Volume 7, Number 28
30 July 2007

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Guest Editorials (free with every subscription)

Impact of interventions for newborn survival: What works and what's needed?

Author: Haws RA | Darmstadt GL

gdarmsta@jhsph.edu

Approximately two-thirds of infant and 40% of under-five childhood mortality occurs during the first 28 days of life, the neonatal period. Most of these 4 million annual neonatal deaths occur within the first few days after birth, predominantly in impoverished settings in developing countries. Meeting United Nations Millennium Development Goal 4 for child survival (see http://www.un.org/millenniumgoals/) will require a substantial reduction in neonatal deaths by the year 2015. While several recent publications have assessed the efficacy and cost-effectiveness of single interventions delivered during the antenatal, intrapartum or postnatal periods to reduce neonatal mortality, none analyzed the efficacy, effectiveness, and cost of packages of interventions to reduce neonatal mortality. In a recent review published in Health Policy and Planning (2007;22:193-215), we assessed the evidence for the impact of packages of interventions (defining "package" as any study employing more than one biologically plausible intervention to improve neonatal survival), paying particular attention to packages implementable at the community level, as most neonatal deaths occur without any contact with the formal health system.

We found that evidence for the impact of neonatal health intervention packages is severely lacking, and there is a weak base on which to formulate policy and effectively implement public health programs to benefit newborns. Just 41 studies, including 19 randomized controlled trials, implemented packages of interventions and reported neonatal health outcomes. None of these were true effectiveness trials, meaning trials conducted at scale in an actual health system. No study targeted women pre-conception; micronutrient supplements were the main intervention during the antenatal period, and intrapartum interventions centered around clean delivery. Only two studies conformed to the packages recommended in The Lancet Neonatal Survival Series using common service delivery mode and time period of implementation for synergistic combinations of interventions. Only two studies reported cost-effectiveness data, which is crucial for program planners to design effective national strategies to save newborn lives.

An evidence-based approach to designing intervention packages will require substantial investment in quality research and program evaluations. For cost-effectiveness and impact, intervention packages should span the continuum of care from the periconceptual to the postnatal periods, and create or strengthen linkages between communities and available health care facilities. Linkages between families, communities, and health facilities -- via community mobilization, education, outreach services, referrals, transport and incorporating existing community health workers in neonatal health care -- are key to enhancing the impact of neonatal intervention packages, but only one-third of studies in our review attempted to facilitate these linkages.

Until neonatal health intervention packages are designed based on rigorous data, predicting their impact will be largely based on trial and error. Improving the evidence base will require significant investment in large-scale effectiveness trials based on existing recommendations yet carefully adapted to local health needs, as well as careful documentation of implementation processes. Many studies are conducted in settings where scale-up is ultimately infeasible, with vast external inputs that are unrealistic for large-scale, sustainable implementation. Effectiveness interventions should foster synergies between programs, health systems, private providers, and community-based workers for lasting change, and carefully document processes and costs, if we are to obtain the data needed to make wise choices about the delivery of interventions to improve neonatal health and survival.

Rachel A. Haws, MHS
Department of International Health, Bloomberg School of Public Health, Johns Hopkins University

Gary L. Darmstadt, MD, MS
Associate Professor and Director, International Center for Advancing Neonatal Health, Bloomberg School of Public Health, Johns Hopkins University

References:

Haws, R.A., Thomas, A.L., Bhutta, Z.A., Darmstadt, G.L. Impact of packaged interventions on neonatal health: A review of the evidence. Health Policy and Planning 22(4):193-215. Jul. 2007.

