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Volume 4, Number 10
8 March 2004

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GUEST EDITORIAL

Enhancing the Management of Reproductive Health Commodities

by Jagdish Upadhyay

upadhyay@unfpa.org

Today many countries have a difficult time securing a constant supply and choice of quality contraceptives, condoms, and other reproductive health (RH) commodities, resulting in increased rates of unplanned pregnancies and sexually transmitted infections, including HIV/AIDS. In response, the United Nations Population Fund (UNFPA) has developed a hi-tech, user-friendly service to keep track of stocks and shipments, identify possible shortages, and replenish stockpiles to meet growing needs on a timely basis.

The system, launched in June 2003, is called the Country Commodity Manager (CCM). CCM is now being used by more than 50 developing countries, and other countries are expected to participate soon. At the touch of a computer key, the system can call up displays of available stock and commodity needs.

The software has been successful in alerting governments to potential shortfalls. For example, in Cambodia a shortfall of male condoms is expected in May 2004 based on estimated monthly use and the expiration dates of stock in the central warehouse. With this information, UNFPA and other donors can now expedite their support and avert a pending crisis.

With demand rising for contraceptives, condoms, and other RH-related commodities for family planning and HIV/AIDS prevention programs, this software illustrates UNFPA’s increased commitment to respond to countries’ needs and also to international agreements. The Programme of Action of the 1994 International Conference on Population and Development exhorts developing nations and the donor community to work together to ensure universal access to RH services by the year 2015. To reach this goal, a secure supply of RH commodities is absolutely essential. It is widely acknowledged that the effort to expand RH services will, in turn, contribute to the attainment of the Millennium Development Goals adopted by world leaders in 2000 to reduce poverty, improve maternal health, and reverse the advance of HIV/AIDS.

The new system is one part of the work of UNFPA’s Commodity Management Unit (CMU) with partners to develop and refine the Global Strategy for Reproductive Health Commodity Security (RHCS). Translating this Strategy to the national level and understanding country and regional perspectives to meet country needs have been priorities of CMU over the past few years.

It is important to understand that most developing countries rely on several donors from many countries, including UNFPA, USAID, IPPF, The UK, The Netherlands, Canada, KFW, and Japan, as well as social marketing organizations and the private sector, for most of their RH-related commodities. For many of them, support from UNFPA is critical.

Capacity building and coordination at the global and national levels have been identified as key elements to achieving RHCS and are high on UNFPA's agenda. CMU helps in strengthening national capacity and developing national policies and priorities in making RHCS a reality. CCM is an example of a tool that can help to facilitate these goals.

For more information about CCM, contact Ravi Fernando at fernando@unfpa.org.

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

FAMILY PLANNING/REPRODUCTIVE HEALTH RESEARCH

A National Study Examining the Effect of Making Emergency Hormonal Contraception Available Without Prescription (research abstract)
In January 2001 in the UK, emergency hormonal contraception was made available for women over the age of 16 years directly from a pharmacist without prescription. This paper reports on a self-completed questionnaire of 419 women to determine if this change led to any improvements or deterioration in the service provided for the women who need it. Researchers found that a greater proportion of women were able to take emergency contraception within 24 hours when they obtained their tablets directly from a pharmacy without a prescription (64% versus 46%). And women who obtained their drugs directly from the pharmacist were just as well informed, just as likely to arrange regular follow-up and generally preferred this system, although they disliked having to pay. The authors write that making emergency hormonal contraception available without prescription has improved services to women who need them, but these improvements are quantitatively minimal, preventing only five additional pregnancies per 10,000 users.

