CONTEXT: Official data on sex ratios at birth suggest a rise in sex-selective abortions in some post-Soviet states following the introduction of ultrasonography. However, questions remain about the validity of official d...
CONTEXT: Official data on sex ratios at birth suggest a rise in sex-selective abortions in some post-Soviet states following the introduction of ultrasonography. However, questions remain about the validity of official data in these nations as well as whether the high sex ratios at birth are a statistical artifact. METHODS: Trends in sex ratios at birth from 1985 to 2009 for 12 post-Soviet states were examined using vital registration data. For the three countries that had had a Demographic and Health Survey (DHS) in 2005-2010 (Armenia, Azerbaijan and Moldova), survey data were used to calculate sex ratios at birth according to birth order, and vital registration data for 2010 were used to estimate the number of "missing" female births (if any). RESULTS: Official data revealed elevated sex ratios at birth in Armenia (117), Azerbaijan (116) and Georgia (121), but not in other post-Soviet states. According to DHS data, sex ratios were high in Armenia and Azerbaijan for first births (138 and 113, respectively); if the first child was a girl, the sex ratio in Armenia was even higher for the second birth (154). Overall, the number of girls born in these countries in 2010 was 10% lower than expected, consistent with 1,972 sex-selective abortions in Armenia and 8,381 in Azerbaijan. Sex ratios did not vary by birth order in Moldova. CONCLUSION: Sex-selective abortion appears to be common in Azerbaijan and Armenia. Family planning and legal interventions are needed to address this issue.
The incidence of induced abortion in Malawi.
Levandowski BA, Mhango C, Kuchingale E … +4 more , Lunguzi J, Katengeza H, Gebreselassie H, Singh S
Int Perspect Sex Reprod Health · 2013 Jun · PMID 23895885 · Publisher ↗
CONTEXT: Abortion is legally restricted in Malawi, and no data are available on the incidence of the procedure. METHODS: The Abortion Incidence Complications Methodology was used to estimate levels of induced abortion in...
CONTEXT: Abortion is legally restricted in Malawi, and no data are available on the incidence of the procedure. METHODS: The Abortion Incidence Complications Methodology was used to estimate levels of induced abortion in Malawi in 2009. Data on provision of postabortion care were collected from 166 public, nongovernmental and private health facilities, and estimates of the likelihood that women who have abortions experience complications and seek care were obtained from 56 key informants. Data from these surveys and from the 2010 Malawi Demographic and Health Survey were used to calculate abortion rates and ratios, and rates of pregnancy and unintended pregnancy. RESULTS: Approximately 18,700 women in Malawi were treated in health facilities for complications of induced abortion in 2009. An estimated 67,300 induced abortions were performed, equivalent to a rate of 23 abortions per 1,000 women aged 15-44 and an abortion ratio of 12 per 100 live births. The abortion rate was higher in the North (35 per 1,000) than in the Central region or the South (20-23 per 1,000). The unintended pregnancy rate in 2010 was 139 per 1,000 women aged 15-44, and an estimated 52% of all pregnancies were unintended. CONCLUSIONS: Unsafe abortion is common in Malawi. Interventions are needed to help women and couples avoid unwanted pregnancy, reduce the need for unsafe abortion and decrease maternal mortality.
Acceptability and feasibility of mifepristone-misoprostol for menstrual regulation in Bangladesh.
Alam A, Bracken H, Johnston HB … +4 more , Raghavan S, Islam N, Winikoff B, Reichenbach L
Int Perspect Sex Reprod Health · 2013 Jun · PMID 23895884 · Publisher ↗
CONTEXT: Annually, more than 700,000 women turn to menstrual regulation, or uterine evacuation with vacuum aspiration; many more resort to unsafe abortion. Using pills for the evacuation of the uterus could increase wome...
