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The Pop Reporter®

Volume 3, Number 45
10 November 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

Individual and Community Effects of Women's Education and Autonomy on Contraceptive Use in India (research abstract)
This study makes use of the National Family Health Survey of 1998-99 to investigate whether differences in women's autonomy can explain much of the relationship between education and contraceptive use among married Indian women with at least one child. The analyses show that a woman's education does not influence her contraceptive use through a strengthening of her position in relation to that of men, but that the inclusion of a simple indicator of her general knowledge reduces education effects appreciably. Further, the average educational level of other women in the census-enumeration area has an effect on a woman's contraceptive use above and beyond that of her own education.

Dual Contraceptive Method Use for Pregnancy and Disease Prevention Among HIV-Infected and HIV-Uninfected Women: The Importance of an Event-Level Focus for Promoting Safer Sexual Behaviors (research abstract)
The authors found that the consistency of condom use varies significantly in the context of dual method contraceptive use depending on whether condoms and a second method are intended for use simultaneously during vaginal sex, or whether these methods are alternated with one another.

Contextual Influences on Reproductive Wellness in Northern India (research abstract)
This article examines community-level influences on five reproductive wellness outcomes in Uttar Pradesh, India. Multilevel modeling was used to estimate household and community-level effects on wellness, with hierarchically organized data from a statewide survey of villages, urban blocks, households, women, health providers, and staff. It was found that the household and community have a strong contextual influence on wellness, although the models explain more of the variation in outcomes between households than between communities.

Female-Condom Use in a Gender-Specific Family Planning Clinic Trial (research abstract)
The authors evaluated female-condom use among women participating in an HIV/STD intervention designed to reduce unprotected sex and expand prevention strategies. Women (n = 360) were recruited from a family-planning clinic and were randomized into an 8- or 4-session intervention group or a control group. Follow-up interviews were conducted at 1, 6, and 12 months. At 1 month, the odds ratios of first-time female-condom use were 9.49 (95% confidence interval [CI] = 4.01, 22.20) in the 8-session group and 4.39 (95% CI = 1.84, 10.49) in the 4-session group relative to controls. Repeated use (n = 21) was predicted by perceived ability to use, by self and partner satisfaction, by dislike of male condoms, and by previous diaphragm use. The authors conclude that gender sensitive cognitive-behavioral interventions can influence women to try the female condom.

HIV/AIDS Behavioral Surveillance Surveys of the Cross-Border Sex-Networker Population in Hong Kong From 1997 to 2001 (research abstract)
Behavioral surveillance surveys on Hong Kong males crossing the border to mainland China for commercial/casual sex consistently found high levels of risk behaviors and low perceived susceptibility of HIV infection.

Social and Behavioural Determinants of Consistent Condom Use among Hotel and Bar Workers in Northern Tanzania (research abstract)
Bar and hotel workers (n=519) in Moshi, Tanzania were interviewed to obtain information about potential predictors of condom use. Samples were collected for the diagnosis of STDs, including HIV. Consistent condom use was defined as always using condoms with sexual partners in the past 5 years. Overall consistent condom use in this population was 14.1%. In multivariate analyses, consistent condom use was inversely associated with low condom self-efficacy, low condom knowledge, and having more than three children. Other significant predictors included perceived condom acceptability and using condoms when last exchanged sex for money or gift.

Estimating the Prevalence of Syringe-borne and Sexually Transmitted Diseases among Injection Drug Users in St Petersburg, Russia (research abstract)
One hundred and one injection drug users (IDUs) returning syringes to the St. Petersburg syringe exchange program were invited to complete a questionnaire requesting demographic, knowledge, and behavioral information and to provide their syringes for antibody testing. The median age of IDUs was 23 years. Syringe prevalences were 10.9% for HIV, 78.2% for HCV, 15.8% for HBV, and 6.9% for syphilis. All respondents recognized drug-related risk factors for getting AIDS. Only two-thirds of subjects recognized condoms to prevent STIs, and half knew that oil-based lubricants are not appropriate for condoms.

Sexually Transmitted Disease Prevalence and Characteristics of Market Vendors in Eastern China (research abstract)
Researchers studied correlates of sexually transmitted diseases in market stall vendors in eastern China. Female gender, low education, and multiple partners were associated with infection. Almost half sought care at pharmacies.