FAMILY PLANNING RESEARCH

Assessing regional differences in contraceptive discontinuation, failure and switching in Brazil
(Research Article)
(You need Adobe Acrobat Reader to access this document)
Reproductive Health. 2007 Jul 10;4(6)
Leite IC | Gupta N
Contraceptive prevalence is relatively high in Brazil (55% among women of reproductive age). However, reversible methods account for less than half of the method mix and widespread differences persist across regions and social groups. This draws attention to the need for monitoring family planning service-related outcomes that might be linked with quality of care. The present study examines the factors associated with method discontinuation, failure and switching among current contraceptive users, with a focus on sub-national assessment. Data for the analysis are drawn from the Brazil Demographic and Health Survey, notably the calendar module of reproductive events. Multilevel discrete-time competing risks hazard models are used to estimate the random- and fixed-effects on the probability of a woman making a specific transition after a given duration of contraceptive use. Contraceptive continuation was found to be highest for the contraceptive pill, the most popular reversible method. Probabilities of abandonment while in need of family planning and of switching to another method were highest for injections. Failure, abandonment and switching were each higher among users in the Northeast region compared to the more prosperous Southeast and South. Findings point to seemingly important disparities in the availability and quality of family planning and reproductive health care services across regions of the country. Expanding access to a range of contraceptive methods, improving knowledge among health agents of contraceptive technologies and increasing medical supervision of contraceptive practice may be considered key to expanding quality reproductive health care services for all.

Transcervical sterilization
(Abstract; subscription needed for full text; Global)
Current Opinion in Obstetrics & Gynecology. 2007 Aug;19(4):325-330.
Abbott J
The purpose of the review is to discuss the methods for achieving success with currently available transcervical sterilization procedures for permanent female contraception. The transcervical approach has long been thought to be the optimal method for permanent female sterilization, with tubal access achieved by blind, direct (hysteroscopic) or indirect (radiological) techniques, and occlusion being achieved by chemical, mechanical, or thermal techniques. Some combination of these access and occlusion methods encompasses all the current procedures and two types predominate. Quinacrine sterilization is a procedure that is widely used in the developing world, while hysteroscopic procedures such as the Essure and Adiana procedures are either currently available or emerging as visually controlled, device-dependent methods for reliable transcervical sterilization that may be performed in an outpatient or office setting with minimal anesthesia and high patient acceptability. Other devices are used but have less supportive data for their continued use. Transcervical methods of female sterilization have good tubal access and occlusion rates, high patient acceptability, and can be performed in an outpatient setting. This combination of factors may offer significant advantages to traditional laparoscopic approaches and render them more cost-effective.

Oral contraception and thrombophilia
(Abstract; subscription needed for full text; Global)
Current Opinion in Obstetrics & Gynecology. 2007 Aug;19(4):370-376.
Blickstein D | Blickstein I
The purpose of the review is to describe current knowledge related to the association between oral contraception and the thrombophilias. The use of oral contraception increases the risk of venous thromboembolism as well as arterial thrombosis. Third-generation pills seem to increase the risk of venous thromboembolism compared with second-generation pills. This effect seems to be reversed or absent for the risk of arterial thrombosis. The effect of oral contraception on the risk of venous thromboembolism is more pronounced during the first year of use. All these risks are further increased in patients with an inborn or acquired tendency for coagulation (thrombophilia). Prospective users of oral contraception are potential candidates for screening/testing, because a positive screen may substantially decrease the risk of a thrombotic event. At present, the available testing methods are not cost effective, and the absolute risk is not defined for each thrombophilia. Until these shortcomings are solved, it is not recommended to test every woman who wishes to use oral contraception. Nevertheless, before starting on oral contraception, each patient should be carefully screened by a physician who should identify an increased risk of thrombophilia and tailor the laboratory testing.

FAMILY PLANNING NEWS

World Bank warns on family planning, economic growth
(News Article; Sub-Saharan Africa)
24 Jul 2007
Akosile A, This Day
Related Abstract; subscription needed for full text: Population issues in the 21st century: The role of the World Bank
(You need Adobe Acrobat Reader to access this document)

Indonesia Copying China Population
(News Article; Asia)
19 Jul 2007
Free Market News