Contraceptive Effectiveness and Safety of Five Nonoxynol-9 Spermicides: A Randomized Trial (research abstract)
This study estimates and compares the effectiveness and safety of 5 spermicides over 6 and 7 months of use, respectively. The spermicides included 3 gels containing 52.5 mg, 100 mg, and 150 mg of nonoxynol-9 per dose and a film and a suppository, each containing 100 mg of nonoxynol-9 per dose. Of 1,536 women enrolled, 868 (57%) either relied on the spermicide for 6 months or became pregnant. The probability of pregnancy during 6 months of typical use of the spermicide was 22% in the 52.5-mg gel group, 16% in the 100-mg gel group, 14% in the 150-mg gel group, 12% in the film group, and 10% in the suppository group. The pregnancy risk in the 52.5-mg gel group was significantly different from that in either of the other gel groups. The pregnancy risks in the three 100-mg product groups were not significantly different.

Which African Men Promote Smaller Families and Why? Marital Relations and Fertility in a Pare Community in Northern Tanzania (research abstract)
This paper, based on data from a case study from two Pare villages, examines the relationship between male attitudes toward reproduction and marital relations. The methodology consisted of a combination of an ethnographic study and in-depth interviews. A subsequent survey was administered to verify the generalisability of the findings of the qualitative work. Findings show that those men who desire fewer children are younger, are educated at least to the primary and often to the secondary level, have wives who have also completed at least primary school, are more affluent, and are likely to be Christian. These men are in a marital relationship where the partners chose each other, they communicate with their wives about important issues, and they make joint decisions, including the number of children they should have.

Acceptance of Contraceptives among Women Who Had an Unsafe Abortion in Dar es Salaam (research abstract)
The purpose of this study was to assess the need for post-abortion contraception and to determine if women who had an unsafe abortion will use a contraceptive method to avoid repeated unwanted pregnancies and STDs/HIV. Women attending Temeke Municipal Hospital, Dar es Salaam, after an unsafe abortion or an induced abortion performed at the hospital (n=788) were counselled about contraception and the risk of contracting STDs/HIV. A free ward-based contraceptive service was offered. Participants (90%) accepted the post-abortion contraceptive service. Of these, 86% stated they were still using contraception 1 to 6 months after discharge. Initially, 55% of the women accepted to use condoms either alone or as part of double protection. After 1 to 6 months, this proportion had dropped to 18%. Single women were significantly more likely to use condoms.

False-Positive Gonorrhea Test Results with a Nucleic Acid Amplification Test: The Impact of Low Prevalence on Positive Predictive Value (news article)
Related news article: Gonorrhea Test May Give False-positive Results
Five women from Hawaii in long-term monogamous relationships tested falsely positive for gonorrhea in an 8-month period, according to a study. All of the women had been tested by the Roche COBAS AMPLICOR CT/NG® test from the same laboratory. Three of the women were tested as part of a family planning examination, and two because of symptoms that were later diagnosed as a non-sexually transmitted disease (STD)-related condition called bacterial vaginosis. None of the women's sexual histories indicated that they were at high risk for contracting an STD.

Endometrial Progesterone and Estrogen Receptors and Bleeding Disturbances in Depot Medroxyprogesterone Acetate Users (research abstract)
This study compared the expression of progesterone and estrogen receptors in the endometrium of bleeding depot medroxyprogesterone acetate (DMPA) users with that of amenorrhoeic DMPA users.

An In Vitro Study of Biological Safety of Condoms and Their Additives (research abstract)
The objective of this study was to develop a sensitive in vitro system to determine the toxic effects of condom material. Researchers used the modified L929 FDA method and a more specific cell type, such as the cervical epithelial tumor cell line HeLa, and they evaluated lubricated (LC), lubricated and flavored (LFC), and lubricated, flavored and colored condoms (LFCC). They found that the condom type affected cell viability and lysosome integrity, with LC inducing an increase in cell viability and LFC a decrease in lysosome integrity. The HeLa cell line in combination with the MTT and NR assay was the most sensitive in vitro system to determine the toxic effects of condom material.

