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Volume 4, Number 3
19 January 2004

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FAMILY PLANNING/REPRODUCTIVE HEALTH RESEARCH

Serum Medroxyprogesterone Acetate Levels in New and Repeat Users of Depot Medroxyprogesterone Acetate at the End of the Dosing Interval (research abstract)
This study examines serum medroxyprogesterone acetate (MPA) levels in new and repeat users of depot medroxyprogesterone acetate at the end of the dosing interval. The study was undertaken at three family-planning clinics in Durban, South Africa. Serum MPA levels were measured in 94 Black African, Indian and White women returning between 11 and 14 weeks after their last injection. The median serum MPA level was 0.88 ng/mL, and wide interindividual variability was observed. Levels in all but one woman were higher than 0.1 ng/mL, the level at which ovulation is reported to resume. MPA levels were not found to vary according to weight, body mass index or ethnicity.

'Come Gather Around Together': An Examination of Radio Listening Groups in Fulbari, Nepal (research abstract)
Using survey data supplemented by anecdotal evidence and service statistics, this study examines the association between membership in radio listening groups and family planning behavior. Multivariate logistic regression models show a significant relationship between radio listenership and knowledge and behavior variables above and beyond the positive association with the radio program itself. Results affirm the importance of a partnership between program organizers, community leaders, NGO partners and the audience community, in order to at least sustain positive family planning outcomes.

Sociocultural and Behavioral Contexts of Condom Use in Heterosexual Married Couples in India: Challenges to the HIV Prevention Program (research abstract)
This article examines sociocultural expectations of sexual behavior and the reasons why not using condoms may be logical to married heterosexual couples in India. Married women who report monogamous sexual relationships with their husbands are a high-risk group for HIV infection in India. Based on the public health model and a population-based perspective on HIV infection prevention, this article illustrates the underlying mechanisms that link the role of women in society, holistic health beliefs, and cultural beliefs about the transmission of HIV with the precursors to nonuse of condoms. The author concludes that promoting condom use requires an emphasis on family health, not only as contraceptives.

Ovarian Follicular Development during the Use of Oral Contraception: A Review (PubMed abstract)
This article reviews the alterations that have been made to the composition of oral contraceptives over the last 40 years and looks at evidence that indicates that reducing the estrogen dose to minimize adverse effects may have compromised the degree of hypothalamo-pituitary-ovarian suppression, particularly during the hormone-free interval or following missed doses.

Sexually Transmitted Infections and Contraceptives: Selective Issues (PubMed abstract)
The authors address specific issues of use and public health concerns as they relate to STDs and certain contraceptives.

The Future of Professional Education in Natural Family Planning (research abstract)
The author, from the College of Nursing, Marquette University, describes in this article a university online distance education natural family planning teacher training program, which offers academic credit and includes theory, practice, and the latest developments in fertility monitoring.

FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS

One, Two, Three or More? (feature article)
Related feature article: The Ancient Art of Making Babies
Related feature article: Brave New Babies
A series of feature articles in the latest issue of Newsweek address such topics as costs of raising a baby and how that impacts family planning; how new technologies enabling sex selection of babies also raise troubling ethical questions; old wives' tales about how to conceive either a boy or a girl.

Revealed: Two British Women Die after Taking Controversial New Abortion Pill (news article)
Two British women have died after taking the controversial abortion pill RU-486, the British government has admitted.

UN Family Planning Chief Urges Bush Resume Funding (news article)
Thoraya Obaid, first Arab woman to head a major United Nations agency, on Wednesday urged US President George W. Bush to drop his controversial ban on funding for the family planning programs she runs around the world. Giving people, especially women, in developing countries the chance to decide when they have children can help limit global population growth and be at least as effective as free trade in tackling poverty, she told Reuters in an interview.

WHO Sets Health Priorities for 2004 (news article)
Reproductive health, the prevention of heart disease, and organ transplantation will top the World Health Organization's priorities this year. Senior World Health Organization officials say those issues will be submitted to its Executive Board next week in Geneva.

Pope Candidate: Condoms Not Sinful & Suggests Contraceptives Can Be Used to Protect Life (news article)
A Catholic cardinal regarded as a successor to Pope John Paul II apparently has diverted from standard church teaching by hinting that using a condom might not be sinful. Someone who has the HIV virus could use a condom to protect life, said Cardinal Godfried Daneels of Belgium in an interview with a Dutch broadcaster.

India: Condoms at Public Toilets! (news article)
This article states that a program has been restarted by the government in India to place condom-vending machines in two railway stations.