HIV/AIDS and STIs RESEARCH

Voluntary HIV Counseling and Testing Integrated with Contraceptive Services Study (VICS): Ethiopia baseline preliminary analysis
(Report; Sub-Saharan Africa)
(You need Adobe Acrobat Reader to access this document)
Baltimore, Maryland, Johns Hopkins Bloomberg School of Public Health, Bill and Melinda Gates Institute for Population and Reproductive Health, June 2007.
Gillespie D | Brahmbhatt H | Bradley H | Karklins S | Tsui A
Integrating voluntary HIV counseling and testing (VCT) with family planning (FP) and other reproductive health (RH) services may be one effective strategy for expanding VCT service delivery in resource poor settings. Using 30,257 VCT client records with linked facility characteristics from Ethiopian non-governmental, non-profit reproductive health clinics, we constructed multi-level logistic regression models to examine associations between family planning (FP) and HIV service integration modality and three outcomes: VCT client composition, client-initiated HIV testing and client HIV status. Associations between facility FP-HIV integration level and the likelihood of VCT clients being atypical FP client-types, versus older (25+ years), ever-married women were assessed. Relative to facilities co-locating services in the same compound, those offering FP and HIV services in the same rooms were 2-13 times more likely to serve atypical FP client-types than older, ever-married women. Facilities where counselors jointly offered FP-HIV services, and served many repeat FP clients, were significantly less likely to serve single clients relative to older, married women. Facilities offering many youth services were even more likely to provide older, married women with VCT services than youth, which may be explained by these facilities' use of highly integrated service delivery. Younger, single men and older, married women were most likely to self-initiate HIV testing (78.2 percent and 80.6 percent, respectively), while the highest HIV prevalence was seen among older, married men and women (20.5 percent and 34.2 percent, respectively). Compared with facilities offering co-located services, those integrating services at room and counselor-levels were 1.9 - 7.2 times more likely to serve clients initiating HIV testing. These health facilities attract both standard MCH clients, who are at high risk for HIV in these data, and young, single people to VCT. This analysis suggests that client types may be differentially attracted to these facilities depending on service integration modality and other facility-level characteristics.

Population and antenatal-based HIV prevalence estimates in a high contracepting female population in rural South Africa
(Research Article; Sub-Saharan Africa)
(You need Adobe Acrobat Reader to access this document)
BMC Public Health. 2007 Jul 18;7(160):1-26.
Rice BD | Batzing-Feigenbaum J | Hosegood V | Tanser F | Hill C
To present and compare population-based and antenatal-care (ANC) sentinel surveillance HIV prevalence estimates among women in a rural South African population where both provision of ANC services and family planning is prevalent and fertility is declining. With a need, in such settings, to understand how to appropriately adjust ANC sentinel surveillance estimates to represent HIV prevalence in general populations, and with evidence of possible biases inherent to both surveillance systems, we explore differences between the two systems. There is particular emphasis on unrepresentative selection of ANC clinics and unrepresentative testing in the population. HIV sero-prevalence amongst blood samples collected from women consenting to test during the 2005 annual longitudinal population-based serological survey was compared to anonymous unlinked HIV sero-prevalence amongst women attending antenatal care (ANC) first visits in six clinics (January to May 2005). Both surveillance systems were conducted as part of the Africa Centre Demographic Information System. Population-based HIV prevalence estimates for all women (25.2%) and pregnant women (23.7%) were significantly lower than that for ANC attendees (37.7%). A large proportion of women attending urban or peri-urban clinics would be predicted to be resident within rural areas. Although overall estimates remained significantly different, presenting and standardising estimates by age and location (clinic for ANC-based estimates and individual-residence for population-based estimates) made some group-specific estimates from the two surveillance systems more predictive of one another. It is likely that where ANC coverage and contraceptive use is widespread and fertility is low, population-based surveillance under-estimates HIV prevalence due to unrepresentative testing by age, residence and also probably by HIV status, and that ANC sentinel surveillance over-estimates prevalence due to selection bias in terms of age of sexual debut and contraceptive use. The results presented highlight the importance of accounting for unrepresentative testing, particularly by individual residence and age, through system design and statistical analyses.