Effectiveness and Mechanism of Action of Desmopressin in the Treatment of Copper Intrauterine Device-related Menorrhagia: A Pilot Study (research abstract)
The aim of this prospective study was to evaluate the effect of vasopressin drug on menstrual blood loss and on changes, if any, in uterine flow impedance. Twenty-four women with IUD-induced menorrhagia were recruited and randomly allocated to treatment with either desmopressin or mefenamic acid. Menstrual blood loss and uterine artery resistance performed in two pretreatment periods were compared with 3-month treatment periods. Menstrual blood loss was significantly reduced in both treatment groups. In the desmopressin group, the effect was clinically useful in all subjects, but in the mefenamic group menstrual blood loss was consistently menorrhagic in two patients. No significant differences were observed in the uterine artery pulsatility index before and during treatment.

FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS

Africa's Family-planning Funding Drought (feature article)
Funding for family planning in Africa has been drying up. Groups are starting to feel the effects of Bush administration regulations that ban aid to those who perform or advocate abortion. At the same time, the battle against HIV/AIDS, which includes prevention as well as issues like AIDS orphans, has taken precedence over more general family planning. And because the two efforts are not integrated, family clinics are finding they're losing ground.

India: For Sterilization, Target Is Women (news article)
This article describes the trend of female focused sterilization in India. There were 114,426 vasectomies in India in 2002-03, and 4.6 million tubal ligations, the analogous operation on women, though ligation is a more complicated operation. As it has been for nearly a half-century, India's family planning program remains dependent on female sterilization. Of the 48% of married couples currently using contraception, according to the National Family Health Survey, female sterilization accounted for 71%.

Sex Still a Dirty Word in China (news article)
Beijing's first sex culture exhibition ended up being shut down the same day when it opened.

WHO Speaks On Practices to Improve Reproductive Health (news article)
African countries are being urged to adopt practices that improve reproductive health and reduce child mortality, as almost half of the 600,000 pregnancy and childbirth-related deaths recorded annually around the world occur in Africa.

Preventing Pregnancy: A Fresh Look at the IUD (review article)
This article urges another look at the IUD and lists the pros and cons of the device based on guidelines which the World Health Organization has drafted.

Female Contraception: Sticking to a Schedule (feature article)
The newest family planning methods include patches and rings, and a pill that regulates the menstrual cycle so that women have a period about every three months. Forgetfulness plays less of a role with these newer methods.

Nigeria: Residents Approve Sexuality Education (news article)
In a survey conducted by the News Agency of Nigeria, the respondents stressed that parents should not shy away from the responsibility of teaching their children facts of life. Some residents of Lagos called for the teaching of a comprehensive sexuality education in schools to assist adolescents and youths in their reproductive health. They believe that the secrecy with which many parents treat the topic drives most youngsters into dangerous adventures, adding that information received from parents and teachers is likely to be more factual than the information obtained from peers and the media, which could be misleading.

FAMILY PLANNING/REPRODUCTIVE HEALTH LAW AND POLICY

US: Natchez Man Charged with Murder after AIDS Death (news article)
A Mississippi man suspected of knowingly infecting several women with the HIV virus is behind bars, charged with murder and aggravated assault.

Shanghai Makes It Easier to Have a Second Child (news article)
Since China's Population and Family Planning Law was promulgated last year, localities have been active in amending their decade-old provisions in line with the law. There are some subtle changes after these revisions.

China: Single Women Banned from Getting Test-tube Babies (news article)
Single women are prohibited from getting pregnant through assisted human reproductive technology like "test-tube baby" technology, according to a newly-revised regulation by the Ministry of Health. The Technological Criteria, Basic Standards and Ethical Principles on Human Assisted Reproductive Technology, also forbids married couples from using the technology to get triplets or more in pregnancy, and twins in gestation should be avoided.

China: Loosening Family Planning Policy Unconducive to Ageing Problem (news article)
In response to recent assumptions among Chinese people that the Chinese government might loosen its family planning policy to cope with the population ageing problem, experts from leading Chinese research institutes have said this is definitely the last option China will choose. Statistics from the Ministry of Civil Affairs showed that China had been reporting a high growth of aged population and had already moved into an ageing society, with about 134 million people aged 60 and above, or 10% of the total population.

HIV/AIDS RESEARCH

AIDS in Africa (report)
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This report, from Congressional Research Service, highlights the most recent developments of the AIDS crisis in Africa, provides background and analysis, explains the leadership reaction in South Africa and elsewhere, reviews responses to the crisis, and summarizes legislative and policy actions.