UK: Sex Disease Battle (news article)
Family planning clinics across Merseyside are to offer free screenings for chlamydia in a move to combat the growing epidemic of the sexually transmitted infection. Chlamydia is the country's most common STI. In Merseyside, clinical research has shown as many as one in 12 females under the age of 24 is infected.

FAMILY PLANNING/REPRODUCTIVE HEALTH LAW AND POLICY

Swiss Consider HIV Tests for Asylum Seekers (news article)
Switzerland’s Federal Health Office could soon carry out HIV tests on all asylum seekers entering the country. The authorities are reacting to the increasing number of infected refugees arriving from sub-Saharan Africa.

Conakry Forum on Promotion of Family Planning Through Advocacy and Legislative Reform: A Milestone in the FP/RH Policy Environment in Francophone Africa (report)
(You need Adobe Acrobat Reader to access this document)
This brief relates how 20 parliamentarians from Benin, Burkina Faso, Chad, Guinea, Mali, and Senegal and 15 of their close allies in the public and nongovernmental sector convened in Conakry, Guinea, in June 2003 to adopt legislative agendas and strategies to improve family planning and reproductive health programs in their respective countries.

The Policy Envionment Score: Measuring the Degree to Which the Policy Environment in Jamaica Supports Effective Policies and Programmes for Adolescent Health--2002 Round (report)
(You need Adobe Acrobat Reader to access this document)
The Policy Environment Score (PES) is intended to measure the degree to which the policy environment in a particular country supports the reproductive health of the population, with particular focus on access to high-quality family planning and reproductive health services. This report describes the implementation and measurement of the PES in Jamaica.

Taiwan: Evolving Demographics Call for Timely Measures (commentary)
This commentary relates recent policy plans made by the President of Taiwan, based on falling fertility rates and increasing longevity.

HIV/AIDS RESEARCH

A Regional Perspective towards Managing HIV/AIDS in Northeast Africa (research article)
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This paper identifies several avenues through which cross-infections take place in the Northeast African context. It suggests that supranational (or regional) organizations, such as the Inter-Governmental Agency for Development or the Common Market for Eastern and Southern Africa, gear themselves to address such issues that require the involvement of more than one country. It provides a list of issues with which such regional organizations could start.

Clinical Development of Microbicides for the Prevention of HIV Infection (research abstract)
This article goes into some detail regarding the current state of the development of microbicides for the prevention of HIV infection. The authors address what would be the ideal anti-HIV microbicide. Information on current multicenter Phase I/II safety and Phase II/III efficacy studies is provided.

Rural Children's Attitudes to People with HIV/AIDS in Mali: The Causes of Stigma (research abstract)
This article presents findings from qualitative research among young people and other community members in rural Mali to elicit knowledge and attitudes regarding HIV/AIDS. Findings indicated that rumours concerning methods of infection are likely to increase the stigmatization of those with the disease. The most frequently stated mode of transmission involved urinating in a place where someone with AIDS had already urinated. Shared clothes, food and water were seen as sources of infection. Both children and teachers recommended that people with AIDS be isolated. Even talking to them would lead to a risk of infection. Discriminatory views were likely to have been reinforced by parents and community elders who possessed the same misinformation. The notion that AIDS results from sexual encounters between young women and dogs belonging to white people in Côte d'Ivoire was also widespread.

The Socioeconomic Impact of HIV/AIDS in the Socialist Republic of Viet Nam (report)
(You need Adobe Acrobat Reader to access this document)
This briefing paper addresses the socioeconomic impact of HIV/AIDS in Viet Nam. It looks at specific subpopulations, HIV/AIDS-related stigma, children, and health sector burdens.

HIV/AIDS NEWS

Thailand Rejects AIDS Vaccine Criticism (news article)
Related news article: World's Biggest HIV Vaccine Trial 'Is a Costly Mistake'
Thailand last week dismissed criticism by American HIV researchers that a massive test of a possible AIDS vaccine on thousands of healthy Thais would fail, saying the US-funded trial still has hopes of breaking new ground. But 22 leading US HIV scientists alleged that the 16,000 Thai volunteers who were expected to receive a shot over the next 2 years will receive a cocktail made of two antiquated AIDS drugs, each of which failed previous human tests.

UN Secretary-General Kofi Annan Launches Global Media AIDS Initiative (press release)
Related news article: Annan Urges Media Leaders to Use Influence to Spread Information in Fight Against AIDS
As part of the ongoing mobilisation of civil society in the fight against HIV/AIDS, United Nations Secretary-General Kofi Annan last week met with leaders of some of the world’s leading media organizations to launch a Global Media AIDS Initiative. The Initiative aims to activate media organizations to reach the world’s people, especially youth, with information about how to prevent and treat HIV and to help combat AIDS-related stigma and discrimination.

