Volume 7, Number 36
24 September 2007

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FAMILY PLANNING RESEARCH

Documentation of contraception and pregnancy when prescribing potentially teratogenic medications for reproductive-age women
(Abstract; subscription needed for full text; Global)
Annals of Internal Medicine. 2007 Sep 18;147(6):370-376.
Schwarz EB | Postlethwaite D | Hung YY | Armstrong MA
Related Abstract; subscription needed for full text: Summaries for patients: Frequency of birth control services with prescriptions for unsafe drugs during pregnancy
Related News Article: Women of child-bearing age not counselled about drugs' impact on fetus: Study
Background: Certain medications are identified by the U.S. Food and Drug Administration (FDA) as class D or X because they increase the risk for birth defects if used during pregnancy. Objective: To assess pregnancy rates and the frequency of contraceptive counseling documented with prescriptions for class D or X drugs filled by women of reproductive age. Design: Description of prescriptions filled in 2001. Setting: A large health maintenance organization in northern California in 2001. Patients: 488 175 women age 15 to 44 years who filled a total of 1 011 658 class A, B, D, or X prescriptions. Measurements: Medications dispensed, contraceptive counseling, and pregnancy testing. Results: A class D or X prescription was filled by 1 of every 6 women studied. Women who filled a prescription for class D or X medications were no more likely than women who filled prescriptions for safer, class A or B medications to have received contraceptive counseling, filled a contraceptive prescription, or been sterilized (48% vs. 51% of prescriptions). There was little variation by clinical indication in rates of contraceptive counseling with class D or X prescriptions, except for isotretinoin. Women who filled a class D or X prescription were only slightly less likely to have a pregnancy documented within 3 months than women filling a class A or B prescription (1.0% vs. 1.4% of prescriptions). Limitations: International Classification of Diseases, Ninth Revision, codes underestimate contraceptive counseling. Documentation of a positive pregnancy test after filling a prescription may overestimate medication use in early pregnancy. Women who filled several prescriptions are overrepresented in prescription analyses.
Conclusion: Prescriptions for potentially teratogenic medications are frequently filled by women of childbearing age without documentation of contraceptive counseling.

Knowledge and use of emergency contraception among women in the Western Cape province of South Africa: A cross-sectional study
(Abstract; subscription needed for full text; Sub-Saharan Africa)
BMC Women's Health. 2007 Sep 12;7(1):14.
Myer L | Mlobeli R | Cooper D | Smit J | Morroni C
Emergency contraception (EC) is widely available free of charge at public sector clinics in South Africa. At the same time, rates of teenage and unintended pregnancy in South Africa remain high, and there are few data on knowledge of EC in the general population in South Africa, as in other resource-limited settings. We conducted a cross-sectional, interviewer-administered survey among 831 sexually active women at 26 randomly selected public sector clinics in the Western Cape province. Overall, 30% of the women had ever heard of EC when asked directly, after the method was described to them. Only 15% mentioned EC by name or description spontaneously. Knowledge of EC was independently associated with higher education, being married, and living in an urban setting. Four percent of women had ever used EC. These data suggest that knowledge of EC in this setting is more common among women of higher socioeconomic status living in urban areas. For EC to play a role in decreasing unintended pregnancy in South Africa, specific interventions are necessary to increase knowledge of the method, where to get it, and the appropriate time interval for its use before the need for EC arises. Future health promotion campaigns should target rural and low socioeconomic status communities.