Incident and prevalent herpes simplex virus type 2 infection increases risk of HIV acquisition among women in Uganda and Zimbabwe
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS. 2007 Jul 31;21(12):1515-1523.
Brown JM | Wald A | Hubbard A | Rungruengthanakit K | Chipato T
An association has been demonstrated between herpes simplex type 2 (HSV-2) and HIV infection among men, but prospective studies in women have yielded mixed results. The objective of the study was to estimate the effects of prevalent and incident HSV-2 infection on subsequent HIV acquisition among women in two African countries. The design was a prospective cohort study. HSV-2 and HIV serostatus were evaluated at enrollment and quarterly for 15-24 months among 4531 sexually active, HIV-uninfected women aged 18-35 years from Uganda and Zimbabwe. The association between prior HSV-2 infection and HIV acquisition was estimated using a marginal structural discrete survival model, adjusted for covariates. HSV-2 seroprevalence at enrollment was 52% in Uganda and 53% in Zimbabwe; seroincidence during follow-up was 9.6 and 8.8/100 person-years in Uganda and Zimbabwe, respectively. In Uganda, the hazard ratio (HR) for HIV was 2.8 [95% confidence interval (CI), 1.5-5.3] among women with seroprevalent HSV-2 and 4.6 (95% CI, 1.6-13.1) among women with seroincident HSV-2, adjusted for confounding. In Zimbabwe, the HR for HIV was 4.4 (95% CI, 2.7-7.2) among women with seroprevalent HSV-2, and 8.6 (95% CI, 4.3-17.1) among women with seroincident HSV-2, adjusted for confounding. The population attributable risk percent for HIV due to prevalent and incident HSV-2 infection was 42% in Uganda and 65% in Zimbabwe. HSV-2 plays an important role in the acquisition of HIV among women. Efforts to implement known HSV-2 control measures, as well as identify additional measures to control HSV-2, are urgently needed to curb the spread of HIV.

A national survey of teachers on antiretroviral therapy in Malawi: Access, retention in therapy and survival
(Research Article; Sub-Saharan Africa)
PLoS One. 2007 Jul;2(7):[5] p..
Makombe SD | Jahn A | Tweya H | Chuka S | Yu JK
HIV/AIDS is having a devastating effect on the education sector in sub-Saharan Africa. A national survey was conducted in all public sector and private sector facilities in Malawi providing antiretroviral therapy (ART) to determine the uptake of ART by teachers and their outcomes while on treatment. A retrospective cohort study was carried out based on patient follow-up records from ART Registers and treatment master cards in all 138 ART clinics in Malawi; observations were censored on September 30th 2006. By this date, Malawi's 102 public sector and 36 private sector ART clinics had registered a total of 72,328 patients for treatment. Of these, 2,643 (3.7%) were teachers. Adjusting for double-registration caused by clinic transfers, it is estimated that 2,380 individual teachers had ever accessed ART. There were 15% of teachers starting ART in WHO clinical stage 1 or 2 with a CD4-lymphocyte count of less than or equal to 250/mm3 and 85% starting in stage 3 or 4. By 30th September 2006, 1,850 teachers were alive on ART (3.5% of all teachers in Malawi). The probability of being alive on ART at 6-months, 12-months, 18-months and 24-months after treatment initiation was 84%, 79%, 75% and 73% respectively. Retention in treatment was better for women (adjusted HR = 1.8) and in those starting ART in WHO Clinical Stage 1 and 2 (adjusted HR = 1.8). Rapid scale up of ART has allowed 2,380 HIV-positive teachers to access life-prolonging treatment. There is evidence that this intervention can help to mitigate some of the shortages of teaching personnel in resource-poor countries affected by a generalised HIV epidemic.

HIV/AIDS and STIs NEWS

Jamaica: New HIV/AIDS 'prevention' drug coming: Group to lobby gov't to make microbicides free to women
(News Article; Central America and the Caribbean)
22 Jul 2007
Brown I, Jamaica Observer

Nigeria: Having HIV negative children with HIV positive partner without being infected
(Feature Article; Sub-Saharan Africa)
20 Jul 2007
Amadi B, Daily Champion (Lagos)

Kenya: HIV/Aids crusader wins top award
(News Article; Sub-Saharan Africa)
25 Jul 2007
Opiyo D, The Nation (Nairobi)

