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Volume 3, Number 34
25 August 2003

"The Pop Reporter" (R) Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs INFO Project When you click on any link below, your Internet browser will access a Web site not connected to "The Pop Reporter." Information accessed through these links and contained in this issue of "The Pop Reporter" does not necessarily state or reflect the views of the INFO Project, Johns Hopkins University, or the US Agency for International Development. All links were verified at the date of mailing. Your computer and/or network configuration regarding Java script, cookies, and other security issues may not allow you to view certain Web sites. Consult your computer technician if you are having problems. Due to the upcoming Labor Day holiday on September 1, next week's edition of "The Pop Reporter" will be mailed on Tuesday September 2.

Guest Editorial

Ensuring Access to Reproductive Health (Guest Editorial)

by Jagdish Upadhyay

upadhyay@unfpa.org

Reliable access to contraceptives, condoms, and other reproductive health commodities is a fundamental requirement for reproductive health. Yet millions of people in developing countries go without these essentials, leaving them vulnerable to unwanted pregnancy, HIV/AIDS, and other sexually transmitted infections.

In 1994, the world’s governments, meeting at the International Conference on Population and Development, agreed on the goal of universal access to reproductive health care by 2015. Since then, the United Nations Population Fund (UNFPA) has taken the lead role in reproductive health commodity security: coordinating the process, forecasting needs, mobilizing support and building logistical capacity at the country level.

One factor contributing to today’s severe shortages of reproductive health commodities and services is insufficient donor funding. While demand for reproductive health services and commodities is increasing, donor support is dwindling.

In 2002, UNFPA experienced a gap of $125 million in trying to respond to requests for reproductive health commodities. The $25 million in extra-budgetary funding that was available was dwarfed by requests totaling $150 million from 73 countries, which went above and beyond allocations provided by the international community and national governments for reproductive health commodities and services.

Unless the gap for reproductive health commodities is filled by concerted and consistent action on the part of program countries, donors, and other partners, the consequences of these projected shortfalls will be grave. It is unconscionable in this era of AIDS that such a simple and inexpensive life-saver as a condom is not universally available.

UNFPA estimates that each $1 million shortfall in contraceptives results in (1):

O 360,000 unwanted pregnancies
O 150,00 additional induced abortions
O 800 maternal deaths
O 11,000 infant deaths

The good news is that the global strategy for reproductive health commodity security is being translated to the country level, and progress is being made. Regional workshops are building capacity to design and implement country-specific plans.

In several countries, national working groups have been established to increase donor coordination and strengthen national capacity to estimate needs and supply, increase demand, and generate behavior change. At a recent meeting in Geneva, co-organized by UNFPA, several Health Ministers from Pacific Island countries endorsed the commitment to strengthen the provision of reproductive health commodities in their region.

While it is clear that progress is being made to close the gap between demand and supply of reproductive health commodities, much remains to be done. Lack of funds is one of the most prominent deterrents to achieving reproductive health commodity security in developing countries. Recognizing that a secure supply of reproductive health commodities and services is essential to reaching The Millennium Development Goals, UNFPA is strengthening coordination with a growing number of partners to meet the needs of populations around the world. In 2002 the Fund cooperated closely with other dveleopment partners, including WHO, UNAIDS, the World Bank, The International Planned Parenthood Federation, The United Sates Agency for International Development, John Snow, Inc., and the Program for Appropriate Technology in Health, in such areas as country capacity development, advocacy, and resource mobilization.

Closing the gap between supply and demand for reproductive health commodities and supplies should be an international priority. It is increasingly clear that countries will not be able to meet their development goals to reduce poverty and mortality rates, and slow the spread of AIDS, unless greater attention is given to meeting people’s basic needs, expanding their choices, and ensuring their right to health, including reproductive health.

1. A Secure Supply of Commodities. Available at:
http://www.unfpa.org/supplies/essentials/1a.htm. Accessed July 9, 2003.

Mr. Upadhyay is Chief of the Commodity Management Unit, United Nations Population Fund.

Family Planning/Reproductive Health Research

Psychosocial Impact of Serological Diagnosis of Herpes Simplex Virus Type 2: A Qualitative Assessment (research abstract)
Research shows that individuals exhibit strong negative emotional and psychosocial responses to a serological diagnosis of HSV-2 infection, which may potentially be amenable to counselling.

