International family planning perspectives最新文献

Context: Women's lack of access to legal abortion is a major contributing factor to high rates of worldwide maternal mortality and morbidity. This article describes changes in the legal status of abortion in countries around the world since 1998.

Methods: The complete texts of new abortion legislation, most often obtained directly from government Web sites, were reviewed to determine changes. Background information was, where possible, also based on a review of complete legal texts. Other sources include the International Digest of Health Legislation (published by the World Health Organization) and Abortion Policies: A Global Review (published in 2002 by the Population Division of the United Nations).

Results: Since 1998, 16 countries have increased the number of grounds on which abortions may be legally performed; in two other countries, state jurisdictions expanded grounds for abortion. Two countries have removed grounds for legal abortion. Other countries maintained existing indications for abortion but adopted changes affecting access to the procedure.

Conclusions: The worldwide trend toward liberalization of abortion laws observed in 1998 has continued. Recognition of the impact of abortion restrictions on women's human rights has played an increasing role in efforts to provide access to abortion.

Context: It is important to examine whether youth from disadvantaged households are less likely than others to use a condom at first sex, even after correcting for shared characteristics within communities.

Methods: Baseline survey data from the Transitions to Adulthood in the Context of AIDS in South Africa study in KwaZulu-Natal were used. Random effects logistic regression assessed the relationship between poverty and 14-22-year-olds' use of condoms at first sex, correcting for shared characteristics of adolescents within each community.

Results: Twenty-three percent of young people had used a condom at first sex. Poor and extremely poor females had about one-third the odds of nonpoor females of using a condom at first sex, even after adjusting for community clustering; among males; however, there was no association between poverty and condom use, after adjusting for background factors and community clustering.

Conclusions: The importance of community clustering of neighborhood-level characteristics differs by gender in South Africa. Poverty remains a central risk factor for HIV among young women, regardless of the surrounding context, but not among men.

Context: Unlike in other African countries, the fertility rate in Mali has remained at a relatively high rate of 6.8 births per woman. Little research exists on the role that community norms play in use of family planning, particularly in low-prevalence countries.

Methods: Data on 7,671 women in union from the 2001 Mali Demographic and Health Survey were analyzed using multilevel modeling techniques to assess the effects of individual and community factors on the adoption of modern contraceptive methods.

Results: Only 5% of women in union were using a modern contraceptive method in 2001. The odds of contraceptive use were elevated among women in the highest wealth quintile, women who approved and whose partner approved of family planning, those who had had recent discussions on family planning with their partner or others and those exposed to family planning messages (odds ratios, 1.4-2.7). At the community level, the odds of modern contraceptive use rose with the proportion of women who were exposed to family planning messages (5.5), and decreased as the mean number of births per woman rose (0.7). In the final model, which included both individual- and community-level factors, the community factors were no longer significant.

Conclusions: Because approval of family planning and discussion of family planning with partners were shown to be the factors most strongly associated with modern contraceptive use in the multilevel model, programs that seek to increase individual approval and those that teach communication between partners could be particularly helpful to increasing contraceptive use in Mali.

Context: Violence toward pregnant women is a gross violation of human rights with adverse health consequences for the woman and potentially for her fetus; however, few studies have examined factors associated with such abuse in developing countries or with population-based data.

Methods: A sample of 2,553 ever-pregnant women aged 15-49 from one urban and one rural site in Bangladesh were surveyed in 2001 as part of a World Health Organization multicountry study. Multilevel logistic regression analysis was used to examine factors associated with physical spousal abuse of women during pregnancy.

Results: Urban and rural women whose mother or mother-in-law had experienced physical spousal abuse had increased odds of experiencing abuse during pregnancy (odds ratios, 2.1-3.4); increased spousal communication was negatively associated with the outcome in both settings (0.6 and 0.7). Among urban women, being older than 19, having a husband with more than 10 years of education and being from certain higher income quartiles were negatively associated with abuse (0.2-0.5); living in a community highly concerned about crime was positively associated with abuse (1.1). Among rural women, being able to depend on natal family support in a crisis was negatively associated with abuse (0.5); being in a marriage that involved dowry demands and being Muslim were positively associated with abuse (1.8 and 3.6, respectively).