Mauritius: Aids women fight fear as well as disease
(News Article; Sub-Saharan Africa)
24 Jul 2007
Porter L, L'Express (Port Louis)

MATERNAL AND CHILD HEALTH RESEARCH

Securing maternal health through comprehensive reproductive health services: Lessons from Bangladesh
(Abstract; subscription needed for full text; Asia)
American Journal of Public Health. 2007 Jul;97(7):1186-1190.
Jahan R
During the past decade, there has been a noticeable reduction of maternal mortality in Bangladesh, in part because of government policy and program initiatives. Of particular note is the comprehensive reproductive health strategy adopted in 1996 under the country's first Health and Population Sector Strategy and the 5-year Health and Population Sector Programme (1998-2003). The latter includes actions in most of the areas recommended in the World Health Organization's 2004 report, Reproductive Health Strategy to Accelerate Progress Towards the Attainment of International Development Goals and Targets. After assessing Bangladesh's achievements and challenges in the design and implementation of a maternal health strategy, the author concluded that mobilizing and nurturing political will is the key to sustaining policy commitment to comprehensive reproductive health.

The policy environment encouraging C-section in Lebanon
(Abstract; subscription needed for full text; Middle East)
Health Policy. 2007 Sep;83(1):37-49.
Kabakian-Khasholian T | Kaddour A | DeJong J | Shayboub R | Nassar A
This study aims to analyse the environment encouraging C-section in Lebanon and to reveal approaches that could be adopted for the reduction of this practice, by considering the attitudes, opinions and actions of different stakeholders. Semi-structured interviews were conducted with 20 selected key players, including hospital directors, midwives, insurance bodies, syndicates and scientific societies, ministries, international agencies, medical schools, media representatives and women's groups. In addition, a group discussion was conducted with 10 obstetricians. Semi-structured interviews were conducted with a convenience sample of 36 women who had a C-section within 4 months preceding the study. Data was analysed using the Policy Maker software version 2.3. Findings of the study point to the role of multiple factors in shaping the current practices related to C-section deliveries, among which are the organisation of the health care system, the dominance of the private sector, the lack of physician accountability, the minimisation of midwives' roles in the process and women's misconceptions about C-sections. Involvement of the diversity of players is important to change practices in maternity care in Lebanon, after considering their position and power. Different strategies making use of available opportunities to improve the current situation are discussed.

Barriers to the utilization of maternal health care in rural Mali
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Social Science and Medicine. 2007 Jul 20;
Gage A
This study used data from the 2001 Demographic and Health Survey and multilevel logistic regression models to examine area- and individual-level barriers to the utilization of maternal health services in rural Mali. The analysis highlights a range of area-level influences on the use made of maternal health services. While the dearth of health facilities was a barrier to receipt of prenatal care in the first trimester, transportation barriers were more important for four or more prenatal visits, and distance barriers for delivery assistance by trained medical personnel and institutional delivery. Women's odds of utilizing maternal health services were strongly influenced by the practices of others in their areas of residence and by living in close proximity to people with secondary or higher education. Household poverty and personal problems were negatively related to all outcomes considered. The results highlight the importance of antenatal care and counseling about pregnancy complications for increasing the likelihood of appropriate delivery care, particularly among women living 15-29km from a health facility. Area-level factors explained a greater proportion of the variation in delivery care than in prenatal care However, significant area variation in the utilization of maternal health services remained unexplained.

MATERNAL AND CHILD HEALTH NEWS

Kenya: Minister's maternity gift to new mothers
(News Article; Sub-Saharan Africa)
25 Jul 2007
Mwaniki M, The Nation

Nigeria: NGO blames maternal mortality on neglect of women
(News Article; Sub-Saharan Africa)
19 Jul 2007
Maduguri RG, Daily Champion

Côte d'Ivoire: Growing number of women presenting with obstetric fistula
(News Article; Sub-Saharan Africa)
24 Jul 2007
Integrated Regional Information Networks (IRIN)

Tanzania: More women dying preventable deaths
(Feature Article; Sub-Saharan Africa)
19 Jul 2007
McGregor S, Inter Press Service News Agency

