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The Pop Reporter®

Volume 4, Number 16
19 April 2004

"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

Plateaus During the Rise of Contraceptive Prevalence (commentary)
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The authors report on an analysis using data from a large set of national surveys to explore the frequency of plateaus in contraceptive use, why they occur, and why they tend to be brief.

Family Structure and Reproductive Health Decision-Making among the Ogu of Southwestern Nigeria: A Qualitative Study (research article)
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This study, from Lagos State University and University of Ibadan, examines the structure of the Ogu family and its influence on reproductive health decision-making using a qualitative approach. Data were sourced through nine focus groups organized in the study area among married men and women. The data reveal that the family structure in the study area is changing, although the dominant pattern remains extended. The findings of the study suggest that there are on-going internal transformations that tend to enhance gender equity in reproductive health decision-making between husbands and wives. The authors write that these changes may be attributed to the widespread influence of western culture and the spread of education in the study population, which are necessary concomitants of economic, political, and cultural changes taking place in the society.

Social Interaction and Contraceptive Change in Northern Ghana (research article)
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The authors examine the impact of social interaction on the adoption of contraception in the Kassena-Nankana district of Northern Ghana. Three major distinct groups of respondents were defined by the social interaction variable: women whose family planning discussion partners are contraceptive users or encouragers (or both); women whose family planning conversational partners are neither users nor encouragers; women who reported never having discussed family planning with their social network partners. While the social interaction variable pertains to the time of the 1995 survey, contraceptive use is at the time of the 1998 survey. Results from this study suggest that social interaction about family planning triggers changes in contraceptive behavior in the rural areas of Northern Ghana. For most women, the decision to initiate family planning practice is facilitated by informal discussions with social network partners who encourage contraceptive adoption.

Unintended Pregnancy Among Newly Married Couples In Shanghai (research article)
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Researchers investigate unintended pregnancies using data from a prospective study of newly married couples in Shanghai. A total of 7,872 newly married couples, enrolled between 1987 and 1988, were followed up until 1994–1995. By 3 months after marriage, 461 couples had conceived; 57% of nonpregnant wives said that their preferred interval between marriage and conception was no more than 3 months. Twenty-one percent of pregnancies occurring between marriage and first birth were reported as unintended; 81% of these resulted from contraceptive failure. Most unintended pregnancies were carried to term; 13% were aborted. The younger the wife and the greater her desired interval between marriage and conception, the greater the likelihood that a pregnancy occurring before first birth was unintended. After first birth, 43% of couples experienced one or more unintended pregnancies, 98% of which were aborted in accordance with the one-child policy. Most of these pregnancies occurred in the 12 months after first birth, when couples tend to rely on ineffective methods of contraception.

Use of Family Planning in Lesotho: The Importance of Quality of Care and Access (research article)
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Researchers identify social and demographic factors affecting contraceptive use and methods choice and explore whether, net of these factors, contraceptive behavior of Basotho women is affected by the family planning environment in which they reside. The study used multilevel models, data from three sources, and focus group discussions of users of contraceptives. Researchers found that women aged 20-29, with at least two living children, and those with secondary or higher education, have the highest probability of using modern methods. Community differences in use of contraception are explained by provider bias, access to a facility, and the type of facility. Excerpts from focus group discussions indicate that the quality of care is also important in influencing the decision by women to use contraception.

Whatever Happened to Family Planning And, for That Matter, Reproductive Health? (commentary)
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This Viewpoint article from the latest issue of International Family Planning Perspectives addresses the successes of family planning programs during the 20th century, as noted in declining fertility rates worldwide. It then tackles the question of the continuing need for such programs to be funded by the state. The author concludes with recommendations for future family planning themes.

Smoking and Reproductive Life: The Impact of Smoking on Sexual, Reproductive and Child Health (report)
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Related news article: Smoking has a 'Shocking' Impact on Reproductive Health
Smoking damages almost all aspects of sexual, reproductive and child health, according to a report from the British Medical Association. The report says smoking reduces fertility, makes 120,000 men impotent, and causes up to 5,000 miscarriages and 1,200 cases of cervical cancer every year in Britain. The habit also increases the risks of childhood cancer.

