International family planning perspectives最新文献

Context: In South Africa, emergency contraceptive pills are available directly from pharmacies without a prescription, yet few studies have assessed pharmacists' knowledge of and attitudes toward the medication.

Methods: In-person interviews were conducted with 34 pharmacists practicing in Soweto and the Johannesburg Central Business District, from February through April 2003. The pharmacists provided data on their knowledge of emergency contraceptive pills and their attitudes toward providing the medication to women in specific situations.

Results: Nearly all pharmacists sold at least one of the two types of dedicated emergency contraceptive pills available in South Africa. Although most had accurate knowledge about the method's dosing schedule, side effects and mechanism(s) of action, more than half erroneously believed that repeated use posed health risks. A large majority of pharmacists believed the pills should be available to rape victims, to single or married women and to women who had never given birth, but almost half did not think the pills should be given to women younger than 18, and a fourth said they would not give them to women with a late menstrual period. About one-third to half of pharmacists supported advance provision of the medication under certain circumstances. Most were willing to display promotional materials on emergency contraceptives in their pharmacies.

Conclusions: Interventions aimed at educating pharmacists about the benefits of emergency contraceptive pills, especially for adolescents, are needed. Government and medical authorities should take advantage of pharmacists' willingness to display educational materials as a way to increase women's knowledge and use of the medication in South Africa.

Context: In Sub-Saharan Africa, where rates of intimate partner violence are high, knowing the prevalence of abuse and associated patterns of risk is crucial to ensuring women's health and development. Intimate partner violence in Tanzania has not been assessed through a population-based survey.

Methods: A household-based sample of women aged 20-44 in the urban district of Moshi, Tanzania, participated in face-to-face interviews in 2002-2003. The lifetime prevalence of exposure to intimate partner violence and the prevalence of exposure during the past 12 months were assessed among 1,444 women who reported having a current partner. Multivariate logistic regression was used to identify factors associated with intimate partner violence.

Results: Twenty-one percent of women reported having experienced intimate partner violence (i.e., having been threatened with physical abuse, subjected to physical abuse or forced into intercourse by a partner) during the previous 12 months; 26% reported such an experience at any time, including the past 12 months. The likelihood of violence in the past year was elevated if the woman had had problems conceiving or had borne five or more children (odds ratios, 1.9 and 2.4, respectively); if her husband or partner had other partners (2.0) or contributed little to expenses for her and her children (3.3); and if she had had no more than a primary education (1.7).

Conclusions: Gender inequality within sexual unions is associated with intimate partner violence. Policies and programs that discourage men from blaming women for infertility, promote monogamous unions and expand access to education for women may reduce intimate partner violence in northern urban Tanzania.

Context: In rural Bangladesh, family planning services--previously provided through household visits and satellite clinics--were transferred to static community clinics under the government's sectoral program for 1998-2003, but the next sectoral program reversed the change without a formal evaluation. It is important to assess changes in utilization and coverage to inform further development of the service delivery system.

Methods: Longitudinal data on use of family planning services and contraceptive methods were collected quarterly in 1998-2002 from married women in about 11,000 households in two rural surveillance areas--Abhoynagar and Mirsarai. Cross-sectional surveys were conducted among women and service providers in 2003 to gather detailed information about the transition to static clinics and women's response to the changes. Quarterly time series graphs of selected indicators were plotted for areas served by community clinics.

Results: In a time of considerable change in service delivery and sources of contraceptive supply, contraceptive prevalence remained constant in Abhoynagar and increased in Mirsarai. Community clinics quickly became the source of supplies for one-third of contraceptive users in Abhoynagar and one-fifth in Mirsarai. In wards where community clinics became operational (mostly in 2001-2002), three-quarters of women had used one at some time.

Conclusions: Despite cultural constraints on mobility, women do not appear to have become dependent on home delivery of contraceptives.

Context: In the Philippines, abortion is legally restricted. Nevertheless, many women obtain abortions--often in unsafe conditions--to avoid unplanned births. In 1994, the estimated abortion rate was 25 per 1,000 women per year; no further research on abortion incidence has been conducted in the Philippines.

Methods: Data from 1,658 hospitals were used to estimate abortion incidence in 2000 and to assess trends between 1994 and 2000, nationally and by region. An indirect estimation methodology was used to calculate the total number of women hospitalized for complications of induced abortion in 2000 (averaged data for 1999-2001), the total number of women having abortions and the rate of induced abortion.

Results: In 2000, an estimated 78,900 women were hospitalized for postabortion care, 473,400 women had abortions and the abortion rate was 27 per 1,000 women aged 15-44 per year. The national abortion rate changed little between 1994 and 2000; however, large increases occurred in metropolitan Manila (from 41 to 52) and Visayas (from 11 to 17). The proportions of unplanned births and unintended pregnancies increased substantially in Manila, and the use of traditional contraceptive methods increased in Manila and Visayas.

Conclusion: The increase in the level of induced abortion seen in some areas may reflect the difficulties women experience in obtaining modern contraceptives as a result of social and political constraints that affect health care provision. Policies and programs regarding both postabortion care and contraceptive services need improvement.

