International Perspectives On Sexual And Reproductive Health[JOURNAL]
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200 papers
A study of refugee maternal mortality in 10 countries, 2008-2010.
Hynes M, Sakani O, Spiegel P … +1 more , Cornier N
Int Perspect Sex Reprod Health · 2012 Dec · PMID 23318170 · Publisher ↗
CONTEXT: Little is known about the prevalence of maternal mortality in refugee camps for populations displaced by conflict, or about the factors contributing to such deaths. METHODS: Maternal Death Review Reports were us...
CONTEXT: Little is known about the prevalence of maternal mortality in refugee camps for populations displaced by conflict, or about the factors contributing to such deaths. METHODS: Maternal Death Review Reports were used to analyze maternal deaths that occurred in 2008-2010 in 25 refugee camps in 10 countries. Assessed outcomes included causes of death; delays in women seeking, reaching or receiving care; and additional aspects of case management. We conducted detailed analyses of avoidable factors that contributed to deaths in Kenya, where the majority of reported cases occurred. RESULTS: Reports were available on 108 deaths, including 68 in Kenya. In every country but Bangladesh, maternal mortality ratios were lower among refugees than among the host population. The proportion of women who had had four or more antenatal care visits was lower among refugee women who had died (33%) than among the general refugee population (79%). Seventy-eight percent of the maternal deaths followed delivery or abortion, and 56% of those deaths occurred within 24 hours. Delays in seeking and receiving care were more prevalent than delays in reaching care. In Kenya, delays in seeking or accepting care and provider failure to recognize the severity of the woman's condition were the most common avoidable contributing factors. CONCLUSIONS: Additional interventions in community outreach, service delivery and supervision are needed to improve maternal outcomes in refugee populations.
The timing of sexual debut among Chinese youth.
Guo W, Wu Z, Qiu Y … +2 more , Chen G, Zheng X
Int Perspect Sex Reprod Health · 2012 Dec · PMID 23318169 · Publisher ↗
CONTEXT: The age at sexual debut is declining in China, but little is known about the relationship between the social and demographic characteristics of Chinese youth and the timing of debut. METHODS: Data were drawn fro...
CONTEXT: The age at sexual debut is declining in China, but little is known about the relationship between the social and demographic characteristics of Chinese youth and the timing of debut. METHODS: Data were drawn from the 2009 National Youth Reproductive Health Survey, which collected background information and age at sexual debut from 22,300 unmarried youth aged 15-24. Life table analysis was used to estimate the gender-specific distributions of sexual debut by age, according to urban or rural residence and by region. Cox proportional hazard regression models were then employed to identify characteristics associated with the timing of debut among males and females. RESULTS: The mean age at sexual debut was 22.8 years (22.5 years for men and 23.1 years for women). Sexual debut before age 18 was rare for both genders, and ages 21-24 appear to be the normative range for sexual debut. Life table analysis found that debut was earlier for males than for females, for those living in a rural area than for those in urban areas, and for those living in western China than for those in other regions. In multivariate hazard regression analysis, males had a 30% greater risk of experiencing sexual debut within each year of age than did females. Living in a household with both biological parents, having a father with a junior or senior high school education, being a college graduate and living in an urban area were associated with a reduced risk of experiencing sexual debut. CONCLUSION: This study provides insight into the basic patterns and social and demographic correlates of sexual debut among Chinese youth.
Sterilization regret among married women in India: implications for the Indian national family planning program.
Singh A, Ogollah R, Ram F … +1 more , Pallikadavath S
Int Perspect Sex Reprod Health · 2012 Dec · PMID 23318168 · Publisher ↗
CONTEXT: In India, female sterilization accounts for 66% of contraceptive use, and age at sterilization is declining. It is likely that some women regret having been sterilized, but data on the prevalence of, and the soc...
