17.
DOCUMENT NUMBER: IND/8028623 ; PIP/118878
CORPORATE NAME: Alan Guttmacher Institute
TITLE: Sex and America's teenagers.

This report summarizes more than a decade of research on the sex behavior of U.S. adolescents and its consequences. Consideration is given to the risk and prevention of unwanted pregnancy and sexually transmitted diseases, adolescent pregnancy outcomes, and organized responses to adolescent sexual and reproductive behavior. (ANNOTATION)

27.
DOCUMENT NUMBER: PIP/058716
AUTHOR: Royston E ; Armstrong S
TITLE: Preventing maternal deaths.

The magnitude and contributing factors of maternal mortality associated with pregnancy and abortion worldwide are reviewed with a view toward the challenge of providing known technology to all to avoid massive suffering. Approximately 500,000 women die in childbirth or as a result of non-medical abortion, and millions more suffer permanent morbidity. The risk ranges from 1/15-1/50 in developing countries, to 1/4000- 1/10,000 in the developed world. The "physiological norm" for pregnancy without care is 1/1200, while historical rates of 1/2000 are documented in Europe. Factors related to the low status of women influence mortality: low marriage age, machismo, dowry, child labor, "double-day" work for women, undernutrition of girls. The medical causes of maternal death are known, and most are preventable with prenatal care and obstetric care of high risk women. Deaths resulting from abortion are unnecessary in the modern world. Similarly, morbidity can usually be avoided, especially that caused by harmful cultural practices such as vaginal cutting and packing and female circumcision. Some ways that health care can be improved are linked systems, "bottom-up" reforms, maternity waiting homes, utilization of existing services, education of women, and reinforcement of beneficial customs such as suckling infants immediately after delivery. Given the financial limitations in most countries, many now emphasize family planning and child health, as though they considered women the vehicle for child survival. Response to the pressing needs for maternal care includes reassessment and strengthening of community-based health care, improving referral systems, and development of an effective "alarm" system to refer women at risk in pregnancy and labor in a timely manner.

29.
DOCUMENT NUMBER: PIP/800075
AUTHOR: Assaad MB
TITLE: Female circumcision in Egypt: social implications, current research, and prospects for change.

The social implications of the practice of female circumcision in Egypt are examined in this paper. Female circumcision is defined as the partial or complete removal of the external female genitalia, varying from removal of the prepuce of the clitoris only to the full excision of the clitoris, the labia minora, and the labia majora. Most Egyptian women are circumcised in the first or second degrees. The practice probably originated in Pharaonic Egypt, in which it was invested with mythological significance. Islamic tradition has reinforced the practice because of the belief that it attenuates sexual desire in women. The legal status is ambiguous. Current research shows that women, especially among lower socioeconomic groups, often do not understand the danger of the operation, which mothers usually cause to be performed on their daughters between the ages of 6 and 10, before the girl reaches puberty. Interviews conducted by the author in a pilot study in 1979 suggest that even in the absence of social and economic change, many uneducated women, given information, will question the validity of female circumcision. This questioning, and the uneducated woman's rejection of the practice, are based on new and emerging values such as respect for modern concepts of health and an enhanced definition of women's identity and roles. Moreover, in most cases, the memory of the operation is sufficiently traumatic so that mere questioning by a trusted service-provider or a friend would receive a positive response. The paper concludes with detailed responses of 4 women interviewed in the pilot study.

39.
DOCUMENT NUMBER: PIP/074265 ; IND/8021540
AUTHOR: Barker GK ; Rich S
TITLE: Influences on adolescent sexuality in Nigeria and Kenya: findings from recent focus-group discussions.

Continuing high rates of adolescent childbearing in sub-Saharan Africa indicate a need for improved understanding of factors which affect adolescent sexuality. As traditional cultural influences on adolescent sexuality in Africa have diminished, peer interaction and modern influences have gained in importance. To study peer interaction and societal factors and their impact on adolescent attitudes toward sexuality and contraception, the author's conducted a series of single-sex focus group discussions with both in-school and out-of-school youth generally receive information on sexuality and family planning from peers (and the media), while those in school receive information in school, although not necessarily relevant information. Young women interviewed perceived unwanted early childbearing as something that affected them, an important precursor to family planning use. However, young people tended to have better information and more positive attitudes about induced abortion than about family planning. (author's)

44.
DOCUMENT NUMBER: PIP/081076
AUTHOR: Barth RP ; Leland N ; Kirby D ; Fetro JV
TITLE: Enhancing social and cognitive skills.

In California, teachers and/or researchers followed 1033 high school students (586 in a treatment group and 447 in a control group) to evaluate the impact of the Reducing the Risk (RTR) curriculum which constantly reinforced avoiding unprotected sexual intercourse and promoted discussion between parent and child. Despite strong objections by a vocal minority of parents, most parents of the children who participated in the study supported the curriculum. The RTR curriculum significantly improved communication with parents about contraception and sexual abstinence (p < .005 at 6 months and p < .05 at 18 months). further, communication about contraception between parents and latino youths in the treatment group increased 2-fold. communication about abstinence also increased greatly for latinos. overall, the curriculum did not improve communication with parents about pregnancy and sexually transmitted diseases. it did significantly improve communication between parents and daughters about pregnancy and stds, however. the curriculum's use of role playing to impart knowledge of pregnancy prevention increased knowledge significantly, suggesting that a cognitive behavior approach results in more knowledge gained and retained for a longer time period. Even though the RTR curriculum did not reduce the percentages of perceptions that all their age peers had had sex, it did keep these perception from increasing over time. The researchers thought it reduced bragging. The curriculum did not affect behavioral intent to abstain from intercourse by about 24% and did not increase sexual intercourse. It did not decrease frequency of intercourse, however. The curriculum did reduce unprotected intercourse by about 40% among the lower-risk students and those students who had not yet had their first sexual intercourse at pretest. These findings supported the importance of using a cognitive behavior approach in sex education before youth have their first sexual intercourse.

54.
DOCUMENT NUMBER: IND/8025487 ; PIP/090542
AUTHOR: Bledsoe CH ; Cohen B
TITLE: Social dynamics of adolescent fertility in Sub-Saharan Africa.

Adolescent fertility tends to be valued and sanctioned in the countries of sub-Saharan Africa when parents have had adequate ritual or training preparation for adulthood and the child has a recognized father. Young women and adolescents who conceive and bear children within this context are widely accepted by society; those who conceive outside of marriage, however, are strongly condemned by society. Over the past 2-3 decades, most African countries have successfully raised their levels of education. Girls and women are increasingly privy to formal school education and training in trade apprenticeships, domestic service, and ritual initiation which had otherwise been denied in the past. These factors, combined with declining menarche in a few areas, and changing economic opportunities, law, and religion make it more difficult to define the exact date of entry into marriage. Many girls are taking advantage of these changing circumstances and their opportunities to obtain educations and resist early marriage and cildbearing. While defying the traditional entry into early marriage, many young women do not, however, refrain from engaging in sexual activities. Pregnancies to unwed mothers are thereby on the rise and may constitute the most profound change observed in the social context of adolescent fertility on the continent. Once pregnant, many women find themselves shut out by family planning programs and prenatal clinics which serve only married women. This paper ultimately concludes that the social context of adolescent childbearing has an effect on the outcome for mother and child which is as important as the physiological maturity of the mother.

74.
DOCUMENT NUMBER: PIP/041083
AUTHOR: Bulatao RA ; Bulatao EQ
TITLE: Effects of in-school population education.

This paper synthesizes what is known about the effects of population education and suggests approaches for learning more. The focus is on in-school population education at the primary and secondary levels; out-of-school programs are important for reaching a wider audience but involve different methodologies and additional issues. Table 1 shows the variety of population education projects in developing countries. It lists all the projects identifiable from several recent source's. in 27 of the countries listed, some form of population education has been formally introduced. in the other 30 countries, some efforts have been made in the area, sometimes ad hoc and typically falling short of full institutionalization. some projects are still in preparation or in a small pilot stage, with plans being drawn up, support being mobilized, curricula being designed, materials being developed, or teachers being trained. it is estimated that introducing a new subject into a school system takes a minimum of 5 years. the emphases in these programs differ by region. asian programs, generally the largest and most developed, cover a variety of topics, perhaps none as often as basic knowledge of population trends and effects, including effects on development and on the environment. several of these programs also cover government policies. discussion of government policy is not reported as a content emphasis in any latin american/caribbean or african program. the caribbean programs lean heavily toward family life and sex education. the african programs are reported to equally emphasize population trends and effects and family life education. the limited experimental evidence reviewed in this paper indicates that classroom instruction can raise population literacy. it also succeeds in creating concern about rapid population growth, even when this goal is not explicit. thus far, effects on students' fertility behavior are not evident. Instituting population education also can contribute to the development of appropriate population policy and can lead to further educational reform. The effects of population education cannot be adequately assessed without considering the amount of effort it takes. Such a varied collection of programs now exists that some attention to their different dimensions is critical. Related to the need to assess effort is the need to assess costs. Detailed analysis of costs in some representative population education programs would be useful. Training costs most likely are the most important, and comparisons of the costs of different training strategies are needed.

98.
DOCUMENT NUMBER: PIP/068480
CORPORATE NAME: Centro de Estudios de Poblacion y Paternidad Responsable [CEPAR]
TRANSLIT/VERNAC TITLE: Informe definitivo de la Encuesta de Informacion y Experiencia Reproductiva de los Jovenes Ecuatorianos en Quito y Guayaquil. 1988.
TITLE: [Final report of the Survey of Reproductive Information and Experience of Young Ecuadorians in Quito and Guayaquil. 1988]

This work presents a summary and descriptive analysis of the principle findings of the 1988 Survey of Reproductive Information and Experience of Young Ecuadoreans (ENJOV-88), which was carried out in Quito and Guayaquil. 802 women and 762 men aged 15-24 years in Quito and 854 women and 798 men in Guayaquil were successfully interviewed. 14.0% of the women aged 15-19 and 45.6% aged 20-24 were married or in union, compared to 3.4% of the men aged 15-19 and 17.1% aged 20-24. Fewer than 20% of the women and 11% of the men had no more than primary educations. Over 46% of both sexes were students, and in both cities over 23% of the women were housewives. 40% of the men in both cities were employed, as were 28% of the women in Quito and 17% in Guayaquil. Most respondents had between 3 and 6 siblings. The average ideal family size ranged from 2.1 for women in Quito to 2.3 for women in Guayaquil and men in Quito. Over 80% of women in both cities approved of employment for married women, compared to 54-65% of men. The mother was the main source of information on sexual questions for 40% of women, followed by "nobody" for 13-22% and friends for 10%. Friends, the father, and nobody were the main source's for men, with about 1/5 for each. 75% of women and 76% of men reported having participated in a sex education course or talk, with about 44% for both sexes occurring in schools. 95% of respondents in quito and 90% in guayaquil believed that sex education should be part of the school curriculum. around 50% of both sexes thought the best age for sex education classes would be 12-14 years. 68% of women and 55% of men reported they would also be interested in sex education classes outside of school. the most widely known contraceptive methods were oral contraceptives for women and condoms for men. 75% of respondents believed both partners should make decisions about contraceptive use. 26% of women and 77% of men reported having premarital sexual experience. 15% of women and 36% of men had their 1st sexual relations before 15 years. the average age at 1st coitus was 17 for women and 15 for men. 11% of women and 14% of men reported using contraception at their 1st coitus. but 19% of women and 34% of men who were 19 or over at 1st coitus used contraception. rhythm and condoms were the most frequently used methods at 1st intercourse. among sexually active unmarried respondents, 21% of women and 35% of men had had relations in the prior 4 weeks. 64% used contraception. only 10.5% of women having their 1st intercourse after marriage used a contraceptive method. 35% of married women and 54% of married men reported using a method. 29% of the women had ever been pregnant. the age-specific fertility rate of women aged 15-19 was estimated at 75/1000. 41% in guayaquil and 24% in quito reported that the 1st child was not wanted, while 54% in guayaquil and 41% in quito reported that the most recent pregnancy was unwanted.

