Advancing Sexual and Reproductive Health and Rights
 
International Family Planning Perspectives
Volume 30, Number 3, September 2004
UPDATE


MATERNAL MORTALITY AMONG TEENAGERS

Worldwide, 70,000 women aged 15–19 die each year of pregnancy- and childbirth-related causes, according to a report published by the international charity Save the Children.1 In all, more than 13 million adolescent females give birth each year—nine in 10 of them in developing countries, where one in three women give birth before their 20th birthday. As a consequence, the main cause of death among women aged 15–19 in developing countries is complications arising from pregnancy and childbirth. Women in this age-group are twice as likely as older women to die of such complications. Younger adolescents face an even greater risk of death: In Bangladesh, for example, the maternal mortality rate among 10–14-year-olds is five times that among 20–24-year-olds. Sub-Saharan Africa has the highest rates of teenage maternal mortality in the world, as well as the highest rates of early marriage and early motherhood. Noting that limited schooling can be both a cause and an effect of teenage pregnancy and childbearing, the report calls for "specific interventions and investments to encourage girls to stay in school and delay motherhood until they are both emotionally and physically ready."

1. Save the Children, 2004, Childeren Having Children: State of the world's Mothers <http://www.savethechildren.org/mothers/report_2004/index.asp>, accessed June 8, 2004.

HALF OF NEW HIV INFECTIONS ARE AMONG YOUTH

In 2003, roughly five million people became infected with HIV, about half of whom were aged 15–24.1 According to the latest estimates from the Joint United Nations Programme on HIV/AIDS, 2003 saw the largest number of new infections in any year since the virus was first identified, bringing the total number of people living with HIV to 38 million. The highest infection rates in 2003 were in Eastern Europe and Asia. For example, some one million new infections occurred in Asia, where 7.4 million people now have HIV; 5.1 million live in India alone. Women now account for roughly half of all HIV-positive people. In Sub-Saharan Africa—still the region with the highest HIV prevalence, and home to two-thirds of the world's infected population—57% of infected adults and 75% of infected young people are female. Since the start of the epidemic, more than 20 million people have died of AIDS, three million of them in 2003.

1. Joint United Nations Programme on HIV/AIDS, 2004 Report on the Global AIDS Epidemic, 2004, <http://www.unaids.org/bangkok2004/report.html>, accessed July 7, 2004.

PREGNANCY OUTCOMES AFTER ORAL TOBACCO USE

Women who use smokeless tobacco products during pregnancy have an increased likelihood of having a low-birth-weight, preterm baby, according to a population-based study conducted in Mumbai, India, between June and November 2002.1 Of 1,217 pregnant women interviewed, roughly 17% had used such a product at least once a day for the previous six months—mainly as a powder or a chewable mixture; 96% of women were followed until delivery. On average, deliveries in the group using tobacco were 6.2 days earlier and preterm deliveries 11.6 days earlier than those in the group not using tobacco. Furthermore, infants of women who reported tobacco use had a lower birth weight than those of women who did not (2,672 g vs. 2,777 g). After adjustment for factors such as women's socioeconomic status, weight, anemia status and number of antenatal visits, the odds of delivery before 28 and 32 weeks were significantly elevated among tobacco users (odds ratios, 8.0 and 4.9, respectively), as were the odds of low birth weight (1.6). The researchers conclude that "smokeless tobacco use in pregnant women reduces birth weight and…shortens the gestational period," and they recommend that the habit "receive specific attention as part of routine prenatal care."

1. Gupta PC and Sreevidya S, Smokeless tobacco use, birth weight, and gestational age: population based, prospective cohort study of 1217 women in Mumbai, India, British Medical Journals 2004, 328(7455): 1538–1540.

MEXICAN AID PROGRAM BENEFITS CHILDREN

Low-income, rural children who participated in Progresa—a large-scale Mexican welfare program that included a nutritional component—experienced increased growth and a decreased rate of anemia by the end of a trial assessing the nutritional impact of the intervention.1 Families enrolled in the program received micronutrient-fortified food, health care, a general cash allowance and help in paying for children's education. Researchers analyzed data from a random sample of children aged 12 months or younger at study entry in 1998; these children came from 205 communities that took part in the program in 1998 and from 142 that joined one year later. Among children who were younger than six months at enrollment and living in the poorest households (those with the bottom 50% of socioeconomic status scores), the increase in height in 2000 was significantly greater if participation in the program had been two years rather than one year (26.4 cm vs. 25.3 cm), after adjustment for age and body length at study entry. The overall age-adjusted anemia rate in 1999 was lower among children who had already received the intervention for one year than among those who had not yet joined the program (44% vs. 55%).

1. Rivera JA et al., Impact of the Mexican Program for Education, Health, and Nutrition (Progresa) on rates of growth and anemia in infants and young children: a randomized effectiveness study, Journal of the American Medical Association, 2004, 291(21):2563–2570.