CONTEXT: In India, female sterilization accounts for 66% of contraceptive use, and age at sterilization is declining. It is likely that some women regret having been sterilized, but data on the prevalence of, and the social and economic correlates of, regret at the national level are insufficient. METHODS: Data for analysis came from 30,999 sterilized women aged 15-49 interviewed in the 2005-2006 Indian National Family Health Survey. Logistic regression analyses and Wald tests were used to identify the social and demographic characteristics associated with sterilization regret. RESULTS: Nationally, 5% of sterilized women aged 15-49 reported sterilization regret. Women sterilized at age 30 or older were less likely than women sterilized before age 25 to express regret (odds ratio, 0.8). Compared with women having only sons, those who had only daughters were more likely to express regret (1.3), while those having both sons and daughters were less likely to express regret (0.8). Women who had experienced child loss had higher odds of reporting regret than women who had not (for one child lost, 1.6; for two or more children lost, 2.0). CONCLUSIONS: Given the large proportion of women undergoing sterilization, the potential numbers experiencing regret are considerable. If age at sterilization continues to decline, sterilization regret is likely to increase. Encouraging couples to delay sterilization and increasing the availability of highly effective reversible contraceptives are options that India may consider to avert sterilization regret.
The desire for sons and excess fertility: a household-level analysis of parity progression in India.
Chaudhuri S
Int Perspect Sex Reprod Health · 2012 Dec · PMID 23318167 · Publisher ↗
CONTEXT: The desire for sons often influences fertility behavior in India. Women with a small number or low proportion of sons may be more likely than other women to continue childbearing. METHODS: Data from India's 2005...
CONTEXT: The desire for sons often influences fertility behavior in India. Women with a small number or low proportion of sons may be more likely than other women to continue childbearing. METHODS: Data from India's 2005-2006 National Family Health Survey were used to examine several hypotheses regarding the association between sex composition of children and parity progression among parous women aged 35-49. Descriptive analyses and multivariate logistic regression analysis that controlled for possible confounders were performed separately by parity. RESULTS: Women with more sons than daughters were generally less likely than those with more daughters than sons to continue childbearing; parity progression driven by the desire for sons accounted for 7% of births. At any given parity, the last-born child of women who had stopped childbearing was more likely to be a son than a daughter (sex ratios, 133-157). In multivariate analyses, women without any sons were more likely than women without any daughters to continue childbearing at parities 1-4 (odds ratios, 1.4-4.5). At most or all parities, continued childbearing was positively associated with having had a child who died, and negatively associated with levels of women's education and media exposure and with household wealth. CONCLUSIONS: The desire for sons appears to be a significant motivation for parity progression. Although population policies that reduce family size are essential, also imperative are policies that reduce desire for sons by challenging the perception that sons are more valuable than daughters.
Use of medicines changing the face of abortion.
Winikoff B, Sheldon W
Int Perspect Sex Reprod Health · 2012 Sep · PMID 23018138 · Publisher ↗
Abstract loading — click title to view on PubMed.
Attitudes and intentions regarding abortion provision among medical school students in South Africa.
Wheeler SB, Zullig LL, Reeve BB … +2 more , Buga GA, Morroni C
Int Perspect Sex Reprod Health · 2012 Sep · PMID 23018137 · Full text
CONTEXT: Although South Africa liberalized its abortion law in 1996, significant barriers still impede service provision, including the lack of trained and willing providers. A better understanding is needed of medical s...
CONTEXT: Although South Africa liberalized its abortion law in 1996, significant barriers still impede service provision, including the lack of trained and willing providers. A better understanding is needed of medical students' attitudes, beliefs and intentions regarding abortion provision. METHODS: Surveys about abortion attitudes, beliefs and practice intentions were conducted in 2005 and 2007 among 1,308 medical school students attending the University of Cape Town and Walter Sisulu University in South Africa. Bivariate and multivariate analyses identified associations between students' characteristics and their general and conditional support for abortion provision, as well as their intention to act according to personal attitudes and beliefs. RESULTS: Seventy percent of medical students believed that women should have the right to decide whether to have an abortion, and large majorities thought that abortion should be legal in a variety of medical circumstances. Nearly one-quarter of students intended to perform abortions once they were qualified, and 72% said that conscientiously objecting clinicians should be required to refer women for such services. However, one-fifth of students believed that abortion should not be allowed for any reason. Advanced medical students were more likely than others to support abortion provision. In multivariate analyses, year in medical school, race or ethnicity, religious affiliation, relationship status and sexual experience were associated with attitudes, beliefs and intentions regarding provision. CONCLUSIONS: Academic medical institutions must ensure that students understand their responsibilities with respect to abortion care--regardless of their personal views--and must provide appropriate abortion training to those who are willing to offer these services in the future.
Legal abortion levels and trends by woman's age at termination.
