International family planning perspectives最新文献

Context: Use of unmet need for family planning to identify prospective clients may misrepresent the actual family planning needs of a population, given that a large proportion of women have ambivalent fertility desires.

Methods: Survey data for 1998 and 2003 from Burkina Faso, Ghana and Kenya were used to examine the fertility desires and motivations of women who said they wanted to delay or limit childbearing. A question on how much of a problem it would be if women found out they were pregnant in the next few weeks measured the strength of their fertility motivations.

Results: In Burkina Faso and Ghana, about a quarter of women who said they wanted to delay or limit childbearing also reported that it would be no problem or a small problem if they became pregnant soon. This response pattern was equally common among contraceptive users and nonusers. In Kenya, more than four in 10 women gave such ambivalent responses. Among women with an unmet need for means of delaying or limiting childbearing, 16-31% of those in Burkina Faso and Ghana, and 30-56% of those in Kenya, said that getting pregnant in the next few weeks would be no problem or a small problem.

Conclusions: It is critical to consider the strength of fertility motivations when determining which women have family planning needs. Targeting women who are the most motivated to avoid childbearing will likely have the greatest impact on reducing unintended pregnancy in Sub-Saharan Africa.

Context: Premarital sexual activity is thought to be rising in Vietnam. However, there is little evidence documenting such an increase, and it is unknown whether levels of premarital sex differ between northern and southern Vietnam and whether premarital sex occurs primarily with a future spouse.

Methods: Surveys conducted in northern Vietnam (Red River Delta) and southern Vietnam (Ho Chi Minh City and surrounding environs) in 2003-2004 among individuals married during one of three important periods in Vietnamese history (1963-1971, 1977-1985 or 1992-2000) were used to assess trends and regional differences in the prevalence and context of premarital sex.

Results: In both regional samples, 31% of men who married in 1992-2000 reported having had premarital sex. The proportion was much lower among women (8% in the South, 12% in the North). The prevalence of premarital sex rose markedly across cohorts in the North but only modestly in the South. Relatively few men had premarital sex with someone other than a future spouse (3-23%). The proportion of the rise in the prevalence of premarital sex that was due to sex exclusively with a future spouse was greater in the North (42%) than in the South (25%).

Conclusions: These results suggest that premarital sex is becoming more common in Vietnam but is still not widespread. Better information about the sexual networks of men in the general population and their contacts with high-risk groups (e.g., commercial sex workers) is needed to ascertain the likelihood that HIV/AIDS will spread to the general population.

Context: Many Nigerian women experience unwanted pregnancies. To prevent associated health problems, it is important to understand the factors related to unwanted pregnancy in Nigeria.

Methods: A community-based survey of 2,978 women aged 15-49 was conducted in eight Nigerian states. Univariate analyses and multivariate logistic regression analyses were used to determine the incidence of unwanted pregnancy, the incidence of seeking an abortion among women with unwanted pregnancies and the factors associated with unwanted pregnancy and abortion-seeking behavior. Additional analyses examined the prevalence of contraceptive use and women's reasons for seeking to terminate unwanted pregnancies and for not practicing contraception at the time their unwanted pregnancies were conceived.

Results: Twenty-eight percent of respondents reported ever having had an unwanted pregnancy; of those, half reported having attempted to end their last unwanted pregnancy. Forty-three percent of women who sought an abortion did so because they were not married, were too young or were still in school. Of the women who were not practicing contraception when they had the unwanted pregnancy, 44% said that they were unaware of family planning, and 22% that they either did not have access to contraceptive services, services were too expensive or they were afraid of side effects. At the time of the survey, 27% of all respondents were at risk of an unwanted pregnancy. Almost half were unaware of contraceptive methods.

Conclusions: Nigerian women often turn to abortion to avoid unwanted births. The provision of family planning counseling and information could substantially reduce the incidence of unwanted pregnancy and induced abortion in Nigeria.

Context: Although Guatemalan law permits induced abortion only to save a woman's life, many women obtain abortions, often under unsafe conditions and in response to an unintended pregnancy. Recent studies indicate that unsafe abortion is a key factor contributing to maternal morbidity and mortality in the country, but no national data on the incidence of abortion exist.

Methods: Surveys of all hospitals that treat women for postabortion complications and of 74 professionals who are knowledgeable about the conditions of abortion provision in Guatemala were conducted in 2003. Indirect estimation techniques were used to calculate the number of induced abortions performed annually. Abortion rates and ratios and the level of unintended pregnancy were calculated for the nation and its eight regions.