CONTEXT: Annually, more than 700,000 women turn to menstrual regulation, or uterine evacuation with vacuum aspiration; many more resort to unsafe abortion. Using pills for the evacuation of the uterus could increase women's access to safe menstrual regulation services and reduce the high levels of abortion- and menstrual regulation- related morbidity in Bangladesh. METHODS: At 10 facilities in Bangladesh, 651 consenting women who were seeking menstrual regulation services and who were 63 days or less past their last menstrual period received 200 mg of mifepristone followed 24 hours later by 800 mcg of buccal misoprostol, administered either at home or in the clinic. Prospective data were collected to determine women's experience and satisfaction with the procedure, menstrual regulation outcome, and the human and physical resources required for providing the method. Focus group discussions were conducted with a purposively sampled group of service providers at each site to understand their attitudes about the introduction of menstrual regulation with medication. RESULTS: The majority of women (93%) with known menstrual regulation outcomes evacuated the uterus without surgical intervention. Overall, most women (92%) were satisfied with use of pills for their menstrual regulation. Providers faced initial challenges and concerns, particularly related to the additional counseling requirements and lack of control over the final outcome, but became more confident after successful use of the medication regimen. CONCLUSIONS: Mifepristone-misoprostol can be safely offered within existing menstrual regulation services in urban and periurban areas in Bangladesh and is highly acceptable to women. Providers' initial concerns diminish with increased experience with the method.
Use of dual protection among female sex workers in Swaziland.
Yam EA, Mnisi Z, Mabuza X … +4 more , Kennedy C, Kerrigan D, Tsui A, Baral S
Int Perspect Sex Reprod Health · 2013 Jun · PMID 23895883 · Publisher ↗
CONTEXT: Female sex workers are at heightened risk of both HIV infection and unwanted pregnancy. Nonbarrier modern contraceptives are highly effective at preventing pregnancy, but offer no HIV protection. A better unders...
CONTEXT: Female sex workers are at heightened risk of both HIV infection and unwanted pregnancy. Nonbarrier modern contraceptives are highly effective at preventing pregnancy, but offer no HIV protection. A better understanding of sex workers' use of condoms and nonbarrier methods is needed to help them meet their contraceptive and STI protection needs. METHODS: A 2011 respondent-driven sampling survey collected reproductive health and contraceptive use data from 325 female sex workers in Swaziland. Multinomial logistic regression analysis was used to identify associations between selected characteristics and four outcomes of contraceptive use over the past month: consistent condom use alone; nonbarrier modern contraceptive use (either alone or with inconsistent condom use); dual method use; and inconsistent condom use, other method use or nonuse. Adjusted predicted probabilities were also calculated to determine patterns of association. RESULTS: After adjustments were made for background and behavioral factors, 16% of female sex workers were found to be consistent users of condoms alone; 39% used nonbarrier modern methods (without consistent condom use); 8% were dual method users; and 38% were inconsistent condom users or used other methods or none. Women who reported recent condom failure were less likely than others to be consistent condom users (6% vs. 22%). Consistent use of condoms alone was more common among women who had had no noncommercial partners in the past month than among those who reported two or more such partners (39% vs. 3%). In addition, respondents who had children were more likely than their nulliparous counterparts to report use of nonbarrier methods alone (65% vs. 14%). CONCLUSIONS: Inconsistent or no condom use among nonbarrier contraceptive users underscores the need to incorporate HIV prevention into family planning interventions, particularly among female sex workers who have children and noncommercial partners.
The influence of intrafamilial power on maternal health care in Mali: perspectives of women, men and mothers-in-law.
White D, Dynes M, Rubardt M … +2 more , Sissoko K, Stephenson R
Int Perspect Sex Reprod Health · 2013 Jun · PMID 23895882 · Publisher ↗
CONTEXT: Evidence from diverse settings suggests that women often have limited control over their own reproductive health decisions. To increase uptake of preventive services and behaviors, it is important to understand...
CONTEXT: Evidence from diverse settings suggests that women often have limited control over their own reproductive health decisions. To increase uptake of preventive services and behaviors, it is important to understand how intrafamilial power dynamics and the attitudes of women, their husband and their mother-in-law are associated with maternal health practices. METHODS: In 317 households in two rural districts of central Mali, women who had given birth in the previous year, their husband and their mother-in-law each completed a survey gauging their attitudes toward constructs of gender, power and health. Bivariate and multivariable logistic regression analyses were conducted to identify associations with four maternal health outcomes: antenatal care frequency, antenatal care timing, institutional delivery and postnatal care. RESULTS: In multivariable analyses, the preferences and opinions of mothers-in-law were associated with the maternal health behaviors of their daughters-in-law. Women's own perceptions of their self-efficacy, the value of women in society and the quality of services at the local health facility were also independently associated with their preventive and health-seeking practices. Husbands' preferences and opinions were not associated with any outcome. CONCLUSION: Interventions focusing on women or couples may be insufficient to advance women's reproductive health in patriarchal societies such as Mali. Future research and programmatic efforts need to address gender norms and consider the influence of other family members, such as mothers-in-law.