Compression of Women’s Reproductive Spans In Andhra Pradesh, India (research article)
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The aim of this study was to elucidate the reasons for the decline of the total fertility rate in Andhra Pradesh, India, which has recently dropped to near-replacement level. Data from the second round of the National Family Health Survey were used to examine the reproductive span (the duration between first marriage and menopause or sterilization) among 4,032 ever-married women aged 15–49 living in Andhra Pradesh in 1998–1999. Between 1992–1993 and 1998–1999, the median age at which women married remained at 15.1, whereas the age at which they adopted sterilization decreased from 24.5 to 23.6. In life-table analyses, reproductive spans of successive cohorts of women decreased, from 22 years among those who married during the 1960s to 15 years among those who married in the 1970s, 10 years among those who married in the 1980s, and 5 years among those who married in 1990–1996. The authors write that these findings suggest that women are making the decision to end childbearing faster than older generations did.

The Potential Role of the Private Sector in Expanding Postabortion Care in Addis Ababa, Amhara and Oromia Regions of Ethiopia (research abstract)
The purpose of this study was to assess the potential of private facilities in expanding access to postabortion care (PAC) in Ethiopia. A cross-sectional study of private health facilities in Addis Ababa (88 facilities), Amhara (31), and Oromia (32) was conducted using a pretested questionnaire and a checklist. The authors found that about 80% of women did not get postabortion family planning methods and that high-level disinfection of non-autoclavable instruments needed improvement. All medium and above clinics had at least one GP, and many had nurse/midwives. Most facilities not providing PAC services would like to provide comprehensive PAC if staff are trained and equipment made available in the market.

FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS

Forced Marriage Pursued As Crime In Sierra Leone Tribunal Cases (news article)
Prosecutors at the Special Court for Sierra Leone have asked the tribunal's trial chamber to amend all previously issued indictments to include a new crime against humanity, forced marriage.

Challenging Guatemala's Macho Culture (feature article)
This feature article from BBC News relates the story of a pastor from Guatemala who decided to have a vasectomy after his fourth child and his struggles with the widespread ignorance and social taboos he has dealt with.

Zanzibar Outlaws Homosexual Acts (news article)
Zanzibar's parliament has passed a bill that outlaws homosexuality and lesbianism. The bill imposes stiff penalties which include up to 25 years imprisonment for those in gay relationships. The overwhelmingly Muslim Indian Ocean island is a key tourist destination on the East African coast.

FAMILY PLANNING/REPRODUCTIVE HEALTH LAW AND POLICY

Shanghai Backs Off from One-child Policy (news article)
China's largest city, Shanghai, is to ease controversial one-child policy laws to allow more couples a second offspring, reflecting growing concerns about a rapidly aging population. Municipal regulations say that from Thursday couples in certain categories can have a second child without having to pay fines that run to three times average per capita annual earnings. While it may seem strange that in an overcrowded city of nearly 17 million people officials have decided, for example, to permit divorcees to have more children, 11 years of negative population growth has authorities worried. They are concerned that the rising number of retirees will put pressure on the younger generation of taxpayers, further straining an already woefully underfunded social security system.

Political Management in the Indonesian Family Planning Program (report)
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This article investigates the political management in the Indonesian family planning program during the Suharto era, from the 1970s through the 1990s.

China: Government to Pay for AIDS Tests, Consultations (news article)
The government will foot the bill for those who voluntarily receive HIV/AIDS tests and consultations, the Ministry of Health announced last week. According to a regulation made public by the Ministry of Health and the Ministry of Finance, people can receive free of charge, if they want, the ELISA and PA HIV tests, two preliminary tests for detecting HIV, and related consultations.

Senegal: Row Over Re-export of Anti-retrovirals Becomes Political (news article)
A minor Senegalese politician who has confessed to re-exporting to Europe subsidised anti-retroviral drugs meant for poor Africans is gaining the support of Islamic and human rights organisations who say he is being persecuted by the government. Abdou Latif Gueye, the former president of the international charity Afrique Aide l'Afrique has admitted buying anti-retroviral drugs from international drugs giant GlaxoSmithKline for distribution at subsidised prices to people living with AIDS in Senegal and then re-exporting part of the consignment at a profit.

Pakistan: Government Hopes to Cut Population Growth to 1.59% by 2008 (news article)
The government has set a target to bring down the national population growth rate from 1.96% to 1.59% by 2008, Punjab Population Minister Naseem Lodhi told a press conference on Tuesday. She said the population department would also increase contraceptive prevalence rate from 37.12% to 43% by 2004 and 47.9% by 2007-8.