Modelling the Social Dynamics of a Sex Industry: Its Implications for Spread of HIV/AIDS (research abstract)
A theoretical model is proposed in this paper for a community which has the structure of two classes (direct and indirect) of commercial sex workers (CSW), and two classes of sexually active male customers with different levels of sexual activity. The main points of this work are illustrated with numerical examples using HIV data from Thailand. Results of biological significance include (i) the change of behavior by the CSW's has a more direct effect on the spread of HIV than that of the male customers; (ii) the basic reproduction number is obtained by considering all possible infection cycles of the heterosexual transmission of HIV, which indicates the importance of understanding the sexual networking in heterosexual transmission of HIV; and (iii) the social dynamics of the sex industry is not just a simple "supply and demand" mechanism driven by the demand of the customers (thus highlighting the need for further understanding of the changing structure of the sex industry).

Barriers to Antiretroviral Adherence for Patients Living with HIV Infection and AIDS in Botswana (research abstract)
Botswana has the highest rate of HIV infection in the world, estimated at 36% among the population aged 15-49 years. To improve antiretroviral (ARV) treatment delivery, the authors conducted a cross-sectional study of the social, cultural, and structural determinants of treatment adherence. One hundred nine patients and 60 health care providers were interviewed; 54% of patients were adherent by self-report, while 56% were adherent by provider assessment. Principal barriers to adherence included financial constraints (44%), stigma (15%), travel/migration (10%), and side effects (9%). On the basis of logistic regression, if cost were removed as a barrier, adherence was predicted to increase from 54% to 74%.

Estimation of AIDS Adult Mortality by Verbal Autopsy in Rural Malawi (research abstract)
In this study, AIDS-related deaths were identified using a standard WHO algorithm, and this observed number of deaths was compared with the expected number. The expected number was derived from a comparison of adult mortality in the sample with the pre-AIDS mortality levels measured in the 1987 Malawi census, giving an 'excess mortality factor' that could be considered to be AIDS related. It was calculated that 74.9% of observed deaths in 1998-2001 would be from AIDS. According to the WHO algorithm, 75.5% of the verbal autopsies (VA) deaths could be categorized as AIDS deaths. The gender-specific figures were 75.1% for females and 76.3% for males. Results were consistent with those found in studies conducted in other areas of sub-Saharan Africa at earlier stages in the epidemic. These results confirm that VA data can be used to estimate with a reasonable degree of confidence the distribution of AIDS- and non-AIDS-related deaths in the aggregate, even in a rural population with relatively low levels of education.

Correlates of HIV-1 Shedding in Cervicovaginal Secretions and Effects of Antiretroviral Therapies (research abstract)
Related news article: HIV Viral Load in Blood May Not Predict HIV Shedding in Vaginal Secretions
Recent research with HIV-infected women finds that the higher the plasma viral load, the more likely that HIV will be found in cervicovaginal secretions. However, in many women with undetectable plasma loads, HIV is still often found in such secretions.

HIV/AIDS NEWS

WHO to Launch HIV-AIDS Drug Program (news article)
The World Health Organization is getting ready to launch a program to help Africa and other developing countries to get the drugs they need to treat millions of people infected with HIV/AIDS, with the aim of having at least 3 million AIDS sufferers under treatment by 2005.

AIDS as a Global Emergency (editorial)
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WHO’s new Director-General has just declared AIDS to be a global health emergency. This move is not unprecedented but does signal a welcome departure from business as usual. In this editorial, the writer outlines three steps necessary to move from this declaration to finding real solutions: acknowledging past failures, explaining to decision-makers that resources need to be allocated in proportion to the problem, and advocating for integrated HIV prevention and care.

Experts Give Legal Suggestions on China's AIDS Problem (news article)
Legal experts agreed that Chinese law needed much improvements to help prevent and control the spread of AIDS and SARS and to stop discrimination against sufferers of HIV/AIDS. The experts at Qinghua (Tsinghua) University AIDS and SARS Summit agreed that laws should help create a good social environment for Aids sufferers rather than restrict their activities forcefully.

Congo: HIV/AIDS Prevalence 20% in Certain Regions (news article)
The prevalence of HIV/AIDS in the Democratic Republic of the Congo may have reached 20% in certain regions of the country, according to the director of the national program against AIDS.