Conclusions: The message that a family history of spousal violence increases a daughter's risk of such abuse should be widely communicated. Further research is needed to determine whether increased couple communication reduces the likelihood of violence or whether absence of violence leads to increased couple communication.

Context: Although a growing number of studies have examined how community factors influence contraceptive use, few have explored how such factors affect method choice.

Methods: Data from the 1998 South Africa Demographic and Health Survey and the 1998 Eastern Cape Facility Survey were used to examine community and health facility influences on the method choices of 1,165 women aged 15-49 who lived in the Eastern Cape. Relative risk ratios from multilevel multinomial models assessed how method choice varied between communities.

Results: The likelihood of using the pill or a more permanent method rather than the injection rose with the proportion of women in a community who controlled their earnings (risk ratios, 3.2 and 3.8, respectively). In communities with higher proportions of females with only a primary education, women were less likely to use the pill instead of the injection (0.1). Higher doctor staffing levels were associated with a greater likelihood of using the pill or a more permanent method (1.5 and 1.4), and having more expired methods in stock was associated with increased use of a more permanent method (2.1). Several facility factors were associated with a decreased likelihood of using the pill rather than the injection: higher numbers of community health workers in an area and higher numbers of facility nurses who had received training on HIV/AIDS in the last year (0.9 for each). Yet a substantial amount of variation in method choice was not accounted for by these variables.

Conclusion: Future research should emphasize the collection of community-level data on structural, behavioral and cultural factors to help explain the variation in method choice between communities.

Context: Peer-led interventions have become a popular method of providing sexual health education to adolescents, but the efficacy of this approach and the methodological quality of recent trials have not been systematically reviewed.

Methods: Electronic and hand searches were conducted to identify quasi-randomized and randomized controlled trials of peer-led adolescent sexual health education published from 1998 to 2005. Studies were eligible if they had an appropriate comparison group, provided preintervention and postintervention data, and reported all outcomes. Study results were summarized and, where appropriate, pooled; in addition, 10 aspects of studies' methodological quality were assessed.

Results: Thirteen articles met the inclusion criteria. Pooled, adjusted results from seven trials that examined the effects of peer-led interventions on condom use at last sex found no overall benefit (odds ratio, 1.0). None of the three trials that assessed consistent condom use found a benefit. One study reported a reduced risk of chlamydia (0.2), but another found no impact on STI incidence. One study found that young women (but not young men) who received peer-led education were more likely than nonrecipients to have never had sex. Most interventions produced improvements in knowledge, attitudes and intentions. Only three studies fulfilled all 10 of the assessed quality criteria; two others met nine criteria.

Conclusions: Despite promising results in some trials, overall findings do not provide convincing evidence that peer-led education improves sexual outcomes among adolescents. Future trials should build on the successful trials conducted to date and should strive to fulfill existing quality criteria.

Context: Contraceptive choices among men who want no more children have been little explored in South Asia, particularly in Nepal, where fertility rates have remained high over the last few decades.

Methods: Using the 2001 Nepal Demographic and Health Survey couple data set, multinomial logistic regression analyses were conducted for 1,041 married men aged 20 or older who had at least one living child and wanted no more children. Regression models examined relationships between selected characteristics and men's reported contraceptive use, and predicted probabilities were estimated to assess interactions between ecological zone, family composition and method choice. The primary goal was to determine whether the number and sex of living children influenced contraceptive use.

Results: Twenty-four percent of men who wanted no more children were not using any contraceptive method at the time of the survey, 30% reported that their wives were sterilized, 12% had had a vasectomy, 7% were using condoms and 27% used other temporary methods. The probability of relying on permanent methods was highest among men who had at least two living sons and lowest among those who had only daughters, while the probability of using no method was highest among those who had only daughters.

Conclusion: In Nepal, men who report a desire to have no more children are likely to choose permanent methods only after they have two living sons.