Context: Indonesia has experienced a dramatic increase in contraceptive use and an equally dramatic fertility decline over the last 30 years. Yet recent reductions in family planning funding, program decentralization and the diminishing role of the public sector as a service provider may lead to lower use among poor women.

Methods: The data for analysis were drawn from the 2002-2003 Indonesia Demographic and Health Survey. Bivariate techniques were used to compare overall contraceptive use, reliance on specific methods, source of supplies and reasons for nonuse of contraceptives between poor and better-off women. Multivariate regression assessed the association between use of a modern method and selected social, demographic and attitudinal characteristics.

Results: Better-off women wanted significantly fewer children than did moderately or extremely poor women (2.8 vs. 3.0-3.4), were more likely to approve of family planning (93% vs. 87-91%) and were more likely to believe their spouses approved (91% vs. 80-87%). Better-off women and moderately poor women had higher odds of using modern contraceptives than did extremely poor women (odds ratios, 1.6 and 1.4, respectively). Compared with women who gave a non-numeric response, those who wanted two or fewer children had higher odds of using a modern method (2.0). The odds were also higher among women who lived in a district in which the mean ideal number of children was below the national median (1.5).

Conclusion: Governmental efforts to increase contraceptive use among poor women need to focus on changing attitudes toward smaller family sizes and family planning.

Context: Gender differences influence decision making about reproductive health. Most information on reproductive health decision making in Latin America has come from women's reports of men's involvement.

Methods: Data were collected in Honduras in 2001 through two national surveys that used independent samples of men aged 15-59 years and women aged 15-49. Bivariate and multivariate analyses were used to identify factors associated with male-centered decision-making attitudes and behaviors regarding family size and family planning use.

Results: Overall, 25% of women and 28% of men said that men alone should be responsible for at least one of these reproductive decisions, and 27% of women and 21% of men said that the man in their household made one or both decisions. For women, having no children and being in a consensual union were each associated with holding male-centered decision-making attitudes; having less than a secondary education, being of medium or low socioeconomic status and living in a rural area were each associated with male-centered decision making. Among men, having less than secondary education and being in a consensual union were each associated with male-centered decision-making attitudes and behavior. Women who had ever used or were currently using modern methods were significantly less likely to hold attitudes supporting male-centered decision-making than were those who relied on traditional methods and those who had never used a modern method.

Conclusions: Programs should recognize power imbalances between genders that affect women's ability to meet their stated fertility desires. In rural areas, programs should target men, encouraging them to communicate with their wives on reproductive decisions.

Context: The association between youths' sexual and reproductive attitudes and behaviors and those of their peers and parents has been documented; however, information on siblings' influence is scarce, especially for developing countries.

Methods: Data on 1,395 female and 1,242 male survey respondents aged 15-24 from three cities in Côte d'Ivoire were analyzed. Life-table analysis was conducted to examine respondents' probability of remaining sexually inexperienced according to siblings' history of premarital childbearing. Cox multivariate regressions were used to estimate respondents' relative risks of sexual debut by age 17 and by age 24.

Results: At any age between 15 and 24 years, the life-table probability of remaining sexually inexperienced was typically lower among persons who had at least one sibling with a premarital birth than among those who had no such sibling. In general, among those with at least one sibling who had had a premarital birth, the probability was lower if the sibling or siblings and the respondent were of the same gender rather than opposite genders, and the probability was lowest among those who had a brother and a sister with a history of premarital childbearing. In the multivariate analysis for males, having one or more brothers only, or having at least one brother and at least one sister, with a history of premarital childbearing was associated with increased relative risks of being sexually experienced by ages 17 and 24. No such association was found for females.

Conclusion: Programs that seek to reduce premarital sexual activity among young people should develop strategies that take into account the potential influence of siblings.

Context: In Zambia, most people know about sexually transmitted infections (STIs) and HIV/AIDS, but this knowledge has not translated into safer sexual practices. An estimated 16% of adults are HIV-positive, with the majority having acquired the infection through heterosexual contact. It is important to know whether characteristics such as wealth are correlated with extramarital sex among men, because men who have sex outside of marriage are key agents of heterosexual transmission of STIs and HIV.

Methods: Data for analysis came from 1,239 married men who participated in the 2001-2002 Zambia Demographic and Health Survey. Multivariate analyses were performed to identify factors associated with men's extramarital sexual behavior, with a focus on wealth.

Results: Overall, 19% of married men had had extramarital sex in the year prior to the survey; their mean number of partners was 1.3. Of the three proxies for wealth included in the multivariate analyses--education, occupation and household wealth index--none were associated with extramarital sex. Living in Southern and Western Provinces of Zambia was associated with significantly increased odds of extramarital sex (2.3 and 3.5, respectively); older age (0.4), older age at first sex (0.6-0.7) and living in Northern Province (0.4) were associated with significantly decreased odds of sex outside of marriage.

Conclusions: Cultural norms specific to regions play an important part in sexual behavior. Socially defined sexual behavior patterns can shed light on extramarital sex and the spread of STIs, including HIV.