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The Pop Reporter®

Volume 3, Number 28
14 July 2003

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FAMILY PLANNING / REPRODUCTIVE HEALTH RESEARCH

Ortho Evra/Evra Versus Oral Contraceptives: Follicular Development and Ovulation in Normal Cycles and After an Intentional Dosing Error (research abstract)
Related news article: Saskatchewan Researchers Rewrite the Textbook on Human Menstrual Cycle http://www.nlm.nih.gov/medlineplus/news/fullstory_13300.html Saskatchewan researchers have made a discovery that could force the rewriting of text books on the female menstrual cycle, which could in turn lead to better infertility treatments, oral contraceptives and fewer "oops" babies. The team discovered that many women actually have the potential to ovulate more than once per cycle, a finding that challenges the dogma on the human cycle.

Syndromic Management of Sexually Transmitted Diseases in Botswana's Primary Health Care: Quality of Care Aspects (research abstract)
The authors evaluated the quality of care of the syndromic management of sexually transmitted diseases (STDs) in Botswana's primary health care through participative observations of 224 consecutive consultations of patients with STDs (135 females and 89 males) by nurses. The quality of history taking and physical examination was acceptable for 25% and 23% of the women and for 54% and 57% of the men, respectively. Approximately, 65% of the women and 81% of the men received appropriate treatment. In half of the health facilities the lack of a fixed light source was the main constraint in carrying out a vaginal speculum examination.

Microinsert Nonincisional Hysteroscopic Sterilization (research abstract)
A cohort of 518 previously fertile women seeking sterilization participated in this prospective, phase III, international, multicenter trial to assess the safety, effectiveness, and reliability of a tubal occlusion microinsert for permanent contraception. Bilateral placement of the microinsert was achieved in 464 (92%) of 507 women. The most common reasons for failure to achieve satisfactory placement were tubal obstruction and stenosis or difficult access to the proximal tubal lumen. More than half of the women rated the average pain during the procedure as either mild or none, and 88% rated tolerance of device placement procedure as good to excellent. Ultimately, 449 of 518 women (87%) could rely on the microinsert for permanent contraception. After 9620 woman-months of exposure to intercourse, no pregnancies have been recorded.

Advancing Towards a Male Contraceptive: A Novel Approach from an Unexpected Direction (research abstract)
This article reviews the development of a male contraceptive agent up to the present time. Several non-hormonal avenues for male contraception are being developed, and a recent study provides an exciting novel approach to male contraception by administration of a drug that modifies the biosynthesis of glycosphingolipids.

"Actual Use" Study of Emergency Contraceptive Pills Provided in a Simulated Over-the-counter Manner (research abstract)
The study was conducted at family planning clinics and pharmacies in the United States. Of classifiable first uses, 1.3% were contraindicated and 28% were incorrect by strict primary definitions of these inappropriate use patterns, based on label instructions; only 6.6% of classifiable first uses were incorrect by a reasonable alternate definition. Fewer than 2% of subjects became pregnant. The authors conclude that women do not need provider intervention to use the levonorgestrel regimen of emergency contraceptive pills safely and effectively.

The Levonorgestrel Two-rod Implant for Long-acting Contraception: 10 Years of Clinical Experience (research abstract)
A total of 249 women (18-40 years old) underwent two-rod implant insertion and were observed for a total of 823 woman-years (6 year follow-up). There were two pregnancies observed during the study (pregnancy rate of 0.24 per 100 woman-years). One pregnancy occurred in the first month, and the other occurred after 6 years of use. The major side effect was menstrual irregularity. No serious side effects were observed during this study.

Advance Supply of Emergency Contraception Effect on Use and Usual Contraception: A Randomized Trial (research abstract)
The authors performed a randomized controlled trial comparing advance provision of emergency contraception (EC) with usual care in 370 postpartum women from an inner-city public hospital in the US to evaluate whether advance provision of EC increases its use and/or adversely affects usual contraceptive practices. They found that women provided with pills were four times as likely to have used emergency contraception as women in the control group over the course of the year. In addition, women were no more likely to have changed to a less effective method of birth control or to be using contraception less consistently.

Development of Methods of Male Contraception: Impact of the World Health Organization Task Force (research abstract)
This review article gives an historical record of the research of the World Health Organization (WHO) Task Force to develop methods of male contraception; examines the social, political, medical, pharmaceutical, funding, and other factors that influenced progress; and suggests reasons why such methods are only now becoming available.