101.
DOCUMENT NUMBER: PIP/046110
AUTHOR: Cherlin A ; Riley NE
TITLE: Adolescent fertility: an emerging issue in Sub-Saharan Africa.

This report reviews and synthesizes available evidence about adolescent in fertility in sub-Saharan Africa. Recent studies primarily from West Africa, suggest relatively high levels of sexual activity, pregnancy, and induced abortion among young unmarried women. At the same time, urbanization and rapidly increasing levels of education are adding to the numbers and visibility of unmarried young women in cities. It is argued that the recent surge of interest in teenage fertility in Africa is rooted in the emergence of adolescence as a stage of life, particularly among the growing numbers of urban young people attending secondary school. The studies also suggest that, relative to most African women, large numbers of sexually active teenagers are using modern contraceptive methods, a development which appears to reflect substantial motivation to avoid pregnancy. The paper attempts to place these findings in a broader social context, multiple steps by which marriage is defined, and the pragmatic uses of sexual activity. It also examines the consequences of adolescent sexual activity, including complications from illegal induced abortion, the spread of sexually transmitted diseases, and the loss to young women and society that occurs when they drop out of school due to pregnancy or child rearing. It is argued that issues of adolescent sexual activity are likely to become increasingly important in Africa in the near future due to urbanization and the dramatic growth in secondary schooling. (author's)

109.
DOCUMENT NUMBER: PIP/070509
AUTHOR: Convisser J
TITLE: The Zaire Mass Media Project: a model AIDS prevention communications and motivation project.

This publication reports on the activities and accomplishments of the Zaire AIDS Mass Media Project, a program designed to motivate safer sexual practices. Zaire has one of the highest HIV seroprevalence rates in the world, with 6-8% of Kinshasa's inhabitants and 3-4% rural inhabitants carrying the virus. In 1988, Population Service International (PSI) initiated the project in conjunction with its Condom Social Marketing Project. Funded by USAID, the project collaborates with the Zaire National AIDS Program. Targeting youth between the ages of 12 and 19 and prospective parents between the ages of 20 and 30, the AIDS Mass Media Project seeks to influence social norms by drawing from Zaire's rich traditions in music and drama. Based on audience research, PSI developed innovative media materials to present the AIDS messages. The project relies on radio spot announcements, dramas, music videos, talk shows, interviews, and contests. The project also conveys its message through printed material such as student notebooks and comic-strip calendars. The project has been facilitated by Zaire's extensive media network, which reaches the urban and rural population in the country's 11 regions. Media post-tests and longitudinal knowledge, attitude, and practice studies conducted over the length of the project reveal a positive change in the attitudes and intended behavior related to safer sexual practices. These studies found increased awareness regarding asymptomatic carriers; increased acceptance and reported practice of abstinence and mutual fidelity; and increased knowledge, acceptance, and reported use of condoms. During the same period, sales by PSI's Condom Social Marketing Project increased by more than 1000%.

118.
DOCUMENT NUMBER: PIP/107715
CORPORATE NAME: IRD / Macro International. Demographic and Health Surveys [DHS] ; Populatiion Reference Bureau [PRB]. International Programs
TITLE: Adolescent women in Sub-Saharan Africa: a chartbook on marriage and childbearing.
GENERAL NOTES: RH Training Materials. Also available in French.

This chartbook provides a statistical profile of the extent of adolescent childbearing, sexual experience, and knowledge and use of family planning in sub-Saharan Africa. Analysis is based on data from the 1986 and 1991 rounds of the Demographic and Health Survey (Botswana, Burundi, Ghana, Kenya, Liberia, Mali, Nigeria, Senegal, Togo, Zimbabwe, and Uganda). Adolescents are defined in this analysis as aged 15-19 years. At least 20% of adolescents were found to have given birth to one or more children or to be pregnant. In Liberia, Mali, and Uganda the proportion was 33-50%. Only in Burundi is teenage childbearing uncommon, but catch-up fertility and high fertility are prevalent during the 20s. Premarital pregnancy occurred among 20-47% of teenagers. In Mali, Nigeria, Senegal, and Uganda most married before the birth of their baby. Single parenthood was prevalent among at least 50% of pregnant adolescents in Burundi, Ghana, Togo, and Zimbabwe. Teenage fertility and total fertility declined in Ghana, Liberia, and Mali. Teenage fertility declined more than total fertility in Kenya, Togo, Uganda, and Zimbabwe. Teenage fertility decline is slower than older women's fertility decline in Botswana. Teenage fertility declined in Burundi without a decline in older women's fertility. In Nigeria and Senegal teenage fertility has declined recently. Annual numbers of teenage births range from 8900 in Botswana to 905,000 in Nigeria. Although 16% of total births are to teenagers in Nigeria, the absolute numbers are large. Most teenage births constitute 15-20% of all births. Many premarital or marital births are unintended. In Botswana, Ghana, Kenya, Liberia, and Togo over 50% of teenagers have premarital sexual experiences. Four patterns, one for each country, are used to represent the age distributions of childbearing and marital status. Knowledge was low for identification of the fertile period of the menstrual cycle. The highest proportion having this knowledge was 20% in Togo. Knowledge of modern contraception ranged 30-95%. The highest modern contraceptive use was among unmarried, sexually active youth in Botswana, Nigeria, and Zimbabwe (22%, 11%, and 14%, respectively). Six policy suggestions are listed.

148.
DOCUMENT NUMBER: CPC/B-10847
AUTHOR: El-Saadawi N ; Hetata S
TITLE: The hidden face of Eve: women in the Arab world.
GENERAL NOTES: Translated and edited by Sherif Hetata.
SOURCE: London, England, Zed Press, 1980. xvi, 212 p.

158.
DOCUMENT NUMBER: PIP/038175
AUTHOR: Fordham J
TITLE: Growing up in a changing world. Part one: youth organizations and family life education: an introduction.

This publication was produced by the International Planned Parenthood Federation at the request of the Informal Working Group on Family Life Education, an alliance of nongovernmental oranizations concerned with the problems of youth. The publication is intended as a tool for organizations whose involvement in family life education is relqatively new, but who have acknowledged the need for such education within their programs. It provides an introduction to concepts and definitions, explores the need for organized programs of family life education, and specifies the role of yough organizations in their provision. The starting point in defining the content of family life education must be the needs of potential recipients. These needs can include learning how to cope with the physical, emotional, and social changes that accompany growing up; establishing and maintaining satisfactory relationships with family members and friends; understanding and coping with changes both in their own lives and society; and developing the knowledge, values, and skills necessary for marriage, parenthood, and community participation. "Growing up in a Changing World" should be viewed as a resource document rather than as a comprehensive curriculum. Youth organizatgions should approach it with a readiness to be flexible and to adapt the materials to meet their own requirements.

159.
DOCUMENT NUMBER: PIP/075633
AUTHOR: Forrest JD
TITLE: Adolescent reproductive behavior: an international comparison of developed countries.

A comparative study of adolescent reproductive behavior in the 1980s examined difference in pregnancy, birth, and abortion levels among teenagers in developed countries especially in the US, Canada, the UK, France, the Netherlands, and Sweden. Only 6 of 37 countries with total fertility rates < 3.5 and per capita income > US$2000/year, and at least 1 million people had adolescent birth rates higher than the US (Bulgaria, Cuba, Puerto Rico, Romania, Hungary, and Chile). The US had the highest abortion rate (42/1000) followed by Hungary (27/1000). Thus the US had the highest adolescent pregnancy rate (96/1000) as well as Hungary (96/1000). The 6 country analysis showed that reducing the level of sexual activity among teenagers is not necessarily needed to achieve lower pregnancy rates. For example, Sweden had the highest levels of sexual activity but its pregnancy rate were 33% as high as those of the US. The rates of sexual activity among teenagers in the Netherlands equaled those of the US, but its pregnancy rates were 14% as high as those of the US. All countries had earlier, more extensive, and better contraceptive use among sexually active teenagers than the US which accounted for their lower pregnancy rates. The more realistic acceptance of sexual activity among teenagers and provision of contraceptives in all the countries except the US differed from the societal ambivalence in the US. Thus ambivalence about sexuality and the appropriateness of contraceptive use results in lower contraceptive use and greater adolescent pregnancy rates. US adolescents constantly receive conflicting messages that sex is romantic, thrilling, and arousing but it is also immoral to have premarital sex. Thus adults need to be more candid about sexuality so they can clearly convey to adolescents their expectations for responsible behavior and to provide the information and services needed to make effective use of contraceptives when sexually active.

163.
DOCUMENT NUMBER: PIP/098472
AUTHOR: Friedman HL
TITLE: Reproductive health in adolescence.

The health and social, psychological, and economic well-being of adolescent girls below the age of 17 are likely to be disadvantaged by pregnancy and childbirth. Although there is a worldwide trend toward higher age of marriage, there is also a worldwide trend toward an increase in adolescent sexual relations prior to marriage. Sexual relations in adolescence, particularly in developing countries, are likely to take place without the use of modern contraceptives or protection against sexually transmitted diseases, including the human immunodeficiency virus. By the year 2000 more than 85%, or over two billion, of the world's people below the age of 20 will live in developing countries. In addition, there are 40 million street children in Latin America, 25-30 million in Asia, and 10 million in Africa. For census or survey purposes unions can be considered to be a) legal marriage, whether civil, religious or customary; and b) common-law marriage, consensual union and cohabitation. The legal minimum age of marriage is often different for males and females. More than 50 countries allow marriage at 16 or below, with parental consent. A much higher proportion of adolescents marry in Sub-Saharan Africa and southern and western Asia; this is less true for eastern Asia, the Caribbean region, and many countries in Latin America. In 11 Sub-Saharan countries surveyed, rates of contraceptive use varied from 1% to 7% among unmarried sexually-active adolescents aged 15-19, and from 1% to 6% for those who were married. In 13 of 14 developing Asian countries surveyed, below 10% of adolescents under age 18 had ever used a modern contraceptive. In Latin America and the Caribbean, in 8 of the 11 countries surveyed the proportion was below 10%. In most of the developing world, abortion is highly restrictive, but even in countries where it is legal, screening procedures, parental consent, and its cost will deter adolescents from safe abortion.

