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The Pop Reporter®

Volume 3, Number 42
20 October 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.

FAMILY PLANNING/REPRODUCTIVE HEALTH RESEARCH

Contraceptive Efficacy of a Depot Progestin and Androgen Combination in Men (research abstract)
The objective of this study was to establish the proof of principle for depot hormonal androgen/progestin combination as a male contraceptive. The study included 55 healthy men in stable fertile relationships. Testosterone (four 200-mg implants, every 4 or 6 months) and 300 mg depot medroxyprogesterone acetate (im, every 3 months) were administered. Once sperm output was suppressed (less than 1 million/ml for 2 consecutive months), men entered a 12-month contraceptive efficacy period, ceasing other contraception. The main outcome measure was contraceptive failure (pregnancy) rate. No pregnancies occurred in 426 person-months (35.5 person-years; 95% confidence limits for contraceptive failure rate, 0–8%/annum), superior to the first year failure rate of condoms, the only reversible male method. Recovery was complete in all but one man with an incidental testicular disorder. The authors write that this is the first male contraceptive efficacy study using a prototype depot androgen/progestin combination to demonstrate high contraceptive efficacy with satisfactory short-term safety and recovery of spermatogenesis.

Service-Delivery Efforts Forge Links Between Population, Health, and the Environment (feature article)
Many organizations are now addressing population, health, and environmental concerns by incorporating reproductive health information and services into environmental protection efforts or adding environmental issues to reproductive health or population education programs. This article describes this new generation of programs in such countries as Ecuador, Guatemala, Belize, Madagascar, Tanzania, and the Philippines. The authors write that the synergy produced by integrating family planning and conservation activities into community-based projects can create more effective and sustainable programs.

Factors Influencing Young Malians' Reluctance to Use Hormonal Contraceptives (PubMed abstract)
During a qualitative evaluation of three peer-education programs in urban Mali, young people stated that they were wary of using either the pill or injectable contraceptives because they believed that these methods would make them sterile. Unmarried women's contraceptive decisionmaking was not primarily driven by a current need to limit fertility, but rather by a future need to maximize it to gain status through childbearing in their marital households. Further interviews explored notions of conception, menstruation, and the perceived action of hormonal methods on the reproductive system. Findings revealed that menstrual disruption (in the form of amenorrhea or prolonged bleeding) appeared to have dire repercussions, including accusations of witchcraft and immoral behavior that could result in a woman's being divorced or in her husband's acquiring an additional wife. The social consequences of side effects were perceived to be more important than their biological manifestations, and together with the fear of sterility, resulted in a preference for the condom.

Trends and Determinants of Contraceptive Method Choice in Kenya (PubMed abstract)
This study uses data from the 1989, 1993, and 1998 Kenya Demographic and Health Surveys to examine trends and determinants of contraceptive method choice in Kenya. The analysis shows that, over time, the use of modern contraceptive methods, especially long-term methods, is higher in urban than in rural areas, whereas the pattern is reversed for traditional methods. Use of barrier methods among unmarried women is steadily rising, but the levels remain disappointingly low, particularly in view of the HIV/AIDS epidemic in Kenya. One striking result from this analysis is the dramatic rise in the use of injectables. Of particular program relevance is the notably higher levels of use of injectables among rural women, women whose partners disapprove of family planning, uneducated women, and those less frequently exposed to family planning media messages, compared with their counterparts who have better access to services and greater exposure to family planning information.

Ectopic Pregnancy among Non-medicated and Copper-containing Intrauterine Device Users: A 10-year Follow-up (research abstract)
This study compared ectopic pregnancy (EP) rates among users of non-medicated IUDs (3,491) and copper-containing IUDs (11,682). The numbers of users at the end of the 10th year were 550 and 569 for non-medicated and copper-containing IUDs, respectively. The gross cumulative lifetable EP rates for 1,000 women were 1.4 and 0.9 at 12 months, and 6.8 and 8.9 at the end of the 10th year, respectively, for the plastic and the copper IUDs. No statistically significant differences were found between the two groups.