HIV/AIDS RESEARCH

The [In]visibility of HIV/AIDS in the Malawi Public Sphere (research abstract)
This paper argues that, far from being invisible, issues of sexuality are omnipresent in the African public sphere; however, this presence is not usually found in the medical nor overtly gender/sexual arenas but in general social contexts. Western derived research models have sought and continue to seek to situate gender and sexual discourse in overt forms, especially when emphasizing public health aspects. The author argues that the perceived secrecy is allied to cultural, male/female, and intra-female power relations. The author finds that significant issues of sexual and medical concerns were 'hidden' in an easy to decode public social sphere. Using a historical model of the colonial and postcolonial construction of this dominant social public sphere in Malawi, he demonstrates that key messages relating to sexuality and sexual behavior can be easily found in social discourse, from where they can be exploited for health promotion purposes.

The Young, the Rich, and the Beautiful: Secrecy, Suspicion and Discourses of AIDS in the South African Lowveld (research abstract)
This article investigates emic accounts of the AIDS deaths that have occurred in a village in the Bushbuckridge district of the South African lowveld. The author argues that while AIDS was publicly hidden and shrouded in secrecy, private gossip created moral scripts about those suspected of having died of AIDS.

Contexts of Vulnerability: Sex, Secrecy and HIV/AIDS (research abstract)
This paper uses three illustrative vignettes to draw attention to some major areas of HIV/AIDS vulnerability related to the themes of sex and secrecy within households and families in South Africa.

HIV/AIDS NEWS

Housewives Account for One-Fifth of India's HIV Cases, Expert Says (news article)
Dr. Suniti Solomon, renowned internationally for her pioneering work with HIV/AIDS in India, has said that 22% of HIV cases in India are housewives with a single partner. More than 82% of the infections in India are through sexual transmission, she noted. Dr. Solmon made her presentation at California State Long Beach College of Liberal Arts.

Free AIDS Drugs for Ethiopia (news article)
The Ethiopian government and US drug giant Pfizer on Friday signed a partnership agreement to provide free medicines to Aids sufferers in the Horn of Africa country, according to the health ministry. Under the deal, Pfizer will provide 50 000 Diflucan tablets to treat Cryptococcus Meningitis and Esophageal Cadidasis infections, common among AIDS patients. The government will distribute the drugs.

Vietnam, U.S. Hold First Military AIDS Discussions (news article)
The US and Vietnamese militaries held their first-ever discussions on heading off HIV/AIDS in a 4-day seminar that ended on Thursday of last week. A US military health specialist said prevention was key.

HIV/AIDS in India: Will It Follow the Same Path as Africa? (feature article)
This feature article from the Voice of America news addresses the question: will the HIV/AIDS epidemic in India follow the same path as it did in Africa? Or can India turn the tide, as was done in Uganda and Thailand?

Zimbabwe: Zim Traditional Doctors Abandon AIDS Research (news article)
Donor fatigue, largely blamed on the decline in democratic principles, has scuttled efforts by Zimbabwe's traditional healers' research into herbs that can possibly cure the HIV virus. The abandonment of the project comes as HIV-related deaths, compounded by the ailing health system, soar to 12,000 a month.

Africa Needs 'Greater Sense Of Urgency' to Manage HIV/AIDS Epidemic (interview)
K.Y. Amoako, the executive secretary of the United Nations Economic Commission for Africa, talks in this interview about his work as chair of the Commission for HIV/AIDS and Governance in Africa, which was established last year by UN Secretary General Kofi Annan to examine the worsening epidemic and recommend specific ways to respond to the impact it is having on governments' ability to function.

Libya Delays Verdict on Bulgarians in HIV Trial (news article)
A Libyan criminal court on Thursday last week postponed its verdict on six Bulgarian medics and a Palestinian doctor charged with infecting hundreds of children with the deadly HIV virus, court officials said.

MATERNAL AND CHILD HEALTH RESEARCH

Obstructed Labour in Adigrat Zonal Hospital, Tigray Region, Ethiopia (research abstract)
Researchers conducted a retrospective (1993–2001) review of delivery registration books, operation theater books, and patients records to describe the frequency, causes, complications, and treatment outcome of mothers with obstructed labor. Of 5,980 hospital deliveries during the study period, 195 (3.3%) were admitted for obstructed labor. Only 14.1% of all cases had received antenatal care, and most (88%) came from rural areas. Mean duration of labor was 45.4 hours for cases of obstructed labor. The most common cause of obstruction was cephalopelvic disproportion (64.9%) followed by malposition/malpresentation (32.5%). Caesarean section was performed in 88 of the 195 cases (46.1%), craniotomy in 31(16.2%), instrumental delivery in 27 (14.1%), hysterectomy in 28 (14.6%), and repair of ruptured uterus in 17 (8.9%). Maternal and neonatal fatality rates were 3.7% and 55.5% respectively.