166.
DOCUMENT NUMBER: PIP/081565
AUTHOR: Gage-Brandon AJ ; Meekers D
TITLE: Sex, contraception and childbearing before marriage in Sub-Saharan Africa.

In sub-Saharan Africa, sexual activity, contraceptive use, and childbearing among never-married women aged 15-24 differs significantly among countries. Analysis of Demographic and Health Surveys data for 7 countries reveals that in some, such as Botswana and Liberia, more than 75% of unmarried women have had sexual intercourse, while in Burundi, only 4% have done so. Although more than 75% of unmarried, sexually experienced young women in the countries studied know of at least 1 modern contraceptive method, less than 30% of these women in most countries have ever used a modern method. Childbearing among unmarried women is almost nonexistent in Burundi (2%) and very low in Ghana (9%), but it is fairly common in Botswana (42%) and Liberia (34%). (author's)

177.
DOCUMENT NUMBER: PIP/068703 ; IND/8019312
AUTHOR: Gomez VM ; Grunberg M ; Morris L ; Whittle L ; Hernandez D
TRANSLIT/VERNAC TITLE: Encuesta nacional de salud reproductiva de adultos jovenes. Avance de resultados.
TITLE: [National survey on the reproductive health of young adults. Preliminary results]

Preliminary results are presented of the 1991 National Survey of Reproductive Health of Young Adults carried out among young men and women ages 15-24 in Costa Rica. Costa Rica's fertility levels have remained almost stationary since the mid-1960s. Although age-specific fertility rates for adolescents aged 15-19 and young women 29-24 have declined, the proportion of births in these age groups has increased since the fertility decline began. Premarital births account for a large share. 1405 males and 1582 females were interviewed in an effort to gain greater knowledge of the attitudes and practices of young people with regard to family formation, contraceptive usage, and related topics. Among males and females, respectively, 56.8% and 57.4% were rural. Among urban respondents, 22.1% and 23.1% were lower class, 14.3% and 13.3% were middle class, and 6.8 and 6.3% were upper class. 85.5% of the males were single, 8.9% were married, and 5.3% were in free unions. 62.7% of the women were single,l 23.9% were married, and 11.9% were in free union. The proportion of single women declined steadily from 93.4% at age 15 to 25.7% at age 24. 16% of both males and females had incomplete primary educations and around 35% had complete primary educations. 32.1% of males and 29.1% of females had incomplete secondary educations. 25% of males and 24% of females still attended school. 39.8% of males and 17.5% of females aged 15-19 and 63.0% of males and 22.7% of females aged 20-24 worked full time. 2/3 of respondents lived in household with 3-6 members. 31.6% of males and 28.0% of females lived in households with 7 or more persons. 76.7% of men and 56.5% of women respondents lived with their mothers, but only 60.4% of males and 42.3% of females lived with their fathers. A high percentage of respondents reported they could talk to their parents about any type of problem and could trust them. 47.2% of males and 62.4% of females reported they had ever had a sex education course. 58.6% of males and 49.4% of females reported they had had sexual relations, 21.6% of males and 12% of females were sexually active before age 15, while 89.4% of males and 81.6% of females were sexually active by age 24. Fewer than 1/3 used contraception at the 1st intercourse. The 1st sexual experience was with the spouse of consensual partner for 3% of males and 38% of females with sexual experience. 15.8% of women aged 15-17, 35.0% aged 18-19, and 41.0% ages 20-24 reported premarital sexual experience. Among respondents sexually active in the past month, 55.6% of males in union and 56.2% of single males used a contraceptive method, as di

181.
DOCUMENT NUMBER: PIP/100680
AUTHOR: Grunseit A ; Kippax S
TITLE: Effects of sex education on young people's sexual behaviour.

The provision of sex education to children and young adults remains highly controversial in some countries. While public opinion in the US is generally in favor of such education, vocal and radical opponents have managed to severely limit the scope and implementation of sex education programs for children and youths. The authors reviewed approximately 1050 database and journal articles on sex education dating back to the mid-1970s. The articles reported findings for controlled intervention studies, quasi-experimental designs, and reviews, but research dealing solely with knowledge and attitudes about sex has been excluded. Moreover, only the behavioral outcomes of other studies are reported. The overwhelming majority of articles reviewed, despite the variety of methodologies, countries under investigation, and year of publication, find no support for the claim that sex education encourages sexual experimentation or increased activity. Instead, and almost without exception, data indicate that sex education targeted to children and young adults helps postpone the initiation of sexual intercourse and/or fosters the effective use of contraceptives. The best outcomes are obtained when education is given prior to the onset of sexual activity. Since some young people may be sexually active at age 12, instruction on sexuality and sex should therefore be initiated well before that age. It should be clear that children in virtually all cultural settings, like adults, are barraged with sexual messages in the media. They will be taught about sex in some manner by adult role models, television, advertisements, and parents, which may or may not be accurate and appropriate. In this context, sex education should be provided to children and youths in the interest of ensuring that all people receive the accurate and complete information on sex which they need and deserve.

185.
DOCUMENT NUMBER: PIP/031382
AUTHOR: Gyepi-Garbrah B ; Nichols DJ ; Kpedekpo GM
TITLE: Adolescent fertility in Sub-saharan Africa: an overview.
GENERAL NOTES: Part of an unnamed series on adolescent fertility from the Pathfinder Fund.

This report discusses the dimensions and implications of adolescent fertility in Sub-Saharan Africa, with particular emphasis on the situation in Nigeria, Kenya, Sierra Leone, Liberia, and Botswana. Over 1/3 of Africa's total fertility is accounted for by adolescents ages 15-24 years and at least 40% of potential mothers are in this age group. At present, most adolescent fertility in Sub-Saharan Africa is marital; however, if rising female school enrollment continues to exert an upward influence on mean age at marriage in the region from current levels of 16-18 years, a larger proportion of births to adolescents will be conceived out of wedlock. The high incidence of medical complications associated with adolescent pregnancy, increasing use of illegal abortion in cases of unplanned and unwanted pregnancy, and growing rates of sexually transmitted diseases in the region contribute to make adolescent fertility a major problem in the Sub-Saharan region. Moreover, as a result of the combined effects of the continuing fall in the age at menarche, declines in adolescent subfecundity, increased sexual activity among unmarried adolescents, low contraceptive use rates, and the tremendous growth in the size of the adolescent population, the number of adolescent pregnancies can be expected to increase dramatically in the years ahead. In most cases, adolescents in Sub-Saharan Africa do not receive family planning counseling, reproductive health education, or prenatal and postnatal health services. Even countries with official family planning programs tend not to gear services to the special needs of adolescents. A number of options are recommended to government and private agencies to counter the serious public health implications of adolescent pregnancy. These include research, seminars and workshops, training programs, observation tours, educational campaigns, peer counseling, women's centers, and a multiservice center approach.

191.
DOCUMENT NUMBER: PIP/068469
TITLE: The Self Center: a school-linked pregnancy prevention program.

This chapter is devoted to a description of a school linked pregnancy prevention program, The Self Center. Participation of junior and senior high schools in this program was based on proximity to Johns Hopkins Hospital and its primary pregnancy prevention program. Students were primarily low income from inner city neighborhoods and in need of reproductive health services. An 8-month start up period involved the education of principals and School Superintendent in program design, the completion of formal authorizations required, the familiarization of parents and family and community members with the plan, the design and approval of evaluation instruments, the set of a clinic in close proximity to the schools, the identification of the schools' health suites as the program center, and training of staff. Quantifiable objectives were 1) to increase the level of knowledge of physical maturation, human sexuality, contraception, fertility, and the costs of an unintended pregnancy, 2) to reinforce positive attitudes toward pregnancy prevention and realistic attitudes toward premature conception and parenthood, 3) to postpone intercourse of those not yet sexually active, 4) to increase use of contraceptive services, 5) to increase us and effectiveness of contraceptive use, and 6) to reduce pregnancy and childbearing rates. In 1981, the program was initiated with 2 staff in the Self Center clinic from 1:30 - 6:00 PM and 2 social workers and 2 nurses providing classroom presentations, group discussions in the school, school counseling, group education in the clinic, clinic counseling, and medical visits. A full description of these activities, case studies, and program use is available. The philosophy of the program was based on empowering student to make responsible decisions. The program was open to understanding the client in the context of family situations, development, educational achievement and expectations, future aspirations, and social relationships; it required sensitivity in probing to uncover some of problems plaguing students. A peer resource team was selected to function as outreach, to distribute materials, and to bring visibility to the center. 85% were reached by at least 1 aspect of the program. For 475 school morning, 47-48 student contacts were made. The student mean was 4 contacts. Utilization and acceptance of the program was high. Counseling was necessary, and the impact of greater because of the school and clinic components.

205.
DOCUMENT NUMBER: PIP/092504
AUTHOR: Hicks EK
TITLE: Infibulation: female mutilation in Islamic Northeastern Africa.

An historical, sociocultural analysis of infibulation in Islamic northeastern Africa suggests that this practice is deeply embedded in the societies in which it occurs and, as such, cannot be eliminated by official decree. Infibulation is widespread in the northern Sudan (and related populations in eastern Chad), the coastal regions of Ethiopia, Eritrea, Djibouti, and northern Somalia, in pastoral, rural, and urban settings. In these societies, infibulation accords girls the right to marriage and the protection and status this union provides; women's collective social identity is based on all women being infibulated; thus, much of the opposition to campaigns to eradicate female circumcision emanates from Islamic women who are concerned about losing the only status position available to them. Although Islam is unrelated to the origin of infibulation, it functions as a vehicle for the perpetuation of this practice. Islam promotes the husband's exclusive rights over his wife and isolates women from access to alternate sources of identity in the public sphere. An analysis of 46 African societies in which infibulation is widespread further identifies male absenteeism and household instability, low women's status, high brideprice, and retention by the wife of membership in her natal group after marriage as other social factors that tend to perpetuate infibulation. More likely to be effective than legislation banning female circumcision is a fundamental transformation of the sociocultural and economic reality that currently shapes women's identities. In the absence of modernization of all spheres of Islamic society, efforts on the part of the feminists, gynecologists, voluntary social agencies, and governments to eradicate infibulation will be met with resistance by the very well

210.
DOCUMENT NUMBER: IND/8027039
AUTHOR: Tejada Holguin R ; Duarte I ; Herold J ; Morris L
TRANSLIT/VERNAC TITLE: Republica Dominicana. Encuesta Nacional de Jovenes, 1992. ENJOVEN-92. Informe preliminar.
TITLE: [Dominican Republic. National Survey of Youth, 1992. ENJOVEN-92. Preliminary results]

Preliminary results from the 1992 Dominican Republic's National Survey of Youth (ENJOVEN-92) are presented. Persons aged 15-24 were interviewed regarding their marital status, labor force participation, fertility, sex education, premarital sexual relations, contraceptive usage, attitudes and knowledge regarding AIDS, and alcohol and tobacco usage. Data are presented by sex for the whole country and separately for the capital district and the rest of the country. (ANNOTATION)

213.
DOCUMENT NUMBER: PIP/106191
AUTHOR: Hosken FP
TITLE: The Hosken report. Genital and sexual mutilation of females. Fourth revised edition.

