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Volume 3, Number 4
27 January 2003
FAMILY PLANNING / REPRODUCTIVE HEALTH LAW AND POLICY
Zimbabwe:
AIDS Emergency Period Extended (news article)
The Zimbabwean government has extended the declaration of emergency
on the HIV/AIDS infection by a further five years to allow affected
people to use generic drugs.
Cambodia
Shuts Down Red-Light District (news article)
Cambodia's notorious Svay Pak shantytown, where girls as young as
10 are employed as prostitutes, has been shut down by the Cambodian
Government.
UNFPA
Says US Funding Cut Worsens Asian Condom Shortage (news article)
A UN Population Fund (UNFPA) official told a forum in Auckland,
New Zealand, that Pacific Islanders face a serious shortage of condoms,
a scarcity that could eventually contribute to a rise in the region's
relatively low HIV/AIDS rate.
South
Africa: New Sex Laws on the Cards (news article)
At a news conference in Pretoria, the South African Law Commission
(SALC) released a report containing its final recommendations on
the law relating to sexual offences, as well as a draft Bill on
Sexual Offences. In its draft Children's Bill, the SALC recommended
that children of all ages be provided with confidential access to
condoms. According to the draft bill on sexual offences, prostitution
by children or mentally impaired people should be decriminalised
in certain circumstances. These included where children benefited
from child prostitution, like siblings in a child-headed household.
In addition, any person infected with a life-threatening sexually-transmissible
disease who failed to disclose that to his or her partner before
having sex will be guilty of rape.
Meetings
on Food Crisis to Highlight Impact of HIV/AIDS as New Type of Famine
Threatens Africa (press release)
Responding to the deadly interaction between HIV/AIDS and food crises
affecting some 40 million Africans, UNFPA, the United Nations Population
Fund, is organizing three regional meetings to help ensure that
relief efforts address both issues in an integrated manner. The
UNFPA initiative, undertaken in partnership with the Joint United
Nations Programme on HIV/AIDS (UNAIDS) and other partners, is part
of an unprecedented coordinated response by the United Nations system
and non-governmental organizations. UNFPA is concerned about young
women reportedly forced into prostitution to feed themselves and
their families, as well as a rise in unprotected sex caused by famine-related
displacement.
Reckless Casanova Sentenced; Man Gets 16 Years for Spreading HIV
(news article)
Because he has known since 1992 that he has the virus that causes
AIDS, a Canadian man's refusal to tell his sexual partners since
then is considered aggravated assault. For that, an upset judge
sent him Chartier to prison for 16 years.
Shifting
Visions: "Delegation" Policies and the Building of a "Rights-Based"
Approach to Maternal Mortality 
(commentary)
"Rights-based" approaches fold human rights principles
into the ongoing work of health policy making and programming. This
commentary argues for choosing the human rights approach that speaks
most effectively to the power dynamics underlying the particular
health problem being addressed. In the case of maternal death in
high-mortality countries, this means a strategic focus on the health
care system itself.
FAMILY PLANNING / REPRODUCTIVE HEALTH RESEARCH
Skin
Patch and Vaginal Ring Versus Combined Oral Contraceptives for Contraception
(Cochrane review)
The review's objective is to compare the contraceptive efficacy,
cycle control, compliance, and safety of the contraceptive skin
patch versus combination oral contraceptives and the contraceptive
vaginal ring versus combination oral contraceptives. The review
included all randomized controlled trials (in MEDLINE, Popline,
Cochrane Controlled Trials Register, EMBASE, and LILACS) in any
language comparing the contraceptive skin patch with a combination
oral contraceptive or contraceptive vaginal ring with a combination
oral contraceptives. Analysis shows that the combination contraceptive
skin patch was similar to the control combination oral contraceptive
in contraceptive efficacy. Patch users had more self-reported cycles
of compliance than oral contraceptive users. No conclusions can
be drawn regarding the vaginal ring as no eligible trials were available.