Mucus Observations in the Fertile Window: A Better Predictor of Conception than Timing of Intercourse (research abstract)
In this study, 782 women were recruited from natural family planning centers in Europe to contribute prospective data on 7,288 menstrual cycles. Daily records of intercourse, basal body temperature, and vaginal discharge of cervical mucus were collected. Probabilities of conception were estimated according to the timing of intercourse relative to ovulation and a 1-4 score of mucus quality. Researchers found a strong increasing trend in the day-specific probabilities of pregnancy with increases in the mucus score. They conclude that the changes in mucus quality across the fertile interval predict the observed pattern in the day-specific probabilities of conception, and they recommend that, to maximize the likelihood of conception, intercourse should occur on days with optimal mucus quality, as observed in vaginal discharge, regardless of the exact timing relative to ovulation.

Sexually Transmitted Herpes Simplex Viruses (research abstract)
This paper reviews the nature of the transmission of HSV-1 and HSV-2.

FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS

India: Condom Vending Machines to Save Men the Blushes (news article)
While in many other parts of the world, the condom is a lifestyle statement, in India it has been seen as a tool to control the population. Satisfied by the response to the 25 or so condom vending machines introduced in Delhi about a year ago, the health ministry now wants to take the machines to small towns and bazaars in those areas where either the HIV/AIDS menace has assumed serious proportions or the population rates have defied all restraining measures. About 10,000 vending machines will be installed later this year at bus stops, railway stations, petrol pumps, and even dhabas.

Most Filipinos Favor Family Planning: Survey (news article)
Related news article: Arroyo: Birth Spacing is Up to Married Couples
Most people in the Philippines favor family planning and will defy the dominant Catholic Church on the issue, results of a recent survey showed. Independent researcher Pulse Asia Inc. found that 97% of respondents believed it was important to have the ability to plan the size of one's family and 71% said a fast-growing population hindered economic development.

Ghana: Chief Condemns Use of Condoms (news article)
The President of the National House of Chiefs has condemned the use of condoms in the fight against HIV/AIDS. He said condoms cannot solve the AIDS problems for Ghanaians. The chief noted that condoms were meant for adults who could not control their sexual desires and deplored the mass promotion of condom use. Addressing members of the House at a workshop on AIDS in Kumasi, Nana Gyapong Ababio urged colleague chiefs to carry the message across to the grassroots and encourage youth to adopt abstinence as the best antidote to AIDS.

Iranian Lovebirds to Get 1st Sex Education CD (news article)
Young Iranian couples could soon be given a sex education CD under a government project aimed at easing a taboo topic that has led to poor sexual knowledge. According to the head of women's affairs in the Islamic republic's interior ministry, the CD will seek to give newlyweds an idea of "how to act when in a couple".

India: Emergency Flashback: Vasectomy Camps are Back (news article)
The family welfare department of the Delhi government will be holding a "mega" vasectomy camp between 9-12 March in more than 10 Delhi hospitals. The reason: to enable men to take more responsibility when it comes to contraception. Vasectomy camps had gained notoriety during the late 1970s as reports of compulsory vasectomy and botched operations started making the rounds.

US Linked to Bizarre Zimbabwe Claim (news article)
The United States was trying to remove Zimbabwe's President Robert Mugabe from power with millions of condoms as weapons, state radio in that country said. It said President George Bush's regime was behind the "rebranding" of prophylactics that carry a bright red and yellow sticker advertising "revolutionary condoms" and a message urging Zimbabweans to "get up, stand up!" A bulletin said condoms carrying a sticker with "an oppositional political message" were being distributed throughout Zimbabwe "in what appears to be collusion between opposition groups and a United States-based condom manufacturer".

FAMILY PLANNING/REPRODUCTIVE HEALTH LAW AND POLICY

UK Tightens Law to Stop Female Genital Mutilation (news article)
The British government condemned the "painful and unacceptable" practice of female genital mutilation as new laws came into force to prevent young girls being sent abroad for circumcision. Britain outlawed female genital mutilation in 1985 but families of immigrant communities who still favor the practice are known to be taking their daughters abroad to have the procedure carried out before returning to Britain. Britain's new legislation reinforces existing laws by making it illegal to take girls abroad for genital mutilation, whether or not it is legal in the country they visit. It will also increase the maximum penalty for either performing or procuring female genital mutilation from 5 to 14 years in prison.