Characteristics associated with emergency contraception use by family planning patients: A prospective cohort study
(Abstract; subscription needed for full text; Global)
Perspectives on Sexual and Reproductive Health. 2007 Sep;39(3):158-166.
Whittaker PG | Berger M | Armstrong KA | Felice TL | Adams J
Little is known about how written family planning clinic policy regarding emergency contraception, as well as personal characteristics, behaviors and attitudes, may influence a woman to use emergency contraception. Between June 2001 and July 2002, women attending publicly funded family planning clinics in Pennsylvania were enrolled in an 18-month longitudinal study. Half attended clinics with a policy of offering emergency contraception in advance; the remainder had only emergent access to the drug. After providing baseline data, women completed monthly automated phone surveys about recent sexual activity, contraceptive use and attitudes toward pregnancy. Characteristics associated with recent use of emergency contraception were examined using multivariate logistic regression. Responses to 3,700 phone surveys from 729 women showed that 25% of those who attended clinics offering advance access used emergency contraception at least once during the study, compared with 8% who attended emergent access clinics. Women attending advance access clinics had significantly elevated odds of having used emergency contraception in the past month (odds ratio, 2.6). Other characteristics positively associated with the likelihood of recent emergency contraception use were familiarity with the drug, having a new sex partner and having unprotected sex at least once (2.0 each); negative feelings toward pregnancy (1.4); and using condoms as one's main contraceptive method (1.8). In addition to discussing and offering advance emergency contraception, providers should further explore specific behaviors and attitudes associated with emergency contraception use.

FAMILY PLANNING NEWS

Has China's one-child policy worked?
(News Article; Asia)
20 Sep 2007
Bristow M, BBC

India: Cipla introduces i-pill helpline on emergency contraception
(News Article; Asia)
20 Sep 2007
The Information Company Private Limited

Family planning to reduce emissions
(News Article; Global)
18 Sep 2007
Warren M, The Australian

China to crack down on rich flouting one-child rule
(News Article; Asia)
15 Sep 2007
Reuters

HIV/AIDS and STIs RESEARCH

Highly active antiretroviral treatment and health related quality of life in South African adults with human immunodeficiency virus infection: A cross-sectional analytical study
(Research Article; Sub-Saharan Africa)
BMC Public Health. 2007 Sep 14;7(1):244.
Louwagie GM | Bachmann MO | Meyer K | Booysen FL | Fairall LR
Health Related Quality of Life (HRQoL) is an important outcome in times of Highly Active Antiretroviral Treatment (HAART). We compared the HRQoL of HIV positive patients receiving HAART with those awaiting treatment in public sector facilities in the Free State province in South Africa. A stratified random sample of 371 patients receiving or awaiting HAART were interviewed and the EuroQol-profile, EuroQol-index and Visual Analogue Scale (VAS) were compared. Independent associations between these outcomes and HAART, sociodemographic, clinical and health service variables were estimated using linear and ordinal logistic regression, adjusted for intra-clinic clustering of outcomes. Patients receiving HAART reported better HRQoL for 3 of the 5 EuroQol-dimensions, for the VAS score and for the EuroQol index in bivariable analysis. They had a higher mean EuroQol index (0.11 difference, 95% confidence interval [CI] 0.04; 0.23), and were more likely to have a higher index (odds ratio 1.9, 95% CI 1.1; 1.3), compared to those awaiting HAART, in multivariate analysis. Higher mean VAS scores were reported for patients who were receiving HAART (6.5 difference, 95% CI 1.3; 11.7), were employed (9.1, 95% CI 4.3; 13.7) or were female (4.7, 95% CI 0.79; 8.5). HAART was associated with improved HRQoL in patients enrolled in a public sector treatment program in South Africa. Our finding that the EuroQol instrument was sensitive to HAART supports its use in future evaluation of HIV/AIDS care in South Africa. Longitudinal studies are needed to evaluate changes in individuals' HRQoL.

The effect on elderly parents in Cambodia of losing an adult child to AIDS
(Abstract; subscription needed for full text; Asia)
Population and Development Review. 2007 Sep;33(3):479-500.
Knodel J | Zimmer Z | Kim KS | Puch S
Our analysis follows a framework described by Knodel et al. that identifies a number of pathways through which an AIDS death can adversely influence the economic, physical, emotional, and social well-being of surviving parents. These include emotional pain and grief from the suffering and death of the child; loss of any material support, caregiving, or assistance with household chores that the child had been providing parents, especially if the child was coresident; time and physical demands on parents who provide care for their ailing children, particularly during the terminal stage of illness; expenses associated with care for the ill child; funeral costs; financial and care responsibilities for orphaned grandchildren; the loss of future old-age support that the deceased child might have provided; and negative community reaction. The death of a grown child from other causes can have many of the same effects; however, the impact of an AIDS death may be particularly severe given the prolonged period of illness and possible negative community reactions that are less commonly associated with other causes.