Recurrent Genital Herpes Treatments and Their Impact on Quality of Life (PubMed abstract)
Herpes genitalis is one of the most common viral sexually transmitted diseases in the world. Outbreaks, and the infectious potential to the patient's sexual partners, may result in significant psychological stress on the patient, and create a strong negative impact on the quality of life (QOL). The topical immune response modifier, resiquimod, and herpes vaccines may eventually be shown to decrease the psychological morbidity of recurrent genital herpes, although not all patients with recurrent genital herpes need suppressive therapy.

Contraceptive Knowledge, Practices and Utilization of Services in the Rural Areas of India (An ICMR Task Force Study) (research article)
This paper is based on observations related to contraceptive knowledge, practices and utilization of services during a large reproductive health survey of eligible married women. Overall contraceptive prevalence was 45.2%, of which 34.2% had used a permanent method. There was no concept of using any family planning method for either postponing the first conception after marriage or spacing between the two child births. A large majority of women (70.5%) used a family planning method for the first time only after completing their desired family size.

Status of Immunodiagnosis and Immunocontraceptive Vaccines in India (PubMed abstract)
This article focuses on the Indian initiative of making kits for diagnosis of various infectious and non-infectious diseases as well as reproductive hormones and hormones in various other endocrine disorders.

Reproductive Health including Family Planning (research article)
(You need Adobe Acrobat Reader to access this document)
In the first section of the paper, the author summarizes selected aspects of family planning programs in Asia. In the second section, the linkages between family planning and other aspects of reproductive health are examined. The third section of the paper focuses on quality-of-care issues related to reproductive health, while in the final section of the paper new roles for reproductive health programmes are examined.

Family Planning/Reproductive Health News

Ghana: New Sex Trade at Tema Port (news article)
A social worker has complained about a new development in Tema, where teenage girls troop to have casual sex with drivers and their mates, who come to the Tema Harbour to cart transit cargoes to the landlocked countries.

Family Planning/Reproductive Health Policy

China to Usher in Major Changes in Population Policies (news article)
The new Chinese State Family Planning and Population Commission will address the need for strategic population research and planning for the world's largest population during the next 25 to 50 years by tackling a much wider range of population-related problems.

Pro-Lifers Question Call for 'Billions More Condoms for Asia' (news article)
Asian countries being targeted by a new WHO drive to promote condoms in a bid to curb AIDS should instead look at the example set by Uganda, where changes in sexual behavior have led to a drop in infection, according to pro-life campaigners in the Philippines. The WHO, which is holding a 4-day conference in Laos, said billions more condoms were needed in Asia, a region it predicts will become the epicenter of the global HIV-AIDS pandemic in the next decade. It said in a statement that rates of condom use in the region remained low and called especially for prostitutes to insist on their clients using condoms every time. Less than 20% of China's estimated 6 million prostitutes consistently used condoms, according to studies cited by the UN agency.

South Africa: New Policies to Enhance Youth Health in Limpopo (news article)
The recently launched policy guidelines on contraception as well as on youth and adolescents in Limpopo will ensure the provision of reproductive health services and the accessibility of healthy lifestyles by youth, according to a Health and Welfare spokesperson. The contraceptive policy was in line with Section 24 of the country's constitution stipulating that everyone, including children, had a right to an environment that was friendly to their health.

The Fifth Asian and Pacific Population Conference: Towards a Repositioning of Population in the Global Development Agenda? (research article)
(You need Adobe Acrobat Reader to access this document)
The author writes that there is an urgent need to reposition population in the global development agenda. In doing so, the first point is that people’s welfare is the ultimate objective of all development planning.

HIV/AIDS Research

Contextual Factors and the Black-White Disparity in Heterosexual HIV Transmission (research abstract)
African-Americans have the highest rates of HIV transmission, including heterosexual transmission, in the United States. Although numerous factors probably contribute to the extreme racial disparity, reasons for its persistence remain poorly explained. This paper examines the evidence that the social and economic environment for many African-Americans discourages long-term monogamy and promotes concurrent sexual partnerships, which may, in turn, fuel the HIV epidemic in this population.

