International family planning perspectives最新文献

Context: More and more Chinese adolescents are engaging in premarital sexual activity. As a result, the numbers of unplanned pregnancies and sexually transmitted infections (STIs) among Chinese young adults have increased markedly.

Methods: A comprehensive sex education program, including information on abstinence, contraception and healthy sexual behaviors, was carried out in a suburb of Shanghai. The program used six methods for providing information and services to unmarried 15-24-year-olds over a period of 20 months. Sexual behavior surveys were conducted among intervention participants and among controls in a comparable town, who did not receive a similar intervention; chi-square tests and logistic regression were used to compare the results.

Results: Participation in the intervention was not associated with delayed sexual initiation, but was associated with reduced odds that youth coerced a partner into having sex (odds ratio, 0.3) and with increased odds of contraceptive use (6.2) and condom use (13.3) during the intervention period. The greater the level of participation, the larger the protective effects. Furthermore, the proportion of youth reporting pregnancy involvement during the intervention period was significantly lower in the intervention group than among controls (19% vs. 26%).

Conclusion: Comprehensive, community-based interventions may be effective in reaching large numbers of Chinese youth and in promoting sexual negotiation, contraceptive use, and pregnancy and STI/HIV prevention.

Context: Most HIV prevention efforts focus on premarital and extramarital sexual behavior, but in areas with high HIV prevalence the protective needs of married and cohabiting couples are just as great and often go unmet. Condom use by these couples is generally low, with resistance from men and cultural norms commonly cited as barriers to increased use.

Methods: A household survey was conducted in an urban and a rural area in KwaZulu-Natal, South Africa, in 1999-2000. From this survey, matched partners in 238 marital or cohabiting relationships were independently interviewed about condom use and attitudes toward condoms, knowledge of AIDS/HIV risk and self-efficacy in preventing HIV infection. Logistic regression analysis was used to assess relationships between condom use and selected demographic and HIV prevention characteristics.

Results: Although couples' knowledge of condoms and where to obtain them was very high, only 15% of men and 18% of women reported consistent or occasional use. The level of use was 8% and 11% among men and women, respectively, in rural, less educated couples, and 29% and 34% among men and women in urban, more educated couples. A majority of urban women had favorable attitudes toward condoms, and they also reported higher self-efficacy regarding HIV prevention than did rural women. A woman's perceived risk of HIV infection from her partner was the most powerful predictor of condom use (odds ratio, 4.0).

Conclusions: The common belief that men's resistance to condom use within stable relationships cannot be overcome may be exaggerated. HIV prevention programs should address the reproductive health needs of these couples.

Context: Although many research studies have documented the relationship between menstrual side effects of contraceptives and discontinuation of use, few have sought to identify factors that predispose women to discontinue because of changes in bleeding patterns. Such information is important to enable family planning providers to better help women and couples choose appropriate methods and use them successfully.

Methods: Forty-eight women participating in six focus group discussions described their experiences using the IUD, the hormonal implant or the three-month injectable. Subsequently, 259 women using one of these methods for the first time were followed for up to 18 months to determine patterns of menstrual bleeding and perceptions of menstrual cycle change over time. Multivariable analytical methods were used to examine the associations between selected measures and method discontinuation.

Results: Contraceptive discontinuation differed by method: Nearly 70% of injectable users had stopped using their chosen method after one year, compared with 34% of IUD users and 10% of implant users. Before initiating a method, women reported an average of five bleeding days per cycle. During the first six months of use, IUD users reported an average of six days of bleeding per cycle; injectable and implant users reported 11-12. In multivariable models, each additional day of bleeding was significantly associated with a 2-4% increase in discontinuation, depending on method type. Among IUD users, women whose husbands knew that they had visited a clinic to initiate a method were less likely than others to discontinue method use (hazard ratio, -1.9). Age was significantly associated with decreased discontinuation among implant users.

Conclusion: Counseling about bleeding and other side effects should be tailored to women's personal contexts and contraceptive experiences.