Impact of drug classes and treatment availability on the rate of antiretroviral treatment change in the TREAT Asia HIV Observational Database (TAHOD)
(Abstract; subscription needed for full text; Global | Asia)
AIDS Research and Therapy. 2007 Sep 17;4:18.
Srasuebkul P | Calmy A | Zhou J | Kumarasamy N | Law M
It is critical to understand the pattern of ART prescription in different regions of the world as ART procurement needs to be anticipated. We aimed at exploring rates and predictors of ART combination changes in clinical practice in Treat Asia HIV Observational Database (TAHOD). Rates of ART changes were examined in patients who started first line triple or more ART combination in TAHOD, and had at least 1 follow-up visit. Rates of ART changes were summarised per follow-up year, and factors associated with changes assessed using random-effect Poisson regression. The Kaplan-Meier method was used to determine durations of patients in their first, second and third regimen. A total of 1846 patients initiated an ART combination with at least three drugs. Median follow up time for the first treatment was 3.2 years. The overall rate of ART change was 29 per 100-person-year. In univariate analyses, rate of treatment change was significantly associated with exposure category, the country income category, the drug class combination, calendar year and the number of combinations. In multivariate analysis, compared to d4T/3TC/NVP, starting ART with another NNRTI-containing regimen, with PI only or with a triple NRTI regimen was associated with a higher risk of combination change (relative risk (RR) 1.6 (95% CI 1.64 - 1.96), p less than 0.001, RR 3.39 (2.76 - 4.16) p less than 0.001, RR 6.37 (4.51 - 9.00), p less than 0.001). Being on a second or a third combination regimen was also associated with a decreased rate of ART change, compared with first ART combination (RR 0.82 (0.68 - 0.99), p = 0.035, RR 0.77 (0.61 - 0.97), p = 0.024). Sites with fewer than 12 drugs used had an increased rate of treatment changes (1.31 (1.13 - 1.51), p less than 0.001). Injecting drug users, and other/unknown exposure was found to increase rate of treatment change (1.24 (1.00 - 1.54), p = 0.055). Percentages of patients who stopped treatment due to adverse events were 31, 27 and 32 in 1st, 2nd and 3rd treatment combinations, respectively. Our study suggests that drug availability impacts on ART prescription patterns. Our data, reflecting real clinic use in Asia, suggest that around half of all patients require second combination ART by 3 years after treatment initiation.

HIV/AIDS and STIs NEWS

Uganda: ARVs worth Sh1b to be destroyed
(News Article; Sub-Saharan Africa)
16 Sep 2007
Basudde E, New Vision (Kampala)

Kenya: Aids takes toll on council staff
(News Article; Sub-Saharan Africa)
19 Sep 2007
Ringa M, The Nation (Nairobi)

Namibia: Omusati men join fight against Aids
(News Article; Sub-Saharan Africa)
19 Sep 2007
The Namibian (Windhoek)

Botswana: HIV threatens child survival
(News Article; Sub-Saharan Africa)
17 Sep 2007
Mmegi/The Reporter (Gaborone)

Uganda: Study warns Hiv+ women on births
(News Article; Sub-Saharan Africa)
17 Sep 2007
Kirunda KA, The Monitor (Kampala)
Related Abstract; subscription needed for full text: Effect of pregnancy on HIV disease progression and survival among women in rural Uganda