Unmet Need for Contraception in Kuwait: A Developing Country Without a Family Planning Program (research article)
The authors estimate the level of unmet need for contraception in Kuwait and examine the characteristics of women with unmet need in comparison with current users. They used data collected in a nationally representative survey of Kuwaiti households conducted in 1999 covering 1689 households (1.2% of all Kuwaiti households) containing 1502 currently married women. Those with unmet need comprised 9.7% of all currently married women; 6.1% wanted to stop childbearing, while 3.6% wanted to space their children. A significantly larger percentage of the unmet need group disapproved of contraception, and believed that Islam forbids family planning compared with current users (30% and 15%, respectively). Approximately 41% of women with unmet need said that their husband disapproved of contraceptive use compared with only 10% of current users. Despite the absence of a family planning program in the country, the perceived contraceptive needs of approximately 90% of all currently married women were being adequately met, while approximately 10% had an unmet need.

Barrier Contraceptive Method Acceptability and Choice Are Not Reliable Indicators of Use (research abstract)
In the San Francisco Bay Area, 510 females aged 15 to 30 years were recruited from reproductive health clinics for this longitudinal study to evaluate associations between measures of acceptability and use of existing over-the-counter barrier methods. The researchers found that neither hypothetical acceptability nor product choice predicted use. Fewer than 50% of participants who chose a female-controlled method used it. Similarly, method satisfaction was not associated with use. However, dissatisfaction was predictive of low levels of subsequent use (male condoms were used despite dissatisfaction).

Couples' Views of the Effects of Natural Family Planning on Marital Dynamics (PubMed abstract)
This was a descriptive survey study designed to learn about the effects of modern natural family planning (NFP) methods on marital relationships. Questionnaires were mailed to 1,400 randomly selected couples known to use NFP and residing in the US; 334 couples (24%) responded. Content analysis was used to identify meanings and themes. Nearly two-thirds of the qualitative comments were positive. Four themes were identified in the positive responses: relationship enhancements, knowledge improvements, spirituality enrichments, and method successes. Three negative themes were identified: strained sexual interactions, worsened relationships, and method problems. Although about one-fourth of the comments indicated that NFP presented challenges, most (74%) found it beneficial, often resulting in stronger bonds, better communication, and improved knowledge.

FAMILY PLANNING / REPRODUCTIVE HEALTH NEWS

China Focuses on Lack of Sex Education (news article)
In China, government leaders are using UN World Population Day to focus on the lack of sex education in the country. Evidence of changing times in China: on Friday, several of the country's state-controlled newspapers recognized UN World Population Day with articles calling for more sex education for Chinese teens.

UK: More Sex Education Called For (news article)
The government has been told it needs to try harder to reduce teenage pregnancy by such methods as giving sex education to children as young as five.

Contraception Catches On in Russia (feature article)
During the 1980s in the Soviet Union, condoms were as hard to find as people who wanted to use one, and Hungarian and East German contraceptive pills collected dust on pharmacy shelves. In 1993, the prescription drug business was transformed overnight to the free-market model. The road has not been an easy one; there have been controversies. Today, 7.8% of women of childbearing age use contraceptive pills, and 16.3% use sponges. Pills have continued to increase their market share in Russia, a trend that parallels the situation in most of Europe. In cities with populations over 100,000, one out of every five women uses a pill for birth control.

FAMILY PLANNING / REPRODUCTIVE HEALTH LAW AND POLICY

AIDS Groups Praise Bush Plan (news article)
US President George W. Bush won applause from AIDS fighters for his $US15 billion plan to fight the disease in Africa and the Caribbean, but some said they remained troubled by key details.

Health Sector Reform: How It Affects Reproductive Health (policy brief)
(You will need Adobe Acrobat to access this document) This policy brief provides an overview of health sector reform, discussing its potential impact on reproductive health services and ways to incorporate reproductive health priorities into evolving health care systems.

Sex Workers and the Cost of Safe Sex: The Compensating Differential for Condom Use among Calcutta Prostitutes (research abstract)
The authors write that anecdotal evidence showing that the fear of a loss in income is one of the most important factors deterring sex workers from using condoms. This has important implications for AIDS policy. They estimate the compensating differential for condom use employing data from a random sample of sex workers in Calcutta and rely on a natural experiment (the nonsystematic placement of sex workers in a safe sex information program) to identify the relationship between condom use and the price for sex. They found that sex workers who always use condoms face large losses of between 66% (FIML) and 79% (IV). The authors conclude with several suggestions for addressing the important policy implications of this finding.