ANTIBIOTIC USE PROTECTS AGAINST STIs BUT NOT HIV

Prophylactic antibiotic use helps prevent some sexually transmitted infections (STIs), but not HIV-1 transmission, according to a randomized controlled trial conducted in an urban slum area of Nairobi, Kenya, between 1998 and 2002.1 Prompted by the association between STIs and HIV transmission, researchers randomly assigned the participants—HIV-negative female sex workers aged 18 or older who had lived in Nairobi for at least two years—to receive one gram of azithromycin or a placebo each month, in addition to free condoms, risk-reduction counseling and STI treatment if needed. Among the 341 women who completed the study, those who had received the antibiotic had a significantly lower risk of testing positive for gonorrhea, chlamydia or trichomoniasis than did those who had not (relative risks, 0.4–0.6). In contrast, the risk of HIV infection was similar for the two groups—some 4% of the treatment group and 3% of the placebo group contracted HIV. The researchers suggest that "the high level of care provided to all study participants may have reduced [the] power to detect a treatment effect." In addition, roughly three-quarters of women in each group were infected with herpes simplex virus type 2 (HSV-2) at enrollment, and preexisting HSV-2 infection was associated with HIV acquisition (relative risk, 6.3)—findings that, according to the researchers, "provide a strong rationale for current trials of HSV-2 suppression as an HIV-1 prevention strategy in Africa."

1. Kaul R et al., Monthly antibiotic chemoprophylaxis and incidence of sexually transmitted infections and HIV-1 infection in Kenyan sex workers, Journal of the American Medical Association, 2004, 291(21):2555–2562.

UNINTENDED PREGNANCYCOMMON IN IRAN

Unintended pregnancy among married women is high in Iran, despite the widespread use of contraceptives.1 In an analysis of data from the 2000 Iran Demographic and Health Survey, 35% of 5,427 currently married women who were pregnant classified their pregnancy as either mistimed or unwanted. Two-thirds of women with unintended pregnancies had been using a method at the time the current pregnancy occurred (72% of urban women and 63% of rural women), of whom 48% were relying on the pill, 11% on the condom, 30% on withdrawal and 12% on another method. In a multivariate logistic regression, women younger than 35 and those with any education had reduced odds of reporting that the pregnancy was unintended (odds ratios, 0.2–0.4 and 0.4–0.8, respectively). Urban residence was positively associated with unintended pregnancy (1.2), perhaps because use of withdrawal was particularly common among urban women (39%), the analysts comment. Given the findings, the researchers recommend the design of "strategies to reduce the rate of unintended pregnancies," especially by increasing the quality of contraceptive services and information.

1. Abbasi-Shavazi MJ et al., Unintended pregnancies in the Islamic Republic of Iran: levels and correlates, Asian-Pacific Population Journal, 2004, 19(1):27–38.

TANZANIAN STUDENTS NEED BETTER SEX EDUCATION

In rural Tanzania, substantial proportions of youth—more than one-half of males and one-fifth of females—attending primary school report having had sex.1 The students—5,134 males aged 14–16 and 4,149 females aged 13–15 from 121 primary schools in Mwanza—were surveyed about sexual behavior and were tested for chlamydial, gonorrheal and HIV infections; females also received a pregnancy test. Of the sexually experienced students, 33% of males and 7% of females said that first sex had occurred before age 14. Among females, 23% said that they had ever been forced to have sex, 1% reported a past pregnancy, and a similar proportion were currently pregnant. Although only 4% of males and 6% of females said they had ever used a condom, the proportions with any of the three sexually transmitted infections (STIs) were small (fewer than 1% and 2%, respectively). Roughly half of all the students had received some form of sex education in the past year; still, misperceptions about how HIV and STIs are spread were more common among these students than among those who had not received such education. The researchers conclude that despite the low STI levels, the "findings highlight the need for high-quality, innovative sexual and reproductive health education for adolescents."

1. Todd J et al., The sexual health of pupils in years 4 to 6 of primary schools in rural Tanzania, Sexually Transmitted Infections, 2004, 90(1):35–42.

IN BRIEF

•HIV-positive women in the Asia-Pacific region face much greater HIV-related discrimination than infected men, according to a report commissioned by the United Nations (UN) Office of the High Commissioner for Human Rights. The report describes examples of discrimination against HIV-positive women, and outlines practical recommendations to counteract these human rights violations. [Paxton S et al., "Oh! This One Is Infected?": Women, HIV & Human Rights in the Asia-Pacific Region, UN Office of the High Commissioner for Human Rights, 2004, <http://www.icw.org/tiki-download_file.php?fileId=42>, accessed June 14, 2004.]

•In World Population Policies 2003, the UN Population Division has updated information on national population policies in all 194 member and nonmember UN states. To obtain the report, which includes information on population growth, population age structure, fertility, mortality, spatial distribution and international migration, send an e-mail to publications@un.org.

•In its report Women of the World: Laws and Policies Affecting Their Reproductive Lives—South Asia, the Center for Reproductive Rights examines laws and policies affecting women's reproductive health in Bangladesh, India, Nepal, Pakistan and Sri Lanka. The report—a resource for those interested in advancing and protecting women's reproductive health and rights through legal advocacy, and in establishing state accountability for violations of those rights—is available at <http://www.reproductiverights.org/pub_bo_wowsa.html>.