Reproductive Health Trends in Eastern Europe and Eurasia (feature article)
This brief provides highlights of surveys taken in 11 countries since 1996, covering a wide range of women's health topics and providing in-depth information on attitudes and behaviors related to reproductive health. The brief is based on a longer report that analyzes and compares survey results across countries. The survey results give program officials, researchers, and policymakers an opportunity to learn about the characteristics of women who have the greatest health needs and the factors that lead to increased contraceptive use, reduced reliance on abortion, and other changes in women's reproductive health behavior.

Essential Elements of Postabortion Care: Origins, Evolution and Future Directions (review article)
This article chronicles the development and expansion of a postabortion care model designed to promote interventions that address abortion-related public health concerns even when abortion laws and policies are restrictive. The authors review years of program experience with the original model, which led to the development of an expanded and updated model, Essential Elements of Postabortion Care.

Moving from Research to Program--The Egyptian Postabortion Care Initiative (review article)
This article reviews the growth of the Egyptian postabortion care experience, from pilot program to work with the Ministry of Health and Population.

Social and Religious Dimensions of Unwanted Pregnancy: An Islamic Perspective (PubMed abstract)
This article reviews the social and religious dimensions of unwanted pregnancy according to an Islamic perspective. According to the author, the purposes of the law and its principles focus on preventing "unwanted pregnancy" and protecting the rights of the fetus and infant.

The Increasing Importance of Sexually Transmitted Diseases in HIV-Infected Persons (review article)
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This article reviews current recommendations for screening, diagnosis, and management of genital herpes simplex virus infection, chlamydial and gonococcal infections, syphilis, and human papillomavirus–associated neoplasia in HIV-infected patients.

FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS

South Africa: Circumcision is 'Barbaric' (news article)
The South African Medical Journal has condemned what it calls the "barbarism" practised on boys in the name of traditional circumcision rituals. "Many of the so-called circumcision schools of today are fake, and deadly," says SAMJ editor Daniel Ncayiyana in the latest edition of the journal. "They have very little to do with the traditional ethos and practice of this ancient ritual, and something must be done to stop the carnage." His call comes in the wake of a fresh crop of deaths and mutilations caused by traditional-style circumcisions.

Pakistan: New Home Delivery Kit Launched (news article)
Green Star Social Marketing, a non-profit organization, has launched a "clean delivery kit" that it believes will make births at home much safer and reduce the infant and maternal mortality rate in Pakistan.

In Brazil, Sterilization Is the Best Pill (news article)
Four of every 10 Brazilian women are surgically sterilized during their childbearing years. This Brazilian phenomenon, unique in the world, is due to a culture of tubal ligation as the preferred method of avoiding conception, including among young women.

A Man's Way to Keep Sperm at Bay (feature article)
This article reviews current research underway to develop a reliable, reversible contraceptive for men.

A New Option in Birth Control (feature article)
This news feature article reviews the new and old methods that allow women to make responsible reproductive choices.

Bangladesh: Early Marriage Causes Cervical Cancer (news article)
Cervical cancer is one of the major causes of high maternal mortality in Bangladesh, and the blame goes to early marriage, early start of sexual activities, multiple sexual partners, and a lack of screening programs.

Nigeria: Government Urged to Allocate 5% to Reproductive Health (news article)
The Bauchi State Government has been urged to allocate 5% of its annual health budget to the reproductive healthcare sector as a way of improving the health status and quality of life of the people and that of women in particular. The call was part of the resolution contained in a communique issued at the end of a 5-day workshop on Reproductive Health Management Strategic Comm-unication and Advocacy in Bauchi.

Driving Home Safe Sex Message in Myanmar (news article)
This article relates how the Red Cross is trying to reach truck drivers in Myanmar with safe sex messages through peer group pressure. The organization trains drivers and people they work closely with, such as ticket sellers, to lead small group discussions with their colleagues about HIV/AIDS. So far the Red Cross has reached 2,400 out of an estimated 3,400 drivers, aged between 25 and 55, at the bus and truck terminals in the capital, Yangon, formerly known as Rangoon.