Pre- and Post-vaccine Measles Antibody Status in Infants Using Serum and Oral-fluid Testing: An Evaluation of Routine Immunization in Addis Ababa, Ethiopia (research abstract)
This study evaluated the effectiveness of the measles routine immunization activities in Addis Ababa, Ethiopia. Infants who presented to 3 health centres between September-November, 1998 for routine measles vaccination were enrolled in the study. In total 296 infants (median age 9 months) provided blood and oral-fluid samples, of which 230 (77%) returned to provide post vaccine samples (median interval of 15 days). Pre-vaccination serology showed 1.4% IgM positive, 2% IgG positive, and 97% seronegative. Post-vaccination seroprevalence of IgM and IgG was 91.3% and 85%, respectively, and 92.9% overall. The seroconversion rate was 92.6%. Based on oral fluid results, 87.3% of children showed specific IgM antibody conversion. The authors write that these results are in support of the recommended age for measles vaccination in Addis Ababa and show the merit of oral-fluid IgM screening as a non-invasive alternative to blood for assessing vaccine effectiveness.

The Introduction of Diphtheria-Tetanus-Pertussis Vaccine and Child Mortality in Rural Guinea-Bissau: An Observational Study (research abstract)
This study examined mortality when diphtheria-tetanus-pertussis (DTP) was first introduced in rural areas of Guinea-Bissau in 1984–1987. Twenty villages in four regions have been followed with bi-annual examinations since 1979; 1,657 children aged 2–8 months were included in the study. During 1984–1987, children receiving DTP at 2–8 months of age had higher mortality over the next 6 months, the mortality rate ratio (MR) being 1.92 compared with DTP-unvaccinated children, adjusting for age, sex, season, period, BCG, and region. The MR was 1.81 for the first dose of DTP and 4.36 for the second and third dose. BCG was associated with slightly lower mortality, the MR for DTP and BCG being significantly inversed. The authors conclude that, in low-income countries with high mortality, DTP as the last vaccine received may be associated with slightly increased mortality. Since the pattern was inversed for BCG, the effect is unlikely to be due to higher-risk children having received vaccination.

First Assessment of the "Ten Steps for the Maternal Breast-Feeding Success" Compliance in Baby-Friendly Hospitals in Brazil (research abstract)
The full text of this paper is available only in Portuguese. This paper presents an assessment of the compliance of the "Ten Steps towards Maternal Breast-Feeding Success" in "Child Friendly Hospitals" in Brazil.

Outcomes of Very Low Birth Weight Infants in a Newborn Tertiary Center in Turkey, 1997-2000 (research article)
The purpose of this study was to determine mortality and morbidity rates and selected outcome variables for very low birth weight (VLBW) infants weighing less than 1500 g who were admitted to the neonatal intensive care unit of one hospital from 1997 to 2000. The number of VLBW admissions to the neonatal intensive care unit (NICU) was 133, with 51 (28.6%) referrals from other maternity centers. The mean birth weight and gestational age of the infants were 1175±252 g and 30.3±2.9 weeks, respectively. Overall survival rate was 83.5%. The authors note that, compared with reports from other developing countries, VLBW infants at this center had higher survival rates, but compared to developed countries, the survival rate was lower, especially for extremely very low birth weight infants.

Maternal Mortality in Rural Areas of China (PubMed abstract)
The purpose of this study, from the National Office for Maternal and Child Health Surveillance, Sichuan University, Chengdu, is to understand the trends and epidemiological characteristics of maternal mortality in rural areas of China from 1996 to 2001. The data analyzed were those from the population-based epidemiological survey conducted by the national maternal mortality surveillance network, which covered a total population of about 35 million. The maternal mortality ratio (MMR) in rural areas of China dropped by 28.4% from 86.4 per 100,000 live births in 1996 to 61.9 in 2001. The leading causes of maternal deaths were obstetric hemorrhage, preeclampsia, and embolism of amniotic fluid. The MMR for obstetric hemorrhage decreased from 48.3 per 100,000 live births in 1996 to 33 in 2001.