Policy Paralysis: A Call for Action on HIV/AIDS-related Human Rights Abuses against Women and Girls in Africa (report)
(You need Adobe Acrobat Reader to access this document)
This report details cases of abuse of women and girls that increase susceptibility to HIV/AIDS. It reviews regional and national legal regimes and makes recommendations for policy action against manifestations of HIV/AIDS human rights abuses against women and girls. The cases demonstrate that the illness, mortality, abuse, and stigma associated with HIV/AIDS are due, to a large extent, to a long tradition of subordination and violent abuse of women and girls in Africa. It argues that reformed national laws and policies to date have not been effective in counteracting this tradition and abusive practices condoned in customary law have exacerbated the problem.

UN to Stop Funding African AIDS NGOs (news article)
The UN agencies that sponsor AIDS programs say they will no longer direct funds to non-governmental organizations (NGOs) in some sub-Saharan states because they lacked accountability. NGOs on Saturday called the move retrogressive, saying it would harm efforts to fight the epidemic in a region where about 26 million people are estimated to be infected with the virus or have full-blown AIDS.

Uganda: Children: Should We Have More or Fewer? (commentary)
This analysis published in a Ugandan newspaper addresses Uganda's population policy and its relationship to realities faced by the Ugandan people.

HIV/AIDS RESEARCH

Guidelines for HIV/AIDS Interventions in Emergency Settings (resource material)
(You need Adobe Acrobat Reader to access this document)
The Guidelines for HIV/AIDS Interventions in Emergency Settings have been developed by the Inter-Agency Standing Committee Task force on HIV/AIDS in Emergency Settings to respond to the growing concern for the development of a more specific response to HIV/AIDS in crises. The purpose of these Guidelines is to enable governments and cooperating agencies, including UN Agencies and NGOs, to deliver the minimum required multi-sectoral response to HIV/AIDS during the early phase of a crisis.

Botswana’s Strategy to Combat HIV/AIDS: Lessons for Africa and President Bush’s Emergency Plan for AIDS Relief (report)
(You need Adobe Acrobat Reader to access this document)
This conference report presents an account of the conclusions made during a November 12, 2003 meeting of the Center for Strategic and International Studies Task Force on HIV/AIDS and officials and experts from Botswana and its international partners. It dwells in some detail on the obstacles and challenges that have arisen in implementing Botswana’s anti-HIV/AIDS program because these suggest lessons for new programs.

Epidemiological Aspects of Transmitted HIV Drug Resistance (research abstract)
This article reviews the epidemiological aspects of transmitted HIV drug resistance. Available data from surveys conducted between 1996 and 2001 show the prevalence of drug resistance among newly HIV-infected individuals to range from 3% to more than 20% in North America and from 5% to 15% in Europe. While transmission of multidrug resistance still appears to be an uncommon occurrence, the authors comment that methodological heterogeneity and problems in study design make it difficult to compare results between different surveys and to draw firm conclusions from the results.

HIV/AIDS NEWS

Few in China Aware They May Be HIV-positive (news article)
Only 10% of China's estimated 1 million people infected with HIV know they carry the deadly virus, exacerbating the difficulty of preventing the spread of the disease, US experts said at the launch of the Global AIDS Program in Beijing.

Study: AIDS Blamed for Big Jump in S. Africa Deaths (news article)
South Africa's adult death rate has jumped by almost 50% over the past 6 years and the country's devastating AIDS epidemic is probably the primary cause, researchers at South Africa's independent Medical Research Council said last week.

Swaziland: Unregulated ARVs Cause Health Havoc (news article)
After years of resisting the introduction of antiretroviral drugs (ARVs) in Swaziland, the government bowed to pressure from international donor organizations last year and permitted their distribution. However, what followed has been a confusing and dangerous free-for-all that has reached the point where some activists have called for the drugs to be banned. In some cases, pharmacies are dispensing ARVS without prescription or instructions informing patients of how to take the medication, and no warning of possible side effects.