Nigeria: HIV/AIDS Figures May Increase, Says Osotimehin (news article)
The Chairman of the National Committee on AIDS, Professor Babatunde Osotimehin, has said the figures of people living with HIV/AIDS in Nigeria that would be released next month will be higher than the 5.8%recorded for 2001. Osotimehin disclosed last week at the Gede AIDS and Infectious Diseases Research Institute training that the change in figure was a result of the fact that Nigerians had yet to come to terms with the reality of the deadly disease.

HIV/AIDS Drugs Run Out in Nigeria (news article)
A government program in Nigeria to provide anti-retrovirals, the drugs which help people infected with HIV/AIDS, has run out of supplies. At least 12,000 people have been receiving the drugs from clinics at about a tenth of market value for more than a year.

Brazil Strikes HIV/AIDS Drug Deal (news article)
Brazil's government has reached a deal with pharmaceutical companies to reduce the price of HIV/AIDS anti-retroviral drugs by around a third. Health Minister Humberto Costa said the deal would save the government about $100 million this year. Brazil is one of the few countries to offer all HIV/AIDS sufferers anti-retroviral drugs free of charge.

When 'The Gift' is HIV (news article)
This article reports on the documentary film "The Gift," about the gay subculture of men who actively seek to be infected with the HIV virus. The director's focus on "bug chasers," as the men are called, is raising fears among some critics that her view is too narrow, and that when her film is seen by the public, it could give rise to a new wave of homophobia similar to the discrimination that emerged in the early 1980s when AIDS first appeared. ("The Gift" is scheduled to be shown Feb. 2 on the Sundance Channel, followed by a limited theatrical release in Los Angeles, New York and San Francisco in March before going to other cities.)

UNAIDS Denies Overestimating Kenya's HIV Crisis (news article)
Related news article: Kenya: Confusion Over HIV Prevalence Rates
The Joint United Nations Programme on HIV/AIDS (UNAIDS) has issued a statement denying that it has overestimated the number of cases of HIV/AIDS in Kenya. The move follows the release of preliminary figures from the Kenya Demographic and Health Survey that suggest that 6.7% of Kenyans have HIV, significantly less than the 9.4%estimated by UNAIDS and the WHO.

MATERNAL AND CHILD HEALTH RESEARCH

The Impact of Maternal Mortality Interventions Using Traditional Birth Attendants and Village Midwives (research abstract)
This study reviews the results of 15 traditional birth attendant (TBA)- and midwife-based interventions that aim to improve skilled assistance in delivery and recognition and referral of complications. Outcome measures used to evaluate the impact of the programs varied. Five of the five programs reviewed that evaluated their impact on maternal mortality demonstrated a decline in maternal mortality ratios, two of three studies measuring morbidity-related indicators found improvement of some but not all morbidity outcomes, six of seven showed a trend of improved referral rates, and three of three found high levels of knowledge retention among trained TBAs. Programs with the greatest impact utilized TBAs and village midwives within multisectoral interventions.

An Intercept Study of Persons Attending Traditional Birth Homes in Rural Southeastern Nigeria (research abstract)
Analysing data from interviews with traditional birth assistants and their clients in rural Nigeria, this paper examines the characteristics and conditions of persons using the services of traditional birth homes.

The Triad of Poverty, Environment and Child Health in Nairobi Informal Settlements (research article)
(You need Adobe Acrobat Reader to access this document)
Twenty four focus group discussions and 62 in-depth interviews were conducted in four informal settlements in Nairobi in 2002 to explore the community members’ expression and understanding of the linkages between urban poor environments and childhood illnesses. Community members identified respiratory tract infections, diarrhea, malaria, skin problems and malnutrition as the five leading illnesses among children aged under-5 years. The mothers linked these illnesses to lack of adequate and clean water, unsafe waste disposal systems, lack of adequate and nutritious food and air pollution. The ability of the mothers to make these linkages, which are quoted verbatim in the paper, shows that their children’s illnesses could mainly be due to the impoverished status and environments rather than their mothers’ lack of biomedical conceptualization of disease processes. The opportunity for child survival programs exists as illustrated by the communities’ conceptual understanding of the linkages between the environment and child health outcomes.