MATERNAL AND CHILD HEALTH RESEARCH

Effects of interpregnancy interval and outcome of the preceding pregnancy on pregnancy outcomes in Matlab, Bangladesh
(Abstract; subscription needed for full text; Asia)
BJOG: An International Journal of Obstetrics and Gynaecology. 2007 Sep;114(9):1079-1087.
DaVanzo J | Hale L | Razzaque A | Rahman M
The objective of this study is to estimate the effects on pregnancy outcomes of the duration of the preceding interpregnancy interval (IPI) and type of pregnancy outcome that began the interval. The main outcome measures of interest included pregnancy outcomes (live birth, stillbirth, miscarriage [spontaneous fetal loss prior to 28 weeks], and induced abortion). When socio-economic and demographic covariates are controlled, of the IPIs that began with a live birth, those less than 6 months in duration were associated with a 7.5-fold increase in the odds of an induced abortion (95% CI 6.0-9.4), a 3.3-fold increase in the odds of a miscarriage (95% CI 2.8-3.9), and a 1.6-fold increase in the odds of a stillbirth (95% CI 1.2-2.1) compared with 27- to 50-month IPIs. IPIs of 6-14 months were associated with increased odds of induced abortion (2.0, 95% CI 1.5-2.6). IPIs greater than or equal to 75 months were associated with increased odds of all three types of non-live-birth (NLB) outcomes but were not as risky as very short intervals. IPIs that began with a NLB were generally more likely to end with the same type of NLB. The main conclusions are that women whose pregnancies are between 15 and 75 months after a preceding pregnancy outcome (regardless of its type) have a lower likelihood of fetal loss than those with shorter or longer IPIs. Those with a preceding NLB outcome deserve special attention in counselling and monitoring.

Impact of maternal body mass index on obstetric outcome
(Abstract; subscription needed for full text; Asia)
Journal of Obstetrics and Gynaecology Research. 2007 Oct;33(5):655-659.
Sahu MT | Agarwal A | Das V | Pandey A
The purpose of the present study was to correlate effect of maternal body mass index (BMI) on obstetric outcome. The studies conducted so far are from Western developed countries and there is a paucity of data from developing countries. A prospective evaluation was carried out of 380 women in one unit of a tertiary care teaching hospital in North India from May 2005 to June 2006 on the effect of maternal BMI on pregnancy outcome. BMI was calculated as weight (kg) divided by height (m2). BMI was used to characterize women as lean (BMI less than 19.8 kg/m2), normal (BMI 19.9-24.9 kg/m2), overweight (BMI 25-29.9 kg/m2) or obese (greater than or equal to 30 kg/m2). Forty-six women (12.1%) out of 380 were underweight, 99 (26.1%) were overweight, 30 (7.9%) were obese and the remaining 205 (53.9%) had normal BMI. Anemia (P = 0.02) and low birthweight (P = 0.008) was significantly present among lean women. Obese women had a significant risk for gestational diabetes (P = 0.0004), pre-eclampsia (P = 0.004), cesarean delivery (P = 0.01) and macrosomia (P = 0.02). Both lean and obese women carry a risk for adverse pregnancy outcome, therefore pregnant women should maintain a normal BMI to achieve a healthy pregnancy outcome.

Evaluation of pregnant women with scarred uterus in a low resource setting
(Abstract; subscription needed for full text; Asia)
Journal of Obstetrics and Gynaecology Research. 2007 Oct;33(5):651-654.
Agarwal A | Chowdhary P | Das V | Srivastava A | Pandey A
Management of post cesarean pregnancy continues to be a dilemma. The present study was undertaken to evaluate the outcome of such pregnancies in a resource constrained setting so that an appropriate management protocol can be decided. An observational study was conducted in the Department Of Obstetrics And Gynecology, King George's Medical University, Lucknow, India. The outcome of all of the women admitted with pregnancy with a previous cesarean section was noted. A total number of 447 women with a post cesarean pregnancy underwent delivery. These comprised 13.7% of total deliveries over the same period. 124 women (27.7%) had successful vaginal delivery while 323 (72.3%) had a repeat cesarean section. Maternal morbidity and perinatal mortality were both significantly higher in the vaginal delivery group (P = 0.00211 and P = 0.0426, respectively). Vaginal birth after cesarean (VBAC) is associated with higher maternal morbidity and perinatal mortality. Therefore the decision for VBAC must be taken only after proper consideration and counseling of the couple.