South Africa: HIV/AIDS Vaccine Trials Underway (news article)
Phase One of the South African AIDS Vaccine Initiative (SAAVI) started on Monday in Soweto and Durbhan. It is one of the first of several human trials to be conducted in the country.

Malawi: Traditional Practices Transformed By AIDS (news article)
The Joint United Nations Programme on HIV/AIDS estimates that up to 15% of Malawians have been infected with HIV. Health activists in Malawi have often pointed the finger at traditional beliefs and practices as being amongst the main catalysts for the spread of HIV. Practices that are being re-examined include those of wife inheritance, sexual cleansing, and initiation.

Reluctance to Face Tests Slows Botswana AIDS Fight (news article)
In Botswana, fewer than 9,000 people are taking the life-extending antiretroviral medicines. Despite the high level of infection in the population, testing and available treatment is not being utilized. The article discusses possible underlying factors contributing to this trend.

India: Experts Want Amendment in Laws to Curb Spread of HIV (news article)
The article explores recent debate surrounding laws that may create barriers for members of marginalized groups to seek medical attention for HIV.

MATERNAL AND CHILD HEALTH RESEARCH

Early Infant Morbidity in the City of Sao Paulo, Brazil (research abstract)
Researchers examined determinants of early infant morbidity for the 1998-birth cohort, City of Sao Paulo, Brazil. Maternal education, Cesarean section, and having fewer than seven prenatal care visits were found to predict early
infant morbidity. It was suggested that physicians should inform mothers about the risks associated with having high numbers of children, as well as the risks associated with unnecessary cesarean sections for the infant.

Risk Ractors for Early Infant Mortality in Sarlahi District, Nepal (research article)
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Over the period 1994–97, 15,469 live-born, singleton infants in rural Nepal were followed to 24 weeks of age to identify risk factors for mortality within 0–7 days, 8–28 days, and 4–24 weeks after the birth. In multivariate models, maternal and paternal education reduced mortality between 4 and 24 weeks only. Miscarriage in the previous
pregnancy predicted mortality in the first week of life, whereas prior child deaths increased the risk of post-neonatal death. A larger maternal mid–upper arm circumference reduced the risk of infant death during the first week of life. Infants of women who did not receive any tetanus vaccinations during pregnancy or who had severe illness during the third trimester were more likely to die in the neonatal period. Finally, maternal mortality was strongly associated with infant mortality. An Arabic summary is included in this document.

The Inequality of Maternal Health Care in Urban sub-Saharan Africa in the 1990s (research abstract)
This study uses Demographic and Health Survey data from 23 countries in sub-Saharan Africa to examine whether the urban poor experience comparable disadvantages in maternal health care. The results show that, although on average the urban poor receive better antenatal and delivery care than rural residents, the care of the urban poor is worse than that of the urban non-poor. This suggests that the urban bias in the allocation of health services in Africa does not benefit the urban poor as much as the non-poor. Multilevel analyses reveal significant variations in maternal health in urban areas across countries of sub-Saharan Africa.

Maternal Mortality in 2000: Estimates Developed by WHO, UNICEF and UNFPA (report)
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Related news article: Southern Africa: Maternal Mortality Stubbornly High
This report discusses the reasons why women in sub-Saharan Africa face the highest maternal mortality rates in the world.

Iraq: Reproductive Health Assessment (report)
Related press release: Maternal Deaths Triple Since 1990, Says UNFPA
According to a new survey conducted by UNFPA, maternal deaths, caused by a crumbling health system in Iraq, have tripled since 1990. Bleeding, ectopic pregnancies, and prolonged labor were among the causes of many of the reported deaths.

Maternal Mortality in Turkey (PubMed abstract)
This hospital-based survey in 53 provinces in Turkey revealed that maternal mortalities make up 5% of all women deaths and maternal mortality is 49.2 per 100,000 live births. Factors related with the status of women that had influence on maternal mortality level in the community included education, socio-economic conditions, early marriage age, and fertility level. Accessibility and availability of maternal health care services are also very important factors to reduce maternal mortality.

Breastfeeding in Bolivia – Information and Attitudes (research abstract)
The objectives of this study were to investigate the relationship between the attitudes of the mother and her family towards breastfeeding and the actual feeding pattern in a Bolivian population, as well as studying the relationship between breastfeeding information, sources, timing, and feeding patterns.