The
Reliability and Validity of Willingness to Pay Surveys for Reproductive
Health Pricing Decisions in Developing Countries (PubMed abstract)
This paper examined the reliability, theoretical and predictive
validity of willingness to pay (WTP) surveys for setting prices
for reproductive health services in developing countries. Evidence
supporting theoretical validity was found in all four country surveys.
Higher income and more highly motivated users had higher WTP than
lower income and less motivated users. The authors concluded that
WTP surveys, when used for reproductive services price setting,
appear to be reliable and valid, and they improve a program manager's
ability to predict client responses to price changes.
Seasonality
of births is associated with seasonality of marriages in Malta
(PubMed abstract)
This study was carried out to quantify secular trends in seasonal
variation in births in Malta. A significant peak in marriages in
the third quarter of the year was found for almost the entire period
under study. This was paralleled by a peak in births (n = 299,558)
for the period 1970-1996, which lagged after the peak in marriages
by 13-14 months. The authors report that, in Malta, the late summer
peak in births appears to be due to a practical and planned approach
by Maltese couples to contraceptive planning, probably influenced
by the Roman Catholic ethos and social pressures, with unprotected
intercourse occurring only after marriage.
Pills,
Injections and Audiotapes: Reaching Couples in Pakistan (PubMed
abstract)
This paper reports on an innovative social marketing intervention
in Pakistan that distributes audiocassettes via chemist shops and
Lady Health Visitors (LHVs) to reach women in a segregated society
with accurate information on hormonal contraceptives. Operations
research was done to assess the utility of the cassette in knowledge
dissemination and adoption of hormonal use. The authors report that
listeners were significantly more knowledgeable than non-listeners
about correct use of hormonals and that hormonal use increased from
12% to 25%. By providing accurate information to urban couples and
by acquiring a knowledgeable critical mass of satisfied users, the
cassette could be a powerful catalyst to further contraceptive diffusion.
Two-Level
Proportional Hazards Models (research abstract)
The authors extend the proportional hazards model to a two-level
model with a random intercept term and random coefficients to understand
the determinants of contraceptive use among Nepalese women in the
Chitwan Valley Family Study.
FAMILY PLANNING / REPRODUCTIVE HEALTH NEWS
Two
Years of the Global Gag Rule: Could the Controversial Policy Be
a Blueprint for Things to Come? (press release)
As America marks the 30th Anniversary of Roe vs. Wade, the world
observes the 2nd year of the US administration's Global Gag Rule.
According to this press release: "The tragic irony of this
misguided gag is that, from Bangladesh to Bali, when women have
better access to comprehensive reproductive health care, economic
opportunities and education, the quality of everyone's lives is
dramatically improved."
HIV / AIDS RESEARCH
Hormonal
Contraceptive Use and HIV-1 Infection in a Population-based Cohort
in Rakai, Uganda (PubMed abstract)
Related news article: No
Higher HIV Risk With Hormonal Contraceptives
Unlike some recent studies, an analysis of 5117 sexually active
Ugandan women found no higher risk of HIV infection among those
taking hormonal contraceptives.
Dual
Infections with HIV-1, HIV-2 and HTLV-I are More Common in Older
Women than in Men in Guinea-Bissau (PubMed abstract)
The authors found that the prevalence of dual infections increased
with age in women, for any combination of dual infection, while
the prevalence decreased with age in men. Control for behavioural
factors did not modify these patterns. They conclude that the pattern
of increased prevalence among older women could have public health
implications, and they recommend that women of older age groups
should be regarded as a potential vulnerable group and included
in HIV/AIDS prevention programmes.
Poverty, Risky Sexual Behaviour, and Vulnerability to HIV Infection: Evidence from South Africa (research article)
HIV / AIDS NEWS
South
Africa: AIDS to Hit Population Growth (news article)
The HIV/AIDS epidemic is set to slash population growth and reduce
the average life expectancy in SA to just 38 years, according to
research published by the Bureau of Market Research at the University
of SA. The study drew on a range of previously published data and
estimates that the total population will grow from its current base
of 40 million to just 49 million by 2015. Without
HIV/AIDS it would have been expected to grow to 61 million.