A decade of inequality in maternity care: Antenatal care, professional attendance at delivery, and caesarean section in Bangladesh (1991 -- 2004)
(Abstract; subscription needed for full text; Asia)
International Journal for Equity in Health. 2007 Aug 30;6(1):9.
Collin SM | Anwar I | Ronsmans C
Bangladesh is committed to the fifth Millennium Development Goal (MDG-5) target of reducing its maternal mortality ratio by three-quarters between 1990 and 2015. Since the early 1990s, Bangladesh has followed a strategy of improving access to facilities equipped and staffed to provide emergency obstetric care (EmOC). The authors used data from four Demographic and Health Surveys conducted between 1993 and 2004 to examine trends in the proportions of live births preceded by antenatal consultation, attended by a health professional, and delivered by caesarean section, according to key socio-demographic characteristics. Utilization of antenatal care increased substantially, from 24% in 1991 to 60% in 2004. Despite a relatively greater increase in rural than urban areas, utilization remained much lower among the poorest rural women without formal education (18%) compared with the richest urban women with secondary or higher education (99%). Professional attendance at delivery increased by 50% (from 9% to 14%, more rapidly in rural than urban areas), and caesarean sections trebled (from 2% to 6%), but these indicators remained low even by developing country standards. Within these trends there were huge inequalities; 86% of live births among the richest urban women with secondary or higher education were attended by a health professional, and 35% were delivered by caesarean section, compared with 2% and 0.1% respectively of live births among the poorest rural women without formal education. The trend in professional attendance was entirely confounded by socioeconomic and demographic changes, but education of the woman and her husband remained important determinants of utilization of obstetric services. Despite commendable progress in improving uptake of antenatal care, and in equipping health facilities to provide emergency obstetric care, the very low utilization of these facilities, especially by poor women, is a major impediment to meeting MDG-5 in Bangladesh.

MATERNAL AND CHILD HEALTH NEWS

Southern Africa: A winning recipe for PMTCT but few follow it
(News Article; Sub-Saharan Africa)
20 Sept 2007
Integrated Regional Information Networks (IRIN)

Nigeria: 'How to tackle maternal mortality rate'
(News Article; Sub-Saharan Africa)
19 Sep 2007
Shittu H, This Day

GENDER and HEALTH RESEARCH

Human papillomavirus and cervical cancer
(Abstract; subscription needed for full text; Global)
Lancet. 2007 Sep 8;370(9590):890-907.
Schiffman M | Castle PE | Jeronimo J | Rodriguez AC | Wacholder S
Cervical cancer is the second most common cancer in women worldwide, and knowledge regarding its cause and pathogenesis is expanding rapidly. Persistent infection with one of about 15 genotypes of carcinogenic human papillomavirus (HPV) causes almost all cases. There are four major steps in cervical cancer development: infection of metaplastic epithelium at the cervical transformation zone, viral persistence, progression of persistently infected epithelium to cervical precancer, and invasion through the basement membrane of the epithelium. Infection is extremely common in young women in their first decade of sexual activity. Persistent infections and precancer are established, typically within 5-10 years, from less than 10% of new infections. Invasive cancer arises over many years, even decades, in a minority of women with precancer, with a peak or plateau in risk at about 35-55 years of age. Each genotype of HPV acts as an independent infection, with differing carcinogenic risks linked to evolutionary species. Our understanding has led to improved prevention and clinical management strategies, including improved screening tests and vaccines. The new HPV-oriented model of cervical carcinogenesis should gradually replace older morphological models based only on cytology and histology. If applied wisely, HPV-related technology can minimise the incidence of cervical cancer, and the morbidity and mortality it causes, even in low-resource settings.