International family planning fellowship program: advanced training in family planning to reduce unsafe abortion.
Dalton VK, Xu X, Mullan P … +4 more , Danso KA, Kwawukume Y, Gyan K, Johnson TR
Int Perspect Sex Reprod Health · 2013 Mar · PMID 23584467 · Publisher ↗
Maternal mortality remains a huge problem in the developing world, especially in Sub-Saharan Africa.1 According to the World Health Organization, efforts intended to decrease maternal deaths need to recognize and address...
Maternal mortality remains a huge problem in the developing world, especially in Sub-Saharan Africa.1 According to the World Health Organization, efforts intended to decrease maternal deaths need to recognize and address unsafe abortions as a significant contributor to the high rates of maternal mortality found in developing countries.2,3 In Africa, where abortions are highly restricted, 680 women die per 100,000 abortions, compared with 0.2-1.2 women per 100,000 in developed countries, where most abortions are legal.4.
Understanding global trends in maternal mortality.
Zureick-Brown S, Newby H, Chou D … +4 more , Mizoguchi N, Say L, Suzuki E, Wilmoth J
Int Perspect Sex Reprod Health · 2013 Mar · PMID 23584466 · Full text
CONTEXT: Despite the fact that most maternal deaths are preventable, maternal mortality remains high in many developing countries. Target A of Millennium Development Goal (MDG) 5 calls for a three-quarters reduction in t...
CONTEXT: Despite the fact that most maternal deaths are preventable, maternal mortality remains high in many developing countries. Target A of Millennium Development Goal (MDG) 5 calls for a three-quarters reduction in the maternal mortality ratio (MMR) between 1990 and 2015. METHODS: We derived estimates of maternal mortality for 172 countries over the period 1990-2008. Trends in maternal mortality were estimated either directly from vital registration data or from a hierarchical or multilevel model, depending on the data available for a particular country. RESULTS: The annual number of maternal deaths worldwide declined by 34% between 1990 and 2008, from approximately 546,000 to 358,000 deaths. The estimated MMR for the world as a whole also declined by 34% over this period, falling from 400 to 260 maternal deaths per 100,000 live births. Between 1990 and 2008, the majority of the global burden of maternal deaths shifted from Asia to Sub-Saharan Africa. Differential trends in fertility, the HIV/AIDS epidemic and access to reproductive health are associated with the shift in the burden of maternal deaths from Asia to Sub-Saharan Africa. CONCLUSIONS: Although the estimated annual rate of decline in the global MMR in 1990-2008 (2.3%) fell short of the level needed to meet the MDG 5 target, it was much faster than had been thought previously. Targeted efforts to improve access to quality maternal health care, as well as efforts to decrease unintended pregnancies through family planning, are necessary to further reduce the global burden of maternal mortality.
Predictors of sexual debut among young adolescents in Nairobi's informal settlements.
Marston M, Beguy D, Kabiru C … +1 more , Cleland J
Int Perspect Sex Reprod Health · 2013 Mar · PMID 23584465 · Full text
CONTEXT: There is a need to better understand the various social, psychosocial and behavioral factors associated with sexual activity among young adolescents in various settings in Sub-Saharan Africa. METHODS: Data were...
CONTEXT: There is a need to better understand the various social, psychosocial and behavioral factors associated with sexual activity among young adolescents in various settings in Sub-Saharan Africa. METHODS: Data were drawn from Wave 1 (2007-2008) and Wave 2 (2009) of the Transition to Adulthood study, which collected information about key markers of the transition to adulthood and social, demographic and psychosocial characteristics of male and female youth living in two informal settlements in Nairobi, Kenya. Logistic regression analyses were used to examine variables associated with experience of sexual debut by Wave 2 among youth who were aged 12-16 and sexually inexperienced at Wave 1. RESULTS: Of the 1,754 youth in the sample, 92 experienced sexual debut between survey waves. For both males and females, sexual debut was positively associated with having permanently dropped out of school (odds ratios, 6.9 and 21.8, respectively), having never attended school (8.6 and 39.4) and having experienced severe family dysfunction (2.8 and 5.7). Lack of parental supervision was a predictor of sexual debut among males only (10.1), whereas low aspiration was a predictor among females only (10.4). Surprisingly, young women, as well as men, who did not have high self-esteem were less likely than those who did to initiate first sex between waves (0.4 and 0.3). CONCLUSIONS: Study findings underscore the importance of school attendance, family dysfunction, parental supervision and self-esteem in driving sexual behavior in this age-group. Further studies are warranted to elucidate how these factors can be addressed in prevention programs for young adolescents.