Part of the introduction to this 439-page report on female genital mutilation (FGM) discusses efforts by the women effected to halt the practice. Part 1 is a reference resource for the reader. It explains the various practices of FGM and gives a map of Africa showing the belt of FGM prevalence, statistics, and an historic background of the practice. Part 2 gives case histories for individual countries grouped by region: East Africa and the Middle East; West Africa; the Arab peninsula; Indonesia and Malaysia; and the Western world. The country studies illustrate the diversity of ways patriarchal societies mutilate girls to affirm male control. Part 3 discusses the attitudes toward women that support FGM in Africa. Male-dominated institutions worldwide, including the international health and population control structures and the UN, support these attitudes towards women. The section also discusses positive initiatives in Africa and worldwide to eradicate FGM (e.g., Burkina Faso's campaign against the practice of excision). Appendices include an 11-page bibliography and a list of ethnic groups practicing FGM.

215.
DOCUMENT NUMBER: PIP/081077
AUTHOR: Howard M ; McCabe JA
TITLE: An information and skills approach for younger teens: postponing sexual involvement program.

In 1983, in Georgia, the Henry W. Grady Memorial Hospital outreach education program implemented its Postponing Sexual Involvement Program for low-income, mostly black, 8th grade students at Atlanta's 4 school systems. During the 1985-1986 and 1986-1987 school years, researchers collected pre-program and post-program data on at least 536 youth to compare the results of treatment group with those of the control group. 76% of all students (75% of program students) were virgins at the beginning of 8th grade. Virgins who experienced the sex education program were considerably more likely to postpone sexual intercourse than those who had not experienced the program. Further, the program's effect continued for at least 12 to 18 months. By the end of 9th grade, 33% fewer program students had experienced first intercourse than the non-program students (24% vs. 39%; p < .05). this held true for both males and females. by the end of the 9th grade, youth who began sexual activity after the program started were less involved in sexual intercourse (e.g., tried sex no more than twice, 28% vs. 43%) and more likely to not expect to have sex in the next 6 months (72% vs. 53%) than non-program youth. fewer females in the program group had sexual intercourse; their pregnancy rate was 33% lower. the program did not affect the sexual behavior of program students who had had sexual intercourse prior to experiencing the program, however. it also did not reduce their pregnancy rate, even though many females had sometimes used a birth control method. thus, the hospital began developing means to increase contraceptive use. these findings indicated that the program was effective for youth who had not yet experienced their first intercourse. nevertheless, the hospital hoped to convince the schools to allow the program to be implemented also at the 7th grade level because of the relatively large proportion of 8th grade students who had had sexual intercourse.

225.
DOCUMENT NUMBER: PIP/109361
CORPORATE NAME: Johns Hopkins School of Public Health. Center for Communication Programs. Population Communication Services / Population Information Program [PCS/PIP]TITLE: Reaching young people worldwide: lessons learned from communication projects, 1986-1995.

This report reviews more than a decade of experience gained by the Johns Hopkins University Population Communication Services in communicating with young people around the world about their reproductive health. The report opens by noting that young people 10-25 years old are in a period of transition between dependent childhood and independent adulthood and that they need adult guidance to make the transition successfully. This is especially true when it comes to making sensible choices about sexual activity. It is often difficult, however, to provide young people with the information they need to make the proper choices because sex is a sensitive topic in many cultures. This problem can be mitigated by using multiple channels, such as the mass media, interpersonal communication, and community mobilization to reach young people. The 32 projects summarized in this report were devised by following a collaborative, step-by-step process to insure effectiveness of outputs. The lessons learned from these communication experiences are 1) to build broad, high-level support from the inception of the project; 2) to start small and expand gradually; 3) to rely on research and evaluation for effective program design; 4) to involve youth from the start; 5) to recognize that youth actively want accurate information about sex; 6) to use information to link young people with services; 7) to involve boys and young men; 8) to work with adults, families, schools, and the community; 9) to use a variety of communication channels; and 10) to provide engaging and positive role models. After providing a summary table displaying the objectives, audience age, communication outputs, and medium or venue of all of the projects, the report summarizes the projects according to geographic region (Africa, Asia, Latin America, Western Asia, and the newly independent states of Eastern Europe). The final section of the report describes additional activities that benefit youth initiatives including worldwide communication activities (the publication of Population Reports, the Media/Materials Clearinghouse, and POPLINE), a sample of projects designed for adults but which reach youth as a secondary audience, and advocacy programs for adults that also protect the health of young people (postponing marriage age and childbearing, arguing against son preference, and championing the rights of daughters to equal privileges as sons).

237.
DOCUMENT NUMBER: PIP/029595
AUTHOR: Jones EF ; Forrest JD ; Goldman N ; Henshaw SK ; Lincoln R ; Rosoff JI ; Westoff CF ; Wulf D
TITLE: Teenage pregnancy in developed countries: determinants and policy implications.

Because of the high adolescent fertility rates in the US, the Alan Guttmacher Institute (AGI) conducted a 1985 study of adolescent pregnancy and childbearing in 37 developed countries. This was an effort to unveil those factors responsible for determining teenage reproductive behavior. This article presents the data from that study. Birthrates were collected and separated into 2 age groups: for those under 18 and those women 18 to 19 years of age. A 42 variable questionnaire was sent to the public affairs officer of the American embassy and family planning organization in each foreign country to provide additional socioeconomic, behavioral, and educational data. Childbearing was found to be positively correlated with agricultural work, denoting a socioeconomic influence. Adolescent birthrates showed a positive correlation with levels of maternity leaves and benefits offered in the country. The lowest birthrates were found in those countries with the most liberal attitudes toward sex as demonstrated through media representation of female nudity, extent of nudity on public beaches, sales of sexually explicit literature, and media advertising of condoms. A negative correlation was seen for equitable distribution of income and the under 18 birthrate. The older teenage birthrate was found to be lower for countries with higher minimum ages for marriage. They also suggested a responsiveness to government efforts to increase fertility. Some general patterns emerged to explain the high teenage birthrate for the US: it is less open about sexual matters than countries with lower adolescent birthrates and the income in the US is distributed to families of low economic status. A more subtle factor is that although contraception is available, it is not that accessible to young men and women because of the cost. Case studies were presented to provide a more detailed understanding of the reasons for the high adolescent birthrates. Examined are desire for pregnancy, exposure to risk of pregnancy, contraceptive use, access to contraceptive and abortion services, and sex education.

238.
DOCUMENT NUMBER: PIP/058855 ; IND/8013475
AUTHOR: Jones EF ; Forrest JD ; Henshaw SK ; Silverman J ; Torres A
TITLE: Pregnancy, contraception, and family planning services in industrialized countries.
GENERAL NOTES: A study of the Alan Guttmacher Institute.

Social scientists conducted a comparative international study to examine relationships between fertility, pregnancy (particularly unplanned pregnancy), and contraceptive use among all women of reproductive age and between contraceptive use and public policies and family planning programs in the period of 1982-1986. This study was unique in that it measured directly the overall extent of unintended pregnancies and focused on the role of public policy, family planning services, and information as catalysts of unwanted pregnancy. Further, this study compared the United States' (US) experience with that of a group of like industrialized countries to identify ways in which the high level of unintended pregnancy in the US might be reduced. Specifically, the study focused on the US, the provinces of Ontario and Quebec in Canada, the Netherlands, and the United Kingdom. Other countries included, among others, Australia, Finland, Ireland, Portugal, and Switzerland. Even though applicable conditions change rapidly since the study period and the study results may no longer hold true, a 1988 study shows that no reduction in sexual activity among the unmarried in the US occurred and condom use has increased. Researchers evaluated national background characteristics, such as religious composition and economic conditions, that may affect personal behavior or public policies and family planning programs. They also looked at institutional factors related to family planning (the independent variables) which included laws and policies, service delivery, and dissemination of information. Contraceptive use made up the 3rd group of variables and measures of fertility and unintended pregnancy (the dependent variables) comprise the 4th group. Researchers were unable to compare national health programs that include the provision of family planning services regardless of income because the US only has these services for low income women.

254.
DOCUMENT NUMBER: PIP/075698
AUTHOR: Kiragu K
TITLE: Factors associated with contraception among high school adolescents in Nakuru district, Kenya.

Determinants of contraceptive use were identified from a survey of 2059 secondary school students in Nakuru District, Kenya, in 1989. Sexual activity was found to be prevalent among 69% of males and 27% of females. This finding was consistent with other reports even though male exaggeration and female concealment is suspected. Contraception use was low, e.g., 10% of regular use among the sexually active. There are many barriers to contraceptive use. These barriers include securing the money to pay for the contraception, raising the issue of contraception with a perhaps suspicious partner, overcoming fears of side effects,maintaining confidentiality, and bargaining with a health system that is not sympathetic to adolescent reproductive health needs. Fewer than 50% have ever used contraception; 70% reported unprotected first intercourse and last coitus. At last coitus, 29% of males and 43% of females used the "safe period" method; however, of this group, only 17% of males and 46% of females knew when the "safe period" in the menstrual cycle occurred. Other methods used at last coitus were condoms (55% males, 43% females), and oral pills (6% males, 10% females). Birth control was obtained most frequently from clinics and then from friends. The results of the logistic regression analysis revealed that female contraceptive use at first and last sex is associated with the highest socioeconomic (SES) group, favorable attitudes toward contraception, and high academic performance. These factors were unrelated to male use. At last use, twice as many men used contraceptives when there was partner approval. The female findings reflect the importance of education of women for economic success in Kenya. School girls are expelled if found to be pregnant, and there are social, financial, and psychological effects for both the women and their families. There is great incentive to use birth control. The implications are that the poor are at greater risk of pregnancy which consequently lowers their probability for upward mobility. Recommendations are to promote education which dispels myths and fears and teaches communication skills particularly to females, and to provide adolescent reproductive health services.

260.
DOCUMENT NUMBER: PIP/069498
AUTHOR: Kirby D ; Barth RP ; Leland N ; Fetro JV
TITLE: Reducing the risk: impact of a new curriculum on sexual risk-taking.