Child Health on a Dollar a Day: Some Tentative Cross-country Comparisons (research abstract)
The objective of this study was to determine the health outcomes of those children living on less than a dollar a day; methods are based on surveys of many thousands of children in over 30 of the poorest countries in the world. The differences in mortality and nutrition are wide, despite these children all living in more or less comparable levels of extreme poverty. Those countries in which extremely poor children fared better were the ones which spent more on health care. There was a much weaker association with spending on education. Perhaps for the poorest children it is downstream measures (ie, health care) rather than upstream measures (ie, education) that have the most direct effect on health outcomes. The author writes that this is not an argument to shift the balance of spending on health and education in developing countries, as education is the most effective long-term solution to lifting a nation out of dire poverty, but makes the point that health care spending does impact more on the poorer children in a country.

Use of Antiretroviral Drugs to Prevent HIV-1 Transmission Through Breast-feeding: From Animal Studies to Randomized Clinical Trials (research abstract)
This review gives an update on ongoing or planned antiretroviral intervention studies in resource-limited settings that are aimed at reducing the risk of mother-to-infant HIV transmission during lactation. These strategies include antiretroviral therapy given to the mother to reduce viral load in plasma and breast milk as well as antiretroviral regimens providing prophylaxis to uninfected infants during the period of breast-feeding. The rationale for the interventions based on animal models and human studies is described as well as the study designs of clinical trials.

The Kola Birth Registry and Perinatal Mortality in Monegorsk, Russia (research abstract)
This study reports the quality and the content of the birth registry are assessed and the perinatal mortality rates in the period 1973-97 estimated for the Arctic town of Monegorsk in northwestern Russia.

Preventing Postnatal Transmission of HIV-1 Through Breast-feeding: Modifying Infant Feeding Practices (research abstract)
In this review, experience is reported from clinical trials or studies additional to their main objective of assessing rates and risk factors for mother-to-child transmission of HIV. This information may inform policy, programming, and training options and may be especially valuable in the absence of conclusive data on the efficacy of the interventions to be applied during the breast-feeding period.

POPULATION NEWS

China: Gender Imbalance Escalating in Chongqing (news article)
Chongqing City, China, is experiencing an increasingly serious gender imbalance with a million single men flooding the city by year 2020, according to the Family Planning Commission Vice Director. A population check last November by the statistic bureau showed that the ratio of boys to girls born in Chongqing City reached 139 to 61. In some distant suburban areas the ratio imbalance reached as high as 700 to 100. The worldwide average ratio of male to female births is 102 to 107.

A Population Crisis Still Looms (news article)
As the European Population Forum in Geneva closed last week, coming to grips with high fertility rates remained a daunting international challenge, particularly in the poorest countries of the world where population growth continues to outstrip resources, places pressure on the environment, and exacerbates social disintegration. Despite encouraging recent reports from the United Nations, human growth remains an issue that requires priority attention around the globe if there is to be realistic hope for achieving sustainable development.

WOMEN'S HEALTH RESEARCH

Reproductive Factors, Hormonal Contraception, and Risk of Uterine Leiomyomata in African-American Women: A Prospective Study (research abstract)
The authors assessed the risk of uterine leiomyomata in relation to reproductive factors and hormonal contraception in a prospective cohort study of US Black women (n=22,895). During 76,711 person-years of follow-up, 2,279 new cases of ultrasound- or hysterectomy-confirmed uterine leiomyomata were self-reported. After adjustment for age, body mass index, smoking, alcohol intake, and other reproductive covariates, the risk of ultrasound- or hysterectomy-confirmed leiomyomata was inversely associated with age at menarche, parity, and age at first birth and positively associated with years since last birth. Current use of progestin-only injectables was inversely associated with risk. No consistent patterns were observed for other forms of hormonal contraception.

Disturbingly Low Levels of Contraception among Women Living with Hepatitis C (research abstract)
The authors describe the prevalence of contraception among a sample of women with hepatitis C (HCV) and compare it with contraceptive use among Australian women, generally, to look for associations between contraception and sample characteristics. Women who self-identified as living with HCV were recruited through a wide range of non-clinical and clinical sites. Of the 462 women surveyed, 34% of those aged 18-49 reported using contraceptives; a much lower prevalence than the 67% in the Australian population. Surprisingly, women who reported concerns about transmission to children were no more likely to use contraceptives. Not surprisingly, women who were lesbian or who did not have a current partner were even less likely to use contraceptives.

Benefits and Risks of Pharmacological Agents Used for the Treatment of Menorrhagia (PubMed abstract)
This article reviews the available literature to compare the efficacy and tolerability of different medical treatments for menorrhagia.

Cluster Randomized Trial of an Active, Multifaceted Information Dissemination Intervention Based on The WHO Reproductive Health Library to Change Obstetric Practices: Methods and Design Issues (research abstract)
This article presents the experience of the authors in conducting a trial to evaluate the improvement in obstetric practices using an active dissemination strategy to promote uptake of recommendations in The WHO Reproductive Health Library.