FAMILY PLANNING/REPRODUCTIVE HEALTH LAW AND POLICY

Ethiopia Bans Circumcision (news article)
At least 350 traditional circumcisers in northern Ethiopia's Gonder region have agreed to abandon the harmful practice as well as other forms of genital mutilation, the Ethiopian News Agency reported on Wednesday. "The circumcisers and those engaged in harmful traditional practices have decided to abandon them after intensive sensitisation work by health officers," the agency said, quoting the Social Services Centre chief Abebaw Gegit in Gonder's Wored area as saying. Traditional circumcision has long been practised in Ethiopia, mainly on young girls.

Botswana to Introduce Routine HIV Testing (news article)
According to this article, the Botswana government is to introduce routine HIV testing in all government facilities and has appealed to the private sector to do the same. The tests would not be compulsory; workers would have the right to refuse.

HIV/AIDS RESEARCH

Estimating the Cumulative Number of Human Immunodeficiency Virus Diagnoses by Cross-linking from Four Different Sources (research abstract)
The authors estimated the cumulative number of people diagnosed with HIV infection in a region of Italy by cross-linking data from four surveillance systems and applying capture-recapture methods. The study was conducted using data referring to residents of the Veneto Region (population 4.4 million) and cross-linked to data from various AIDS, death, and hospital registries. Using the sample coverage approach, they estimated that, since the beginning of the epidemic in Veneto, an estimated 11,281 people should have been reported to at least one registry; thus, the estimated coverage of the four registries was 77.3%.

Mobility and the Spread of Human Immunodeficiency Virus into Rural Areas of West Africa (research abstract)
The findings of this study suggest that mobility appears to be a key factor for HIV spread in rural areas of West Africa, because population movement enables the virus to disseminate and also because of the particularly risky behaviors of those who are mobile.

Incidence and Estimated Rates of Residual Risk for HIV, Hepatitis C, Hepatitis B and Human T-cell Lymphotropic Viruses in Blood Donors in Canada, 1990–2000 (research article)
This article reports trends in the incidence of blood-transmissible viral markers in Canada and estimates of the risk of undetected infection in donors over the last decade. The authors extracted anonymous donor and blood-transmissible disease information from the Canadian Blood Services National Epidemiology Donor Database for 8.9 million donations from 2.1 million donors between June 1990 and December 2000. They found that, except for HBV, the estimated risk of undetected infection (residual risk) has decreased over time.

Pre-exposure Chemoprophylaxis (PREP) as an HIV Prevention Strategy (research article)
This paper reviews chemoprophylaxis as a possible prevention strategy for the sexual transmission of HIV.

HIV/AIDS NEWS

Barbados: Attitude Not Helping (news article)
According to this article, some Barbadians are not taking the HIV/AIDS virus as seriously as they should. A Senior Medical Officer of Health and Communicable Diseases has described the level of seriousness being adopted as "disappointing".

US Health Chief Warns Asia Against AIDS (news article)
The rapid spread of AIDS in China and India could destroy any chance of containing the disease, US Health and Human Services Secretary Tommy Thompson warned Sunday. China's government over the past year has acknowledged that AIDS is spreading rapidly in the country, and Thompson said officials he met with, including Executive Vice Health Minister Gao Qiang, had been "very responsive" to his concerns about the epidemic. They admitted to past mistakes in handling the crisis, but said they were planning a new AIDS prevention, treatment, and education campaign.

Nigeria: HIV/AIDS Among Prostitutes on the Increase (news article)
This article describes the increase in the prevalence rate of HIV/AIDS among commercial sex workers despite targeted prevention efforts.

MATERNAL AND CHILD HEALTH RESEARCH

Eclampsia, a Major Cause of Maternal and Perinatal Mortality: A Prospective Analysis at a Tertiary Care Hospital of Peshawar (PubMed abstract)
This prospective cross-sectional observational study (from January 2001 to March 2002) included all the patients admitted to the unit, with eclampsia, at the Department of Obstetrics and Gynaecology, Hayatabad Medical Complex, Peshawar. During the study period 71 patients developed eclampsia (frequency, 1.2%). Thirty five percent of patients developed major complications and 16.9% of them died (48% of overall maternal mortality).