"Reducing the Risk" is a new sexuality education curriculum, based on social learning theory, social inoculation theory, and cognitive-behavioral theory and employing explicit norms against unprotected sexual intercourse. In a quasi-experimental evaluation, this curriculum was implemented at 13 California high schools where 758 high school students were assigned to treatment and control groups and were surveyed before their exposure to the curriculum, immediately afterwards, 6 months later, and 18 months later. Among all the participants, the program significantly increased participants' knowledge and parent-child communication about abstinence and contraception. Among the students who had not begun to have intercourse prior to the pretest, the curriculum significantly reduced the likelihood that they would have intercourse by 18 months later. "Reducing the Risk" did not significantly affect the frequency of sexual intercourse or the use of birth control among sexually experience students. Among all lower-risk youth and among all students who had not initiated sexual intercourse prior to their exposure to the curriculum, the curriculum appears to have significantly reduced unprotected intercourse, either by delaying the onset of intercourse or by increasing the use of contraceptives. For those students who were not sexually active before their participation in the program, effects seem to have extended across a variety of subgroups, including both whites and Latinos as well as lower-risk and higher-risk youths, but were particularly strong among lower-risk youths and females. (author's)

262.
DOCUMENT NUMBER: PIP/099614
AUTHOR: Kirby D ; DiClemente RJ
TITLE: School-based interventions to prevent unprotected sex and HIV among adolescents.

Individuals aged 13-19 years account for less than 1% of diagnosed cases of AIDS in the US. The long latency period between HIV infection and clinical manifestations, however, means that AIDS case surveillance is not an useful marker of the current incidence of HIV infection among adolescents. More than 20% of AIDS cases have occurred among individuals in their twenties. These youths were most probably infected when they were adolescents. Even so, the current numbers of AIDS cases is representative only of unprotected sexual intercourse and HIV infection earlier in their lives. The seroprevalence of HIV infection is more indicative of the current nature of the HIV/AIDS epidemic among youths. Among youths younger than 20 applying to the military, the prevalence of HIV infection per 1000 whites, blacks, and Hispanics was 0.17, 1.00, and 0.29, respectively. Among Job Corps entrants aged 16-21, the prevalence per 1000 entrants for whites, blacks, and Hispanics was respectively 1.2, 5.3, and 2.6. By age 21, 25% of teens become infected with a sexually transmitted disease (STD), with about 2.5 million adolescents becoming infected with a STD annually. HIV prevention programs which effectively reduce the level of unprotected sex are therefore urgently needed. The authors discuss the role of schools in HIV prevention, the effectiveness of generations of sex and HIV education curricula, school-based programs to improve access to contraceptives, comprehensive school-based programs, programmatic recommendations, and research recommendations in the areas of statistical power, randomization, long-term follow-up, and the selection of appropriate outcome measures.

272.
DOCUMENT NUMBER: PIP/102230
AUTHOR: Klepinger DH ; Lundberg S ; Plotnick RD
TITLE: Adolescent fertility and the educational attainment of young women.

The authors present new estimates of the relationship between teenage childbearing and educational attainment. The analyses are based upon a sample of 2795 young women interviewed annually over the period 1979-91 in the National Longitudinal Survey of Youth. Subjects were 1445 whites, 906 blacks, and 444 Hispanics aged 14-20 in 1979, except for those in the special military subsample or the oversample of economically disadvantaged whites. Controlling for an extensive set of personal and community characteristics, researchers found that childbearing as a teenager lowers the educational attainment of young women. Schooling attained among whites, blacks, and Hispanics was reduced by almost three years among those who bore a child before age 20. Having a child before age 18, however, has a significant effect among only blacks, reducing years of schooling by 1.2 years. Other recent research has reported that the social and economic effects of teenage childbearing are not as great as early studies of the relationship between teenage childbearing and adult outcomes had suggested. The results of this study, however, suggest that such revisionist findings are open to challenge.

276.
DOCUMENT NUMBER: PIP/109686
AUTHOR: Koso-Thomas O
TITLE: The circumcision of women: a strategy for eradication.

Female circumcision is a traditional practice in many parts of Africa that has significant medical consequences. The main arguments in its favor, including cleanliness, aesthetics, improved health and social benefits, are refuted in this monograph. This practice was studied in Sierra Leone, where it affects 90% of females, and is carried out by secret societies. Female initiates are usually in their early teens and must undergo training and participate in elaborate rituals. The health effects vary with the typ of circumcision and the conditions under which it is performed. Immediate consequences include pain, hemorrhage, urinary tract problems, and serious infections. Scar formation leads to late sequelae of dysmenorrhea, dyspareunia, pelvic infections and abscesses, hematocolpos, infertility, difficulty urinating, urinary tract infections and anal incontinence and fissures. Female circumcision is also a cause of later reproductive difficulty due to obstructed labor, resulting in several obstetrical complications. Psychological effects differ among women who have undergone it voluntarily, and those who have been forced to undergo this ritual, with the latter suffering much more psychologically. A pilot study of 135 people in Sierra Leone found that a significant number favor female circumcision and believe that it is essential to their culture. This attitude is related to illiteracy. In a survey of 300 women in Sierra Leone, tradition was the most common reason given for circumcision (85%), followed by social identity and religion. Circumcision was related to Muslim religion and inversely related to educational level. Statistical breakdown by tribe, method, complications, age, and attitude regarding circumcision is provided. A detailed strategy for the eradication of female circumcision is outlined.

294.
DOCUMENT NUMBER: PIP/065559
AUTHOR: Lema VM
TITLE: Sexual behaviour, contraceptive practice and knowledge of reproductive biology among adolescent secondary school girls in Nairobi, Kenya.

1751 adolescent secondary school girls aged between 12-19 years were interviewed by means of self-administered questionnaire to determine their knowledge on reproductive biology, sexual behavior and its relationship to contraceptive practice in late 1986. 23.8% of all the girls had been or were sexually active at the time of the study. 94.5% of the sexually active girls had not or were not using any method of contraception, while the rest, (5.5%) were mainly using unreliable or risky methods of contraception. 1.7% of the sexually active girls admitted to having been pregnant at one time and had sought abortion. The majority of the girls displayed profound ignorance and misinformation regarding their reproductive biology and contraception. Their mothers played a minor role in imparting this knowledge, their sources of information being fairly unreliable. While 77.8% of the girls were against school girls having sexual relationships, 90.7% of them felt that all women (including school girls) should be given contraceptives to protect themselves from unwanted pregnancies. (author's modified)

296.
DOCUMENT NUMBER: PIP/134591
AUTHOR: Lightfoot-Klein H
TITLE: Prisoners of ritual: an odyssey into female genital circumcision in Africa.

This book draws from information gained during the author's extensive field trips to Africa, particularly Sudan, to describe and discuss the practice of female genital mutilation, often relaying the words of the male and female informants. The first part contains an introduction and eight chapters on 1) the interview procedure and underlying rationale; 2) female circumcision in African countries in general and in Sudan in particular; 3) the current situation in Sudan; 4) specific episodes and records of conversations; 5) voices of reason; 6) a history of clitoral excision and infibulation practices in the Western world; 7) male circumcision; and 8) an overview that relates female genital mutilation to certain practices in the West. Part 2 contains two chapters that present images of Sudanese women and girls and describe the author's odyssey in Sudan. Appendices contain the texts of interviews with women and with men.

321.
DOCUMENT NUMBER: PIP/091612
AUTHOR: Meekers D
TITLE: Sexual initiation and premarital childbearing in Sub-Saharan Africa.

Data from Demographic and Health Surveys was used in logistic models to examine the probability of premarital sex behavior, adolescent pregnancy, and desire or not for pregnancy. Country data were examined for Burundi, Ghana, Kenya, Liberia, Mali, Togo, and Zimbabwe between 1986 and 1989. Although adolescent sexual activity has been high and increasing in most African countries, there has been large variation by socioeconomic group and between countries. The analysis of the effects of literacy, religion, place of residence, and year of first intercourse on the likelihood of having first sexual intercourse, before the age of 15 years among sexually experienced women, showed that literate women in Ghana, Kenya, Mali, Togo, and Zimbabwe were more likely to engage in early sexual activity than illiterate women. The effect of urban residence was small and not significant, except for Burundi. Age at first intercourse has increased over time in all countries. Norms regarding premarital behavior vary between countries; a relative measure of these differences was shown with first sexual intercourse data for ever married women, never married women, and all women with sexual experience. Sexual experience of never married women varied from 5.2% in Burundi to 81.0% in Liberia. Among ever married women the range was 13.4% in Mali to 65.1% in Togo. In the logistic model, the likelihood that a never married woman being sexually experienced increased with age. In Ghana and Liberia, Muslim women were less likely to have had sexual intercourse. When controlling for other variables, literacy had no significant effects on sexual experience of unmarried women. The likelihood of a premarital birth among married women was the most strongly correlated with age at first marriage. Literate women were more likely to have premarital childbearing in all countries except Zimbabwe. After controlling for other variables, only in Liberia did literacy have a significant effect on the likelihood of having a premarital birth. This finding confirmed that the change was not adolescent sexual behavior and childbearing, but the social context. Other findings indicated that the social disorganization hypothesis was supported, but did no exclude the possibility of rational behavior for some women. Dissatisfaction about the timing of the birth was found to be greater for premarital births than children born out of wedlock.

332.
DOCUMENT NUMBER: PIP/135743
AUTHOR: Mohamud A
TITLE: Female genital mutilation: a continuing violation of the human rights of young women.

More than 100 million African women and girls in more than 26 African countries have had their genitals mutilated through the ancient traditional practice of female circumcision. The estimated 2 million girls who undergo female genital mutilation (FGM) annually experience both immediate and long-term adverse health consequences. However, most girls who have undergone FGM either do not associate their health problems with circumcision or simply accept and tolerate them as part of womanhood and a prerequisite for marriage. Among people who practice FGM, being uncircumcised is associated with pollution and foul smells, infertility, and uncontrollable sexuality and promiscuity. Such a condition and the anticipated behavior will only disgrace the family and wreak havoc upon the entire clan. FGM is used by the male dominated, patriarchal society to repress women's status and sexuality, but women are key players in continuing the tradition. FGM is among the most protected cultural practices in Africa. The author considers FGM as a human rights issue, action against FGM, the Inter-Africa Committee on Traditional Practices affecting the Health of Women and Children, youth organizations involved in combatting FGM, types of FGM, health problems arising from FGM, and reasons for the practice of FGM.

336.
DOCUMENT NUMBER: IND/8030241 ; PIP/105851
AUTHOR: Morris L
TITLE: Sexual behavior of young adults in Latin America.

There are currently 82 million persons aged 15-24 living in Latin America and the Caribbean. The number of people in this age group will grow to 128 million by 2020. Analysis of survey and interview data from Latin America indicates the existence of high fertility, unintended pregnancies, and sexually transmitted diseases among teens and young adults in the region. Most sexually active young adults for whom data are available report a low frequency of sexual activity, generally with one partner. Such a low frequency and sporadic nature of sexual activity may contribute to the inconsistent use of contraception. While the most commonly used method at first intercourse in many areas was rhythm, less than 31% of female respondents in those countries could identify the most fertile period during the menstrual cycle. Less than 26% of young males could identify the period of the menstrual cycle in which a woman is most likely to conceive. The combination of sexual experience at an early age and such lack of knowledge concerning reproductive health and contraception points to the need for effective sex education programs at the primary level in school and better surveillance data on youth risk behaviors.