The
Impact of HIV/AIDS on Provinces and LSM Groups in South Africa
(press release)
The toll of the HIV/AIDS epidemic in South Africa continues to mount
as is evident from the increasing numbers of HIV-positive people
and a rapid increase in the number of AIDS-related deaths.
Africa:
Year-Ender 2002, Slow Start to HIV/AIDS Treatment Roll-Out (news
article)
The World Health Organisation (WHO) threw down a challenge to the
international community when, at the Barcelona international AIDS
conference in August, it set a target of three million HIV-positive
Africans to be on antiretroviral (ARV) HIV/AIDS therapy by 2005.
AIDS activists responded with cautious optimism, not least because
fewer than 30,000 people in Africa were on ARVs in 2001. WHO's target
represents just half of the six million Africans who currently require
ARV treatment.
Central
African Republic: French NGO Gets Land to Build HIV/AIDS Centre
(news article)
Hanuman, a French NGO campaigning against HIV/AIDS has acquired
land on which an HIV therapy centre worth US $230,000 will be built.
The NGO would this year sponsor eight specialists for training in
France on computer-based HIV treatment and drug prescription. The
trainees would include a physician, a pharmacist and a biologist.
Rise
in Taiwan HIV Infections (news article)
Official figures from Taiwan show the number of people diagnosed
with HIV increased by 16% in 2002.
MATERNAL AND CHILD HEALTH RESEARCH
Utilisation
of Postnatal Care in Bangladesh: Evidence from a Longitudinal Study
(PubMed abstract)
Empirical studies often showed that the use of health services is
related to the availability, quality and cost of services, as well
as to social structure, health beliefs, and personal characteristics
of the users. This paper examined factors associated with the utilisation
of healthcare services during the postnatal period in Bangladesh.
Both bivariate and multivariate analyses of the data confirmed that
mother's age at marriage, husband's occupation in the service or
business sectors, and number of pregnancies prior to the index pregnancy
are significantly associated with the utilisation of postpartum
healthcare.
Postnatal
Depression and Infant Growth and Development in Low Income Countries:
A Cohort Study from Goa, India (research abstract)
Related news article: Mothers'
Depression Linked to Poor Growth in Babies
Babies born to women who suffer postnatal depression in the first
6 weeks of their child's life develop more slowly than other infants,
according to research from South Asia.
Breastfeeding
Knowledge, Breastfeeding Confidence, and Infant Feeding Plans: Effects
on Actual Feeding Practices (research abstract)
This was a prospective descriptive study to explore relationships
among breastfeeding knowledge, breastfeeding confidence, and infant
feeding plans and their effects on feeding practices in first-time
breastfeeding mothers. Telephone interviews were conducted prenatally
and at 6 weeks, 3 months, and 6 months postpartum. Breastfeeding
knowledge was strongly correlated with breastfeeding confidence
and actual lactation duration. Whether a cause or consequence, daily
human milk substitute feeding was associated with negative breastfeeding
outcomes.
User
Fees Impact Access to Healthcare for Female Children in Rural Zambia
(research abstract)
User fees offer revenue and may decrease inappropriate care. However,
user fees may deter needed care, especially in vulnerable populations.
Cross-sectional analysis of healthcare utilization in a large Zambian
hospital was conducted for children 3-6 years of age during a 1-month
observation period. Trends suggest female children may be less likely
to present for care when user fees are imposed.
Increased
Risk of Mother-to-Infant Transmission of Hepatitis C Virus by Intrapartum
Infantile Exposure to Maternal Blood (research abstract)
Virological and clinical data from 73 hepatitis C virus (HCV) infected
pregnant women who gave birth to 75 children were merged retrospectively,
by logistic regression analysis, to investigate risk factors for
vertical transmission of HCV. Increased risk of HCV transmission
during vaginal deliveries suggests cesarean section may reduce the
risk of vertical HCV transmission in selected cases.