Inequalities in Child Mortality in Mozambique: Differentials by Parental Socio-economic Position (research abstract)
This study investigates the relation between socio-economic parental position (education and occupation) and child death in Mozambique using data from the Mozambican Demographic and Health Survey carried out between March and July 1997. The analysis included 9,142 children born within 10 years before the survey. The researchers found that paternal education seemed to reflect the family's social standing in the Mozambique context, showing a strong statistical association with post neonatal and child mortality.

Anthropometry and Body Composition of 18 Year Old Men According to Duration of Breast Feeding: Birth Cohort Study from Brazil (research article)
Related research article: Breast Feeding and Obesity in Childhood: Cross Sectional Study
Related news article: Breast Milk 'Won't Prevent Obesity'
Breastfeeding may not actually protect children against obesity later in life, according to new research. Previous studies have suggested breast milk may prevent obesity, but two studies in this week's British Medical Journal appear to refute that theory. The studies, which together looked at more than 5,000 people, found no evidence to support the claim.

Building a Global Movement: The White Ribbon Alliance for Safe Motherhood, 1999-2003 (report)
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This publication describes the formation of the White Ribbon Alliance for Safe Motherhood, its development from a small group of committed citizens to a global movement encompassing 24 countries and over 200 members, and the strategic planning process towards strengthening the Global Secretariat's organizational structure. The important lessons learned by the global alliance, its members, and other alliances are highlighted within the text. This publication is a useful tool for understanding how such an alliance is formed and can grow from just a few people to a large, vocal mass movement demanding change and action around an issue.

Vertically Transmitted Herpesvirus Infections (review article)
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This article reviews the various types of vertically transmitted herpes viruses and management strategies in newborns.

MATERNAL AND CHILD HEALTH NEWS

Nigeria: Infant Mortality Rate Highest in Africa (news article)
The Association of Community Health Practitioners of Nigeria reports that the infant mortality rate of Nigeria was the highest in sub-Saharan Africa. Infant morbidity and mortality rate of Nigeria was among the lowest in sub-Sahara-Africa between 1986-1993, but since 1993, the reverse has been the case.

Growth of 30 Percent Chinese Babies Impaired by Lack of Breast Milk (news article)
State media in China has reported that 30% of Chinese babies experience impaired growth because their mothers are unable to breastfeed them. Some women face harsh physical conditions, making them unable to produce breast milk, while others are simply too busy working to breastfeed their babies.

POPULATION RESEARCH

A Diminishing Population Whose Every Cohort More than Replaces Itself (research article)
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The authors observe that a dynamic population model can have period fertility that is always below replacement and cohort fertility that is always above replacement. They ask whether such a paradoxical population will get larger or smaller and show that it must become smaller. Cohort replacement does not imply population replacement, and emphasizing fertility timing and cohort fertility ignores the issue of relative cohort size. The resolution of this apparent paradox reinforces the importance of the level of
period fertility in demographic analysis.

A System of Model Fertility Schedules with Graphically Intuitive Parameters (research article)
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In this paper the author proposes a new family of models for age-specific fertility schedules in which three index ages determine the schedule's shape. The new system is based on constrained quadratic splines, has easily interpretable parameters, is flexible enough to fit a variety of "noiseless" schedules well, and is inflexible enough to avoid implausible estimates from noisy data. Across a set of more than 200 contemporary ASFR schedules, the new model fits a majority better, and in some cases much better, than the Coale-Trussell model. When fit to a recent Swedish time series, model parameters exhibit simple, regular changes over time, suggesting utility in forecasting applications. In simulated small-sample data the new model produces plausible ASFR estimates, with errors similar to Coale-Trussell.

POPULATION NEWS

Australia: Population Boom Time to Go Bust (news article)
With Australia's birth rate now below replacement rate, the number of babies needed to replace the current population, growth is expected to stagnate over the next 50 years.

Russian Population May be Halved within 70 Years (news article)
An international forum has revealed that the Russian population is falling by 0.7% every year. If this process continues, then the population will be halved within the next 70 years.