366.
DOCUMENT NUMBER: PIP/105564
AUTHOR: Palma I ; Quilodran C
TITLE: Adolescent pregnancy in Chile today: from marriage to abortion.

Births to female adolescents comprise almost 13% of total births in Chile each year, for a total of approximately 38,000 live births to adolescent girls annually in the country. Girls in contemporary Chilean society have a range of possible options if they become pregnant. They may get married, live with their partner outside of marriage, be a single mother, give their child up for adoption, or abort the fetus. Although this latter option is illegal in Chile, research indicates that there are 130,000-150,000 clandestine abortions in the country per year. One-third of abortions produce complications requiring hospitalization. The proportion of women under age 24 hospitalized for abortion-related complications increased from 36% of the total in 1970 to almost 49% in 1985. The authors investigated the consequences of each option pregnant girls have from working class strata in Santiago. Findings are based upon group discussions with 85 young mothers and interviews with two young women who had opted for abortion and two who had given their babies for adoption. Participants were aged 10-19 years. Each option following adolescent pregnancy has risks, obstacles, and challenges requiring a significant degree of sacrifice. The girls fear the loss of their future, of self-esteem, and of the affection of their partners, parents, and friends. The girls also fear that their child will ultimately reject them when they learn of their mother's premarital pregnancy. Young mothers have their rights curtailed and their access to work and school restricted or denied.

378.
DOCUMENT NUMBER: PIP/067538
AUTHOR: Pick de Weiss S ; Diaz Loving R ; Andrade Palos P ; David HP
TITLE: Effect of sex education on the sexual and contraceptive practices of female teenagers in Mexico City.

After reviewing the literature on the relationship between sex education and sexual and contraceptive behavior, the National Research Council (1987) recently concluded that the existing evaluation of the effects of sex education on sexual and contraceptive practice is helpful but not sufficient. 1 possible explanation for the different results obtained are the diverse sociodemographic characteristics of the sample(s) of teens under consideration. Another aspect which might account for the differences seen in the literature focuses on the areas covered in the course. In Mexico, no studies have been undertaken which deal with the relationship between sex education and sexual and contraceptive behaviors. A study carried out with 392 adolescent females ages 16-17 of lower and middle lower socioeconomic status showed that merely attending a sex education course did not affect the initiation or continuation of sexual activity, contraceptive behavior, or even the perception of accessibility to contraception. Providing information on sexuality, partner relationships, and where contraception can be obtained does not appear to have any effect on sexual activity. Receiving information on pregnancy prevention and obtaining contraceptives was found to be related to contraceptive use. Although less dramatic, information about partner relationships and sexuality produced increases in contraceptive use. (author's modified)

391.
DOCUMENT NUMBER: PIP/096610
CORPORATE NAME: Population Council
TITLE: Family planning and gender issues among adolescents. Draft.

Gender bias can start before birth and extend throughout the life cycle. It pervades most aspects of life from nutrition received, education attained, and level of domestic responsibilities to sexuality. Adolescent boys, for example, are taught to be sexually aggressive while adolescent girls are taught to send a message of passive sexual submission and, at the same time, to resist male advances. The consequences of adolescent sexual activity are especially severe for girls; the prevalence of adolescent abortion has increased along with rates of sexually transmitted diseases (STDs) and HIV infection. While rates of female adolescent sexual activity are high, there is evidence that the much of this activity is unwelcome by the girls. Studies show that adolescents, especially younger girls, are less likely than older women to use contraceptives. Adolescent pregnancy is still stigmatized and causes many young girls to leave school despite the perceived benefits of motherhood. Unwanted pregnancies result in unsafe abortions which are a leading cause of maternal deaths in teenagers. Unwanted sex is generally also unplanned, and many girls have little or no sex education and lack the negotiation skills necessary to use non-systemic contraception, yet they fear the side effects of hormonal contraception or IUDs. Young women are particularly susceptible to STDs and HIV infection which spreads more easily from men to women than vice versa. To incorporate adolescent issues and gender sensitization concerns into their work, family planning and reproductive health professionals can 1) offer agency-sponsored recreational activities to allow girls to gain support, friendship, social alternatives to sexual activity, and information; 2) engage the community at all levels (parents, teachers, leaders, and young people) to address harmful gender-related practices and seek appropriate responses; 3) encourage males of all ages to become involved in education, outreach, and clinical services for boys; 4) develop model programs with a holistic approach to reproductive health to address sexuality, STDs, HIV, nutrition, and other issues; 5) provide sex education which pays specific attention to the needs of girls as compared to boys; 6) educate young women about their bodies and their fertility cycles; and 7) provide boys with information about male and female sexuality and opportunities to explore the issues of sexuality. Research needs include documenting 1) the outcomes of specific interventions; 2) how gender affects sexual and contraceptive behavior and attitudes in specific settings; 3) the gender ideology of girls and boys and how this relates to unwanted sex, contraceptive use, unwanted pregnancy, STDs, condom use, and sexual performance pressures; and 4) the association of unwanted early pregnancy and child abuse. Particular attention should be paid to girls aged 12-16 years because they are particularly neglected, virtually all pregnancies occurring in this group are unwanted, and avoiding pregnancies in this group has a larger demographic impact than avoiding pregnancies among older girls.

397.
DOCUMENT NUMBER: CPFH/25453cr989
AUTHOR: Prada E ; Singh S ; Wulf D
TRANSLIT/VERNAC TITLE: Adolescentes de hoy, padres del manana, ColombiaTITLE: [Adolescents of today, parents of tomorrow, Colombia]
GENERAL NOTES: Summary of the book "Adolescentes de hoy, padres del manana", written by Elena Prada, Susheela Singh y Deidre Wulf. Published by the Alan Guttmacher Institute, 1988

In 1988 the Alan Guttmacher Institute funded a project on adolescent family patterns in Colombia, Brazil and Peru. Data was collected on demographic characteristics of the population, literacy levels, education, marital patterns, consensual unions, knowledge and practice of contraception, and patterns of fertility for those 10-19, with emphasis on those 15-19. Although the term adolescent refers to those 10-19, those 20-24 are also included in the analysis because they recently left adolescence and now represent an older generation. This article only focuses on data from Colombia and is divided into 2 parts: part 1 examines the interrelationship of adolescence with early marriage, sexual unions, adolescent pregnancies, contraception and abortion. Part 2 concentrates on the roles of adolescent mothers. 1/3 of the population are under 15. In 1985 there were 6.5 million and by the year 2000 there will be 7.8 million. 1 out of 10 urban Colombians are literate, compared to 1 out of 5 rural. Temporary relationships are more common with women than men. In 1985 4% of men 15-19 had ever been in a relationship as against 15% of women in the same age category. 1/2 of Colombian women had their 1st sexual relations before 20 and 50% of them did not result in marriage. 1986 93% of women between 15-19 knew about 1 contraceptive method. Demographic Surveys in 1976 demonstrated that 30% of the women 15-19 were pregnant, with 27% using a contraceptive and 43% not using any. In 1986 the % of pregnant women rose to 34% (urban areas rose from 24-33% and rural areas decreased from 38 to 35%). A large % of adolescents have their 1st child before marriage and many get pregnant during their 1st sexual encounter. In 1986 20% were unwed mothers, while 12% of adolescents married in their 2nd or 3rd months of pregnancy. Studies in Colombia demonstrate that infant mortality rates are higher among adolescents than those women delivering at older ages.

404.
DOCUMENT NUMBER: PIP/107791
AUTHOR: Raffaelli M ; Siqueira E ; Payne-Merritt A ; Campos R ; Ude W ; Greco M ; Greco D ; Ruff A ; Halsey N
TITLE: HIV-related knowledge and risk behaviors of street youth in Belo Horizonte, Brazil.

Individual interviews were conducted with 379 youth who work and/or live on the streets of a large Brazilian city to assess HIV-related knowledge, sources of information, risk behaviors, and prevention beliefs and strategies. Respondents demonstrated high levels of factual knowledge about HIV transmission (84% correct) coupled with high levels of misconceptions about casual transmission (53% correct) and intermediate levels of knowledge about prevention (64% correct). Only 54% of the respondents had heard about AIDS recently, and 37.5% said they talked to someone about AIDS. The most common sources of information about HIV/AIDS were the mass-media and friends. Over half the sample reported taking precautions to reduce their risk of HIV infection; however, the proportion of youth taking effective precautions was low. Among the 247 youth (65% of the sample) who had initiated sexual activity, lifetime condom use was reported by 18%, and condom use at last intercourse by 10%. Youth with higher levels of knowledge were more likely to report behavior changes to avoid HIV infection. These findings underscore the urgent need for prevention programs tailored to street youth in developing countries. (author's)

424.
DOCUMENT NUMBER: PIP/066993
AUTHOR: Sadik N
TITLE: Population policies and programmes: lessons learned from two decades of experience.

This publication contains an UNFPA assessment of the accomplishments of population activities over the last 20 years. The world's leading multilateral population agency, UNFPA decided to conduct the study in order to identify obstacles to such programs, acquire forward-looking strategies, and facilitate interagency cooperation. The 1st section examines 3 categories of population activities: 1) population data, policy, and research; 2) maternal and child health, and family planning; 3) and information, education, and communication. This section also recognized 9 key issues that affect the success of population programs: political commitment, national and international coordination, the role of non-governmental organizations (NGOs) and the private sector, institutionalization, the role of women and gender considerations, research, training, monitoring and evaluation, and the mobilization of resources at the national and international level. The 2nd section of the publication discusses population policies and programs in the following regions: sub-Saharan Africa, the Arab States, Asia and the Pacific, and Latin America and the Caribbean . Finally, the 3rd section provides and agenda for the future, discussing the significance of international efforts in the field of population, as well as pointing out the programmatic implications at the national and international levels. 2 annexes provide demographic and socioeconomic data for 142 countries, as well as the government perceptions of demographic characteristics for individual countries.

440.
DOCUMENT NUMBER: IND/8031381 ; PIP/118753
AUTHOR: Senderowitz J
TITLE: Adolescent health: reassessing the passage to adulthood.