Violence
Against Women Increases the Risk of Infant and Child Mortality:
A Case-Referent Study in Nicaragua
(research article)
Using a demographic database covering a random sample of urban and
rural households in Leo'n, Nicaragua, the authors investigated the
impact of violence against mothers on mortality risks for their
offspring before 5 years of age. The results suggest an association
between physical and sexual violence against mothers, either before
or during pregnancy, and an increased risk of under-5 mortality
of their offspring. The type and severity of violence was probably
more relevant to the risk than the timing, and violence may impact
child health through maternal stress or care-giving behaviors rather
than through direct trauma itself.
Immunization
of Children at Risk of Infection with Human Immunodeficiency Virus
(research article)
This paper reviews the literature on the safety, immunogenicity
and effectiveness in children infected with HIV of vaccines currently
recommended by WHO for use in national immunization programs. Although
two HIV-infected infants have developed vaccine-associated paralytic
poliomyelitis, several million infected children have been vaccinated
and the evidence does not suggest that there is an increased risk.
The policy of administering routine vaccines to all children, regardless
of possible HIV exposure, has been very effective in obtaining high
immunization coverage and control of preventable diseases.
Determinants
of Waiting Time to Third Pregnancy Using Censored Linear Regression
(PubMed abstract)
The intervals between pregnancies have important effects on fertility
and maternal and infant health outcomes. This study used linear
regression with censored observation to assess the determinants
of the waiting time to third pregnancy. The analysis was applied
to data from the Second Malaysian Family Life Survey consisting
of 1,172 women who had their second delivery ending in a live birth.
Contraceptive use, age of the woman, duration of breast-feeding,
length of previous pregnancy interval and education of the woman
all affect the waiting time to third pregnancy significantly.
Role
of Health-seeking Behaviour in Child Mortality in the Slums of Karachi,
Pakistan (PubMed abstract)
In this population-based case control study, the role of family
health-seeking behaviour in under-five-year child mortality was
explored through the combined approach of examining health-seeking
behaviour regarding treatment generally, and in specific in relation
to illness before death. Factors significantly associated with child
mortality in the multivariate analysis were mothers changing healers
quickly, using a traditional healer or an unqualified doctor and
mothers to whom doctors did not explain the treatment, even when
maternal education was controlled for.
MATERNAL AND CHILD HEALTH NEWS
Single-Parent
Homes Studied: Afflictions Later in Life Are Seen for Children
(news article)
Children growing up in single-parent families are twice as likely
as their counterparts to develop serious psychiatric illnesses and
addictions later in life, according to an important new study. The
scientists found that children with single parents were twice as
likely as the others to develop a psychiatric illness such as severe
depression or schizophrenia, to kill themselves or attempt suicide,
and to develop an alcohol-related disease.
Tufts
University Research Shows TV Carries Messages that Influence Infants'
Behavior (news article)
Researchers from Tufts University have found that 12-month-olds
are able to draw implications for their own actions by observing
televised emotional reactions of another person toward a particular
object, such as a ball.
MEN'S HEALTH RESEARCH
Diagnosis,
Prevention, and Treatment of Osteoporosis in Men (review article)
Though commonly seen as a disease afflicting only women, osteoporosis
affects more than 5 million men in the United States. Alcohol abuse,
glucocorticoid excess, and hypogonadism are the principle risk factors
for osteoporosis in men. Diagnostic parameters and screening recommendations
for bone mineral density testing have not been firmly established
in men. The treatment and prevention of osteoporosis has been well
studied in women, thus many of the treatments for men with the disease
were extrapolated from studies predominantly involving women. Prevention
of osteoporosis in men is best directed toward risk-factor modification
and supplementation.
