International family planning perspectives最新文献

Context: To date, no quantitative studies have examined the prevalence or correlates of sexual violence among college students in Chile.

Methods: An anonymous survey with questions on gender-based violence, demographic and socioeconomic characteristics, and childhood experiences with violence was administered to students at a major public university in Santiago. Descriptive statistics were generated to determine the prevalence and context of sexual victimization experienced by female students, and ordered logit models were used to identify associated risk factors.

Results: Nine percent of subjects reported that the most severe form of undesired sexual contact they had experienced since age 14 was rape; 6% indicated attempted rape and 16% another form of sexual victimization. Seventeen percent of subjects reported having experienced some form of undesired sexual contact in the past 12 months alone. Alcohol or other drugs had been used in most cases of rape or attempted rape, by the victim (6%), the perpetrator (9%) or both (56%). In four sequential models, factors associated with increased odds of victimization included low parental education (Model 1) and childhood sexual abuse (Models 3 and 4); the association between witnessing domestic violence and victimization attained marginal significance (Model 2). Attending religious services during adolescence was associated with reduced odds of victimization (Models 1 and 2). Childhood sexual abuse was the only factor associated with victimization when all variables were included.

Conclusions: A substantial proportion of young women in the sample reported experiences of rape, attempted rape or other forms of forced sexual contact, indicating a need for further attention to this public health problem in Chile.

Context: Information on abortion levels and trends can inform research and policies affecting maternal and reproductive health, but the incidence of legal abortion has not been assessed in nearly a decade.

Methods: Statistics on legal abortions in 2003 were compiled for 60 countries in which the procedure is broadly legal, and trends were assessed where possible. Data sources included published and unpublished reports from official national reporting systems, questionnaires sent to government agencies and nationally representative population surveys. The completeness of country estimates was assessed by officials involved in data collection and by in-country and regional experts.

Results: In recent years, more countries experienced a decline in legal abortion rates than an increase, among those for which statistics are complete and trend data are available. The most dramatic declines were in Eastern Europe and Central Asia, where rates remained among the highest in the world. The highest estimated levels were in Armenia, Azerbaijan and Georgia, where surveys indicate that women will have close to three abortions each on average in their lifetimes. The U.S. abortion rate dropped by 8% between 1996 and 2003, but remained higher than rates in many Northern and Western European countries. Rates increased in the Netherlands and New Zealand. The official abortion rate declined by 21% over seven years in China, which accounted for a third of the world's legal abortions in 1996. Trends in the abortion rate differed across age-groups in some countries.

Conclusions: The abortion rate varies widely across the countries in which legal abortion is generally available and has declined in many countries since the mid-1990s.

Context: Understanding shifts in contraceptive method mix is key to helping policymakers, program managers and donor agencies meet current contraceptive demand and estimate future needs in developing countries.

Methods: Data from Demographic and Health Surveys, Reproductive Health Surveys and other nationally representative surveys were analyzed to describe trends and shifts in method mix among married women of reproductive age from 1980 to 2005. The analysis included 310 surveys from 104 developing countries.

Results: Contraceptive use among married women of reproductive age increased in all regions of the developing world, reaching 66% in Asia and 73% in Latin America and the Caribbean in 2000-2005, though only 22% in Sub- Saharan Africa. The proportion of married contraceptive users relying on the IUD declined from 24% to 20%, and the proportion using the pill fell from 16% to 12%. The share of method mix for injectables rose from 2% to 8%, and climbed from 8% to 26% in Sub-Saharan Africa, while the share for condoms was 5-7%. The overall proportion of users relying on female sterilization ranged from 29% to 39%, reaching 42-43% in Asia and in Latin America and the Caribbean in 2000-2005; on average, the share of all method use accounted for by male sterilization remained below 3% for all periods. Use of traditional methods declined in all regions; the sharpest drop-from 56% to 31% of users-occurred in Sub-Saharan Africa.

Conclusions: To meet the rising demand for modern methods, it is critical that future programmatic efforts provide methods that are both accessible and acceptable to users.

Context: HIV prevalence is high among South African youth. Health behavior models posit that the perceived level of risk of HIV infection is associated with the level of HIV risk behavior; however, there has been limited research in Sub-Saharan Africa on factors associated with perceived risk or on the relationship between perceived risk and risk behaviors.

Methods: Longitudinal data collected in 2002 and 2005 from 3,017 black, colored and white youth in Cape Town, South Africa, were analyzed using multivariate regression to examine whether a reciprocal relationship exists between sexual experience and perceived HIV risk. Independent variables taken from the 2002 survey were used to predict dependent variables taken from the 2005 survey.

