Advancing Sexual and Reproductive Health and Rights
 
International Family Planning Perspectives
Volume 29, Number 4, December 2003
UPDATE


THE POPULATION GAP WIDENS

Although the world's population is expected to increase by 46% between 2000 and 2050, the increase in less-developed countries (excluding China) is projected at 71%, compared with 5% in more-developed countries.1 According to a report from the Population Reference Bureau, Africa remains the fastest growing region: Despite a projected population decrease of 22% in AIDS-ravaged Southern Africa, Africa's population as a whole is expected to increase by 119% by midcentury, given projected increases of 76% in Northern Africa and 124-193% in Eastern, Western and Middle Africa. In contrast, Europe's population is expected to decline by 9%, with an increase of 6% in Northern Europe more than offset by decreases of 4-18% in the remainder of the region. These extremes are driven by large differences in birthrates and population structure. In Africa, the total fertility rate (TFR) is 5.2 lifetime births per woman and 42% of the population is younger than 15, whereas Europe has a TFR of 1.4 and only 17% of its population is younger than 15.

1. Haub C, 2003 World Population Data Sheet, Washington, DC: Population Reference Bureau, 2003.

HIV CONTRIBUTES TO FERTILITY DECLINE IN ZIMBABWE

HIV infection may account for one-quarter of the fertility decline in Zimbabwe since the late 1980s, according to an analysis of data from a cross-sectional, population-based study conducted in Manicaland province between July 1998 and January 2000.1 Of 5,307 women aged 15-49 who were surveyed, roughly one-half had practiced contraception regularly during the previous three years, and one-quarter had tested positive for HIV. The estimated total fertility of the HIV-positive women was 4.11 births per woman--8.5% less than that among uninfected women (4.49). In multivariate logistic regressions limited to sexually active women, those infected with HIV had reduced odds of having given birth in the previous year (odds ratio, 0.8) and of current pregnancy (0.6). Furthermore, HIV-related subfertility was associated with reduced contraceptive use, being divorced or widowed, not having had sex in the past month and having a history of genital discharge (0.5-4.3 for symptomatic women and 0.7-4.0 for asymptomatic women), as well as with having missed two or more periods (2.6 for symptomatic women). The analysts conclude that HIV-related subfertility in Manicaland--a rural area with a relatively high contraceptive prevalence--may be mediated through divorce, widowhood, reduced coital frequency and increased amenorrhea. After extrapolating their findings to the whole country, the researchers estimate that one-quarter of the 28% national decline in total fertility during the late 1980s and 1990s could be "directly attributable to the HIV epidemic."

1. Terceira N et al., The contribution of HIV to fertility decline in rural Zimbabwe, 1985-2000, Population Studies, 2003, 57(2):149-164

VITAMIN A REDUCES EARLY INFANT MORTALITY

Giving vitamin A to low-birth-weight babies within the first two days of life reduces their risk of dying before age six months.1 Between June 1998 and March 2001, all infants born in Tamil Nadu, India, were randomized to receive either two oral doses of vitamin A (24,000 international units each) within 48 hours of birth or a placebo. The six-month mortality rate among the 5,786 infants who had received vitamin A was 22% lower than that among the 5,833 infants who had received a placebo--54 per 1,000 live births vs. 69 per 1,000 live births. However, the effect of vitamin A supplementation was limited to low-birth-weight babies: The six-month mortality rate among infants who had weighed less than 2,500 g at birth and had received vitamin A was 37% lower than the rate among infants of higher birth weight. The researchers propose that the vitamin helps newborns fight infection by stimulating the intestine and lung lining to mature, and by strengthening the immune system.

1. Rahmathullah L et al., Impact of supplementing newborn infants with vitamin A on early infant mortality: community based randomised trial in southern India, British Medical Journal, 2003, 327(7):254-257.

DOMESTIC ABUSE OF PREGNANT WOMEN IN MEXICO

Partner abuse during pregnancy is common, and its likelihood is increased if a woman or her partner has a childhood history of domestic violence, according to a survey of 914 women in the third trimester of pregnancy who attended prenatal health clinics in Morelos, Mexico, in 1998-1999.1 Some 24% of women reported that they had experienced physical, emotional or sexual abuse since becoming pregnant--a proportion similar to that reporting abuse in the year before pregnancy (25%). However, among women who had been mistreated while pregnant, the severity of emotional abuse (e.g., insults, threats and humiliation) increased after conception--perhaps, the researchers suggest, because of women's "reduced sexual availability" or the "concern about or stigma against physically injuring a pregnant woman." In multivariate analyses, abuse during pregnancy was associated with low socioeconomic status (prevalence ratio, 1.2), abuse before pregnancy (7.8), having witnessed domestic abuse during childhood (1.3) and having a partner who had been abused as a child (7.0). Furthermore, the researchers estimate that 61% of women with all four risk factors were mistreated during pregnancy. The investigators call for "interventions that reduce the use of violence by men and the violent behavior that is learned in childhood."

