International family planning perspectives最新文献

Context: Although Croatia is still in an early stage of HIV infection, the rising rates of infection in other central and eastern European countries suggest the need to understand HIV knowledge, attitudes and sexual behaviors among young adults in Croatia.

Methods: Data from a multistage probability sample of 1,093 Croatians aged 18-24 surveyed in 2005 were used in regression models that examined the associations between HIV-related knowledge, attitudes and sexual behavior and predictors of condom use at first and last sexual intercourse and condom use consistency.

Results: For both men and women, condom use at first intercourse and positive attitudes toward condom use were the most robust predictors of condom use at last intercourse and consistent condom use. In addition, for women, having peers with less traditional attitudes regarding sexuality was associated with consistent condom use (odds ratio, 1.3).

Conclusions: Risky sexual behaviors are common among young adults in Croatia. Pragmatic and comprehensive sex education programs should target young people before they become sexually active.

Context: Because individuals' and couples' needs vary, the availability of a variety of contraceptive choices is a key component of successful family planning programs. Most women in Uzbekistan rely on a single contraceptive method (the IUD), but it is unclear whether this reflects constraints on choice or simply a widespread preference.

Methods: Nationally representative data from the 1996 Uzbekistan Demographic and Health Survey and the 2002 Uzbekistan Health Examination Survey were used to evaluate the relationship between demographic characteristics and knowledge and use of contraceptives among sexually active women. Separate multivariate regression analyses were performed for 1996 and 2002.

Results: Nearly all sexually active women knew about contraceptives, and in 2002 most reported that they had ever used the IUD (71%) or any modern method (77%). In both surveys, women with higher levels of wealth (odds ratios, 2.2-3.1) and education (1.9-2.5) were more likely than other women to know about contraceptive methods other than the IUD. Higher levels of wealth and education, as well as urban residence and non-Uzbek ethnicity, were also associated with the use of contraceptives other than the IUD, although these relationships were generally weaker in 2002 than in 1996.

Conclusion: Despite the high prevalence of contraceptive use in Uzbekistan, the country's reproductive health program may be constraining method choice. Expanded programmatic efforts emphasizing choice from a range of methods are needed, especially among subgroups of women who have little knowledge or experience with methods other than the IUD.

Context: Calls for increased inclusion of men in matters of reproductive health emphasize the need for research into vasectomy acceptability and decision making. Vasectomy is a safe, simple and effective method of contraception, but is underused worldwide.

Methods: Focus group discussions and in-depth interviews were conducted with potential and actual sterilization clients and their partners in the Kigoma Region of Tanzania. Content analysis was used to search for emergent themes related to vasectomy decision making.

Results: Six themes emerged as overarching factors contributing to the vasectomy decision-making process: economics, spousal influence, religion, provider reputation and availability, uncertainty about the future, and poor vasectomy knowledge and understanding. There was substantial communication between partners regarding the vasectomy decision, and wives had a strong influence on the outcome; however, men and women agreed that husbands would resist vasectomy if wives initially raised the topic. Vasectomy acceptance is limited by the scarcity of skilled vasectomy providers and by the fact that men and women hold many of the same misunderstandings about vasectomy, including a fear of decreased sexual performance as a result of the procedure.

Conclusions: Spousal discussions are important in the decision to get a vasectomy, but these discussions should be initiated by the male partner. Programs need to educate men about contraceptive options, including vasectomies. Detailed, culturally relevant knowledge of the barriers and facilitators individuals experience during their decision- making process will enable vasectomy promotion programs to more successfully target appropriate populations.

Context: Contraceptive prevalence increased by nine percentage points from 1993 to 2000 in Bangladesh, but there was almost no decline in the total fertility rate.

Methods: Data from the 1999-2000 Bangladesh Demographic and Health Survey and from the Matlab Demographic Surveillance System area collected between 1978 and 2001 were analyzed to explain the lack of change in fertility and to examine relationships among contraceptive prevalence, the abortion ratio, desired fertility and total fertility.

Results: After a maternal and child health and family planning program was initiated in part of Matlab in 1977, the total fertility rate in the intervention area declined from 4.8 in 1979 to 2.9 in 2000, while fertility in the comparison area dropped from 6.3 to 3.5. Over this period, contraceptive prevalence rose from 30% to 70% and from 16% to 50% in the two areas, respectively; meanwhile, the abortion ratio fell from 4.3 to 3.6 in the intervention area, but rose from around two to 8.2 in the comparison area. Trends in desired fertility in each area were similar, declining from about 4.0 children per woman in 1979 to about 2.5 children in 2000. Among women at each level of parity, fertility generally decreased as the number of sons increased, and fertility was highest for women without sons.

Conclusions: Preference for male children and parental concern over infant and child mortality may partially explain the difference between desired family size and fertility. A reduction in breast-feeding and an increase in use of less-effective contraceptive methods might be responsible for the inconsistency in the relationship between contraceptive use and fertility.