Breastfeeding Intentions, Patterns, and Determinants in Infants Visiting Hospitals in La Paz, Bolivia (research abstract)
Research from Latin America has shown that the rate of exclusive breastfeeding of Bolivian infants fell rapidly during the first months of life. Not feeding the infant colostrum and Latin ethnicity were associated with a shorter duration of exclusive breastfeeding. Rural mothers were four times more likely to discard the colostrum than urban mothers. Breastfeeding duration was shorter than what the mothers reported to be the ideal duration of exclusive breastfeeding for the infant.

Physical, Psychological, Emotional, and Sexual Violence During Pregnancy as a Reproductive-risk Predictor of Low Birthweight in Costa Rica (research abstract)
The aim of this study was to determine the prevalence of physical, psychological, emotional, and sexual violence during pregnancy and the association that that violence has with low birthweight. Women (n = 118) interviewed were residents of a low-income urban settlement of San José, Costa Rica. The newborns of the mothers who suffered acts of violence weighed on average 449.4 g less that the newborns of the women who had not been exposed to acts of violence. The mothers who suffered acts of violence were three times as likely to have a newborn with low birthweight.

MATERNAL AND CHILD HEALTH NEWS

Malaria Increases Baby's HIV Risk (news article)
According to experts studying HIV positive women in Uganda, research demonstrates that women infected with malaria are more likely to pass HIV on to their unborn child. Treating malaria could significantly reduce the number of babies being born with HIV. HIV positive women are infected more frequently and more severely with malaria when compared to women who do not have the virus. They also have a higher risk of developing anaemia, miscarrying, having a low birth weight baby and delivering prematurely. High levels of HIV in their bodies means they are more likely to pass on the virus to their child.

Optimal Birth Spacing Has the Potential to Reduce Infant Mortality by Up to 24 Percent and Under-Five Mortality by Up to 35 Percent in Less Developed Countries (press release)
Related report: Birth Spacing: Three to Five Saves Lives
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Experts advise women that waiting 3 years or longer between the births of their children could potentially reduce infant mortality by up to 24% and under-five mortality by up to 35% in less developed countries.

MEN'S HEALTH RESEARCH

A Clinical Trial of 7-Methyl-19-Nortestosterone Implants for Possible Use as a Long-Acting Contraceptive for Men (research abstract)
This study in 35 normal volunteers demonstrates that 7-methyl-19-nortestosterone acetate, when administered in a sustained release fashion via subdermal implants, can inhibit spermatogenesis over a prolonged period after a single administration and has the potential to be used as a male contraceptive.

MEN'S HEALTH NEWS

India: Health Dept. Sets Vasectomy Target (news article)
The Pune health services division will perform 1,000 non-scalpel vasectomies in three days, beginning November 8, to commemorate the inauguration of the ambitious Rs 6.5-crore Infosys Foundation’s super-speciality building on the Sassoon hospital premises.

POPULATION RESEARCH

Explanations of the Fertility Crisis in Modern Societies: A Search for Commonalities (research abstract)
Near-global fertility decline began in the 1960s, and from the 1980s an increasing number of European countries and some Asian ones achieved very low fertility (total fertility below 1.5) with little likelihood of completed cohort fertility reaching replacement level. Earlier theory aiming at explaining this phenomenon stressed the incompatibility between post-industrial society and behaviour necessary for population replacement. Recent theory has been more specific, often concentrating on the current Italian or Spanish situations or on the contrast between them and the situation in either Scandinavia or the English-speaking countries, or both. Such an approach ignores important evidence, especially that from German-speaking populations. The models available concentrate on welfare systems and family expenses, omitting circumstances that may be unique to individual countries or longer-term factors that may be common to all.

The South African Fertility Decline: Evidence from Two Censuses and a Demographic and Health Survey (research abstract)
This paper describes the South African fertility decline from 1955 to 1996. After identifying and adjusting for several errors in the 1996 census data, the author's argue that total fertility at that time was 3.2 children per woman nationally and 3.5 children per woman for African South Africans. These levels are lower than in any other sub-Saharan African country. The authors also show that fertility in South Africa has been falling since the 1960s. Thus, fertility transition predates the establishment of a family planning program in the country in 1974.