YOUTH HEALTH RESEARCH

Unwanted Pregnancy and Sexually Transmitted Infection among Young Women in Rural Kenya (research abstract)
This paper examines the strategies used by young women in Kenya to deal with the risks of unwanted pregnancy and infection by sexually transmitted infections and HIV/AIDS. Qualitative data were obtained from eight focus group discussions conducted with school attending girls aged between 15 and 19 years in Makueni District of Eastern Kenya. Findings suggest that, despite knowledge of the protective value of condoms and other contraceptives, the use of these methods by girls is hampered by the inability to access them, the fear of the side effects of contraceptives, and the desire by girls to remain faithful to their religious calling. Most girls also resort to the use of traditional methods, whose potency and efficacy is unproven.

In Forests and Factories: Sexual Behaviour among Young Migrant Workers in Nepal (research abstract)
This paper presents data from a follow-up qualitative study comprising in-depth interviews with 11 male and 12 female young migrant workers reporting high-risk sexual behavior. Exploring the circumstances of such episodes in both village and factory environments, the study found that young people experience a wide range of consensual and coercive sexual relationships while still in home communities.

Teenage Pregnancy Experiences in Rural Kenya (PubMed abstract)
This community-based survey describes the socioeconomic determinants of teenage pregnancy, experiences of health problems during pregnancy, and health care utilization patterns among adolescents (12-19 years old) in rural Kenya.

YOUTH HEALTH NEWS

Uganda: You Don't Need Sex, Janet Tells Youths (news article)
The First Lady, Janet Museveni, has asked youth in Uganda to abstain from premarital sex. "You do not need sex at your age. Wait until you are married. You can choose to fight AIDS by saying no and be able to stay alive," she told the youth, speaking at the official opening of the annual youth conference at the International Conference Centre in Kampala. She said abstinence would help them avoid the deadly HIV/AIDS and unwanted pregnancies, which could destroy their future.

Indonesia: Students Urge Government to Provide Sex Education (news article)
Learning from the increase in the number HIV/AIDS cases, especially among teenagers, students have urged the government to provide sex education classes where they can also learn about the hazards of injecting drugs.

SPECIAL REPORTS/PROFILES/RESOURCES

The Internet and the Dilemma of Africa’s Development (research abstract)
This article examines the dilemma of African countries as they are swept along by this Internet 'e-uphoria'. It provides data on Internet use in Africa and on impediments to growth and development of the Internet on the continent. The article shows that even though all 54 countries in Africa now have Internet access, at least in their capital cities, the global impact of their connectivity is negligible. It argues that ongoing efforts to widen connectivity on the continent, being undertaken by American and European companies driven entirely by the profit motive, may create a new and dangerous form of techno-dependency. The article concludes with suggestions for resolving this and other problems that accompany current efforts to introduce widespread Internet use in African countries.

Ethiopia: Interview with Sahlu Haile, Population Expert (interview)
Ethiopia’s population explosion is undermining any economic progress the country makes, says Sahlu Haile, who heads the Packard Foundation in the country. The foundation, which spends around US$5 million a year in Ethiopia on addressing population issues and family planning, says that greater access to contraceptives is key in addressing future development of the country. In an interview on January 11 in Awash, eastern Ethiopia, Sahlu was interviewed by the UN Integrated Regional Information Networks on these and related issues.

Developing HIV/AIDS Work with Drug Users: A Guide to Participatory Assessment and Response (resource material)
(You need Adobe Acrobat Reader to access this document)
This 120-page guide, produced by The International HIV/AIDS Alliance, describes how to design and carry out an assessment on HIV/AIDS and drug use based on a Participatory Assessment and Response approach. The approach builds on the Alliance's work in adapting Participatory Rural Appraisal methods for HIV/AIDS work. The guide offers a step-by-step description of how the approach can be used to develop HIV/AIDS work among drug users.

Ethiopia: Interview with Director of HIV/AIDS Film Hidden Tears (interview)
Ethiopia’s fledgling film industry is turning its attention to fighting the HIV/AIDS virus. In this interview, the documentary film-maker, Kidane Yilak, explains why he felt compelled to make the country’s first-ever film addressing the stigma and discrimination prompted by the virus, and the threat posed by HIV/AIDS, which has infected an estimated 2.2 million people in Ethiopia.

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Johns Hopkins Bloomberg School of Public Health: The INFO Project

Volume 4, Number 319 January 2004