Fertility Awareness and Post-abortion Pregnancy Intention in Addis Ababa, Ethiopia (research abstract)
The aim of the study was to assess the knowledge of post-abortion patients regarding return of fertility and pregnancy intentions. A cross sectional study was undertaken in four government hospitals in Addis Ababa, Ethiopia. Four hundred post-abortion cases were interviewed at the point of their discharge to get information on their fertility awareness and future pregnancy intentions. Seventeen percent of the respondents who reported that the pregnancies were unwanted admitted some kind of interference with the pregnancy. Thirty six percent reported that they were assisted at clinics for inducing the abortion. Overall, 82% of them reported not having a plan to become pregnant in the 3-month period following the abortion. Seventy three percent of them were not able to tell the time at which they could become pregnant if involved in sexual intercourse after the present abortion.

MATERNAL AND CHILD HEALTH NEWS

Latin America: Pregnant Women Are Not 'Patients' (feature article)
Despite the lack of a scientific basis for practices like routine episiotomy, enemas, and perineal shaving, they continue to be used in maternity hospitals throughout much of Latin America. This feature article relates the traumas women endure and what activists are doing to correct the problems.

MEN'S HEALTH RESEARCH

Challenging Dominant Norms of Masculinity for HIV Prevention (research abstract)
This paper considers counter normative ideas of masculinity through highlighting the discussions of young South African men aged 13–25 years in focus groups and in-depth individual interviews conducted in Gauteng Province.

Religious Affiliation and Extramarital Sex Among Men in Brazil (research article)
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The aim of this study was to gain a better understanding of men’s sexual risk behavior. The authors used data on married and cohabiting men who had participated in the 1996 Brazilian Demographic and Health Survey. They found that 12% of married or cohabiting men reported having had at least one extramarital partner in the previous 12 months; half of these had had two or more. Among men who had had sex with an extramarital partner in the last year, 40% reported having used condoms during last extramarital sex. Compared with members of evangelical religions, other men were significantly more likely to report having had an extramarital partner and unprotected extramarital sex in the last 12 months. Region of residence was also strongly correlated with extramarital sex. The authors write that in Brazil, religious affiliation and region of residence exert a major influence on risk behavior.

POPULATION RESEARCH

Rural-Urban Migration and Its Effects on Infant and Child Mortality in Ghana (research article)
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This paper examines the socioeconomic characteristics of rural-urban migrants, child mortality, and maternity child health care in Ghana. Data from the 1988 Ghana Demographic and Health Survey shows that infant mortality is lower among rural-urban migrants compared to rural non-migrants. Proportional hazards model estimates reveal that the survival chances of children of rural-urban migration persist after controlling for socioeconomic characteristics. However, these advantages disappear after demographic variables are included in the model despite the proximity of and accessibility to medical facilities enjoyed by the migrants. The authors write that this finding suggests that socioeconomic and demographic characteristics of migrants could be an important determinant of the survival of children of rural-urban migrants.

Monogamous Networks and the Spread of Sexually Transmitted Diseases (research abstract)
This study presents a novel modelling approach in which the authors adapt the notion of a sexual contact network to a monogamous population by allowing the nature of the links to change (previous models assumed all links within the network to be concurrent active partnerships). They use the underlying network to represent potential sexual partnerships, only some of which are active at any one time. Thus, serial monogamy can be modelled while maintaining the patterns of mixing displayed by the population.

Conceptualisation, Development, and Evaluation of a Measure of Unplanned Pregnancy (research abstract)
In this study, researchers develop a measure of unplanned pregnancy that is valid, reliable, and appropriate in the context of contemporary demographic trends and social mores and that can be used in a variety of situations, including the production of population prevalence estimates.

Likelihood-based Inference for Stochastic Models of Sexual Network Formation (research abstract)
The authors write that mathematical models for the transmission dynamics of STDs indicate that heterogeneity in sexual activity level allow them to persist even when the typical behavior of the population would not support endemicity. This insight focuses attention on the distribution of sexual activity level in a population. In this paper, the researchers develop several stochastic process models for the formation of sexual partnership networks.

POPULATION NEWS

Asia's Baby Shortage Grows (feature article)
Teeming populations have long been synonymous with Asia. But in Hong Kong, schools and nurseries are closing because there aren't enough children to fill classes. And governments from South Korea to Singapore are trying to encourage women to have more children.