Context: In Mexico, family planning advice has been incorporated into the clinical guidelines for prenatal care. However, the relationship between women's receipt of family planning advice during prenatal care and subsequent contraceptive use has not been evaluated.

Methods: Data were collected in 2003 and 2004 in 17 Mexican states from 2,238 urban low-income women postpartum. Participating women reported on prenatal services received and contraceptive use. Logistic and multinomial logistic regression models evaluated whether receiving family planning advice during prenatal care predicted current contraceptive use, after quality of care in the community, service utilization, delivery characteristics, household socioeconomic characteristics, and maternal and infant characteristics were controlled for.

Results: Overall, 47% of women used a modern contraceptive method. Women who received family planning advice during prenatal care were more likely to use a contraceptive than were those who did not receive such advice (odds ratio, 2.2). Women who received family planning advice had a higher probability of using condoms (relative risk ratio, 2.3) and IUDs (5.2), and of undergoing sterilization (1.4), than of using no method.

Conclusions: Integrating family planning advice into prenatal care may be an important strategy for reaching women when their demand for contraception is high.

Context: Periodic assessments between 1972 and 1999 found consistent increases in the intensity and types of effort exerted by national family planning programs in developing countries. An updated evaluation was needed to examine whether these trends have been affected by recent changes in the family planning environment, such as decentralization, the HIV/AIDS pandemic and funding reductions.

Methods: In 2004, informants in 82 developing countries completed a questionnaire that assessed 30 dimensions of program effort and included several new scales to explore current issues. Selected results were compared with findings from prior rounds of the study.

Results: Family planning effort increased between 1999 and 2004, both globally and within regions. When the data were weighted by country population size, effort declined slightly overall but increased in four of six regions. Countries with low initial scores improved more than those with high initial scores. Contraceptive access varied by region and was lowest in Sub-Saharan Africa. The strongest justifications for programs were improving maternal and child health and preventing unwanted births. Changes in funding were often judged to have had negative effects on programs. Unmarried youth and women receiving postabortion care received the least emphasis among special populations of interest.

Conclusions: Although average program effort scores have risen again, increases in effort, funding and access to contraceptive methods are still needed in many countries, especially in rural areas and among the poor. More emphasis should be placed on providing postpartum and postabortion family planning services.

Context: The relationship between individuals' perception of their risk for acquiring HIV and their use of condoms is poorly understood. Understanding this relationship is crucial to the development of effective strategies to fight HIV and AIDS.

Methods: Data from the Mozambique 2001 Adolescent and Young Adult Reproductive Health and Behavior Risk Survey are used to compare 15-24-year-olds' assessments of their HIV risk with assessments based on current and past sexual behavior. In bivariate and probit regression analyses, the relationship between correct risk assessment and the likelihood of condom use at last intercourse is examined.

Results: Twenty-seven percent of women and 80% of men who considered themselves to have no risk or a small risk of contracting HIV were actually at moderate or high risk. For both men and women, the prevalence of condom use at last sex was more than twice as high among those who assessed their risk correctly (30% and 16%, respectively) as among those who did not (14% and 6%). Multivariate analysis showed that correct assessment was positively associated with condom use; the association was driven by use among never-married individuals. Never-married males who assessed their risk correctly were 18% more likely than other males to report condom use; never-married females, 17% more likely than other females.

Conclusions: Educational messages should aim at enabling individuals to correctly assess their own HIV risk and encouraging behavior change based on self-assessment of risk.

Context: Although there is increasing recognition of the global scope of domestic violence and the potential reproductive health consequences of violence, little is known about the relationship between physical and sexual domestic violence and gynecologic morbidity in developing country settings.

Methods: A sample of 3,642 couples from northern India was created by matching husbands and wives who responded to the men's and women's surveys of the 1995-1996 PERFORM System of Indicators Survey. The association between men's reports of physical and sexual violence they had perpetrated against their wives and wives' reports of gynecologic symptoms was analyzed in bivariate and multivariate analyses.

Results: Overall, 37% of men said they had committed one or more acts of physical or sexual violence against their wives in the past 12 months, with 12% reporting physical violence only, 17% sexual violence only and 9% both physical and sexual violence. Thirty-four percent of women reported at least one symptom of gynecologic morbidity. Compared with women whose husbands reported no violence, those who had experienced both physical and sexual violence and those who had experienced sexual violence only had elevated odds of reporting gynecologic symptoms (odds ratios, 1.7 and 1.4, respectively).

Conclusions: Plausible mechanisms through which domestic violence may influence gynecologic morbidity include physical trauma, psychological stress or transmission of STIs. Reproductive health care that incorporates domestic violence support services is needed to meet the special needs of abused women.