Canada: HIV-positive Immigrants Spark Concern (news article)
An estimated 60% of HIV-positive people from Ontario's African and Caribbean communities do not know they have the virus, creating what a researcher calls a "significant public-health challenge."

Stunted Child-Overweight Mother Pairs: An Emerging Policy Concern? (research paper)
(You will need Adobe Acrobat to access this document) This paper explores the global prevalence of an emerging phenomenon: the coexistence of a stunted child and an overweight mother in the same household. It also tests whether this phenomenon is associated with a country's level of economic development and urbanization. Policy directions for public nutrition are highlighted.

The 'Acquired Income Deficiency Syndrome': School Fees and Sexual Risk in Northern Tanzania (research abstract)
This article examines the impact of structural adjustment policies on young women's educational opportunities and reproductive health in the Kilimanjaro Region of Tanzania.

HIV / AIDS RESEARCH

HIV Prevalence and Risk Behavior Among Clients of Female Sex Workers in Abidjan, Côte d'Ivoire (research abstract)
The authors assessed socio-demographic and behavioural characteristics of clients of female sex workers in Abidjan, and to determine their HIV prevalence and related risk factors. A total of 526 clients agreed to participate, and 423 (80.4%) provided a saliva sample for testing for HIV antibodies. Reported condom use was very high: 92.7% said they always use condoms, and 95.4% reported condom use during the visit preceding the interview. The overall HIV prevalence among the clients who provided a saliva sample was 13.4%.

HIV / AIDS NEWS

Experts: HIV Treatment in Developing Countries Makes Economic Sense (news article)
A leading economist dismissed arguments that treating HIV in developing countries is not cost-effective and increases the virus' resistance, saying it is more expensive not to treat the virus that causes AIDS.

Swaziland: Data Collection an Effective Weapon in Anti-HIV/AIDS Arsenal (news article)
A new information gathering programme will soon provide an essential database of medical and other humanitarian needs in the agricultural heart of Swaziland to fill gaps in the national records and bring much needed insight into how to best counter the spread of HIV/AIDS.

Indian Officials to Investigate Stoning of Woman with HIV (news article)
The government in the south Indian state of Andhra Pradesh has begun a probe into the stoning death of a 30-year-old HIV-positive widow after expressions of outrage from AIDS rights campaigners worldwide.

MATERNAL AND CHILD HEALTH RESEARCH

Violence against Pregnant Women in Developing Countries: Review of Evidence (research article)
(You will need Adobe Acrobat to access this document) This study systematically reviews the literature to estimate the prevalence of violence against pregnant women in developing countries (estimated at 4% to 29%). The main risk factors found for abuse during pregnancy were belonging to a low-income group, low education in both partners, and unplanned pregnancy.

Kangaroo Mother Care: A Method for Protecting High-risk Low-birth-weight and Premature Infants against Developmental Delay (research abstract)
This prospective study examined the relationship between intervention with the Kangaroo Mother Care (KMC) and the subsequent mental development of the infants. In the study, 431 low-birth-weight and premature infants (1801 g) were assigned randomly to KMC or Traditional Care (TC); and of these, 336 (78%) received the Griffiths test at 12 months of corrected age. After control for the infant's health at birth, family socioeconomic status, and mother labor and delivery characteristics, the KMC infants had a higher IQ than those given TC. The difference was most highly significant for infants who were more premature (30-32 weeks of gestational age), had required intensive care, and had a diagnosis of doubtful or abnormal neurological development at 6 months.

Maternal Immunisation in Developing Countries (research abstract)
In this review article, the authors make their case for a trial of the effectiveness of maternal immunisation with a pneumococcal vaccine in preventing serious illness or death in young infants in developing countries.

The Extraordinary Decline of Infant and Childhood Mortality among Palestinian Refugees (research abstract)
This article documents the levels and patterns of infant and child mortality among Palestinian refugees in Jordan, Lebanon and the Palestinian areas based on comparable data from household sample surveys conducted since 1995. The findings show that Palestinian refugees have clear advantage in mortality levels as compared to their non-refugee counterparts in every setting, and refugees living in the camps have similar or lower levels of mortality than their non-camp counterparts, other things being equal.

Family and Community Support to Adolescent Mothers in Swaziland (research abstract)
At Mbabane Government Hospital in Swaziland, 25% of the deliveries are by women aged 10-19 years. Thirty-one adolescent mothers were recruited from Mbabane Obstetric Unit after childbirth and were visited in their homes 7 days after delivery and interviewed about the family, community and health professional support experienced for themselves and their newborns. Researchers found that support from families and community and health professionals were generally poor, and pregnancies among adolescents were unplanned. Information from parents and the community on sexuality and reproductive health had been grossly lacking.