Beliefs about cervical cancer and human papillomavirus (HPV) and acceptability of HPV vaccination among Chinese women in Hong Kong
(Abstract; subscription needed for full text; Asia)
Preventive Medicine. 2007 Aug-Sep;Online access July 18, 2007. 45(2-3):130-134.
Lee PW | Kwan TT | Tam KF | Chan KK | Young PM | Lo SS | Cheung AN | Ngan HY
The objective was to assess the knowledge and beliefs on cervical cancer and HPV infection and to evaluate the acceptability of HPV vaccination among Chinese women. Seven focus groups were conducted with ethnic Chinese women aged 18-25 (n=20), 26-35 (n=13), and 36 and above (n=16) in a community women's health clinic in Hong Kong in 2006. The discussions were audio taped, transcribed and analyzed. Recurrent themes related to cervical cancer, HPV infection and vaccination were highlighted. Diverse conceptions on likely causes of cervical cancer were noted, covering biological, psychological, environmental, lifestyle and sexual factors. Most women had not heard of HPV and its mode of transmission. The participants had difficulties understanding and accepting the linkage between cervical cancer and the sexually transmitted HPV infection. HPV infection was seen as personally stigmatizing with significant adverse impact on self-esteem and significant relationships. Participants favored HPV vaccination both for themselves and their teenage daughters if authoritative endorsement was provided. Inadequate knowledge and misconceptions on cervical cancer and HPV were common. Most participants welcomed and favored having HPV vaccination. Apart from promoting HPV vaccination, cervical cancer prevention should also include strategies to promote knowledge and minimize the stigmatizing effect of a sexually transmitted HPV infection.

Identifying intimate partner violence: Comparing the Chinese abuse assessment screen with the Chinese revised conflict tactics scales
(Abstract; subscription needed for full text; Asia)
BJOG: An International Journal of Obstetrics and Gynaecology. 2007 Sep;114(9):1065-1071.
Tiwari A | Fong DY | Chan KL | Leung WC | Parker B | Ho PC
The objective was to assess the measurement accuracy and the utility of the Chinese Abuse Assessment Screen (AAS). The design used was a cross-sectional study. An antenatal clinic of a public hospital and a community centre in Hong Kong was the setting for the study. A total of 257 Chinese women consisting of 100 pregnant women and 157 nonpregnant women were sampled. The Chinese AAS was administered first, followed by the Chinese Revised Conflict Tactics Scales (CTS2). This was performed in the same sitting, and each participant was interviewed once either at an antenatal clinic (for the pregnant women sample) or at a community centre (for the nonpregnant women sample). Main outcome measures: Estimates of the sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios. Using the Chinese CTS2 as the standard, the specificity estimates of the Chinese AAS for emotional, physical and sexual abuse were greater than or equal to 89%, while the sensitivity estimates varied from 36.3 to 65.8%. The sensitivity improved in the screening for more severe cases (66.7%). The positive predictive values were greater than or equal to 80%, and the negative predictive values varied from 66 to 93%. Factors such as the age difference between the couple and the woman's need for financial assistance were found to be associated with intimate partner violence (IPV). The Chinese AAS has demonstrated satisfactory measurement accuracy and utility for identifying IPV when the Chinese CTS2 was used as the standard.

GENDER and HEALTH NEWS

Ghana: Dont justify negative culture against women - Prof. Greenstreet
(News Article; Sub-Saharan Africa)
19 Sep 2007
Ghanaian Chronicle

Zimbabwe: Chiefs fight violence in the home
(News Article; Sub-Saharan Africa)
17 Sep 2007
Masvingo, UN Integrated Regional Information Networks

Zimbabwe: State embarks on women empowerment programme
(News Article; Sub-Saharan Africa)
17 Sep 2007
The Herald (Harare)