Sedgh G, Bankole A, Singh S … +1 more , Eilers M
Int Perspect Sex Reprod Health · 2012 Sep · PMID 23018136 · Publisher ↗
CONTEXT: Assessments of abortion levels and trends by women's age at termination can be used to monitor trends in unintended pregnancy by age and can inform relevant programs and policies. METHODS: Legal abortion inciden...
CONTEXT: Assessments of abortion levels and trends by women's age at termination can be used to monitor trends in unintended pregnancy by age and can inform relevant programs and policies. METHODS: Legal abortion incidence data were compiled from national statistical offices and nationally representative surveys of more than 40 countries where legal abortion is generally available. Age-specific abortion rates and percentage distributions of abortions by age were computed, and trends since 1996 and 2003 were examined. Subregional and regional estimates were developed for geographic areas where the majority of the population was represented by the data. RESULTS: The median year for the most recent estimates of abortions by woman's age was 2009. Adolescents accounted for a smaller share of abortions than their share of the population in the majority of eligible countries with data. In most countries, the highest age-specific abortion rates and proportions of abortions were among women aged 20-29. Since 1996, adolescent abortion rates have increased the most in Belgium, the Netherlands and Scotland (22-42%), and have decreased the most in Estonia, Hungary, Iceland, Slovakia and Slovenia (40-55%). The proportion of abortions obtained by adolescents was higher in North America (18%) than in Europe overall (11%), although the proportion in Northern Europe (18%) was the same as that in North America. CONCLUSIONS: Higher abortion rates in particular age-groups probably reflect higher-than-average levels of unmet need for contraception or difficulty using methods consistently and effectively, and a stronger desire to avoid childbearing. Each of the patterns observed has implications for service and information needs within countries.
Feasibility of expanding the medication abortion provider base in India to include ayurvedic physicians and nurses.
Jejeebhoy SJ, Kalyanwala S, Mundle S … +5 more , Tank J, Zavier AJ, Kumar R, Acharya R, Jha N
Int Perspect Sex Reprod Health · 2012 Sep · PMID 23018135 · Publisher ↗
CONTEXT: The availability of trained abortion providers is limited in India. Allowing ayurvedic physicians and nurses to perform medication abortions may improve women's access to the procedure, but it is unclear whether...
CONTEXT: The availability of trained abortion providers is limited in India. Allowing ayurvedic physicians and nurses to perform medication abortions may improve women's access to the procedure, but it is unclear whether these clinicians can provide these services safely and effectively. METHODS: Allopathic physicians, ayurvedic physicians and nurses (10 of each), none of whom had experience in abortion provision, were trained to perform medication abortions. In 2008-2010, these providers performed medication abortions in five clinics in Bihar and Jharkhand for 1,225 women with a pregnancy of up to eight weeks' gestation. A two-sided equivalence design was used to test whether providers' assessments of client eligibility and completeness of abortion matched those of an experienced physician "verifier," and whether medication abortions performed by nurses and ayurvedic physicians were as safe and effective as those done by allopathic physicians. RESULTS: Failure rates were low (5-6%), and those for nurses and ayurvedic physicians were statistically equivalent to those for allopathic physicians. Provider assessments of client eligibility and completeness of abortion differed from those of the verifier in only a small proportion of cases (3-4% for eligibility and 4-5% for completeness); these proportions, and rates of loss to follow-up, were statistically equivalent among provider types. No serious complications were observed, and services by all three groups of providers were acceptable to women. CONCLUSION: Findings support amending existing laws to improve women's access to medication abortion by expanding the provider base to include ayurvedic physicians and nurses.
The incidence of menstrual regulation procedures and abortion in Bangladesh, 2010.
Singh S, Hossain A, Maddow-Zimet I … +3 more , Ullah Bhuiyan H, Vlassoff M, Hussain R
Int Perspect Sex Reprod Health · 2012 Sep · PMID 23018134 · Publisher ↗
CONTEXT: Bangladesh is unique in including menstrual regulation (MR) services as part of the government family planning program, despite having a highly restrictive abortion law. The only national estimates of MR and abo...