Results: Nearly 65,000 induced abortions are performed annually in Guatemala, and about 21,600 women are hospitalized for treatment of complications. Abortions occur at a rate of 24 per 1,000 women aged 15-49, and there is one abortion for every six births. The abortion rate is higher than average in the Southwest (less developed, mainly indigenous population) and Metropolitan (more developed, mainly nonindigenous population) regions (29-30 per 1,000 women). Over a quarter of all births are unplanned; combining unplanned births with abortions yields estimates that 32% of pregnancies in Guatemala are unintended, with an unintended pregnancy rate of 66 per 1,000 women.

Conclusions: Unsafe abortion has a significant impact on women's health in Guatemala. Comprehensive government programs are needed to address the issues of unintended pregnancy and unsafe abortion, with attention to regional differences.

Context: Thailand has undergone dramatic social changes in the last two decades, yet little is known about factors related to sexual initiation among adolescents.

Methods: A survey using the audio computer-assisted self-interviewing method was conducted to assess social and demographic characteristics, substance use, sexual behavior, and knowledge of HIV and STIs among 1,725 vocational school students aged 15-21 living in northern Thailand. Gender differences for these factors were evaluated using chi-square and Mann-Whitney U tests. Multivariate survival analysis using Cox proportional hazards models assessed associations between these variables and sexual initiation for each gender.

Results: Males initiated sexual intercourse at an earlier age than females (median ages of 17 and 18, respectively). At any given age, sexual initiation was associated with having a nonagricultural background and using alcohol or methamphetamine (adjusted rate ratios, 1.3-2.9). For males, initiation was also associated with having parents who did not live together, having a friend as a confidant, tobacco use, high perceived risk for HIV and high STI knowledge (1.3-1.7). For females, other factors associated with earlier initiation were younger age at interview, living away from family, lacking a family member as a confidant, high perceived risk for STIs and ever having smoked marijuana (1.3-2.4).

Conclusions: Interventions to ameliorate the adverse consequences of early sexual initiation need to address social influences such as parents and peer groups. Programs should identify and target high-risk subgroups, such as those who are sexually experienced at an early age and those engaged in patterns of generalized risk-taking.

Context: Levels of modern contraceptive knowledge and use among people living in rural areas of Guatemala differ substantially from those of people living in urban areas. Understanding the pace and extent of rural-to-urban migrants' adoption of urban contraceptive practices is important in determining if there is a strong need for migrant-focused reproductive health programs.

Methods: Bivariate and multivariate analyses of data on 971 married male and female respondents in the 1999 Guatemalan Migration and Reproductive Health Survey were used to examine how migration status and duration of residence in an urban area are associated with knowledge of modern contraceptive methods and current contraceptive use.

Results: Migrants' contraceptive knowledge was positively associated with the number of years they had lived in an urban area. Mayan migrants in Guatemala City did not accumulate contraceptive knowledge at the same rate as non-Mayan migrants, perhaps due to cultural and linguistic barriers to obtaining knowledge of and access to contraceptives. Rural-to-urban migrants eventually achieve a level of modern contraceptive use slightly below that of urban nonmigrants, with the level of contraceptive knowledge being an important factor associated with use of modern methods.

Conclusions: Migrants possess limited knowledge of modern contraceptive methods and, therefore, may experience unmet need for contraception or may have a limited choice of modern contraceptive methods during their first years in an urban destination. Programs designed to raise contraceptive awareness and use should target recent migrants--particularly indigenous Mayans--in urban areas.

Context: Early age at first sex has been identified as a risk factor for unplanned pregnancy and HIV infection. However, the emotional relationships and physical behaviors that precede first intercourse, and how they differ by sex, also may provide important cues about how to prevent sexual risk behavior.

Methods: The precoital activities of 2,051 adolescents aged 17-19 in Cebu, Philippines, are examined using 1998-2000 and 2002 data from the Cebu Longitudinal Health and Nutrition Survey. The timing and tempo of emotional relationships and physical behaviors for males and females are described. Cox proportional hazards models are used to identify the characteristics associated with age at first sex.

