International family planning perspectives最新文献

Context: In Nepal, marriage occurs at a relatively young age and arranged weddings are widespread. However, recent changes in the family formation process and the timing of first sexual intercourse suggest that a transformation may be under way.

Methods: Data on marriage, cohabitation and first sexual intercourse from the 2001 Nepalese Demographic and Health Survey were used to describe the family formation process. The sequence of these events and the intervals between them were explored for currently married men and women. Hazard models were used to identify factors associated with behavioral changes over time.

Results: The average age at marriage among women married before age 20 increased from 13.7 years for those born in 1952-1956 to 15.6 years for those born in 1977-1981, while remaining relatively stable for men married before age 25 (17.3 years for the 1942-1946 birth cohort to 17.7 for the 1972-1976 birth cohort). After individual and couple characteristics were controlled for, younger age at interview was associated with greater odds of simultaneous marriage and cohabitation for both genders (odds ratios, 1.3-1.7). Younger age at interview was also associated with premarital sex among men--those aged 39 or younger had significantly higher risks than older men of having had premarital sex, with odds ratios rising from 1.6 among those aged 35-39 to 1.8 among those aged 15-24.

Conclusions: It is important not only to promote education as a means of delaying marriage and childbearing, but also to implement programs and services that prevent reproductive health problems for young married couples.

Context: Persons displaced by armed conflicts, natural disasters or other events are at increased risk for health problems. The Republic of Georgia has a substantial population of internally displaced women who may face elevated risks of STIs and pelvic inflammatory disease (PID).

Methods: The 1999 Georgia Reproductive Health Survey was used to examine the prevalence of self-reported STI and PID diagnoses among displaced and nondisplaced sexually experienced women. Multivariate analyses were conducted to determine whether displacement is associated with STI and PID risk, and whether the behavioral and socioeconomic factors associated with these diagnoses differ between internally displaced women and the general population.

Results: In models that controlled for behavioral factors only, displacement was associated with elevated odds of PID diagnosis (odds ratio, 1.3), but the relationship was only marginally significant when socioeconomic factors were added (1.3). Displacement was not associated with STI diagnosis. The factors associated with STI and PID diagnoses among displaced women generally differed from those in the general population, but access to medical care and previous STI diagnosis were associated with PID diagnosis in both groups. Among nondisplaced women, residing in the capital city was associated with increased odds of STI diagnosis (2.2) but reduced odds of PID diagnosis (0.8).

Conclusions: These findings highlight the importance of displacement status in determining a woman's reproductive health risks, and underscore the complex relationships between behavioral and socioeconomic variables and the elevation of STI and PID risk.

Context: Each year, thousands of Nigerian women have unintended pregnancies that end in illegal abortion. Many such procedures occur under unsafe conditions, contributing to maternal morbidity and mortality.

Methods: In a 2002-2003 survey of women and their providers in 33 hospitals in eight states across Nigeria, 2,093 patients were identified as being treated for complications of abortion or miscarriage or seeking an abortion. Women's abortion experiences and the health consequences and associated costs were examined through bivariate analysis. Multivariate analysis was used to examine the characteristics of women by type of pregnancy loss and to compare characteristics among three groups of women who had induced abortions in differing circumstances.

Results: Among women admitted for abortion-related reasons, 36% had attempted to end the pregnancy before coming to the hospital (including 24% with and 12% without serious complications), 33% obtained an induced abortion at the facility (not withstanding the country's restrictive law) without having made a prior abortion attempt and 32% were treated for complications from a miscarriage. Of women with serious complications, 24% had sepsis, 21% pelvic infection and 11% instrumental injury; 22% required blood transfusion and 10% needed abdominal surgery. The women in this group were poorer and later in gestation than those who sought abortions directly from hospitals. They paid more for treatment (about 13,900 naira) than those who went directly to the hospital for an abortion (3,800 naira) or those treated for miscarriage (5,100 naira).