Risk
Factors for Kaposi's Sarcoma in Men Seropositive for Both Human
Herpesvirus 8 and Human Immunodeficiency Virus (PubMed abstract)
Related news article: Risk
Factors for Kaposi's Sarcoma in Men with HIV
HIV-infected men with Kaposi's sarcoma (KS) were almost 9 times
more likely to have DNA from the KS virus in blood cells than were
HIV-positive men without KS.
POPULATION RESEARCH
International
Adoption Rate in US Doubled in the 1990s (research article)
The United States adopts more children from abroad than any other
country. Three-fourths of the 20,000 children adopted by U.S. parents
last year were from China, Russia, South Korea, Guatemala, or Ukraine.
The
Impact of Rural-urban Migration on Under-two Mortality in India
(PubMed abstract)
This paper examines the impact of rural-urban migration on under-two
mortality in India, using data from the 1992/93 Indian National
Family Health Survey. The authors report that problems faced by
migrants in assimilating into urban societies create mortality differentials
between rural-urban migrants and urban non-migrants. They suggest
their findings highlight the need to target migrants in the provision
of health services, and demonstrate that rural areas continue to
have the highest levels of infant-child mortality.
POPULATION NEWS
US
Latinos Outnumber Blacks, Census Estimates (news article)
For the first time in US history, people calling themselves Latino
now outnumber those identified solely as black, according to new
Census Bureau figures.
Iranian
Primary Care Produces Big Results
The Iranian health-care system, which places a heavy emphasis on
primary care, has dramatically increased life expectancy and lowered
population growth since 1986, according to the vice chancellor of
Tehran University of Medical Sciences.
Canada:
Chinese Population Balloons (news article)
According to data from the 2001 census released by Statistics Canada,
mainland China has become Canada's prime immigrant source, with
136,135 Mandarin-speaking people in the Greater Toronto Area claiming
it as their birthplace. That moves them ahead of their 110,735 Cantonese-speaking
compatriots from Hong Kong.
WOMEN'S HEALTH RESEARCH
Discrepancy
between Consensus Recommendations and Actual Community Use of Adjuvant
Chemotherapy in Women with Breast Cancer (research article)
Related news article: Older
Women Less Likely to Receive Chemotherapy for Breast Cancer
Actual use of chemotherapy for breast cancer differs markedly from
consensus recommendations, and the gap between ideal and actual
care widens for older women. Decreased use with age may reflect
knowledge of clinical trials that show decreasing efficacy of chemotherapy
with increasing age.
Physician
Specialty is Significantly Associated with Hormone Replacement Therapy
Use (PubMed abstract)
The study compared the characteristics of postmenopausal women seen
by gynecologists versus family physicians and determined factors
associated with current hormone replacement therapy (HRT) use. The
authors found that the adjusted odds of current HRT use among women
receiving care from gynecologists was 2.6 times that among women
receiving care from family physicians. This practice variation may
reflect physicians' uncertainty surrounding the preventive value
of HRT.
Differences
in Breast Cancer Stage, Treatment, and Survival by Race and Ethnicity
(research abstract)
Using data from 11 population-based tumor registries, the authors
conducted a retrospective cohort study to evaluate the relationship
between race and ethnicity and breast cancer stage, treatments,
and mortality rates. Relative to non-Hispanic whites, blacks, American
Indians, Hawaiians, Indians and Pakistanis, Mexicans, South and
Central Americans, and Puerto Ricans had 1.4- to 3.6-fold greater
risks of presenting with stage IV breast cancer. In addition, blacks,
American Indians, Hawaiians, Vietnamese, Mexicans, South and Central
Americans, and Puerto Ricans had 20% to 200% greater risks of mortality
after a breast cancer diagnosis. Breast cancer survival may be improved
by targeting factors, particularly socioeconomic factors, that underlie
these differences.