Results: Males engage in precoital physical behaviors and first sex at younger ages than females. Although the standard order in which the two sexes engage in emotional relationships for the first time is the same, males progress through the sequence more quickly than females. After adolescents have progressed through the sequence of emotional relationships, there is a gap of a least a year before they begin to have sex. In the multivariate analysis, rapid progression through the sequence of emotional relationships was associated with initiating sex at a younger age for females (hazard ratio, 1.5), but not for males.

Conclusion: The period between first date and first sex experienced by both males and females provides an opportunity to ensure that adolescents have access to the information and services that will allow them to make informed choices about sexual behavior.

Context: A cultural preference for sons may be a factor driving recourse to abortion in India, as women carrying female fetuses may decide to terminate their pregnancies. To assess this hypothesis, more information on the incidence of abortion, and on maternal and social correlates of the procedure, is needed.

Methods: Birth order-specific abortion ratios were calculated using the birth histories of 90,303 ever-married women aged 15-49 who participated in India's 1998-1999 National Family Health Survey. For the first four births, the association between abortion and various maternal and social variables, including the sex of the respondent's last child, was assessed using logistic regression.

Results: The overall abortion ratio was 17.0 per 1,000 pregnancies. The ratio increased from 5.3 per 1,000 pregnancies for first-order births to 25.8 per 1,000 pregnancies for third-order births and then declined. The strongest predictor of abortion was maternal education: Women with at least a primary education were more likely than those with no education to have had an abortion (odds ratios, 1.9-6.7). Rural residence was associated with a reduced likelihood of abortion (0.6). There was no association between the sex of a woman's previous child and the odds that she subsequently had an abortion.

Conclusion: At the national level, it is likely that unintended pregnancy, rather than the sex of the previous child, underlies demand for abortion in India. Rising educational attainment among women may lead to an increase in the demand for abortion.

Context: Emergency contraception can play an important role in reducing the rate of unintended pregnancies in Nigeria. Although it is included in the national family planning guidelines, there is limited awareness of this method among clients.

Methods: In 2003-2004, a sample of 256 health care providers within Lagos State were surveyed about their knowledge of, attitudes toward and provision of emergency contraceptives, using a 25-item, self-administered questionnaire. Frequencies were calculated for the various measures, and chi-square tests were used to determine significant differences.

Results: Nine in 10 providers had heard of emergency contraception, but many lacked specific knowledge about the method. Only half of them knew the correct time frame for effective use of emergency contraceptive pills, and three-fourths knew that the pills prevent pregnancy; more than a third incorrectly believed that they may act as an abortifacient. Fewer than a third of respondents who had heard of the pills knew that they are legal in Nigeria. Of those who had heard about emergency contraception, 58% had provided clients with emergency contraceptive pills, yet only 10% of these providers could correctly identify the drug, dose and timing of the first pill in the regimen. Furthermore, fewer than one in 10 of those who knew of emergency contraception said they always provided information to clients, whereas a fourth said they never did so.

Conclusions: Nigerian health care providers urgently need education about emergency contraception; training programs should target the types of providers who are less knowledgeable about the method.

Context: Adolescents' past and current partnerships influence their sexual health risks. Males' responsibilities and needs in terms of sexual health have long received less attention than females'. It is important to examine male adolescent sexual and contraceptive patterns within the broader context of partnership dynamics.

Methods: In May 2000, 1,438 males aged 13-19 living in the urban shantytowns of Recife, Brazil, were surveyed. Adolescents gave detailed partnership, sexual and contraceptive history data in the form of month-by-month calendars for the prior two years. Logistic regression analyses were used to examine the associations between prior and current partnership experience and contraceptive use.

Results: Overall, 76% of respondents reported having had at least one partnership in the past two years; 49% of partnerships involved intercourse. On average, steady and casual partnerships lasted 4.7 months and 1.6 months, respectively. Respondents typically had spent 2.8 months of the past two years in a sexual partnership, 1.2 months of which were unprotected by contraceptive use. Of those with a recent partnership, having had a prior sexual partner was associated with elevated odds of being sexually active in the current or most recent partnership (odds ratio, 4.0). Of sexually active adolescents, having used contraceptives at first sex or in a former sexual partnership was associated with elevated odds of having used a condom in the current or most recent sexual partnership (7.9 and 6.5, respectively).

Conclusions: Prevention programs need to have an accurate portrait of adolescent partnership dynamics, an adequate understanding of adolescent sexuality and a realistic estimation of actual exposure to risk, so interventions and messages can be tailored to adolescents' realities.