Conclusions: Policy and program interventions are needed to improve access to contraceptive services and postabortion care in order to reduce abortion-related morbidity and mortality.

Context: Alcohol use is frequently identified as a contributor to risky sexual behaviors; however, research results are mixed. Given the conflicting evidence, researchers have focused on other factors, such as expectations about alcohol's effects that might help explain the relationship of alcohol use and risky sexual behaviors.

Methods: Cross-sectional data from 312 sexually experienced males aged 18-30 in a shantytown in Lima, Peru, were used in logistic regression models to identify associations of heavy episodic drinking and sex-related expectations about alcohol with sexual risk behaviors.

Results: Heavy episodic drinking was associated with having had two or more sexual partners and having had sex with a casual partner in the past year (odds ratios, 2.8 and 2.5, respectively). After controlling for alcohol consumption, sex-related expectations about alcohol were associated with these high-risk sexual behaviors, as well as with not using a condom at last sex (1.2) and not using a condom at last sex with a casual partner (1.3).

Conclusion: Beliefs about the effect of alcohol on sexual performance could help explain links between alcohol consumption and risky sexual behavior not completely accounted for by the pharmacological effects of alcohol.

Context: Although premarital partnerships-whether or not they involve sex-are widely discouraged in India, some youth do form such partnerships. It is important to know more about the nature of and the factors associated with these relationships.

Methods: Data are drawn from a community-based study of 15-24-year-olds in urban slum and rural settings in Pune District, Maharashtra. Multivariate analyses were conducted to identify associations between youths' individual, peer and family factors and their experience of romantic relationships and physical intimacy, including intercourse.

Results: Among young men, 17-24% had had a romantic relationship, 20-26% had engaged in some form of physical intimacy and 16-18% had had sex; the proportions among young women were 5-8%, 4-6% and 1-2%, respectively. Exposure to alcohol, drugs or pornographic films and having more frequent interaction with peers were positively associated with romantic and sexual relationships for both young women and young men. Educational attainment was negatively associated with both types of relationships for young women, but only with sexual relationships for young men. Closeness to parents was negatively associated with relationships only for young women. Young women whose father beat their mother were more likely than other young women to form romantic partnerships, and those beaten by their family had an elevated risk of entering romantic and sexual partnerships. Youth who reported strict parental supervision were no less likely than others to enter relationships.

Conclusions: Program interventions should ensure that youth are fully informed and equipped to make safe choices and negotiate wanted outcomes, while positively influencing their peer networks; encourage closer interaction between parents and children; and be tailored to the different circumstances and experiences of young women and men.

Context: Little is known about health care providers' knowledge of, attitudes toward and provision of emergency contraceptive pills in the English-speaking Caribbean, where sexual violence and unplanned pregnancies are persistent public health problems.

Methods: We conducted interviewer-administered surveys of 200 Barbadian and 228 Jamaican pharmacists, general practitioners, obstetrician-gynecologists and nurses in 2005-2006. For each country, Pearson's chi-square tests were used to assess differences in responses among the four provider groups.

Results: Nearly all respondents had heard of emergency contraceptive pills, and large majorities of Barbadian and Jamaican providers had dispensed the method. However, about half had ever refused to dispense it; frequently cited reasons were medical contraindications to use, recent use, method unavailability, safety concerns and being uncomfortable prescribing it. Only one in five providers knew that the method could be safely used as often as needed, and few knew that it was effective if taken within 120 hours of unprotected sexual intercourse. About a quarter of Barbadian and half of Jamaican providers thought the method should be available without a prescription, and half of all providers believed that its use encourages sexual risk-taking and leads to increased STI transmission. Nonetheless, most respondents believed the method was necessary to reduce rates of unintended pregnancy and were willing to dispense it to rape victims, women who had experienced condom failure and women who had not used a contraceptive.

Conclusions: Future educational efforts among Jamaican and Barbadian health care providers should emphasize the safety and proper use of emergency contraceptive pills, as well as the need to increase the availability of the method.