GENDER and HEALTH RESEARCH

Human papillomavirus (HPV) infections as risk factors for cytological and histological abnormalities in baseline PAP smear-negative women followed-up for 2 years in the LAMS study
(Abstract; subscription needed for full text; South America)
European Journal of Obstetrics and Gynecology and Reproductive Biology. 2007 Aug;133(2):239-246.
Gontijo RC | Derchain SF | Roteli-Martins C | Braganca JF | Sarian LO
The objective of the study was to assess the role of Human papillomavirus (HPV) as determinant of the incident cytological abnormalities (SIL) and cervical lesions (CIN) during a 24-month follow-up of baseline PAP smear-negative subgroup of women included in the Latin American Screening study (LAMS). A group of 365 women with normal Pap smear and negative or positive high-risk Hybrid Capture II test were prospectively followed-up for 24 months at Campinas and Sao Paulo (Brazil). The incidence rate (IR) and risk ratio (RR and 95% CI) of developing cytological or histological abnormality during the follow-up was calculated for HPV-negative and HPV-positive women. During the 12-month follow-up, women HPV-positive at baseline had developed a significantly higher rate of incident LSIL (IR = 3.5%, RR = 1.4; 95% CI 1.1-1.7) and HSIL (IR = 0.7%, RR = 1.5; 95% CI 1.4-1.7) abnormality. For HSIL, the IR increased to 2.1% and the RR increased to 1.7 (95% CI 1.5-1.9) among those followed for 24 months. Similarly, women with positive HPV tests were at a higher risk of developing CIN 2-3 (IR = 2.6%, RR = 1.5; 95% CI 1.4-1.6) during the first 12 months of follow-up, and for those followed for 24 months, this RR increased further to 1.7 (95% CI 1.5-1.9) although the IR was 0.7%. Oncogenic HPV infections comprise a significant risk factor for incident cervical abnormalities, and HPV test is a useful adjunct to cytology in detecting the high-risk patients among baseline PAP smear-negative women.

Fetal gender and postpartum depression in a cohort of Chinese women
(Abstract; subscription needed for full text; Asia)
Social Science and Medicine. 2007 Aug;65(4):680-684.
Xie RH | He G | Liu A | Bradwejn J | Walker M
To examine the relationship between fetal gender and postpartum depression, we conducted a cohort study in Changsha, Hunan, China between September 2004 and January 2005. Women aged 18-40 years with their first live birth of a singleton infant who came to hospital for postpartum examination at 6 weeks after childbirth were invited to participate. Women with known psychiatric disorders or a history of psychiatric disorders were excluded. Data on demographic and clinical information were collected. Postpartum depression was assessed by the Chinese version of the Edinburgh Postnatal Depression Scale. Fifty-two women (17.3%) were found to have postpartum depression. The rate of postpartum depression in women who gave birth to a female infant was 24.6% while the rate in those women who gave birth to a male infant was 12.2%. The relative risk for postpartum depression of women who gave birth to a female infant as compared with those who gave birth to a male was 2.89, after adjusting for potential confounding by maternal age, education level, family income, living condition, gravidity, number of prenatal care visits, and mode of delivery. We conclude that the risk of postpartum depression is increased in Chinese women who give birth to a female infant as compared to those who gave birth to a male infant. We speculate that this is associated with the negative reactions of family members towards the birth of a female baby.

Screening for cervical cancer in an African setting
(Abstract; subscription needed for full text; Sub-Saharan Africa)
International Journal of Gynecology and Obstetrics. 2007 Aug;98(2):168-171.
Cronje HS | Beyer E
The objective of the study was to estimate the proportion of women who were screened for cervical neoplasia with Papanicolaou (Pap) smears in 2002 in the Free State province of South Africa, and determine whether progress had been made since 1985. A cross-sectional survey was done using 1887 smears, which represented 5% of the 37,749 smears examined at the 7 laboratories serving the province in 2002. Extrapolating the results to the census data for 2002, Pap smears were taken in 4.1% of the female population aged 15 to 65 years during that year. The rates were 18.8% for white women, most of whom use private medical services, and 2.6% for black women, almost all of whom use public medical services. In 1985, in a similar study found that 7.1% of the female population was screened with Pap smears, which means that cervical screening decreased by 42% over the 17 years (P less than or equal to 0.0001; 95% confidence interval, -3.1% to -2.9%). In view of the deterioration of cervical screening services documented in this study, it seems unlikely that Pap smear screening will succeed in Africa.