UN Warns HIV Infections Soaring among Asian Women (news article)
Related press release: Women in Mekong Region Faced with Higher Rates of HIV Infection than Men
(You need Adobe Acrobat Reader to access this document)
Related news article: International Women’s Day Issue: Alarming Vulnerability of Female to HIV Infection
HIV infection rates among Asian women are soaring, and being married is one of the biggest factors because many women contract the disease from their husbands, the United Nations said Monday.

Ghana: AIDS Watch: Use of Condoms--Men 6%, Women 2% (news article)
Hotels in Ghana might soon be compelled by government policy to put condoms in their bedrooms. The policy would be giving strength to the HIV/AIDS awareness, which admits that condom use is generally low, with an estimated 6% of men and 2% of women using them.

MATERNAL AND CHILD HEALTH RESEARCH

Antenatal Care: Provision and Inequality in Rural North India (research abstract)
This paper examines factors associated with use of antenatal care in rural areas of north India, investigates access to specific critical components of care, and studies differences in the pattern of services received via health facilities versus home visits.

Pregnancy Planning by Mothers of Pacific Infants Recently Delivered at Middlemore Hospital (research abstract)
This paper describes pregnancy planning by mothers of Pacific infants recently delivered at Middlemore Hospital. Mothers (n=1,365) were asked if the pregnancy was planned, if the pregnancy was unplanned, the form of contraception used, or, if not used, their main reasons for not using contraception. A planned pregnancy was reported by only 40% of women. Of the 60% who did not plan their pregnancies, 70.8% were not using contraception when they conceived. The main reasons given by women for not using contraception were that they never thought about contraception (46.8%), did not like using contraception (42.5%), decided to take a chance (39.4%), did not want to risk the associated weight gain (30.4%), and did not think they could have a baby (17.3%). Factors significantly associated with non-use of contraception by women who did not plan their pregnancy were lack of post-school qualifications and strong alignment with Pacific culture.

Survival among Motherless Children in Rural and Urban Areas in Guinea-Bissau (PubMed abstract)
A historical cohort study was set up in urban and rural areas in Guinea-Bissau to investigate the mortality of motherless children. Relatives of 128 motherless children from a rural cohort and 192 from an urban area, as well as a total of 807 controls, were examined and interviewed. Controlling for significant background factors revealed that motherless children had a markedly higher mortality than that of controls in both urban (mortality rate ratio [MR] 2.32) and rural areas (MR = 4.16). Virtually all the excess mortality occurred among children under 2 years of age when their mother died.

Reducing Child Mortality Rates and Improving Child Health in Iraq (report)
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This paper looks at opportunities for improving child health in Iraq, focusing on key interventions for reducing child and infant mortality rates. These include programmes for promoting breastfeeding; improved care of newborn babies; oral rehydration treatment for diarrhoea; nutritional education and use of vitamin supplements; vaccinations; domestic hygiene; and use of antibiotics. The paper also highlights the factors which limit implementation of these programmes, in particular post-war lack of security, with its related problems of poor infrastructure, shortages of supplies and lack of reliable water and electricity; a weakened health system; and a chronic shortage of trained staff in areas such as nursing, public health and data management.

MATERNAL AND CHILD HEALTH NEWS

Pregnancy Risks in Non-prescription Drugs (news article)
Many pregnant women are endangering their unborn children by using non-prescription, over-the-counter drugs, according to a report in the Wall Street Journal. The report said women often assume if medications don't require a prescription, they are safe to take during pregnancy, but most medicines have been tested only for use in the general adult population.