Low-Dose
Combination of Flutamide, Metformin and an Oral Contraceptive for
Non-Obese, Young Women with Polycystic Ovary Syndrome (research
abstract)
This study assesses whether the endocrine-metabolic benefits of
combined flutamide-metformin treatment are maintained in the presence
of a low-dose oral contraceptive (OC). The authors concluded that
when a low-dose OC is administered with a low-dose flutamide-metformin
combination in women with PCOS, the beneficial effects are maintained
on hyperinsulinaemia-dyslipidaemia, which are key determinants of
long-term complications. Hence, in daily practice, such a low-dose
quatuor may become a therapeutic option of first choice for young
women with PCOS.
Fertility
Preservation in Breast Cancer Patients: IVF and Embryo Cryopreservation
after Ovarian Stimulation with Tamoxifen (research abstract)
Related news article: New
Role for Tamoxifen as Fertility Drug for Breast Cancer Patients?
US fertility experts have discovered a potential new role for the
wonder drug tamoxifen - helping breast cancer patients to have babies
by IVF.
WOMEN'S HEALTH NEWS
Conclusive
Proof That Tamoxifen Can Prevent Breast Cancer (news article)
Scientists at Cancer Research UK say they now have conclusive proof
that tamoxifen can prevent breast cancer in healthy high-risk women.
The findings, published in a recent issue of the Lancet, show that
the drug reduced the incidence of breast cancer by 38% in healthy
women with a high chance of developing the disease. Researchers
say the next challenge is to minimise the side-effects of tamoxifen
so that it can fulfil its potential as a frontline preventative
drug.
Cervical
Cancer: Risk Doubles with Longer Screening Intervals (news article)
A rigorous case-control study found that a woman's relative risk
of invasive cervical cancer doubled if she was screened at 2- or
3-year intervals after her last negative cervical smear, rather
than at 1-year intervals.
Cutting
Calories Via Any Diet Regulates Hormones (news article)
Women with a hormonal problem that can lead to irregular periods
and infertility experience an improvement in their symptoms after
a few months of dieting, regardless of whether they opt for a low
or high protein diet, according to new research.
YOUTH HEALTH RESEARCH
Psychosocial
Correlates of HIV Risk Behavior in Adolescent Girls (research
abstract)
This study presents the preintervention data of a pilot HIV-prevention
randomized controlled trial developed for single, sexually active
adolescent girls. Using self-administered questionnaires, 129 single,
sexually active adolescent girls 15 to 19 years of age were assessed
on demographics and risk behaviors. Additionally, the following
were assessed: HIV-related information and motivation to reduce
risk. Assessments revealed limited HIV-related knowledge, ambivalence
regarding risk reduction, and considerable risk behaviors. Compared
with girls at lower risk for HIV, those at higher risk were more
likely to be white and older and to have better HIV-related knowledge
but less motivation to reduce risk.
STI
Risks High Among Zimbabwe's Youth (research article)
Though many Zimbabwean youth become sexually active at early ages,
they encounter barriers to needed health information and services.
Teen
Pregnancy, Motherhood, and Unprotected Sexual Activity (research
abstract)
The authors examined the sexual behaviors and attitudes toward condom
use of adolescent mothers (N = 572) from ethnic minority groups.
They found that unprotected sex was associated with behavioral intentions
to use condoms, pregnancy, having a steady partner, more frequent
church service attendance, and ever having anal sex. Findings support
the urgent need for broad-based HIV prevention efforts for adolescent
mothers that build on theoretical concepts and address the realities
of their lives.
PROFILES / SPECIAL REPORTS
"What
About Us?" Bringing Infertility into Reproductive Health Care
(report)
Infertility is a major reproductive health problem throughout much
of the world. Despite the prevalence and seriousness of infertility,
however, the population and reproductive health field has largely
neglected this problem. This issue of Quality/Calidad/Qualité,
with clinic-based narratives and case reports from India and Nigeria,
illustrates what is involved in trying to address the problem of
infertility in developing countries.
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