Taking chances, making choices: The tactical dimensions of "reproductive strategies" in southwestern Nigeria
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Medical Anthropology. 2007 Jul;26(3):229-254.
Cornwall A
Reproductive outcomes may be less a result of consciously pursued "reproductive strategies" than of other choices, and are subject to the influence not only of other individuals, but also of caprice and circumstance. Drawing on ethnographic research in southwestern Nigeria, I argue that to understand the outcomes of reproduction in terms of reproductive strategies and reproductive choices is to profoundly misunderstand the contingencies with which women and men contend as they seek to manage the circumstances in which they find themselves. Through a series of case studies that illustrate some of these circumstances, I explore questions of choice and contingency in having and bringing up children.

GENDER and HEALTH NEWS

Africa: Taking on violence against women
(Feature Article; Sub-Saharan Africa)
23 Jul 2007
Kimani M, Africa Renewal (United Nations)

South Africa: Mass male circumcision - What will it mean for women?
(News Article; Sub-Saharan Africa)
24 Jul 2007
UN Integrated Regional Information Networks

Broccoli and other vegetables linked with decreased risk of aggressive prostate cancer
(News Article; Global)
25 Jul 2007
Science Daily
Related Abstract; subscription needed for full text: Prospective study of fruit and vegetable intake and risk of prostate cancer

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

Family planning and reproductive health: The link to environmental preservation
(Abstract; subscription needed for full text; Global)
Population and Environment. 2007 May;28(4-5):247-258.
Speidel JJ | Weiss DC | Ethelston SA | Gilbert SM
This paper seeks to refocus the attention of environmentalists on the importance of population trends to environmental sustainability and identifies prevention of unintended pregnancy as potential common ground for environmentalists and family planning advocates. The health and other welfare benefits of preventing unintended pregnancy are felt most keenly by individual women, men, and their families. At the same time, however, preventing unwanted pregnancies usually results in smaller family size, an important factor in slowing population growth and, as a result, a source of broader benefits-including environmental benefits-to society.

Irregular workers or ethnic kin? Post-1990s labour migration from Bulgaria to Turkey
(Abstract; subscription needed for full text; Europe)
International Migration. 2007 Aug;45(3):157-181.
Parla A
This paper addresses the invisibility of the post-1990s irregular migration flows from Bulgaria to Turkey in the literature despite the increasingly significant number of such migrants. I suggest that this invisibility stems partially from a problem of classification that has to do with implicit suppositions about ethnicity and migration. The post-1990s Turkish immigrants from Bulgaria are not specified in accounts of irregular migrant flows directed towards Turkey since they are assumed to belong to the category of ethnic "return" migrants: Because of their ethnic identity as Turkish, all Turkish migrants from Bulgaria tend to get considered as part of the intermittent "return" migration waves from Bulgaria, the most notable and well-known of these being the flight of more than 300,000 Turks in 1989. However, while the ethnic affiliation of the post-1990s migrants from Bulgaria renders them invisible as irregular migrants within scholarly migrant typologies, the same ethnic affiliation does not necessarily work to their advantage when it comes to their legal and social reception in Turkey. Based on ethnographic fieldwork that prioritizes micro-level analysis from below, the paper demonstrates that the self designated ethnic affiliation of these migrants, counterpoised against their social marginalization as "the Bulgarian" domestics, heightens the paradoxes of belonging and affects migration strategies. The paper thus underscores the significance of ethnic affiliation as a factor that needs to be adequately taken into account in describing the present and in assessing the future of this particular migratory pattern.