Completing the Fertility Transition in the Developing World: The Role of Educational Differences and Fertility Preferences (research abstract)
This study summarizes patterns of educational differentials in wanted and unwanted fertility at different stages of the fertility transition. Data used were from Demographic and Health Surveys in 57 less developed countries. As the transition proceeds, educational differentials in wanted fertility tended to decline and differentials in unwanted fertility tended to rise. An assessment of fertility patterns in developed and less developed countries with low fertility concludes that these differentials are likely to remain substantial when less developed countries reach the end of their transitions.

Decision Science and Cervical Cancer (PubMed abstract)
Mathematical modeling is an effective tool for guiding cervical cancer screening, diagnosis, and treatment decisions for patients and policymakers. The authors provide an overview of mathematical modeling, especially decision analysis and cost-effectiveness analysis, and examples of how it can be used for clinical decision making regarding the prevention, diagnosis, and treatment of cervical cancer. Included are applications as well as theory regarding decision science and cervical cancer. Mathematical modeling can answer such questions as the optimal frequency for screening, the optimal age to stop screening, and the optimal way to diagnose cervical cancer. Results from one mathematical model demonstrated that a vaccine against high-risk strains of human papillomavirus was a cost-effective use of resources, and discussion of another model demonstrated the importance of collecting direct non-health care costs and time costs for cost-effectiveness analysis.

WOMEN'S HEALTH RESEARCH

The Value of Transvaginal Ultrasound to Monitor the Position of an Intrauterine Device after Insertion. A Technology Assessment Study (research abstract)
In this prospective comparative study, researchers assessed the accuracy of clinical evaluation of IUD position. The clinical evaluation was compared with the transvaginal ultrasound (TVU) measurement of IUD position both immediately after insertion and 6 weeks after insertion. The primary outcome measures were the positive and negative predictive values (PPV and NPV) of the clinical evaluation of IUD position. One hundred ninety-five women were included consecutively, 181 women (92.8%) were available for follow-up. The PPV and NPV of clinical evaluation of IUD position immediately after insertion were respectively 0.60 (95% CI: 0.39–0.81) and 0.98 (95% CI: 0.96–1.0). The prevalence of an abnormally positioned IUD was 7.7% (95% CI: 3.9–11.4). The PPV and NPV of the clinical evaluation at follow-up were respectively 0.54 (95% CI: 0.26–0.81) and 1.0 (95% CI: 0.98–1.0). The prevalence of abnormal position was 4.0% (95% CI: 1.7–7.1). Thus, clinical evaluation is an excellent test for the evaluation of the position of an IUD and routine TVU is not indicated for this purpose.

Bacterial Vaginosis in Sexually Experienced and Non–sexually Experienced Young Women Entering the Military (research abstract)
In a cross-sectional study of 1938 women, the researchers attempt to estimate the prevalence of bacterial vaginosis in a non-clinic national sample of young women. Bacterial vaginosis prevalence was 27%, with 28% in sexually experienced and 18% in non–sexually experienced women. Clinically, bacterial vaginosis was directly related to multiple sexual partners, self-report of vaginal discharge, self-report of vaginal odor, and concurrent Chlamydia trachomatis infection, and inversely related to hormonal contraceptive use.

WOMEN'S HEALTH NEWS

UNICEF Lauds Progress on Women's Health in Afghanistan (news article)
In 2002, the maternal mortality ratio in Afghanistan stood at 1,600 deaths per 100,000 live births - and in the northeastern province of Badakhshan the highest maternal mortality ratio ever recorded was registered, standing at 6,500 deaths per 100,000 live births. That equates to one woman dying ever 20 minutes in Afghanistan as a result of complications in childbirth or pregnancy. The article describes improvements in women’s health, including an increase in the coverage, utilization and quality of emergency obstetric care across the country.

YOUTH HEALTH RESEARCH

Entertainment Television as a Healthy Sex Educator: The Impact of Condom-Efficacy Information in an Episode of "Friends" (research abstract)
This study assessed the impact of condom-efficacy messages in an episode of "Friends" on teens. A national sample of 506 adolescents 12 to 17 years old who had been regular viewers of "Friends" the previous year were surveyed by telephone shortly after the episode aired. At least 27% of the sample saw the episode, and 65% of these viewers recalled its depiction of condom failure resulting in pregnancy. Forty percent of the viewers watched with an adult. Ten percent of viewers talked to an adult about condom efficacy as a result of the show. Compared with other viewers, youth who talked with an adult were more likely to report learning about condoms from the episode and appeared less likely to reduce their perceptions of condom efficacy after the episode.