1. Castro R, Peek-Asa C and Rulz A, Violence against women in Mexico: a study of abuse before and during pregnancy, American Journal of Public Health, 2003, 93(7):1110-1116.

HONG KONG STUDENTS' EXPERIENCE OF MENARCHE

When asked about their first menstruation, large proportions of female students at six high schools in Hong Kong, China, reported having had negative emotional experiences.1 Of 1,573 female students who had already had their first period, 72-86% had felt annoyed, embarrassed, surprised, worried, scared or confused about their first menstruation; 34-37% had felt angry or sick. In contrast, 74% had felt more grown up, 39% more feminine and 14-23% happy, proud or excited by their experience. Nearly one-half of students had been completely unprepared for menarche, whereas only 4% had been well prepared. Regression analyses showed that negative emotional responses were predicted by poor self-esteem, inadequate preparedness, negative perceptions of menstruation and agreement with local, negative attitudes toward menstruation. On the other hand, positive emotions were linked to positive body image, adequate preparedness, perceptions of menstruation as a natural event and disagreement with local attitudes toward menstruation. The analysts conclude that "the understanding of Chinese adolescent girls' responses to menarche needs to take various psychosocial and cultural factors into account."

1. Tang CSK, Yeung DYL and Lee AM, Psychosocial correlates of emotional responses to menarche among Chinese adolescent girls, Journal of Adolescent Health, 2003, 33(3):193â??201.

MULTIPLE PARTNERSHIPS AMONG SOUTH AFRICAN MEN

Factors that predict whether men have more than one partner include perceptions about gender norms regarding sexual behavior, according to a study of sexual attitudes and practices among male attendees at sexually transmitted infection (STI) clinics in Capetown, South Africa.1 Two-thirds of the 2,233 men interviewed between November 1996 and February 1997 had had multiple partners in the past six months. More than one-half (58%) of all respondents had previously had an STI and only 35% had used a condom in the past six months. In a logistic regression analysis, having more than one partner was associated with being younger than 26, having an STI history, having negative attitudes toward condom use, believing that men cannot control their sexual desires and not believing women have the right to refuse sex. The researchers conclude that having multiple partners is linked with "male gender constructions that value sexual prowess," and urge communities in South Africa not only to understand how existing gender constructions fuel the spread of STIs but also "to develop strategies to address effectively these gender issues."

1. Meyer-Weitz A et al., Determinants of multi-partner behaviour of male patients with sexually transmitted diseases in South Africa: implications for interventions, International Journal of Men's Health, 2003, 2(2):149â??162.

HIGH RISK OF GENITAL HERPES AMONG TANZANIAN WOMEN

A substantial proportion of women aged 15-49 in urban Tanzania have herpes simplex virus type 2 (HSV-2), an infection associated with HIV infection, according to a study of 382 randomly selected women who attended three primary health care clinics in Moshi between September and December 1999.1 In all, 39% of women tested positive for antibodies to HSV-2; these women comprised 23% of 15-19-year-olds, 37% of 20-29-year-olds and 49% of 30-49-year-olds. Women who were older than 29, had a history of spontaneous abortion, had had first sex before age 18 and reported a total of two or more partners had increased odds of being infected with HSV-2 (odds ratios, 1.5-3.6). Commenting that the prevalence of HSV-2 is high among women of reproductive age in urban Tanzania--even by ages 20-29--the investigators suggest that infection occurs in the first few years of sexual debut and, hence, "young people should be targeted more by public health interventions."

1. Msuya SE et al., Seroprevalence and correlates of herpes simplex virus type 2 among urban Tanzanian women, Sexually Transmitted Diseases, 2003, 30(7):588-592.

IN BRIEF

•Africa has now begun to manufacture generic AIDS drugs. The South African company Aspen Pharmacare announced it is producing antiretrovirals containing stavudine--the generic version of Bristol-Meyers Squibb's Zerit. One month's supply will cost 20-40% less (depending on the dose) than the nongeneric drug in South Africa. [Nessman R, South African company begins production of first generic AIDS drugs in Africa, Associated Press, Aug. 7, 2003, , accessed Aug. 18, 2003.]

•The Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs and the Advocacy for Population Program have launched a Spanish-language Web site for adolescents, called Entra en Accíon (Act Now). In addition to providing information on health and sexuality, the site covers topics such as nutrition, democracy, drug and alcohol prevention, vocational training and life skills. It also includes an online counseling service and links to youth organizations. The Web site can be found at

The Emergency Contraception Website has now been translated into Arabic. The site, created by the Association of Reproductive Health Professionals, Ibis Reproductive Health and the Office of Population Research at Princeton University, is a referral service (within the United States and Canada) as well as an educational source, and it includes a searchable database of contraceptives available worldwide that can be used for emergency contraception. Users can visit the Arabic version at or through the main site at .