Results: In 2005, most youth (82% of males and 83% of females) viewed themselves as being at no or small risk of HIV infection. A reciprocal relationship in which higher perceived HIV risk was associated with a delay in sexual debut (odds ratio, 0.8) and sexual experience was associated with higher perceived risk (1.4) was found for females, but not for males. Knowing someone who had died of AIDS was associated with sexual debut and with an elevated perceived HIV risk among females (1.7 and 1.3, respectively). The associations between race and perceived risk of HIV infection varied by gender.

Conclusions: HIV/AIDS education and prevention programs should consider more carefully how gender and race may intersect to influence risk perceptions and risk behaviors. In addition, possible reciprocal relationships between risk behaviors and risk perceptions should be considered in education and intervention programs.

Context: Although there is a growing body of research examining the issue of nonconsensual sex among adolescents, few studies have looked at coerced sex within marriage in settings where early marriage is common, or at sex that may not be perceived as forced, but that is unwanted.

Methods: A cross-sectional study, using both survey research and in-depth interviews, was conducted among 1,664 married young women in Gujarat and West Bengal, India. Descriptive data and multinomial logistic regression were used to identify the prevalence and risk factors for occasional and frequent unwanted sex. Qualitative data were analyzed to examine the context in which unwanted sex takes place.

Results: Twelve percent of married young women experienced unwanted sex frequently; 32% experienced it occasionally. The risk of experiencing unwanted sex was lower among women who knew their husband fairly well at the time of marriage, regularly received support from their husband in conflicts with other family members or lived in economically better-off households. Frequent unwanted sex was associated with not yet having had a child or having become pregnant, with lower education and with agreeing with norms that justify wife beating.

Conclusion: For married young women, sex is not always consensual or wanted. Further research is required to determine the effects of unwanted sex on sexual and reproductive health outcomes and to help programs develop the best strategies for dealing with coerced sex within marriage.

Context: Although the reduction of maternal mortality levels is a key Millennium Development Goal, community-based evidence on obstetric complications and maternal care-seeking behavior remains limited in low-resource countries.

Methods: This study presents an overview of key findings from the 2001 Bangladesh Maternal Health Services and Maternal Mortality Survey of ever-married women aged 13-49. The survey collected data on the prevalence of obstetric complications, women's knowledge of life-threatening complications, treatment-seeking behavior and reasons for delay in seeking medical care.

Results: Bangladeshi women report low but increasing use of antenatal care, as well as low rates of delivery in a health facility or with the assistance of a skilled provider. Although almost half of women reported having one or more complications during pregnancy that they perceived as life threatening, only one in three sought treatment from a qualified provider. More than three-fourths of women with the time-sensitive complications of convulsions or excessive bleeding either failed to seek any treatment or sought treatment from an unqualified provider. The principal reason cited for failing to seek care for life-threatening complications was concern over medical costs, and pronounced socioeconomic disparities were found for maternal care-seeking behavior in both urban and rural Bangladesh.

Conclusions: Despite these gaps in access to skilled delivery and effective emergency obstetric care, some progress has been made in reducing maternal mortality levels. Improved obstetric care and declining levels of fertility and unwanted pregnancy may have played critical roles in addressing the maternal health care needs of Bangladeshi women.

Context: Research examining hormonal injectable contraceptive continuation has focused on clients' intentional discontinuation. Little attention, however, has been paid to unintentional discontinuation due to providers' management of clients who would like to continue use but arrive late for their scheduled reinjections.

Methods: A cross-sectional survey of 1,042 continuing injectable clients at 10 public clinics was conducted in South Africa's Western and Eastern Cape provinces. Bivariate logistic regression analyses were used to identify associations between specific variables and the likelihood of receiving a reinjection, among clients who returned to clinics late but within the two-week grace period for reinjection.

Results: Of 626 continuing clients in the Western Cape, 29% were up to two weeks late and 25% were 2-12 weeks late for their scheduled reinjection; these proportions among 416 continuing clients in the Eastern Cape were 42% and 16%, respectively. Only 1% of continuing clients in the Western Cape who arrived during the two-week grace period did not receive a reinjection; however, 36% of similar clients in the Eastern Cape did not receive a reinjection. Among late clients in the Eastern Cape who did not receive a reinjection, 64% did not receive any other method. Few variables were significant in bivariate analyses; however, certain characteristics were associated with receiving reinjections among late clients in the Eastern Cape.

Conclusions: It is common for clients to arrive late for reinjections in this setting. Providers should adhere to protocols for the reinjection grace period and have a contraceptive coverage plan for clients arriving past the grace period to reduce clients' risk of unintentional discontinuation and unintended pregnancy.