CONTEXT: Bangladesh is unique in including menstrual regulation (MR) services as part of the government family planning program, despite having a highly restrictive abortion law. The only national estimates of MR and abortion incidence are from a 1995 study, and updated information is needed to inform policies and programs regarding the provision of MR and related reproductive health services. METHODS: Surveys of a nationally representative sample of 670 health facilities that provide MR and postabortion care services and of 151 knowledgeable professionals were conducted in 2010, and MR service statistics of nongovernmental organizations were compiled. Indirect estimation techniques were applied to calculate the incidence and rates of MR and induced abortion. RESULTS: In 2010, an estimated 647,000 induced abortions were performed in Bangladesh, and 231,400 women were treated for complications of such abortions. Furthermore, an estimated 653,000 MR procedures were performed at facilities nationwide. However, an estimated 26% of all women seeking an MR at facilities were turned away, and about one in 10 of those who had an MR were treated for complications. Nationally, the annual abortion rate was 18.2 per 1,000 women aged 15-44, and the MR rate was 18.3 per 1,000 women. CONCLUSIONS: The incidence of induced abortion is the same as that of MR, which suggests considerable unsatisfied demand for the latter service. Furthermore, the high rates of complications from MRs highlight the need to improve the quality of clinical services. Increased access to contraceptives and MR services would help reduce rates of unplanned pregnancy and unsafe abortion.
Ethnic inequality in Guatemalan women's use of modern reproductive health care.
Ishida K, Stupp P, Turcios-Ruiz R … +2 more , William DB, Espinoza E
Int Perspect Sex Reprod Health · 2012 Jun · PMID 22832150 · Publisher ↗
CONTEXT: Guatemala has some of the poorest reproductive health indices and largest disparities in health in Latin America, particularly between indigenous and ladina women. To reduce these disparities, it is necessary to...
CONTEXT: Guatemala has some of the poorest reproductive health indices and largest disparities in health in Latin America, particularly between indigenous and ladina women. To reduce these disparities, it is necessary to understand how indigenous women's disadvantages in linguistic, socioeconomic or residential characteristics relate to their underutilization of reproductive health services. METHODS: Logistic regression analyses of a nationally representative sample of women aged 15-49 from the 2008-2009 National Survey of Maternal and Infant Health were used to estimate ethnic disparities in women's use of institutional prenatal care and delivery, and in met demand for modern contraceptives. Using predicted probabilities, we estimated the extent to which these disparities were attributable to a language barrier among indigenous women and to their disadvantage in selected socioeconomic and residential characteristics. RESULTS: The ethnic difference in use of institutional prenatal care was small; however, institutional delivery was far less common among indigenous women than among ladina women (36% vs. 73%), as was met need for modern contraceptives (49% vs. 72%). Not speaking Spanish accounted for the largest portion of these ethnic differentials. Indigenous women's poor education and rural residence made up smaller portions of the ethnic differential in modern contraceptive use than did their economic disadvantage. CONCLUSION: The large proportion of indigenous women who use institutional prenatal care suggests that further integrating the three services may increase their use of institutional delivery and modern contraceptives. Adding speakers of local Mayan languages to the staff of health facilities could also help increase use.
Treatment-seeking for symptoms of reproductive tract infections among young women in India.
Sabarwal S, Santhya KG
Int Perspect Sex Reprod Health · 2012 Jun · PMID 22832149 · Publisher ↗
CONTEXT: Small proportions of Indian women report seeking treatment for symptoms suggestive of reproductive tract infections (RTIs). Most studies on treatment-seeking have focused broadly on women of reproductive age, an...
CONTEXT: Small proportions of Indian women report seeking treatment for symptoms suggestive of reproductive tract infections (RTIs). Most studies on treatment-seeking have focused broadly on women of reproductive age, and little is known about the experiences of adolescent girls and young women, particularly the unmarried. METHODS: Data from 2,742 married and 2,108 unmarried women aged 15-24 who reported at least one symptom of an RTI in the past three months were drawn from a subnationally representative survey of youth in India in 2006-2008. Multivariate logistic regression analysis was conducted to identify associations between respondents' characteristics and treatment-seeking from a formal medical provider. In addition, among those who had used such providers, associations between characteristics and use of private rather than public providers were identified. RESULTS: About two-fifths of married and one-third of unmarried women had sought treatment from formal medical providers for their RTI symptoms. While married women's experience of intimate partner violence was negatively associated with seeking treatment from a formal provider (odds ratio, 0.8), their perceived access to sexual and reproductive health services and their awareness of STI symptoms were positively associated with such treatment (1.3-1.4). Both married and unmarried women were more likely to seek treatment from private than from public providers, and two indicators of women's autonomy were positively correlated with using private providers (1.6-2.8). CONCLUSIONS: Limited treatment-seeking for RTI symptoms by young women underscores the need to address power imbalances within marriage and to encourage health care providers to develop appropriate strategies to reach younger, as well as unmarried, women.