MEN'S HEALTH RESEARCH

Drug Use, Sexual Behaviours and Practices among Male Drug Users in Hanoi, Vietnam: A Qualitative Study (research abstract)
This qualitative study was conducted among drug users in Hanoi, Vietnam to describe their drug use practices and sexual behaviors, as well as potential factors that might contribute to the recent increase of HIV among them and local sex workers. A total of 63 drug users in five main districts of Hanoi were recruited for in-depth interviews and focus group discussions. The study found that drug users in Hanoi have been engaging in high-risk injecting behaviors and practices. They reported frequently visiting female sex workers (FSWs) and low condom use. Drug users had poor understanding and practices of cleaning injecting equipment, little knowledge of infection through sexual routes, and infrequent knowledge of their HIV infection status. The study provides evidence that young and new injecting drug users are at particularly high risk of HIV infection, are sexually active, and can serve as a bridge between the drug user and FSWs populations.

POPULATION RESEARCH

Population: A Lively Introduction (resource material)
(You need Adobe Acrobat Reader to access this document)
In the new 4th edition of this Population Bulletin, author Joseph McFalls discusses the basic forces of demographic change — fertility, mortality, and migration — and common assessment measures. Also covered are how these three forces affect a population's size and growth rate, and how population projections are calculated; common demographic variables such as age, sex, and race/ethnicity; and issues and problems associated with population growth.

Interpopulational Differences in Progesterone Levels during Conception and Implantation in Humans (research abstract)
This longitudinal study was designed to ascertain whether lower progesterone also characterizes conception, implantation, and gestation in women from nonindustrialized populations. The authors compared rural Bolivian Aymara women (n=191) to women from Chicago (n=29) and found that mean-peak-luteal progesterone in the ovulatory cycles of Bolivian women averaged 71% that of the women from Chicago. In conception cycles, progesterone levels in Bolivian women during the periovulatory period were 63%, and during the peri-implantation period were 50%, those of the US women. These observations argue that lower progesterone levels typically characterize the reproductive process in Bolivian women and perhaps others from nonindustrialized populations. The authors discuss the possible proximate and evolutionary explanations for this variation, note the implications for developing suitable hormonal contraceptives, and elucidate the etiology of cancers of the breast and reproductive tract.

POPULATION NEWS

Pakistan: Population Growth Rate Declined to 1.96% (news article)
It was announced last week that the population growth rate of Pakistan had declined to 1.96% from 3.1%. The contraceptive prevalence rate rose from 11% in 1990 to 34%. And the total fertility rate has decreased from 6.8 births per woman in 1980 to 4.1 births per woman today.

Scotland: City Babies are an Endangered Breed (news article)
Scotland's biggest cities are becoming child-free zones, according to stark new figures that reveal the pattern of falling birth rates behind the country’s dramatic population decline. The number of babies being born in Glasgow, Edinburgh, Dundee, and Stirling have plummeted to all-time lows.

Nigeria: Population and False Conceptions (commentary)
This columnist, writing from Nigeria, addresses a new government policy intended to force Nigeria's population growth rate from its current 2.5% to 3% to not more than 2%by the year 2015.

Baby Blues Hit Korea (news article)
South Korea's birth rate in 2002 plunged to the lowest in the world with women having an average of 1.17 children, according to the National Statistical Office. In Japan the rate is 1.33, the United States 2.13, and Britain 1.64.

As Birth Rate Plunges, Quebec Town Tries Family-friendly Subsidies (news article)
The fertility rate in Quebec is one of the lowest in the Western world. As recently as 1960, Quebec families averaged nearly four children, but Quebec couples today produce only 1.4 children - a rate well below the rest of North America and comparable to those of Italy and Spain, Catholic countries that also lag far behind the replacement fertility rate of 2.1. This article relates how one town is trying to encourage the birth of children, from $750 in prizes for bedroom sets to generous government spending for ice hockey uniforms.

Dogs Take a Lead Over Children (news article)
In America, there are now more dogs per household than children.

Singapore Tries to Spark Baby Boom (news article)
A renewed effort is underway in Singapore to reverse an alarming baby shortage, with the government mulling longer paid maternity leave and a host of other family-friendly incentives to spark a procreation boom.

