Suchergebnisse

Forty eight of the African continent's 54 sovereign states are located in the Sub-Saharan Africa (SSA) region, with the government of each defining and shaping its own health services and delivery systems. This paper reviews the trends and patterns of contraceptive practice in the region. Using survey data available from the Demographic and Health Surveys and Performance Monitoring and Accountability 2020, the study finds modern contraceptive practice to be on the rise overall but with much geographic variation. The contraceptive methods most frequently used are injectables and, more recently, implants. Higher levels of use are observed among unmarried sexually active than married females. Although use is rising, contraceptive discontinuation rates are also high. Recent program initiatives discussed include expanding long-acting contraceptive options, promoting and delivering contraceptive methods in the postpartum period, and relying on community health workers for contraceptive outreach and service delivery. SSA's family planning situation remains challenged by weak health systems which must address competing priorities to manage disease prevention as well as primary health care. Increasing investments in family planning delivery in many SSA countries, however, augur for continued rapid uptake of modern contraception, possibly matching if not outpacing the record of other regions.

The linkages between marital relationship quality (MRQ) and health are well established in the West, although mutual spousal influence on each other is underexplored. In the sub-Saharan African context, despite continued health challenges and changing marital structures, this research has been neglected. This study examined the influence of spousal MRQ domains — such as trust, commitment and conflict resolution — on each other's self-reported health over time, using two waves of data from 725 couples in peri-urban Ethiopia using the Actor Partner Interdependence Model. Although MRQ and self-rated health measures of wives and husbands were associated, these relationships were complex and gendered. While the wife's health rating had a positive influence on the husband's relationship quality, the husband's health ratings were negatively associated with the wife's relationship quality. Expanding knowledge on the role of spousal influence can broaden understanding of couple mechanisms that potentially promote positive health behaviours and protect the health of spouses in different settings.

This study examines the levels and correlates of contraceptive failure and discontinuation in Romania, together with the consequences of contraceptive method failure in terms of induced abortion. Of special interest are women who rely on the traditional method of withdrawal and the proportion of withdrawal failures resulting in abortion. Our analysis is based on multiyear calendar data concerning women's contraceptive use and monthly reproductive behaviors collected in the 1999 Romanian Reproductive Health Survey. Weibull regression models are estimated to analyze the determinants of discontinuation and failure for all methods combined and for withdrawal. Overall, 19 and 28 percent of women became pregnant within the first year of using any contraceptive method and of practicing withdrawal, respectively. About 57 and 59 percent of failures from use of all methods and from withdrawal ended in abortion, accounting for 30 percent and 22 percent, respectively, of all abortions reported between 1994 and 1999. These findings suggest that high rates of contraceptive discontinuation and failure contributed significantly to the widespread reliance on induced abortion among Romanian women during this period.

SummaryPostpartum sexual abstinence may be a major determinant of fertility and of maternal and child health in sub-Saharan Africa. This study examines the relationship between ethnicity and abstinence using data from the 1988 Ghana Demographic and Health Survey. There is considerable diversity in the length of abstinence although only for one ethnic group, the Mole-Dagbani and other Ghanaians, is abstinence, both actual and ideal, very long. Respondents in most ethnic groups believe their abstinence to be adequate. A key motivation for abstinence is the unwillingness to have sexual intercourse with nursing mothers. Education, urbanisation, changes in marriage patterns and religious traditions are major factors shaping the ethnic differentials in abstinence. In comparison to breast-feeding, abstinence appears to have relatively little impact on the length of the birth interval and, for Ghana, has relatively few implications for fertility and child health.

This study examines the prevalence of self-reported reproductive tract infections (RTIs) and treatment seeking among married, recently pregnant women in Uttar Pradesh state, India. Associations between RTI symptom reporting and background characteristics are examined in a population-based sample of 18,506 married women with a pregnancy in the 3 years prior to a 1995 statewide survey. Logistic regression analyses are used to assess the effects of sociodemographic covariates on the probability of reporting an RTI symptom. Nearly one out of four women reports experiencing at least one RTI symptom, with the most common symptoms being abnormal vaginal discharge and pain during urination. Reporting of RTI symptoms significantly increases if the woman's last pregnancy did not end in a live birth or if she has low economic status. Symptom reports also increase with age and decrease with parity. Only one-third of women reporting an RTI symptom sought treatment. The results indicate that survey interviews can be a cost-effective option for measuring the magnitude of RTI symptoms experienced and identifying sociodemographic influences. The findings suggest the need for improved RTI screening procedures and treatment at health facilities in this populous state of northern India.

Front Matter -- José Luis Bobadilla -- Preface -- Contents -- Summary -- 1 Introduction -- 2 Healthy Sexuality -- 3 Infection-Free Sex and Reproduction -- 4 Intended Births -- 5 Healthy Pregnancy and Childbearing -- 6 Program Design and Implementation -- 7 Costs, Financing, and Setting Priorities -- References -- APPENDIX A WHO Recommendations for Treatment of STD-Associated Syndromes -- APPENDIX B Examples of Programs to Promote Safe Pregnancy and Delivery -- Appendix C Estimating the Cost of Interventions: The Mother-Baby Package -- APPENDIX D Biographical Sketches -- Index -- Selected Publications, Committee on Population.

This study uses couple‐level data to measure couples' concordance of self‐reported time since last coitus and of condom and other contraceptive use at last sexual intercourse among monogamous couples in Liberia (N = 1,673), Madagascar (N = 4,138), and Namibia (N = 588). The study also examines the characteristics associated with sexual behavior and contraceptive use occurring in the 28 days prior to the interviews among couples whose reports are concordant. Overall, our study finds less than 75 percent concordance in reporting of time since last coitus. Use of condoms and other contraceptives yielded fair (0.27) to substantial (0.67) agreement on the kappa index. Factors predicting a shorter time since last coitus among concordant couples in at least two of the countries included wealth, spousal age difference, education, and both partners wanting another child. The discordant reports of recent sexual behavior and contraceptive use suggest that caution should be exercised when inferring couples' behavior from the report of one spouse, that concordant reports should be examined when possible, that methodological changes to improve the validity of spousal reports should be pursued, and that family planning and HIV‐prevention programs should target those groups found to be using condoms and other contraceptives less frequently, particularly poorer couples.