HIV/AIDS News

Handling of AIDS Crisis Must Consider Rights (editorial)
This article discusses domestic violence in the spread of HIV/AIDS, in particular, a woman's dilemma if her husband is HIV-positive, violent and wants sex. Subjugated in marriages where many have no economic or legal independence, infection is often unavoidable: if you have nowhere to go, having sex with your infected spouse is not a matter of choice.

Mutations in HIV Drugs by Good Pill Takers (news article)
Research has shown that resistance mutations to anti-HIV medications are more likely to occur in patients who take most of their medications than in those who don't. These findings might change the argument that life-saving antiretroviral drugs should be denied to some populations because poor pill-taking behavior might accelerate the creation of resistant mutations of the HIV virus.

Asian Experts to Step Up Anti-AIDS Programme for Sex Workers (news article)
Asian health experts have agreed to expand a program to ensure rigorous condom use in the sex industry in a bid to prevent the escalation of the HIV/AIDS epidemic.

AIDS Warning for Bangladesh Police (news article)
Police brutality towards prostitutes, homosexuals, and drug users could trigger an HIV/AIDS epidemic in Bangladesh, a new report from Human Rights Watch warns.

Maternal and Child Health Research

Care for Perinatal Illness in Rural Nepal: A Descriptive Study with Cross-sectional and Qualitative Components (research abstract)
This article was based on a survey of 23,669 women, on 30 case studies of perinatal morbidity and mortality, and on 43 focus group discussions with mothers, other family members, and health workers in rural Makwanpur district, Nepal. Researchers found that the major obstacles to seeking care were a limited capacity to recognise danger signs, the need to watch and wait, and an overwhelming preference to treat illness within the community.

Searching for Antibodies to HHV-8 in Children Born to HIV-1 Infected Mothers from Sao Paulo, Brazil: Relationship to Maternal Infection (research article)
(You need Adobe Acrobat Reader to access this document)
Researchers searched for HHV-8 antibodies in plasma samples obtained from a cohort of children born to HIV-1 infected mothers from São Paulo, Brazil, a city that ranks the first in the number of pediatric AIDS cases in Latin America. No case of anti-latent antibodies and a 7.4% frequency of anti-lytic antibodies were detected among children. The detection of HHV-8 antibodies varied according to a child's HIV-1 status: no antibodies were detected in HIV-1 non-infected children and 10.9% and 8.3% frequencies of antilytic antibodies in truly HIV-1 infected children and in children in whom the HIV-1 status could not be defined. Because concordant results were obtained by the analysis of plasma samples obtained from mother-child pairs and considering the children's age, the antibodies detected in the present study probably reflect maternal antibodies.

Exclusive Breastfeeding and Nutritional Status in Bangladesh (PubMed abstract)
Researchers assessed exclusive breastfeeding practices and examined its effect on nutritional status of children from 0 to 24 months age. They found that 16% of women still exclusively breastfed their children for less than 6 months. Bivariate analysis showed that maternal education and family income were important correlates of exclusive breastfeeding, and exclusively breastfed children were nutritionally better off.

The Use of Short-course Zidovudine to Prevent Perinatal Transmission of Human Immunodeficiency Virus in Rural Kenya (PubMed abstract)
in a rural area in Kenya, HIV-infected mothers were given a daily dose of 400 mg of ZDV starting at 36 weeks of gestation and another 300 mg every three hours intrapartum. After delivery, mothers and their children were followed-up and clinically monitored every 3-4 months for two years, and child and mother mortality rates were analyzed. Of the 825 mothers who consented, 216 (26.2%) were infected with HIV. Of those infected, 51 (23.6%) took the full prescribed dose, 69 (31.9%) took only the prenatal dose, and the remaining 96 (44.4%) did not take any dose. Failure to take ZDV was attributed mainly to delivery occurring earlier than expected, while non-compliance to the intrapartum dose was due to mothers giving birth at home and fear of traditional birth attendants. The HIV-free survival of children at 24 months was significantly associated with mother survival and prenatal ZDV compliance.