WOMEN'S HEALTH RESEARCH

Influence of HRT on Prognostic Factors for Breast Cancer: A Systematic Review after the Women’s Health Initiative Trial (research abstract)
In this literature review, the authors found that the Women’s Health Initiative (WHI) study, showing a worsening of some prognostic parameters for breast cancer, is in contradiction to most published observational studies, which tend to be retrospective, not well matched, and do not consider most confounding factors. In view of these data, the authors write that current clinical messages to patients should be changed: one can no longer declare that breast cancers developed while using HRT are of better prognosis.

Estrogen plus Progestin and Colorectal Cancer in Postmenopausal Women (research abstract)
Related news article: Hormone Use May Cut Colon Cancer Risk in Women
Hormone replacement therapy (HRT) with estrogen and progestin seems to reduce the risk of colon cancer in women who are past menopause, this new research shows. However, the cancers that do occur seem to be more advanced than those seen in non-HRT users.

Breastfeeding and Breast Cancer: A Case-control Study in Southern Brazil (research article)
This paper investigates the relationship between breastfeeding and breast cancer in Southern Brazil. Researchers used a case-control design with two age-matched control groups. A total of 250 cases of breast cancer were identified in women from 20 to 60 years of age, with 1,020 hospital and community controls. According to analysis, breastfeeding did not have a protective effect against breast cancer. The odds ratio (OR) for women who breastfed was 0.9 compared to women who did not breastfeed. For women who breastfed for six months or less, the OR was 1.0.

WOMEN'S HEALTH NEWS

NIH Asks Participants in Women’s Health Initiative Estrogen-Alone Study to Stop Study Pills, Begin Follow-up Phase (press release)
Related news article: Second Estrogen Trial Stopped by U.S. Researchers
The National Institutes of Health said on Tuesday it had stopped a large trial of women taking estrogen replacement therapy after finding the pills not only failed to improve their health, but may have slightly raised the risk of stroke. It is the second large trial of hormone replacement therapy to have been stopped abruptly in 2 years. In July 2002, women taking estrogen plus progestin were told to stop because of the risk of heart attack, stroke, and some forms of cancer.

South Africa: The Risky Uuse of Vaginal Substances and Douching Still Common among Some Women (press release)
New findings by the Medical Research Council has revealed that some women are still using a combination of traditional remedies, patent medicines, antiseptics, and household detergents to clean and make their vaginas dry and tight, and these practices known as vaginal douching increase women's risk of HIV and STI infection. The researchers found that douching and vaginal substance use were common, with 97% of respondents reporting douching and 94% reporting vaginal substance use for "dry sex."

New Research Aims at Menopause without Hormones (feature article)
This feature article relates how new research is aimed at helping menopausal women without increasing their risk of disease.

Genital Mutilation Affects Women Globally (feature article)
This feature article from The Johns Hopkins Newsletter provides an overview of FGM practices worldwide.

YOUTH HEALTH RESEARCH

HIV Prevention for Young People in Developing Countries: Report of a Technical Meeting (report)
(You need Adobe Acrobat Reader to access this document)
This report collates presentations and discussions at the HIV Prevention for Young People in Developing Countries technical meeting sponsored by USAID Office of HIV/AIDS, the Institute for Youth Development, and YouthNet/Family Health International.

YOUTH HEALTH NEWS

UK: Teenage Pregnancies Rise Despite Government Campaign (news article)
Teenage pregnancies in England have risen by more than 800 in 12 months despite the millions of pounds spent by the government on strategies to reduce them. Latest figures from the Teenage Pregnancy Unit, published on the unit's website and without fanfare by ministers, show pregnancies among under-18s rose from 38,439 in 2001, of which 46% were aborted, to 39,286 in 2002.

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Johns Hopkins Bloomberg School of Public Health: The INFO Project

Volume 4, Number 10 8 March 2004