MEN'S HEALTH RESEARCH

Plants for Male Fertility Regulation (research abstract)
This paper reviews fertility-regulating agents in 80 plants, including the type of extract, dose, animal model, and pharmacological activity of each.

POPULATION NEWS

South Korea: Population to Top Out in 2023 (news article)
With Korea's total fertility rate, or births per woman, dropping rapidly, experts say the nation's population will top out in 20 years and then begin to shrink.

Rapid Population Growth, Crowded Cities Present Challenges in the Philippines (feature article)
This short article reviews the population challenges facing The Philippines, a country of 80 million people where the average number of children born to a woman is close to four and where 37% of the population is under age 15.

UN Body Notes 'Positives' in Pak Population Trends (news article)
The Country Population Assessment (CPA) 2003 for Pakistan has shown some positive trends in population, related developmental factors and reproductive health compared to those in the past few years. The CPA observed that the annual growth rate had declined to 2% and the total fertility rate to 4.5 births per woman.

India Continues to Add Country-loads to Its Population (news article)
India added about 180 million to its population in the past decade. These staggering figures give the government something to think about after years of labouring over exactly how to maintain the delicate balance between coercing or encouraging citizens to plan their families.

Germany: Call for More Kids (news article)
Germany's family affairs minister announced a program aimed at publicizing German companies that adopt flexible employment policies aimed at encouraging Germans to have more children. The minister said that of 190 countries monitored by world bodies, Germany's birthrate was 181st.

WOMEN'S HEALTH RESEARCH

Intrauterine Devices and Pelvic Inflammatory Disease (research abstract)
This article examines recent studies that assess the risk of PID with IUD use, explains why some of the assumptions on which the arguments regarding a lack of an association between IUD use and PID are based might not be correct, and recommends additional trials to evaluate IUDs as one of several contraceptive options.

Genital Ulcers in Women (research abstract)
This report discusses genital ulcer disease (GUD) in women, recognized as an important co-factor for acquisition of HIV. GUD etiology has been elucidated in the past decade, with the availability of multiplex polymerase chain reaction. Worldwide, herpes simplex virus-2 (HSV-2) is the leading cause of GUD. However, mainly in women in developed countries, the incidence of GUD causation by HSV-1 is rising, owing to adolescents who are HSV-1 naïve and to increased oral sex practices.

Does Contraception Benefit Women? Structure, Agency, and Well-being in Rural Mexico (research abstract)
The authors of this paper examine Amartya Sen's contributions to the concept of human well-being from a gender perspective and argue that this concept is particularly useful for explaining women's decisions on contraceptive use. The study draws on data collected in six rural communities of Chiapas, Mexico. It emphasizes the ways in which public discourse articulates the apparent benefits of having small families; the context of the household and community in which rural women make reproductive decisions; and the impact of family planning programs on women's sense of subjective well-being.

Sexually Transmitted Infections in a Female Population in Rural North-east Brazil: Prevalence, Morbidity and Risk Factors (research abstract)
A total of 341 women (84%) were examined gynaecologically and colposcopically to determine the prevalence of major sexually transmitted infections (STIs) and gynaecological morbidity in women of reproductive age living in rural communities in north-east Brazil and to assess risk factors associated with the presence of STIs. The prevalence of human papilloma virus (HPV), bacterial vaginosis (BV), and trichomoniasis (TV) was 26%, 15%, and 10%, respectively. Vulvovaginal candidiasis (VC) as well as infections with N. gonorrhoeae and C. trachomatis were detected in 6%; syphilis seroreactivity, in 3%. Multiple infections were very common, and 51% of women had at least one STI. Vaginal discharge, the predominant morbidity (56%), was significantly associated with BV, vulvovaginal itching with VC, and lower abdominal pain with C. trachomatis infection. Being unmarried was a significant risk factor for having an STI. Among unmarried women, age (<20 years) was a significant risk factor.

WOMEN'S HEALTH NEWS

Over-the-counter Pain Relievers Effective in Protecting Against Breast Cancer (news article)
Regular use of ibuprofen and aspirin inhibits the formation and growth of breast cancer, according to data published in the Proceedings for the 94th Annual Meeting of the American Association for Cancer Research. The data, taken from the National Cancer Institute's (NCI) Women's Health Initiative (WHI) Observational Study, concluded that weekly doses of non-steroidal anti-inflammatory drugs (NSAIDs) had a significant effect in reducing the risk of breast cancer.