Estimating Time to Pregnancy from Current Durations in a Cross-sectional Sample (research article)
(You need Adobe Acrobat Reader to access this document)
A new design for estimating the distribution of time to pregnancy is proposed and investigated in this article. The design is based on recording current durations in a cross-sectional sample of women, leading to statistical problems similar to estimating renewal time distributions from backward recurrence times. Non-parametric estimation is studied in some detail and a parametric approach is indicated. The results are illustrated on Monte Carlo simulations and on data from a recent European collaborative study. The role and applicability of this approach is discussed.

Men's Health Research

The Paternal-Age Effect in Apert Syndrome Is Due, in Part, to the Increased Frequency of Mutations in Sperm (research summary)
Related news article: Disease-causing Genetic Mutations In Sperm Increase With Men's Age
The research examines increased mutation rates in sperm as men age. Here, the researchers look at a paternal-age effect and the exclusive paternal origin of mutations relating to Apert syndrome (AS). As the incidence of sporadic AS births increases exponentially with paternal age, the authors determined that the frequency of AS mutations in sperm also increases. The results suggest that older men's sperm is more likely to contain disease-causing genetic mutations that also seem to increase a sperm's chances of fertilizing an egg.

Men's Health News

Relief Agencies to Involve Men in Women's Health (news article)
The article describes recent changes in some relief organizations’ planning of women’s health programs to include men’s health issues. Organizations in Africa, the Middle East and Central Asia are now incorporating shared health concerns between men and women, particularly around issues of disease prevention and contraception.

Philippines: Mission Impossible (commentary)
Exclusively male reproductive health clinics are a new way to address men’s reproductive health problems such as sexual dysfunctions, sexually transmitted diseases and screening of prostate cancer. This, according to a report by UNICEF and Philippines’ Ministry of Health, is a major step towards improving the reproductive health of both men and women. The male reproductive health program also addresses issues of domestic violence and gender-relations.

Population Research

Evolution of Population Concerns: Reflections from the Asian and Pacific Population Conferences (review article)
(You need Adobe Acrobat Reader to access this document)
This paper describes the development of the Asian and Pacific Population Conferences in terms of participation, organization, and, especially, the debate on emerging issues
in response to the changing demographic scene. The population growth pattern and the general locale that prompted the discussions during the first and subsequent
Conferences are set forth. The role of the United Nations, especially ESCAP, in placing population issues on the agendas of governments across the Asian and Pacific region are also discussed.

Population News

The De-Sperm-inator (feature article)
The article examines the lack of access to birth control and the effect on already strained populations and ecosystems in several developing countries. According to the article, increased research efforts in the area of male contraception are underway to address larger population and health concerns.

India: Government Takes Small Step to Curb Huge Population (news article)
The government of India is taking a small step towards stabilising its population in the coming years: private hospitals could reach villagers' doorsteps and offer them free contraceptives and other healthcare facilities. The scheme owes its origins to the National Population Policy, which accepts that the government can do little in population control unless private and voluntary organisations are involved.

Women's Health Research

Use of a Levonorgestrel-Releasing Intrauterine System to Treat Bleeding Related to Uterine Leiomyomas (research abstract)
Sixty-seven women with uterine leiomyomas who chose the LNG IUS as their method of contraception were studied. The LNG IUS was associated with a profound reduction in menstrual blood loss. For women with leiomyomas of this size, the LNG IUS provides effective medical treatment of bleeding.

Randomized Field Trial of Vaginal Douching, Pelvic Inflammatory Disease and Pregnancy (PubMed abstract)
Studies have reported that women who use vaginal douche products are at increased risk for pelvic inflammatory disease. There was little or no indication of a greater risk of PID among women assigned to use the douche product, although it may relate to a lower probability that a woman can become pregnant.

Risk Factors for Infection with Herpes Simplex Virus Type 2: Role of Smoking, Douching, Uncircumcised Males, and Vaginal Flora (PubMed abstract)
Epidemiologic serosurveys suggest that Herpes simplex virus type 2 (HSV-2) infections occur more frequently in women than in men. This study attempted to identify unique correlates of HSV-2 infection in women that might contribute to their increased susceptibility of infection or suggest opportunities for decreasing the incidence of disease. It was determined that HSV-2 infection may occur more often in women who douche, smoke, have sex with uncircumcised partners, or have bacterial vaginosis.