UAE Population Topped Four Million in 2003 (news article)
The population of the United Arab Emirates (UAE) grew by 7.6% to 4.041 million by the end of 2003 compared with 3.754 million in the previous year. This makes the UAE's population growth in 2003 the highest in the Arab world and one of the highest rates in the world.

Money, Pope Can't Make Italian Women Have More Kids (feature article)
The birth rate of 1.23 children per woman in Italy is the second lowest in the Western world. The government's response has been to try to bribe couples into having babies. Last year, the labor and welfare minister offered 1,000 euros (about US$1,200) to every woman who had a second child. Last week he announced that he would make a similar payment to every woman who gave birth for the first time. Rocco Falivena, the mayor of Laviano, went one better, and last year offered women 10,000 euros (about US$12,000) for each additional baby.

WOMEN'S HEALTH RESEARCH

Contraceptive Use Dynamics among Migrant Women in Kenya (research article)
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This paper investigates the relationships between migration and the determinants of contraceptive use in Kenya based on the 1988/1989 Kenya Demographic and Health Survey. The paper examines whether the contraceptive use dynamics of women who migrate characteristically differ from that of non-migrants. The authors' principal hypothesis is that women who migrate comprise a group who acts rationally to maximize their other lifetime aspirations at the expense of their reproductive roles. The study further assumes that through the influence of fertility process by migration characteristics, contraceptive use is also influenced. The association between the process of migration and contraceptive use dynamics is analysed using cross-tabulation with percentages and logistic regression analysis. The findings show that, in Kenya, migration influences contraceptive use among migrant women. That is, the probability of using contraception is higher among the migrant women than the non-migrants. Because fertility behavior is influenced by change and characteristics of place of origin and destination, public policy interventions are necessary to account for the residential experience of women served by family planning and maternal child health programs in different places.

Effects of Conjugated Equine Estrogen in Postmenopausal Women With Hysterectomy (research abstract)
Related news article: Estrogen Offers No Overall Benefit For Disease Prevention In Postmenopausal Women With Prior Hysterectomy
The benefits and risks of unopposed estrogen therapy for postmenopausal women with a prior hysterectomy are uncertain. The estrogen-alone component of the Women's Health Initiative assessed whether conjugated equine estrogen (CEE) therapy would reduce coronary heart disease incidence and the risk of stroke, fractures, and breast and colorectal cancers in women who participated in this randomized, placebo-controlled trial. A summary estimate of overall risks and benefits did not favor CEE therapy for postmenopausal women with hysterectomy.

Reproductive Health Issues for Nigerian Women in Menopause (research abstract)
The authors of this paper assume a bio-psycho-social analytical framework to examine the health status of women in menopause in Nigeria.

Analysis of Ruptured Uterus in Debre Markos Hospital, Ethiopia (PubMed abstract)
This article, from Bethzata Medical Centre, Addis Ababa, Ethiopia, determines the incidence of uterine rupture in a rural hospital and examines its cause, type, and outcome. All patients who were admitted and operated on for uterine rupture in one hospital over a period of 2 years were studied. There were a total of 1,830 deliveries and 70 uterine rupture cases. Frequency of occurrence of uterine rupture was 3.8% (1 in 26 deliveries). The peak incidence was between 25 to 29 years. Mean parity was 3.6. Intraoperatively, 62 were found to have complete and 8 incomplete rupture. Hysterectomy was done for 57 and repair for 13. The postoperative complication rate was 24.3%, sepsis being the most common cause of death.

Overestimation of Complication Rates in Evaluations of Chlamydia Trachomatis Screening Programmes—Implications for Cost-effectiveness Analyses (research abstract)
The authors identified three cost-effectiveness studies and evaluated them for evidence for the quoted probabilities of C. trachomatis infection. They found that the assumptions for the rates of pelvic inflammatory disease (PID) (clinical and subclinical) after C. trachomatis infection varied from 15% to 80%, and for ectopic pregnancy, tubal factor infertility, and chronic pelvic pain after PID from 5–25%, 10–20%, and 18–30%, respectively. The assumptions were based on data from high-risk populations, case-control data, and data not accounting for misdiagnoses. Using data obtained from local registrations, they estimated the probability of a clinical PID (0.43%), ectopic pregnancy (0.07%), and tubal factor infertility (0.02%) for women with a current infection. They write that the effect of overestimation is potentially the greatest in populations with a low prevalence, since the currently assumed cost savings associated with screening may disappear when using more realistic estimates for complications.