WOMEN'S HEALTH RESEARCH

Rural Indian Women's Care-seeking Behavior and Choice of Provider for Gynecological Symptoms (PubMed abstract)
This study used data from the India National Family and Health Survey-2 conducted in 1998-99 to investigate the level and correlates of care-seeking and choice of provider for gynecological symptoms among currently married women in rural India. Of the symptomatic women surveyed, 31% sought care, overwhelmingly from private providers (70%). Only 8% of women consulted frontline paramedical health workers. Care-seeking behavior and type of providers consulted varied significantly across different Indian states. Significant differentials in care-seeking by age, caste, religion, education, household wealth, and women's autonomy suggest the existence of multiple cultural, economic, and demand-side barriers to care-seeking.

Reproductive Risk Factors Related to Socioeconomic Status in Pregnant Women in Southern Brazil (research abstract)
This article evaluated patterns of drug use during pregnancy and other potential reproductive risks in pregnant women. The authors applied a standard questionnaire to 412 pregnant women classified as low socioeconomic status (SES) or as middle/high SES in two cities of South Brazil. They found that 77% of the women used at least one medication during pregnancy. Significant differences were observed when comparing low SES and middle/high SES groups for the following variables: teenage pregnancies (28.4% vs. 12.4%); self-medication (21.8% vs. 13.1%); smoking habits (21.5% vs. 5.1%); unplanned pregnancies (69.5% vs. 51.8%); unwanted pregnancies (31.3% vs. 10.9%), and abortion attempts (13.1% vs. 5.8%). The average number of drugs consumed, however, was not different between low SES and middle/high SES.

Can a Brief Video Intervention Improve Breast Cancer Clinical Trial Knowledge and Beliefs? (research abstract)
In this study, 262 women in the US (161 breast cancer survivors and 101 controls) were shown a video vignette in which a physician discussed the concept of a clinical trial (CT) with a woman who was in the process of making a treatment decision. A pretest-post-test design was used and improvements in clinical trial knowledge and beliefs were assessed. The results of the study indicate that video modeling is a powerful tool for increasing CT knowledge, but not for improving CT beliefs.

Screening for Breast Cancer: Candidacy and Compliance (research abstract)
Using data collected from 20 focus groups, the researchers attempt to draw conclusions as to why some women accept invitation for free screening mammography and others do not. The research examines the role of ethnicity and perceptions about mammography in relation to issues of screening and compliance.

Does Stage at Diagnosis Influence the Observed Relationship Between Socioeconomic status and Breast Cancer Incidence, Case-Fatality, and Mortality? (research abstract)
This study assessed the associations between socio-economic status (SES) and breast cancer incidence, case-fatality, and mortality by stage of disease at diagnosis using recent data in the United States. The authors found that as SES decreased, localized breast cancer incidence rates decreased, while incidence rates of distant disease increased. These results confirm some previously reported findings and suggest that associations between lower SES and lower localized breast cancer mortality rates are influenced mainly by underlying associations between SES and localized breast cancer incidence, whereas regional breast cancer mortality rates appear to reflect the underlying association between SES and regional case-fatality rates.

YOUTH HEALTH RESEARCH

Adolescent Sexual and Reproductive Health Behavior in Dodowa, Ghana (report)
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This report presents findings from a baseline study conducted by CEDPA and the Ghana National Association of Teachers (GNAT) in support of a local sub-project, the GNAT Initiative under CEDPA's global ENABLE Project. Baseline data and information were gathered on the current sexual and reproductive health status of in-school and out-of-school adolescents and young teachers in Dodowa, Ghana. Some key findings include: 1) high-risk sexual activity among adolescents was common and reflected in casual, multiple partners, unprotected and forced sex within a wide sexual network; 2) teacher-student sexual relations were observed; 3) adolescent pregnancy, unsafe abortion and young unwed mothers are not uncommon in Dodowa; 4) although awareness about HIV/AIDS was high among adolescents, this knowledge seemed not to have been reflected in their sexual lifestyles.