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

Delayed marriage and very low fertility in Pacific Asia
(Abstract; subscription needed for full text; Asia)
Population and Development Review. 2007 Sep;33(3):453-478.
Jones GW
The retreat from universal marriage in Pacific Asia is an important phenomenon in its own right, signifying major changes in family relationships and roles of women and posing serious challenges to official and social attitudes to sexuality in the region. It is also likely to be related to the sharp declines in fertility already noted. This article focuses on the causes of delayed marriage rather than on its ramifications for familial relationships, and will emphasize the interrelatedness between trends in marriage and fertility. The article has four objectives. First, it sets the regional trends in nonmarriage in context by comparing them with trends in European countries, where delayed marriage, as well as increased cohabitation, has been strongly in evidence. It then considers the implications of the long and increasing post-puberty premarriage periods for sexuality among the unmarried and the incidence of cohabitation. The article then examines possible reasons for rising singlehood and for the sharp differences observed between different Pacific Asian populations. It considers the role of delayed marriage in the fertility decline from two perspectives: first, the disaggregation of fertility declines into their component parts, and second, behavioral and motivational relationships between delays in marriage and decline of childbearing within marriage. The concluding section draws out some unanswered questions and issues for further research.

Associations of self-reported violence with age at menarche, first intercourse, and first birth among a national population sample of young Australian women
(Abstract; subscription needed for full text; Oceania)
Women's Health Issues. 2007 Sep-Oct;17(5):281-289.
Watson LF | Taft AJ | Lee C
This paper estimates the relation between women's experience of violence and the age of menarche, first sexual intercourse, and first birth. The data are from the Younger Cohort of the Australian Longitudinal Study on Women's Health, which includes 9,683 women, aged between 22 and 27 years in 2000, who responded to surveys in both 1996 and 2000. In 1996, 9% of women reported current or previous partner violence and a further 5% reported it in 2000. Similarly, 11% and 8% reported recent nonpartner violence. Fifteen percent of the women reported first intercourse at less than 16 years. Early first intercourse was strongly associated with partner violence whereas young age at menarche and teenage birth were only associated with partner violence reported when women were less than 24 years old. Reported partner and recent nonpartner violence, when prevalent in 1996 or when occurring between 1996 and 2000, were consistently associated with early age at first intercourse; the earlier that age, the stronger the association. Women reporting intercourse before 14 years were the most likely to report partner violence, with odds ratios between 7 and 14 when compared with first intercourse reported by young women greater than 17 years. These data clearly demonstrate a nexus between early intercourse and reported violence and add to the evidence of risks associated with early sexual initiation. These findings substantiate the need to prevent or reduce rates of early sexual abuse, to protect very young women from sexual exposure and to assist and support young women in their sexual decision making. We need to identify young women who have already experienced abuse or violence and undertake therapeutic interventions to prevent further victimization.

China's future and its one-child policy
(Report; Asia)
American Enterprise Institute: On the Issues. 2007 Sept;:1-3.
Eberstadt N., American Enterprise Institute
Surveying the policy horizon for China today, there are any number of important challenges that would deserve extensive comment: the need to build and maintain more efficient institutions and arrangements for financial intermediation, for example; or the requirements for making the transition from export-oriented growth to development focused on the domestic Chinese consumer; or the great looming question of how to manage China's prospective urbanization process over the coming generation. But one topic above all will have a critical impact upon China's future, and that is its population policy. China's very future hinges on this policy, although not in the way the official formulation suggests. It is hardly an exaggeration to suggest that the program may threaten China's growth and stability, possibly even China's very culture. If the Chinese government could make a single decision today to enhance the nation's long-term outlook and position, it would be to recognize that coercive population control has been a tragic and historic mistake, and it would abandon it, immediately and without reservation.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

Child deaths worldwide fall below 10 million a year for first time, new UN figures show
(News Article; Global)
13 Sep 2007
UN News Center

Romanians burdened by birth rate decline
(News Article; Europe)
18 Sep 2007
Associated Press

Urban growth threatens heritage of Vietnam's capital
(News Article; Asia)
18 Sep 2007
Associated Foreign Press