Women's Health News

Women's Access to Health Care Linked to Better Living (feature article)
Whether women have access to health care has social repercussions in rich and poor nations alike. This article looks at the barriers to providing access in developing nations of the world and why it matters.

Botswana: Government Urged to Formulate Laws Criminalizing Marital Rape (news article)
Botswana has been urged to follow the lead of countries such as Canada and Zimbabwe to put into place laws which prosecute marital rape. The article considers varied perspectives on women’s right to refuse sex. A study in Botswana showed that apart from alcohol abuse, gender-based violence, and HIV/AIDS, marital rape was another serious problem involved in sexual violence.

Kenyan Women Reject Sex 'Cleanser' (news article)
In Kenya, health care workers and women activists are calling for an end to the traditional sexual custom known as "cleansing," saying the practice spreads HIV/AIDS. According to the report, widows must sleep with the cleanser to be allowed to attend their husbands' funerals or be inherited by their husbands' brother or relative, another controversial custom that aid workers said is contributing to the spread of HIV/AIDS.

Youth Health Research

Need for Intimacy in Relationships and Motives for Sex as Determinants of Adolescent Condom Use (research abstract)
The study investigates the extent to which need for intimacy in relationships and motives for sex are capable of distinguishing between adolescents who always have protected sex and adolescents who do not, with reference to both steady and casual relationships. Using a questionnaire, 424 males and 277 females aged 15 to 23 years answered questions about sexual behavior and various outcome behaviors, such as having casual sex and condom use. Two-thirds of the participants (470) were sexually experienced. The researchers found that in adolescence, the factors which influence the decision to have (un)protected sex depend on the kind of relationship that exists between the partners. In addition, the goals which adolescents pursue with regard to their relationships and with regard to having sex fulfill an important role in the decision-making process whether to use condoms.

Knowledge of Sexual Health Issues among Unmarried Young People in Nepal (research article)
(You need Adobe Acrobat Reader to access this document)
The results of this study are from a sex and sexuality education survey distributed among young people at secondary school. Results show that schools play an important role in informing young people about sexual health matters. However, on examination of the topics that are being covered in class, it is apparent that the more easily taught, less challenging, factual and biological issues are fairly consistently being covered, whereas the broader issues such as feelings and relationships are often
being overlooked. This study found in-depth knowledge regarding many sexual health issues to be low among both young men and young women in Nepal, with the exception of particular knowledge concerning HIV/AIDS.

Youth Health News

UNFPA India Program To Focus On Adolescents (news article)
The U.N. Population Fund has launched its sixth country program for India for 2003-07, which includes a special focus on adolescents. The program will address the reproductive health needs of youths and set up efforts to prevent HIV/AIDS, as well as improve childbirth mechanisms in India.

Brazil to Distribute Millions of Condoms to High School Students (news article)
Brazil's health ministry plans to distribute 3.4 million condoms to high school students in five cities as part of a program to combat teen pregnancies and AIDS.

East Malaysia: Need to Provide Correct Information on Reproductive Health (news article)
The Prime Minister's wife opened the Eighth World International Association of Maternal and Neonatal Health Conference with an exhortation to disseminate correct information on living skills and reproductive health, including sex education, to youngsters.

Books/Book Reviews

The Harvard Medical School Guide to Men’s Health (book)
The author observes that men's health concerns are widely disparate from that of women, who live longer and healthier lives than men. The third section of the book is a review of selected health problems in men, including urologic conditions of sexuality and reproduction, and prostate diseases. The review describes in detail the scope and possibilities for research on men’s health issues.

Special Reports/Profiles/Resources

Sudan: Special Report on Women in the South (feature article)
The report describes urgent and interrelated needs – both health and social – of women in Sudan. In some war-affected areas the rate of maternal deaths has risen as high as 865 per 100,000 births, according to a UNICEF-sponsored study, compared with a rate of 550 per 100,000 births across the whole of Sudan. In addition, estimates made by a group of major aid agencies in 1998 suggest the literacy rate among women in parts of southern Sudan could be as low as 10%.

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Johns Hopkins Bloomberg School of Public Health: The INFO Project

Volume 3, Number 3425 August 2003