How Gender Roles Influence Sexual and Reproductive Health among South African Adolescents (PubMed abstract)
This article examines links between gender ideology or gender roles and the social impact of adolescent childbearing in the lives of rural and urban adolescents in KwaZulu/Natal, South Africa. It employs a triangulated research methodology (focus-group discussions, narrative role playing and discussions, and questionnaires and in-depth interviews) to inform an analysis of adolescents' notions of male and female gender ideals. Results indicate that gender ideals are grounded in traits that reinforce poor sexual negotiation dynamics and behavioral double standards and that place adolescents at risk for early pregnancy and other sexual and reproductive health complications.

Adolescent Girls Literacy Initiative for Reproductive Health (A GIFT for RH) (report)
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This paper reports on a study that examines the impact of a
health-focused literacy class that combines reproductive health knowledge along with literacy training. The project is entitled 'Lalima' and this paper assesses its impact on adolescent girls' knowledge and attitudes towards reproductive health issues and changes on key issues.

YOUTH HEALTH NEWS

Uganda: Museveni 'to Ban' Circumcision (news article)
Related news article: Circumcision Explained
Ugandan President Yoweri Museveni's threat to ban circumcision so as to curb the spread of HIV/AIDS has drawn strong reaction from traditionalists in the country. The traditionalists say that such a move would be regarded as interference in people's cultures and would be resisted strongly. The circumcision of boys is practiced by a small minority of Ugandans but it is extremely common elsewhere in Africa. In a related story, the president's press secretary said that President Yoweri Museveni did not threaten to ban circumcision during his address to youth leaders. "At no point during his speech did the President threaten to ban the practice of circumcision," she said. "Male circumcision is a recommended health practice and the president is fully aware of this. He cannot, therefore, advocate its ban."

SPECIAL REPORTS/PROFILES/RESOURCES

Reproductive Health Awareness: A Wellness, Self-Care Approach (training manual)
Reproductive Health Awareness (RHA) is a holistic approach to reproductive health incorporating many important aspects such as body awareness, self-care, gender, sexuality, and interpersonal communication. The RHA manual consists of 14 modules, which cover these topics in depth and explain how these issues affect people throughout the lifecycle. The modules are adaptable to a variety of settings and audiences and are designed to allow trainers flexibility. Each module can be used independently, allowing for one specific topic to be integrated into an existing training program, or the manual can be used in its entirety to create an RHA workshop. The activities highlighted will help providers increase knowledge, examine attitudes, and practice skills to address the broad range of clients and community members they serve.

Female Condom and Dual Protection: Training for Community-Based Distributors and Peer Educators (training manual)
This manual provides a two-day curriculum demonstrating how to incorporate the female condom and dual protection into the program of already functioning community health workers. Using two family planning methods simultaneously enhances the degree of protection against both unintended pregnancy and STIs; therefore, this manual contains activities designed to introduce the female condom, provide strategies to bring about behavior change to ensure dual protection, and reintroduce the use of the male condom.

Sustaining the Benefits: A Field Guide for Sustaining Reproductive and Child Health Services (training manual)
This guide is a reference for NGO and program managers who wish to build enduring community-based programs. It explains the term "sustainability" and accompanies readers through a process of transforming that understanding into organizational action. Although it can stand alone, users of the guide may find it useful to explore the sustainability concepts in a workshop setting.

IPPF Medical Bulletin (Volume 37 Number 5 October 2003) (resource material)
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This edition of the IPPF Medical Bulletin presents two article: "Strengthening the quality of reproductive health care: IPPF’s quality improvement programme" and "The Standard Days Method for family planning."

American Sexuality Magazine (vol. 1 no. 6) (resource material)
This issue of American Sexuality magazine contains 13 articles centered around abstinence and sex education programs in the US.

Draft Guidelines on Ethical Participatory Research with HIV Positive Women (resource material)
These guidelines can serve to appraise the extent to which research projects align with principles of participatory
research. The authors propose that you set up a "stakeholders' research advisory group" to consist of diverse members of the community(ies) concerned and others who wish to conduct the research with them. Together
the author recommends the group go through these guidelines to identify areas where opinions differ in order to enable you to discuss and resolve them, before proceeding further.

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