"This paper reviews current data on adolescent health, with an emphasis on sexual and reproductive activity. It assesses, by region, trends in sexual knowledge, contraceptive use, marriage, fertility, and sexually transmitted diseases, including HIV. It also looks at related issues of sexual abuse and genital mutilation as well as nutritional needs and health problems stemming primarily from risk-taking behavior." The geographical focus is on developing countries. (EXCERPT)

441.
DOCUMENT NUMBER: PIP/029591
AUTHOR: Senderowitz J ; Paxman JM
TITLE: Adolescent fertility: worldwide concerns.

There is growing concern over the adverse health, social, economic, and demographic effects of adolescent fertility. Morbidity and mortality rates ar significantly higher for teenage mothers and their infants, and early initiation of childbearing generally means truncated education, lower future family income, and larger completed family size. Adolescent fertility rates, which largely reflect marriage patterns, range from 4/1000 in Mauritania; in sub-Saharan Africa, virtually all rates are over 100. In most countries, adolescent fertility rates are declining due to rising age at marriage, increased educational and economic opportunities for young women, changes in social customs, increased use of contraception, and access to abortion. However, even if fertility rates were to decline dramatically among adolescent women in developing countries, their sheer numbers imply that their fertility will have a major impact on world population growth in the years ahead. The number of women in the world ages 15-19 years is expected to increase from 245 million in 1985 to over 320 million in the years 2020; 82% of these women live in developing countries. As a result of more and earlier premarital sexual activity, fostered by the lengthening gap between puberty and marriage, diminished parental and social controls, and increasing peer and media pressure to be sexually active, abortion and out-of-wedlock childbearing are increasing among teenagers in many developed and rapidly urbanizing developing countries. Laws and policies regarding sex education in the schools and access to family planning services by adolescents can either inhibit or support efforts to reduce adolescent fertility. Since contraceptive use is often sporadic and ineffective among adolescents, family planning services are crucial. Such programs should aim to reduce adolescents' dependence on abortion through preventive measures and increase awareness of the benefits of delayed sexual activity. Similarly, sex education should seek to provide a basis for intelligent, informed decision making. Programs tailored to reach teenagers in schools, recreational centers, and the workplace have particular potential.

450.
DOCUMENT NUMBER: PIP/064992
AUTHOR: Singh S ; Wulf D
TITLE: Today's adolescents, tomorrow's parents: a portrait of the Americas.

The report presents a descriptive overview of teenage childbearing based on data from the Demographic and Health Surveys in Brazil. Colombia, and Peru as well as information from the Dominican Republic, Ecuador, El Salvador, Guatemala, Mexico, and Trinidad and Tobago with comparisons to the US and Canada. Chapters include topics on education, employment, marriage, consensual norms and sexual activity, childbearing, and consequences of teenage childbearing. In general, adolescents aged 10-19 have higher employment levels in urban areas. As many as 50% of all women have married or started a sexual relationship before age 20, and sexual relationships before age 20 are more common in rural areas. Better education is related to a lower likelihood of having had a sexual relationship before age 20. Knowledge of contraception varies widely, but most have knowledge of oral contraceptives. Contraception is higher in urban areas and in people with some secondary schooling. Guatemala and Peru have the greatest number of married women 15-19 not using contraceptives and not desiring a child soon. Rural fertility rates are higher than urban. The proportion of women with children before age 20 is similar among Latin American and Caribbean countries. Many teen pregnancies, particularly in the US are unplanned and unwanted.

452.
DOCUMENT NUMBER: PIP/122867
AUTHOR: Slack AT
TITLE: Female circumcision: a critical appraisal.

The introductory section of this article on female genital mutilation (FGM) briefly describes the historical and geographic extent of FGM and the main arguments supporting and rejecting it. The second section describes the four basic types of FGM as well as the conditions under which it occurs and takes a closer look at its origins. The third section examines the rationales presented for continuing FGM, including achieving sexual control over females, religious dictates, reproductive myths, and tradition. The fourth section counters these arguments by relaying the effects of FGM on health (immediate and short-term complications, long-term complications, and psychological trauma) and on female sexuality, by debunking attempts to assign religious significance to the practice, and by exposing the arguments used to support the practice as myths arising from misinformation rather than reality. The fifth section reviews the occurrence of FGM in Western culture, and the sixth section considers arguments that pit claims of cultural self-determination against human rights. The seventh section makes a distinction between voluntary and involuntary participation in an act of cultural self-determination, and the eighth section argues for the universal applicability of human rights principles. The article concludes with a review of measures against FGM, including legislation, religious education, health education, and consideration of the example of Chinese foot-binding. It considers the prospects for change arising from international efforts, health education, the influence of role models, legislation, and a multidisciplinary approach.

459.
DOCUMENT NUMBER: PIP/117285
AUTHOR: Stewart L ; Eckert E
TITLE: Indicators for reproductive health program evaluation. Final report of the Subcommittee on Adolescent Reproductive Health Services.

This report presents indicators developed by the Reproductive Health Indicators Working Group for evaluating interventions aimed at improving adolescent reproductive health services. A short list of key indicators includes the following: existence of government policies, programs, or laws favorable to adolescent reproductive health; number/percentage of providers who successfully complete training programs on adolescent reproductive health services; number of facilities serving adolescents located within a fixed distance or travel time of a given location; total number of contacts with adolescents; percentage of participants competent in communication with adolescents on reproductive health issues; percentage of adolescents who know of at least one source of information and/or services for sexual and reproductive health; adolescents' knowledge of reproductive health; percentage of adolescents who used protection at first/most recent intercourse; adolescent contraceptive user and/or non-user characteristics; proportion of births to adolescent women that are wanted. Separately printed chapters present indicators for evaluating reproductive health interventions in the areas of safe pregnancy, sexually transmitted diseases/human immunodeficiency virus, women's nutrition, and breast feeding.

466.
DOCUMENT NUMBER: IND/8026836
AUTHOR: Stupp P ; Monteith R ; Cuadra Garcia R ; Whittle L
TRANSLIT/VERNAC TITLE: Encuesta sobre Salud Familiar Nicaragua 92-93. Informe final.
TITLE: [Nicaraguan Family Health Survey, 1992-1993. Final results]

This is the final report of a survey undertaken in Nicaragua in 1992 and 1993 on demographic trends, family planning, and maternal and child health. The survey includes some 9,200 households, of which about one-third are in Managua, one-third in other urban areas, and one-third in rural areas. Chapters are included on fertility, family planning, women in need of family planning, the use and potential for use of sexual sterilization, family planning preferences, attitudes, infant mortality, the use of maternal and child health services, breast-feeding and infant nutrition, reproductive health, use of health services, and knowledge of AIDS.

476.
DOCUMENT NUMBER: PIP/108498
AUTHOR: Toubia N
TITLE: Female circumcision as a public health issue.

Female circumcision is practiced in 26 African countries, and it is estimated that at least 100 million women are circumcised. The mildest form is clitoridectomy and the more severe type is infibulation. Girls are commonly circumcised between the ages of 4 and 10 years. Since the operator is usually a nonprofessional without surgical experience, complications are common: hemorrhage and severe pain that can even result in shock and death. The most common long-term complication is the formation of dermoid cysts in the line of the scar. Childbirth adds other risks for infibulated women and vesicovaginal fistula is often the result. The attendant urinary incontinence leads to ostracism of these women. In sum, female circumcision is a major contributor to childhood and maternal mortality and morbidity in communities with poor health services. The physical complications add to the psychological trauma: many infibulated women have a syndrome of chronic anxiety and depression arising from their condition, intractable dysmenorrhea, and the fear of infertility. The psychological sequelae of immigrant women who live in societies where such practice is condemned is even worse and may need professional counseling to address their sexual identity and cultural identification. Tightly infibulated women require clinical intervention for deinfibulation in order to preclude serious maternal and fetal complications during childbirth. Reinfibulation is medically harmful and even though some women request it, health professionals who comply are ethically reprehensible. In Sweden a 1982 law makes all forms of female circumcision illegal, as does a law that was passed in the United Kingdom in 1985. In France several cases were brought against parents under child abuse laws for circumcising or attempting to circumcise their French-born daughters. In the United States a 1993 bill drafted by the Congressional Women's Caucus would make the practice illegal and fund a program to assist immigrant communities to deal with the problem.

477.
DOCUMENT NUMBER: PIP/097837
AUTHOR: Toubia N
TITLE: Female genital mutilation: a call for global action.

Each year at least 2 million girls face the risk of genital mutilation, most of whom are between 2 and 8 years old. About 85-114 million females worldwide have mutilated genitalia. Most of these females reside in Africa. They encounter pain, trauma, and often, physical complications (e.g., bleeding, infections, and death). Female genital mutilation (FGM) consists of clitoridectomy (partial or total removal of the clitoris and/or the labia minora) or infibulation (total removal of the clitoris, partial or total removal of the labia minora, and incisions in the labia majora). FGM is a cultural, not religious, tradition which is used to prepare girls for womanhood. Muslims, Christians, some animists, and one Jewish sect practice FGM, but none of these religions require FGM. It is used to perpetuate women's second-class status. FGM enhances the sexual pleasure of men while genitally mutilated women sense little or no sexual pleasure. This denial of sexual pleasure can have psychological effects on women. These women therefore become sexual objects and reproductive vehicles for men. The FGM practitioners vary by area and include traditional birth attendants, female laypeople, physicians and other trained health personnel, and women leaders. African women created the Inter-African Committee Against Traditional Practices Affecting the Health of Women and Children in 1984, which serves as the basis for global action against FGM. African immigrants in developed countries have taken the practice of FGM with them. Women in these countries have brought FGM to the fore and are pressing for laws against it. Protection from physical and sexual abuse, such as FGM, is a child's right. Information on prevalence, physical and psychological effects, and religious requirements are needed to take action against FGM. Legal remedies include international action and national law. Each country's mass communication systems and popular culture should be engaged in spreading information about FGM and in generating discussions on FGM.

488.
DOCUMENT NUMBER: IND/8030377 ; PIP/104713
CORPORATE NAME: United Nations. Department for Economic and Social Information and Policy Analysis. Population Division
TITLE: The sex and age distribution of the world populations. The 1994 revision.
GENERAL NOTES: Publication order number E.95.XIII.2

The population projections included in this UN volume were based on the 1994 revisions. Projections and estimates were given for national populations and regions. Sex and age distributions were provided for the period 1950-90 and projected figures were provided for 1995-2050. The projections included high, medium, and low fertility variants. Countries were included if their population exceeded 150,000. Smaller countries were included in regional totals only. A full description of methodology and projection assumptions was given in a prior publication, "World Population Prospects: The 1994 Revision." Estimates were derived from available national data and adjusted for deficiencies and inconsistencies. The sex and age structure was set for the base year of 1990 and data was consistent with previous censuses and surveys and past trends in fertility, mortality, and migration.

489.
DOCUMENT NUMBER: PIP/052642 ; IND/8010122
CORPORATE NAME: United Nations. Department of International Economic and Social Affairs
TITLE: Adolescent reproductive behaviour, evidence from developed countries, Vol. 1.