ADOLESCENT HEALTH RESEARCH

Sexual risk-taking behaviors among boys aged 15-18 years in Tehran
(Abstract; subscription needed for full text; Middle East)
Journal of Adolescent Health. 2007 Oct;41(4):407-414.
Mohammad K | Khalaj Abadi Farahani F | Mohammadi MR | Alikhani S
The purpose of this study is to evaluate the extent and potential correlates of sexual risk-taking behaviors among adolescent boys aged 15-18 in metropolitan Tehran. Data were collected from a population-based, cross-sectional survey of adolescent males (ages 15-18) residing in Tehran, Iran. Of 1385 subjects, 382 reported sexual experience (27.7%). The article is mainly considering sexually experienced subjects. Two factors were considered as sexual risk-taking behavior ("not using condom or inconsistent condom use in sexual contacts" and "ever had multiple sexual partners in lifetime.") Several other factors were considered as independent variables and their relations were assessed using t test, x/2 test, and logistic regression models. Having no access to Internet, feeling regretful at sexual debut, having one sexual partner in lifetime and lower knowledge of condoms are predictors of condom non-use. Older age, using alcoholic drinks, early sexual debut, and poor knowledge of reproductive physiology are predictors of multiple sexual partners among adolescent boys aged 15-18 years. Appropriate interventional programs should be implemented for adolescents in Iran to encourage and enable them to delay first sex and abstain unwanted and unplanned penetrative sex, to stress the health risks of alcohol use in terms of sexual health and finally to enhance their knowledge on different aspects of reproductive health particularly prevention against STI/HIV.

Sexual practices of church youths in the era of HIV/AIDS: Playing the ostrich
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS Care. 2007 Sep;19(8):966-969.
Nweneka CV
The church could be a powerful force for social and behavioural change, particularly in the current efforts to combat the HIV/AIDS pandemic. Anecdotal evidence suggests that church youths are sexually active but few studies have documented the sexual practices of these youths. We looked at the sexual practices of 341 youths in two churches in southern Nigeria. Sixty-five percent were sexually experienced; age at first sexual intercourse for males was seven years and eight years for females. By 19 years of age, 42% of the females and 44% of the males had become sexually active. In the 12 months preceding the study, 19% of the sexually experienced youths abstained from sex, 30% had one sexual partner and 28% had more than one sexual partner; 60% had used condoms 24% of whom used them always. These results suggest that sexual practices of committed church youths might be similar to those of youths in the wider society. More might be achieved by a more pro-active engagement of the church in young people's sexual and reproductive health matters.

Brief report: Risky sexual behavior of adolescents in Belgrade: Association with socioeconomic status and family structure
(Abstract; subscription needed for full text; Europe)
Journal of Adolescence. 2007 Oct;30(5):869-877.
Vukovic DS | Bjegovic VM
The aim of this study was to investigate the association between socioeconomic status and family structure with risky sexual behaviors in adolescents. A total of 1782 15-year-old Belgrade schoolchildren (47.5% boys and 52.5% girls) completed a questionnaire from the WHO study, "Health behavior of schoolchildren". Adolescents with a higher weekly disposable income, those who perceived their family as wealthy, and those with difficulties in communication with their mothers were more likely to have had been sexually active (odds ratios (OR) = 2.497, 1.876, and 1.253, respectively). Adolescents with a higher weekly disposable income were more likely to use contraception (OR = 0.233), but those who perceived their families as better-off and those living with only one parent were more likely not to use contraception (OR = 4.794, 22.295 [living with father], and 6.169 [living with mother], respectively). The perceived family wealth was significantly associated with having sexual intercourse and having sexual intercourse without using contraception. Family structure had a limited independent association with sexual behavior.

ADOLESCENT HEALTH NEWS

Namibia: Project aims at AIDS-free life
(News Article; Sub-Saharan Africa)
18 Sep 2007
Gaomas S, New Era (Windhoek)

Mozambique: Guebuza urges youth to lead fight against AIDS
(News Article; Sub-Saharan Africa)
21 Sep 2007
Agencia de Informacao de Mocambique (Maputo)

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The Pop Reporter--Delivering thought-provoking global health news to your desktop.

Johns Hopkins Bloomberg School of Public Health: The INFO Project

Volume 7, Number 3624 September 2007