Adolescent Health in the Caribbean: A Regional Portrait (research abstract)
This study assessed youth health in the Caribbean Community and Common Market countries and describes the prevalence of health-related factors. The authors used a self-administered classroom questionnaire to address general health, health care, nutrition, sexual history, drug use, mental health, and violence. Most youths reported good health; however, 1 in 10 reported a limiting disability or significant health problems. Violence was a pervasive concern. Of those who reported history of sexual intercourse, many reported that their first intercourse was forced, and nearly half reported that they were aged 10 years or younger when they first had intercourse.

Short and Long-term Impact of Adolescent Pregnancy on Postpartum Contraceptive Use: Implications for Prevention of Repeat Pregnancy (research abstract)
This study describes patterns and changes in contraceptive use among pregnant adolescents in early and later postpartum compared with nonpregnant adolescents. One-hundred-seventy-six pregnant and 187 nonpregnant adolescents, recruited through community clinics, were interviewed three times (baseline, 6-month follow-up, 12-month follow-up) about their condom and hormonal contraceptive practices. Pregnant adolescents increased hormonal contraceptive use from baseline to early postpartum, but decreased use from early postpartum to late postpartum. Nonpregnant adolescents did not change their hormonal contraceptive use over time. Neither group changed condom use over time. Pregnant adolescents were more likely to be consistent dual users and hormonal-only users during the 6-month follow-up compared with nonpregnant adolescents.

Effect of Social Exclusion on the Risk of Teenage Pregnancy: Development of Hypotheses Using Baseline Data from a Randomised Trial of Sex Education (research abstract)
This paper develops hypotheses on the relationship between socioeconomic and educational dimensions and the risk of teenage pregnancy by examining whether dislike of school and socioeconomic disadvantage are associated with cognitive/behavioral risk among 13/14 year olds in English schools. The results indicate that those disliking school were more likely to have sexual intercourse, expect sexual intercourse by age 16, and expect to be parents by the age of 20. Therefore, those disliking school might be at greater risk of teenage pregnancy because they are more likely to see teenage pregnancy as inevitable or positive.

YOUTH HEALTH NEWS

Vouchers Reduce Teens' Access to Contraception (news article)
Teens are more likely to take advantage of free contraception if they can get it directly than if they have to ask for vouchers they can redeem at community clinics, new research suggests. The report compared the effectiveness of two systems designed to provide teens with free contraception: one that used school-based clinics to distribute vouchers for free birth control, and one in which the clinics distributed contraception to students who made an appointment. Under the two systems, roughly 11% of students asked for contraception, suggesting that handing out contraception, rather than vouchers, does not increase the likelihood teens will ask for it.

BOOKS/BOOK REVIEWS

Simples Métodos de Control de la Natalidad (book)
This is a fully updated Spanish-language edition of a classic natural birth control book, published for Spanish-speaking Americans who wish to explore their reproductive choices without using invasive or hormonal methods of contraception. It provides accurate information on natural and effective reproduction choices based on research and training conducted worldwide. The authors are experienced medical experts in reproductive health, family planning, and fertility treatments.

Global Prescriptions: Gendering Health and Human Rights (book)
This book reviews a decade of women's participation in UN conferences, transnational networks, national advocacy efforts and sexual and reproductive health provision, assessing both their strengths and weaknesses. It contains trenchant critiques of the Cairo, Beijing, and Copenhagen conference documents and of World Bank, WHO, and health sector reform policies. It also offers case studies of national-level reform and advocacy efforts and appraises the controversy concerning TRIPs, trade, and essential AIDS drugs. That controversy, the author argues, starkly illuminates the "collision course" of transnational corporate and global trade agendas with the struggle for gender, racial, and regional equity and the human right to health.

Contraception: Your Questions Answered (book)
This book is one of the original books in the Your Questions Answered (YQA) series. It serves as a primary source of information about reversible methods of contraception. Written in an informal and yet highly informative question-and-answer style, it represents a dialogue between general practitioner (asking the questions) and reproductive health specialist (providing the answers). As for all YQAs, the main aim of the book is to give practical guidance to busy clinicians when they are faced with patients who wants help with a health problem - for this book, the questions pertain to choosing and using the best means of controlling fertility. Most chapters conclude with questions frequently asked by patient - the answers to which can be very difficult for the unprepared and busy clinician to improvise "on the spot."

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