Adolescent reproductive behavior as evidenced in developed countries comprised the 1st volume of the United Nations study on adolescent reproductive behavior. The study is broken into 4 chapters on levels and trends of adolescent birth rates, pregnancy and abortion, sexual exposure, and contraceptive use. Birth rate trends showed a general rise from 1950-70 (except in Japan, Eastern Europe, and the USSR) as women were viewed with earlier ages of maturity and given increased autonomy as traditional moral teachings were relaxed. Accessibility to contraception and abortions from 1970 to the present has lowered adolescent birth rates. The pregnancy rate was determined as the number of births and abortions per year and therefore includes miscarriages and still births from its count. Sexual exposure was the hardest category to quantitate among 15-19 years olds. A combination of marriage levels, dual sex/cohabitation levels, and projections of premarital sex from surveys were used, but in many countries adequate surveys could not be found. Teenagers are becoming sexually active at increasingly younger ages. Contraceptive prevalence was the crucial factor mediating sexual activity rates and pregnancy rates. The study documents available information to adolescents, type of contraception used for the 1st time and the subsequent preference. The most effective forms of contraception were used by married adolescents and ineffective contraceptive methods were mainly used by single adolescents. Adolescent birth rates for the mid 1980's gave a wide range from Japan at 4 births/1000 teenage girls to 78 births/1000 girls in Bulgaria, but most northern and western European countries had rates from 10-25 births/1000 girls. Pregnancy rates have declined over the past 20 years except in the US where they have stabilized at a high 98/1000 women ages 15-19 years. Abortion rates of 44/1000 in the US in contrast to Europe's 20/1000 explains why the US does not have a drastically higher adolescent birth rate. Teenage contraception prevalence rates were considerably higher among northern and western European countries when compared with the US. Long term trends on adolescent birth rates were difficult to assess due to the lack of data or the lack of trends for abortion, sexual exposure, and contraceptive prevalence. One trend that was documented was the decreased usage of marriage to legitimize an unwanted pregnancy since the 1970's. Availability of abortions and contraceptive methods have replaced 'shot gun' weddings. Abortion rates have stabilized at high levels in the developed countries suggesting that the liberalization of contraception laws and education policies have not been effective. There were no central family planning counsels coordinating the efforts to teach the adolescents and sway their already lackadaisical attitude.

490.
DOCUMENT NUMBER: PIP/063220
CORPORATE NAME: United Nations. Department of International Economic and Social Affairs. Population Division
TITLE: Adolescent reproductive behaviour, evidence from developing countries, vol. II.

This report on adolescent pregnancy and sexual behavior (APSB) is a response to the World Population Conference in 1984 for governments to be informed on all aspects of adolescent reproductive behavior. This study was done in 2 volumes: the 1st one reviewed the situation in developed countries, while this 2nd volume reviews APSB in developing countries. Adolescence is defined as "the state or process of growing up," or "the period of life from puberty to maturity." The study uses ages 13-19 to define the period of adolescence. The various issues highlighted in this report are: 1) levels and trends in adolescent fertility; 2) sexual exposure; 3) contraceptive use; 4) health consequences of early childbearing and 5) summary and conclusions. Due to the lack of data on APSB a global review was done on as many countries as possible, drawing information from censuses, surveys and vital registrations. The framework of analysis is one in which adolescent birth rates are perceived as consequences of interacting factors such as childbearing and contraceptive use. Childbearing rates vary between countries: in 14 out of 39 countries in Africa teen-age pregnancies accounted for 150 births per 1000 women; while fewer than 50 births per 1000 women were found in North Africa, East and Southeastern Asia, and in the non-Arab countries of Western Asia. Adolescent fertility rates have remained unchanged in Sub-Saharan Africa (SSA), East Asia, and Southeastern Asia since 1970. Fertility rates began to decline in the 1980's in Guatemala, Honduras, Jamaica, Mexico and Panama. A critical factor influencing the relation between sexual exposure and pregnancy is contraceptive use. Contraceptive prevalence rates are very low among married adolescents in SSA and Asia. Among unmarried teenagers in Latin America and the Caribbean, prevalency rates ranged from 20-70%. The high incidence of maternal morbidity and mortality for those under 20, and the lack of educational opportunities to learn about sexuality are major problems.

517.
DOCUMENT NUMBER: PIP/074614 ; IND/8021692
AUTHOR: Westoff CF
TITLE: Age at marriage, age at first birth, and fertility in Africa.

The social and proximate determinants of fertility, age at first marriage and age at first birth, are examined in terms of the nature and extent of impact for African countries using World Fertility and Demographic Health Survey data. A fertility model is constructed. Countries are grouped as those with large increases in age of marriage over the past 20-30 years: Egypt, Morocco, Tunisia, and Sudan. The 2nd group with a beginning trend to lower ages of marriage includes Kenya, Mauritania, Nigeria, Senegal, Togo, Uganda, and Zimbabwe, and perhaps Benin, Burundi, and Ghana. Countries with no evidence of a trend toward later age at marriage and first birth are Cameroon, Ivory Coast, and Lesotho. In Liberia, marriage age is increasing but first births are decreasing. Botswana and Mali are also included. Analysis includes 126 regions. The trend is for regions with late marriage to have more women with some education, less child mortality, and women's preferences for fewer children, which accounts for 70% of the variance of age at marriage. Causal path analysis is used to determine the direct and indirect effects. Total fertility rate (TFR) is the fertility measure. The results show that 70% of the reproductive intention on fertility is mediated through contraceptive practice. African countries show 43% of TFR is explained by reproductive intentions and contraceptive prevalence (CP). 64% of the variance in CP is explained by women's desire for no more children and the age at first marriage. Educational variables (2) with low intercorrelations have direct effects on the proportion of women who desire no more children and indirect effects through age at first marriage and at first birth. These 4 variables account for 56% of the variance in intentions. The rural percentage adds very little in explanatory power. Only 29% of the variance in age at marriage is explained by rural residence and the 2 education measures. Polygamy, religion, education, and age at marriage are analyzed and findings are similar to those of Lesthaeghe. In the final model, 66% of the variance in TFR is explained by a direct path with the proportion rural and with no education, age at first birth, and CP, which is influenced primarily by the percentage of women desiring no more children and age at marriage. Reproductive intentions are determined by education, educational change, and age at first birth. Age at first birth is related to age at first marriage, which is explained by the 3 background variables and 29% of the variance. Child mortality and postpartum amenorrhea are not accounted for. Duration of breast feeding is, however, included and shows a spurious correlation. Changes in reproductive preferences and changes in education explain 19% and 27% of the variance in the changes in age at marriage and age at first birth. Changes in TFR are attributed to contraceptive usage which is 42% of the variance, but the sample includes only 50 regions.

519.
DOCUMENT NUMBER: PIP/094776
AUTHOR: Westoff CF ; Blanc AK ; Nyblade L
TITLE: Marriage and entry into parenthood.

The purpose of this cross country comparison was to describe differences and similarities in marital status, marital stability, never married populations, and age at first marriage and first birth. This information is useful in policy formulation at the interval level and for identifying groups with special needs. Data was obtained from the Demographic and Health Surveys. Ample numbers of charts and tables supplement the text, such as marital status by 5-year age groups for 37 countries, marital status by urban and rural residence and country, extent of polygynous unions by country and 5-year age groups, marital stability by level of education, and median age at first marriage in 5-year age groups and country. The conclusions were that in 37 developing countries the average age of marriage occurred before the age of 20 years with the birth of the first child shortly thereafter. In most countries women married only once; in the Dominican Republic, Ghana, and Liberia women married more than once by a factor of 1 to 3. Marriage age tended to be younger for rural women and women with less education. Polygynous unions were still common in West Africa. Childbearing occurred regardless of marriage in many places: there were 20% of never married women with a birth in 7 countries. The trend in many countries is for younger cohorts to marry later and have their first birth later than older cohorts: in North Africa; parts of Sub-Saharan Africa, excluding Burundi, Mali, and Niger; the Asian countries of Indonesia, Sri Lanka, and Thailand; and the South American countries of Colombia, the Dominican Republic, Peru, and Trinidad and Tobago. There were clear cases of the inadequacies of measuring marriage patterns for Botswana and Namibia, countries where there are a range of sexual unions. More meaningful questions pertained to patterns of sexual behavior and age at initiation of sexual relations. Differences in the proportions never married explain the variation by country to the proportion in union. Differences also reflected age at first marriage.

524
DOCUMENT NUMBER: PIP/102559
AUTHOR: Whittle L ; Gomez VM ; Morris L
TRANSLIT/VERNAC TITLE: Comportamiento sexual de los costarricenses menores de 25 anos: Encuesta Nacional de Salud Reproductiva de Adultos Jovenes.
TITLE: [Sexual behavior of Costa Ricans younger than 25 years old: National Survey of Reproductive Health of Young Adults]

The principal results are presented of the 1991 National Survey of Reproductive Health of Young Adults regarding first intercourse and subsequent sexual behavior of Costa Rican youth under 25. The average age at first intercourse was 15.4 for men and 16.9 for women. Among male and female respondents, 41.9% and 30.1% 15-19 years old, 79.7% and 71.5% 20-24 years, and 58.6% and 49.4% overall had sexual experience. 54.9% of the men had their first sexual experience with a female friend, 26.3% with a girlfriend or fiancee, 11.5% with a prostitute, and 2.5% with a wife or partner. 55.8% of the women had their first sexual experience with a boyfriend or fiance and 37.4% with a husband or partner. Geographic variations were observed in the age at first intercourse. 56.8% of male respondents and 30.2% of female respondents had had premarital sexual experience. Comparison of survey results with data from the 1986 National Survey of Fertility and Health suggest that no great changes have occurred in patterns of premarital sexual behavior, although the proportion of unmarried girls 15-17 years old who were sexually active increased from 9.1% in 1986 to 15.8% in 1991. Women were 16.5 and their partners were 21.7 years old on average at the first premarital sexual encounter. Men were 15.3 years old and their partners were 18.1 on average. Sexual experiences of unmarried men were usually sporadic. 22.6% of males but 47.2% of females had their second sexual experience within one month of the first. The first sexual experience for males and females respectively occurred at home for 9.2% and 27.5% and at the partner's home for 36.2% and 23.9%. 31.5% of rural, 33.2% of urban, and 32.3% of all males used contraception at the first premarital intercourse, as did 16.9% of rural, 28.7% of urban, and 22.2% of all women. Condoms were used at the first premarital intercourse by 71.7% of males and 49.1% of females who used contraception. Lack of knowledge and the unanticipated nature of the encounter were the main reasons given for not using contraception.

554.
DOCUMENT NUMBER: PIP/079526
AUTHOR: Xenos P ; Gultiano SA
TITLE: Trends in female and male age at marriage and celibacy in Asia.

Trends in the mean singulate ages at entrance to marriage (SMAM) for males and females in Asia are examined for 17 Asian countries for the 20th century through the early 1980s. Data were obtained from censuses and some national surveys for 110 observations by country and year. A description of the SMAM measure is provided. The female mean age at marriage has risen by 4 or more years for all countries except the People's Republic of China. Male trends are contrasted, i.e., males rise in SMAM is less than females and their pattern is less regular. There are downturns that have been associated with short-term demographic structural changes, e.g., as in the large in-migration of males in Hong Kong and the resulting high sex ratios and the consequence: declining male age at marriage. The rate of change in marriage timing is another gender difference. Males have a less rapid pace of change