Women's empowerment and ideal family size: an examination of DHS empowerment measures in Sub-Saharan Africa.
Upadhyay UD, Karasek D
Int Perspect Sex Reprod Health · 2012 Jun · PMID 22832148 · Publisher ↗
CONTEXT: The Demographic and Health Survey (DHS) program collects data on women's empowerment, but little is known about how these measures perform in Sub-Saharan African countries. It is important to understand whether...
CONTEXT: The Demographic and Health Survey (DHS) program collects data on women's empowerment, but little is known about how these measures perform in Sub-Saharan African countries. It is important to understand whether women's empowerment is associated with their ideal number of children and ability to limit fertility to that ideal number in the Sub-Saharan African context. METHODS: The analysis used couples data from DHS surveys in four Sub-Saharan African countries: Guinea, Mali, Namibia and Zambia. Women's empowerment was measured by participation in household decision making, attitudes toward wife beating and attitudes toward refusing sex with one's husband. Multivariable linear regression was used to model women's ideal number of children, and multivariable logistic regression was used to model women's odds of having more children than their ideal. RESULTS: In Guinea and Zambia, negative attitudes toward wife beating were associated with having a smaller ideal number of children (beta coefficients, -0.5 and -0.3, respectively). Greater household decision making was associated with a smaller ideal number of children only in Guinea (beta coefficient, -0.3). Additionally, household decision making and positive attitudes toward women's right to refuse sex were associated with elevated odds of having more children than desired in Namibia and Zambia, respectively (odds ratios, 2.3 and 1.4); negative attitudes toward wife beating were associated with reduced odds of the outcome in Mali (0.4). CONCLUSIONS: Women's empowerment--as assessed using currently available measures--is not consistently associated with a desire for smaller families or the ability to achieve desired fertility in these Sub-Saharan African countries. Further research is needed to determine what measures are most applicable for these contexts.
Increasing postpartum contraception in rural India: evaluation of a community-based behavior change communication intervention.
Sebastian MP, Khan ME, Kumari K … +1 more , Idnani R
Int Perspect Sex Reprod Health · 2012 Jun · PMID 22832147 · Publisher ↗
CONTEXT: The Indian family planning program, though successful in increasing contraceptive use among couples who have achieved their desired family size, has not been equally successful in educating couples about the use...
CONTEXT: The Indian family planning program, though successful in increasing contraceptive use among couples who have achieved their desired family size, has not been equally successful in educating couples about the use of contraceptive methods for birth spacing. METHODS: An evaluation was conducted of a behavior change communication intervention integrated into the existing government program to increase knowledge and use of the lactational amenorrhea method and postpartum contraception through counseling by community workers. The intervention, which ran between September 2006 and January 2007, was conducted among 959 pregnant women aged 15-24 who lived in Uttar Pradesh, India. The evaluation used logistic regression analyses to measure differences in knowledge and contraceptive use between baseline and the four- and nine-month postpartum follow-up surveys within and between the intervention and comparison groups. RESULTS: The follow-up data show increases in knowledge of the lactational amenorrhea method and spacing methods and in use of spacing methods. At four months postpartum, women in the intervention group were more likely to know the healthy spacing messages than those in the comparison group (odds ratio, 2.1). At nine months postpartum, women in the intervention group, those with higher knowledge of healthy spacing practices and those with correct knowledge of two or more spacing methods were more likely than others to be using a contraceptive method (1.5-3.5). Use of modern contraceptives for spacing at nine months postpartum was 57% in the intervention group versus 30% in the comparison group. CONCLUSIONS: Targeted behavior change communication using community workers is an effective and feasible strategy for promoting postpartum contraception.
Incidence of induced abortion by age and state, Mexico, 2009: new estimates using a modified methodology.
Juarez F, Singh S
Int Perspect Sex Reprod Health · 2012 Jun · PMID 22832146 · Publisher ↗
CONTEXT: Because abortion laws in Mexico, which are generally highly restrictive, are determined by individual states, state-level data are essential for policymakers to make informed decisions. In addition, age-specific...