Why the silence on population?
(Abstract; subscription needed for full text; Global)
Population and Environment. 2007 May;28(4-5):237-246.
Campbell M
The tripling of the world's population growth since 1960 has received little public attention the past decade. Six reasons for the silence around this subject constitute a "perfect storm". The first five are: visibility of actual fertility decline in the developed countries as well as a number of the developing ones; well justified attention to the impact of high levels of consumption on the environment; an implicit welcome by conservative political and religious forces to reduced needs for family planning; the tragedy of AIDS dominating international health concerns; and the 1994 Cairo conference's focus on examples of coercive family planning while nearly ignoring the coercion of women forced into unwanted childbearing. These five relatively new developments have been supported by standard demographic theory containing an assumption that couples naturally want many children, making it difficult to see the many barriers blocking women's options to manage their own childbearing.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

Eastern Serbia dies slow death from depopulation
(Feature Article; Europe)
25 Jul 2007
Balkan Investigative Reporting Network

Russia: Demographic future bleak for city
(News Article; Asia)
24 Jul 2007
The St. Petersburg Times

ADOLESCENT HEALTH RESEARCH

Women's attitudes on human papillomavirus vaccination to their daughters
(Abstract; subscription needed for full text; Asia)
Journal of Adolescent Health. 2007 Aug;41(2):204-207.
Chan SS | Cheung TH | Lo WK | Chung TK
This study assessed the impact of an information pamphlet on acceptance of human papillomavirus (HPV) vaccine in Chinese women. The pamphlet increased the self-perceived knowledge on cervical cancer and HPV of the study subjects and had a positive influence on women accepting HPV vaccination for their daughters (p less than .001).

A brief, low-cost, theory-based intervention to promote dual method use by Black and Latina female adolescents: A randomized clinical trial
(Abstract; subscription needed for full text; North America)
Health Education and Behavior. 2007 Aug;34(4):608-621.
Roye C | Silverman P | Krauss B
HIV/AIDS disproportionately affects young women of color. Young women who use hormonal contraception are less likely to use condoms. Brief, inexpensive HIV-prevention interventions are needed for high-volume clinics. This study was a randomized clinical trial of two interventions: (a) a video made for this study and (b) an adaptation of Project RESPECT counseling. Four hundred Black and Latina teenage-women completed a questionnaire about their sexual behaviors and were randomly assigned to (a) see the video, (b) get counseling, (c) see the video and get counseling, or (d) receive usual care. At 3-month follow-up, those who saw the video and received counseling were 2.5 times more likely to have used a condom at last intercourse with their main partner than teens in the usual care group. These differences did not persist at 12-month follow-up. This suggests that a brief intervention can positively affect condom use in the short term.

Predicting willingness to engage in unsafe sex and intention to perform sexual protective behaviors among adolescents
(Abstract; subscription needed for full text; Europe)
Health Education and Behavior. 2007 Aug;34(4):686-699.
Myklestad I | Rise J
This article examines the sociocognitive processes contributing to intention to use contraception and willingness to engage in unsafe sex, using extended versions of the theory of planned behavior (TPB) and the Prototype/Willingness model. Data were obtained from a questionnaire delivered to all the pupils in ninth grade (N = 196) at three schools in Oslo. Hierarchical multiple regression analysis was used to predict intention and willingness. The results showed that subjective norm was the most important predictor of intentions for girls, whereas moral norm was most important for boys' intentions and willingness. Prototypes were the most important predictor for girls' willingness. Implications of the findings are discussed.

ADOLESCENT HEALTH NEWS

Building reminders of a global crisis
(News Article; Sub-Saharan Africa)
24 Jul 2007
Ramirez M, Seattle Times

More sex education needed in China - expert
(Feature Article; Asia)
26 Jul 2007
Wenjuan D, China Daily

India: Government lesson: Talk sex, but mind your language
(News Article; Asia)
24 Jul 2007
IBNLive

LAW AND POLICY

China province sets huge fines for one-child rule
(News Article; Asia)
25 Jul. 2007
Reuters

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Johns Hopkins Bloomberg School of Public Health: The INFO Project

Volume 7, Number 2830 July 2007