WOMEN'S HEALTH NEWS

Zim Prostitutes Hated During the Day, Worshipped at Night in Botswana (feature article)
This feature article from newzimbabwe.com tells the story of Zimbabwean commercial sex workers.

YOUTH HEALTH RESEARCH

An Evaluation of the Use of the Transdermal Contraceptive Patch in Adolescents (research abstract)
Researchers from the Division of Adolescent Medicine, University of California, San Francisco, evaluated the acceptability and feasibility of using the new transdermal contraceptive patch in adolescents. They used a 3-month longitudinal trial with the Ortho Evra™ transdermal contraceptive patch in 50 adolescent girls (aged 15-18). Participants were followed after 1 month and 3 months of treatment. Forty participants (80%) completed 1 month of treatment and 31 (62%) completed all 3 months. There were no pregnancies during treatment. At the 3-month follow-up, 87.1% of participants reported perfect compliance. The authors write that ease of use, the fact that it does not require daily attention, and the ease of concealment were among the main reported advantages. The most common complaints were application site reactions and breast discomfort.

Impact of a School-based Peer Sexual Health Intervention on Normative Beliefs, Risk Perceptions, and Sexual Behavior of Zambian Adolescents (research abstract)
The purpose of this study was to determine whether adolescents' normative beliefs about abstinence and condoms, their personal risk perception, and safer sex practices changed after the implementation of a peer sexual health education intervention implemented in Zambian secondary schools. Three schools were randomly assigned to the intervention condition and two to the control condition. Three rounds of data from male and female adolescents in grades 10 and 11 were collected at baseline in July 2000, at first follow-up in the second half of September 2000, and at second follow-up in early April 2001. A total of 416 respondents aged 14–23 (at baseline) were interviewed. Student self-reports showed positive changes in normative beliefs about abstinence immediately after the intervention, and these improvements were largely sustained until 6 months after the intervention. Students became more likely to approve of condom use and to intend using condoms immediately after the intervention, but these positive outcomes could not be sustained during the 6 months that followed the intervention. Normative beliefs regarding condom use took longer to develop: these were only observed at 6 months follow-up. Students reported reductions in multiple regular partnerships. There was no change in condom use.

Effects of a Community-based Sex Education and Reproductive Health Service Program on Contraceptive Use of Unmarried Youths in Shanghai (research abstract)
This study evaluated the effectiveness of a youth-friendly intervention in promoting one safe sex behavior: contraception and condom use among unmarried young people aged 15–24 years in Shanghai. The study was conducted in two towns of a suburban area of Shanghai (one intervention, one control), with comparable socio-cultural-economic and demographic characteristics. The intervention intended to build awareness and offer counseling and services related to sexuality and reproduction among unmarried youths. Baseline surveys were conducted in both sites before the implementation of the intervention, and similar surveys were conducted in both sites 20 months after the intervention. In total, 1,220 unmarried young people from the intervention site and 1,007 from the control site, including 1,304 out-of-school youths and 923 high school students, were recruited, and about 92% of them were successfully followed up. At baseline, there was no statistical difference in contraceptive use between the intervention and control groups. After intervention, the proportions reporting regular contraceptive use and condom use in the intervention group were much higher than that in the control group. The regular contraceptive use and ever condom use were correlated with subject's occupation and family economic status, respectively. After adjusting for demographic factors, the subjects from the intervention group were 14 times as likely to use contraceptives at onset of intercourse as those from the control group.

Poverty and Sexual Risk Behaviour among Young People in Bamenda, Cameroon (research article)
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The hypothesis of this study is that poverty motivates both young males and females to engage in risky sex. The study data are from the survey on the Sexual Behavior of the Young People of Bamenda, Cameroon (August 1995). Young people whose fathers were unemployed and those who lived in poor households were more likely to have multiple sexual partners or to have had casual sexual relations than others in the year preceding the survey. Multivariate logistic regression analyses indicated that young people who had not lived with both parents and had insufficient means to satisfy their needs were more likely than others to have multiple sexual partners or to have had casual sexual relations.

A Peer Education Example on HIV/AIDS at a High School in Ankara (PubMed abstract)
This study evaluated the success of a peer education model conducted in four classes of an Anatolian high school in Ankara, Turkey, in 2000. The authors, from the Department of Public Health, Hacettepe University Faculty of Medicine, Ankara, found a significant difference in the general scores of the students before and after education by peer educators.

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