CONTEXT: Because abortion laws in Mexico, which are generally highly restrictive, are determined by individual states, state-level data are essential for policymakers to make informed decisions. In addition, age-specific abortion estimates are needed, given societal concern about young women's risk for unwanted pregnancy and abortion. METHODS: The Abortion Incidence Complications Method, an established approach designed to obtain national and broad regional estimates, was extended to produce for the first time estimates for age-groups and states. Data included government statistics on postabortion patients and health professionals' estimates concerning abortion complications. States were classified into six regions according to level of development. RESULTS: In 2009, the abortion rate in Mexico was 38 per 1,000 women aged 15-44. The rate was 54 per 1,000 in Region 1 (Mexico City), the most developed region; 35-41 per 1,000 in Regions 2, 3 and 4, which are moderately developed; and 26-27 in Regions 5 and 6, which are the least developed. States' rates of abortion incidence and treatment for induced abortion complications were generally consistent with development level, although exceptions emerged. Age-specific abortion rates peaked among women aged 20-24 and then steadily declined with age; this pattern was observed nationally, regionally and in most states. CONCLUSION: Extension of the Abortion Incidence Complications Method to obtain state- and age-specific data is feasible. Unsafe abortion is common in all states of Mexico, especially among women aged 15-24, suggesting a need for improved family planning and postabortion services.
Spousal separation and interpretation of contraceptive use and unmet need in rural Nepal.
Ban B, Karki S, Shrestha A … +1 more , Hodgins S
Int Perspect Sex Reprod Health · 2012 Mar · PMID 22481148 · Publisher ↗
Abstract loading — click title to view on PubMed.
Stability and change in fertility preferences among young women in Malawi.
Sennott C, Yeatman S
Int Perspect Sex Reprod Health · 2012 Mar · PMID 22481147 · Full text
CONTEXT: Although studies have demonstrated change in fertility preferences over time, there is a lack of definitive knowledge about the level and direction of change among individuals, especially young and unmarried wom...
CONTEXT: Although studies have demonstrated change in fertility preferences over time, there is a lack of definitive knowledge about the level and direction of change among individuals, especially young and unmarried women. Furthermore, little is known about the factors associated with changes in fertility preferences over time. METHOD: The analysis uses the first five waves of data from a longitudinal study of a random sample of women aged 15-25 in southern Malawi. The data were collected four months apart over an 18-month period, between June 2009 and December 2010. Multinomial logit regression models were used to calculate relative risk ratios and identify associations between four categories of life events-reproductive, relationship, health and economic-and shifts in fertility timing preferences. RESULTS: In each four-month period, more than half of the women reported changes in the desired timing of their next birth, and delays and accelerations in timing desires were common. Several life events, including having a child, entering a serious relationship and changes in household finances were associated with changes in the level and direction of fertility preference. CONCLUSION: Shifts in fertility timing preferences often occur in response to changes in life circumstances. Understanding the reasons for these shifts may aid family planning providers in meeting women's contraceptive needs.
Women's empowerment and choice of contraceptive methods in selected African countries.
Do M, Kurimoto N
Int Perspect Sex Reprod Health · 2012 Mar · PMID 22481146 · Publisher ↗
CONTEXT: It is generally believed that women's lack of decision-making power may restrict their use of modern contraceptives. However, few studies have examined the different dimensions of women's empowerment and contrac...
CONTEXT: It is generally believed that women's lack of decision-making power may restrict their use of modern contraceptives. However, few studies have examined the different dimensions of women's empowerment and contraceptive use in African countries. METHODS: Data came from the latest round of Demographic and Health Surveys conducted between 2006 and 2008 in Namibia, Zambia, Ghana and Uganda. Responses from married or cohabiting women aged 15-49 were analyzed for six dimensions of empowerment and the current use of female-only methods or couple methods. Bivariate and multivariate multinomial regressions were used to identify associations between the empowerment dimensions and method use. RESULTS: Positive associations were found between the overall empowerment score and method use in all countries (relative risk ratios, 1.1-1.3). In multivariate analysis, household economic decision making was associated with the use of either female-only or couple methods (1.1 for all), as was agreement on fertility preferences (1.3-1.6) and the ability to negotiate sexual activity (1.1-1.2). In Namibia, women's negative attitudes toward domestic violence were correlated with the use of couple methods (1.1). CONCLUSIONS: Intervention programs aimed at increasing contraceptive use may need to involve different approaches, including promoting couples' discussion of fertility preferences and family planning, improving women's self-efficacy in negotiating sexual activity and increasing their economic independence.