Social desirability bias in sexual behavior reporting: evidence from an interview mode experiment in rural Malawi.
Kelly CA, Soler-Hampejsek E, Mensch BS … +1 more , Hewett PC
Int Perspect Sex Reprod Health · 2013 Mar · PMID 23584464 · Full text
CONTEXT: Social desirability bias is problematic in studies that rely on self-reported sexual behavior data. Where gender norms create different expectations about socially acceptable behavior, males and females face dis...
CONTEXT: Social desirability bias is problematic in studies that rely on self-reported sexual behavior data. Where gender norms create different expectations about socially acceptable behavior, males and females face distinct pressures in reporting certain outcomes, which can distort assessments of risk for HIV and STIs. METHODS: In 2009, relationship and sexual behavior data were collected from 1,750 never-married males and females aged 16-18 via audio computer-assisted self-interviewing (audio-CASI) during the third round of the Malawi Schooling and Adolescent Study. A comparison group of 311 youth completed an identical questionnaire in face-to-face interviews. To assess whether interview mode may have influenced participants' reporting of sensitive behavior, reports of sexual experience in the two groups were compared. Multiple logistic regression analysis was used to identify associations between interview mode and reports of these behaviors, by gender. RESULTS: In adjusted regression models, males were less likely to report ever having had a girlfriend in audio-CASI than in face-to-face interviews (odds ratio, 0.4), but they were more likely to report having had sex with a relative or teacher (3.5). For females, reports of ever having had a boyfriend or having had sex did not differ between modes. A small proportion of females reported ever having had sex with a relative or teacher in audio-CASI, while none did so in face-to-face interviews. CONCLUSIONS: The method used for collecting relationship and sexual behavior data may influence the reported prevalence of some key behaviors, particularly among males. Further research is needed to improve methods of collecting sensitive data.
Early marriage, marital relations and intimate partner violence in Ethiopia.
Erulkar A
Int Perspect Sex Reprod Health · 2013 Mar · PMID 23584463 · Publisher ↗
CONTEXT: A considerable proportion of women worldwide are married during childhood. Although many studies have examined early marriage (before age 18), few have compared outcomes or correlates among girls married during...
CONTEXT: A considerable proportion of women worldwide are married during childhood. Although many studies have examined early marriage (before age 18), few have compared outcomes or correlates among girls married during different stages of adolescence or have focused on girls married very early (before age 15). METHODS: Data from a population-based survey conducted in 2009-2010 in seven Ethiopian regions were used to examine early marriage among 1,671 women aged 20-24. Cross-tabulations and logistic regression were used to compare characteristics and contextual factors among girls married before age 15, at ages 15-17 or at ages 18-19 and to identify factors associated with selected marital outcomes. RESULTS: Seventeen percent of respondents had married before age 15 and 30% had married at ages 15-17. Most of those who married before age 18 had never been to school. Compared with young women who had married at ages 18-19, those married before age 15 were less likely to have known about the marriage beforehand (odds ratio, 0.2) and more likely to have experienced forced first marital sex (3.8). Educational attainment was positively associated with foreknowledge and wantedness of marriage and with high levels of marital discussions about fertility and reproductive health issues. CONCLUSIONS: Initiatives addressing the earliest child marriages should focus on girls who have left or never attended school. Given the vulnerability of girls married before age 15, programs should pay special attention to delaying very early marriages.
Community-based distribution of injectable contraceptives: introduction strategies in four sub-Saharan African countries.
Hoke T, Brunie A, Krueger K … +5 more , Dreisbach C, Akol A, Rabenja NL, Olawo A, Stanback J
Int Perspect Sex Reprod Health · 2012 Dec · PMID 23318171 · Publisher ↗
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