YOUTH HEALTH RESEARCH

Applying Social Franchising Techniques to Youth Reproductive Health/HIV Services (report)
(You will need Adobe Acrobat to access this document) This paper examines what role social franchising might have in expanding reproductive health and HIV services for youth.

CAMP: A Community-based Approach to Promoting Safe Sex Behaviour in Adolescence (research abstract)
This paper describes the development and assessment of the Community Awareness Motivation Partnership (CAMP) Teen Theatre intervention, which addresses the role of contraceptive use in safe sex behaviour through a brief informative, entertaining, and culturally responsive dramatization program. In a large group of adolescents (N = 1613) between the ages of 11 and 18, the intervention produced short-term changes in safe-sex behavioral intentions and knowledge.

Predictors of Condom Use among Adolescent Thai Vocational Students (PubMed abstract)
In this study, anonymous self-report questionnaires were used to collect data, and a cross-sectional correlational design was used with a cluster-based sample of 425 students aged 18 to 22 years from eight randomly selected private vocational schools in Bangkok, Thailand. Overall, 49.9% of participants were sexually active (64.8% of men and 32% of women). Of the sexually active participants, only 6.3% reported using condoms every time when having sex in the beginning of the relationship, and 10.2% during the last few times. Twenty-four percent of sexually active participants had unplanned pregnancies, and 7% had sexually transmitted diseases (STDs).

Frequency and Perceived Credibility of Reported Sources of Reproductive Health Information among Primary School Adolescents in Arusha, Tanzania (research abstract)
This paper describes adolescents' sources of reproductive health information and perceived credibility of those sources. A questionnaire survey was conducted among 1,247 seventh grade pupils in Arusha district. Mass media ranked first as sources of reproductive health information, followed by teachers and health workers. Health workers ranked first in credibility followed by parents, while credibility rating for media was low. Religious leaders and respondents' friends played a rather minor role as sources of reproductive health information, and their credibility ratings were also low.

YOUTH HEALTH NEWS

"One Billion Adolescents: the Right to Health, Information and Services": UNFPA Calls for More Action to Support Young People (press release)
More than one billion people are 10 to 19 years old: the largest youth generation in history. These adolescents need knowledge, choices and opportunities, and their voices and concerns must be recognized so they can enjoy healthy and productive lives, said Thoraya Ahmed Obaid, Executive Director of UNFPA, the United Nations Population Fund. Speaking on World Population Day, 11 July, Ms. Obaid said that too many young people suffer severe consequences because they lack access to adequate education and health care. More than 70,000 teenage girls are married every day and nearly 40,000 give birth. "For these young women, this means an incomplete education, limited opportunities and serious health risks," said Ms. Obaid.

Afghan Teens Speak Out Against Early Marriage - World Population Day: A Personal Story (feature article)
"If my parents tried to force me to marry, I would refuse," declared Zohal, 16, as her fellow students nodded in agreement. The Afghan teenagers had just heard government leaders say that early marriage closes girls' educational prospects and threatens their health, in a forum marking World Population Day. Such outspokenness is rare in a country where conservative traditions hold firm, daughters bring a dowry and early pregnancy contributes to soaring rates of maternal mortality.

China Targets Adolescent Health with Sex Education (news article)
All first-grade students in junior middle schools of Jiashan City, east China's Zhejiang Province, received a special card on sexual health on July 11, World Population Day.

PROFILES / SPECIAL REPORTS / RESOURCES

Handbook on Access to HIV/AIDS-related Treatment (handbook)
(You will need Adobe Acrobat to access this document) This handbook aims to support nongovernmental organizations (NGOs), community-based organizations (CBOs), and groups of people living with HIV/AIDS (PLWHA) in developing countries that are providing treatment to people living with HIV/AIDS or are thinking of doing so. It is intended to help NGOs, CBOs, and PLWHA groups to find practical ways to understand, plan and undertake work on HIV/AIDS-related treatment.

Population Reference Bureau Graphics Bank (resource)
The Graphics Bank contains more than 100 PowerPoint presentations that put international population and health topics in perspective; many slides also have talking points. You can view or print the PowerPoint files or print the graphics on transparency sheets for use with an overhead projector. You can tailor them by combining them or editing them to suit your purpose. However you choose to use them, these graphics will save you time and enhance the points you are making.

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