Fertility differences among developing countries: are they still related to family planning program efforts and social settings?
Jain AK, Ross JA
Int Perspect Sex Reprod Health · 2012 Mar · PMID 22481145 · Publisher ↗
CONTEXT: In many developing countries, fertility has declined steadily in recent decades, while the average strength of family planning programs has increased and social conditions have improved. However, it is unclear w...
CONTEXT: In many developing countries, fertility has declined steadily in recent decades, while the average strength of family planning programs has increased and social conditions have improved. However, it is unclear whether the synergistic effect of family planning programs and social settings on fertility, first identified in the 1970s, still holds. METHODS: Data from 40 developing countries in which Demographic and Health Surveys were conducted in 2003-2010 were used to examine associations among socioeconomic conditions, family planning program effort strength and fertility. Cross-tabulations and multiple regression analyses were conducted. RESULTS: Variation among countries in scores on the Family Planning Program Effort Index, but not on the Human Development Index, has diminished since the 1970s. On average, fertility levels were lower among countries with better social settings or stronger family planning programs than among those with poorer settings or weaker programs; they were lowest in the presence of both good social settings and strong programs. In addition, fertility was positively associated with infant mortality and negatively associated with female education, but not associated with poverty. About half of the 2.3-birth difference in fertility between countries in Sub-Saharan Africa and those elsewhere can be attributed to differences in program efforts and social settings. CONCLUSIONS: Policies focused on improving levels of female education, reducing infant mortality and improving family planning services can be expected to have mutually reinforcing effects on fertility decline.
Multiple deprivations and maternal care in India.
Mohanty SK
Int Perspect Sex Reprod Health · 2012 Mar · PMID 22481144 · Publisher ↗
CONTEXT: Research on inequalities in the utilization of maternal health care services is often confined to only the economic domain. Individuals and families living in acute poverty may simultaneously experience multiple...
CONTEXT: Research on inequalities in the utilization of maternal health care services is often confined to only the economic domain. Individuals and families living in acute poverty may simultaneously experience multiple dimensions of deprivation, which together may obstruct their access to basic health services. It is important to examine the linkages between multiple deprivations and maternal health care. METHODS: Data from the 2005-2006 Indian National Family Health Survey were used to examine ever-married women's receipt of antenatal care, medical assistance during delivery and postnatal care services across three dimensions of deprivation: education, wealth and health. Bivariate analyses, principal component analyses and binomial logistic regression analyses were conducted. RESULTS: Thirty-two percent of ever-married Indian women reported being deprived in one of the three dimensions, 18% in two and 7% in all three; 43% were deprived in none. Women deprived in all three dimensions were less likely than those not deprived in any to have received antenatal care (predicted probabilities, 0.3 vs. 0.8) or postnatal care (0.2 vs. 0.7); the likelihood that a birth occurred with medical assistance was smaller for women deprived in three dimensions than for those deprived in none (0.2 vs. 0.8). These patterns held true for all of the larger Indian states. Differentials in utilization of maternal care services across deprivation levels were higher in states where service coverage was low and lower in states where service coverage was high. CONCLUSION: More research is needed to understand how multiple deprivations are associated with health inequality across cultures and how to use this knowledge to improve delivery of basic health services.
Can family planning programs reduce high desired family size in Sub-Saharan Africa?
Bongaarts J
Int Perspect Sex Reprod Health · 2011 Dec · PMID 22227628 · Publisher ↗
During the past half century, fertility declines have been pervasive in Asia and Latin America. Between the early 1950s and the early 2000s, the total fertility rate (TFR)-the average number of live births a woman would...
During the past half century, fertility declines have been pervasive in Asia and Latin America. Between the early 1950s and the early 2000s, the total fertility rate (TFR)-the average number of live births a woman would have during her lifetime, assuming constant fertility rates-dropped from 5.7 to 2.4 births per woman in Asia and from 5.9 to 2.3 births per woman in Latin America.1 Only a handful of countries in these regions still have fertility rates higher than four births per woman. In Sub-Saharan Africa, however, fertility remains high in the large majority of countries. Although some declines have occurred, the average total fertility rate in 2005-2010 exceeded 5.1 births per woman-more than double the levels observed in Asia and Latin America.
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