Advancing Sexual and Reproductive Health and Rights
 
International Family Planning Perspectives
Volume 31, Number 1, March 2005
UPDATE


More Girls Than Boys Are HIV-Infected at Birth

The risk of prenatal HIV infection is greater among females than among males, according to a study conducted in Blantyre, Malawi, between April 2000 and March 2003.1 Of the 998 female newborns, 13% were found at birth to be infected with HIV—twice the proportion infected among the 966 males (6%). In addition, of those who tested negative at birth, 10% of females had become infected by age 6–8 weeks, compared with 7% of males. In multivariate analyses controlling for maternal viral load, female gender was significantly associated with an elevated risk of infection at birth (odds ratio, 2.1). The researchers comment, however, that "the biological mechanisms involved in gender differences influencing transmission" are unknown.

1. Taha TE et al., Gender differences in perinatal HIV acquisition among African infants, Pediatrics, 2005, 115(2):e167–e172.

Young Mothers Have High Risk of Adverse Outcomes

In Latin America, teenage mothers have elevated odds of experiencing adverse pregnancy and perinatal outcomes, including maternal death and early neonatal death.1 In an analysis of data collected by the Perinatal Information System database on 854,377 young women from 18 Latin American countries who had pregnancies between 1985 and 2003, women aged 19 or younger were significantly more likely than those aged 20–24 to have experienced adverse pregnancy (i.e., an operative vaginal delivery, an episiotomy or postpartum hemorrhage) and perinatal (i.e., inflammation of the endometrium following childbirth, a low-birth-weight or very low birth weight birth, a preterm or very preterm birth, or a small-for-gestational-age birth) outcomes (odds ratios, 1.1–3.8). Furthermore, compared with 20–24-year-old women, adolescents aged 15 or younger had higher odds of anemia and death (1.4 and 4.1, respectively), and of having had a child die within its first week of life (1.5). The researchers conclude that "By reducing the number of adolescent pregnancies and by providing better prenatal and obstetric care…, maternal and perinatal morbidity in the developing world could be reduced."

1. Conde-Agudelo A, Belizán JM and Lammers C, Maternal-perinatal morbidity and mortality associated with adolescent pregnancy in Latin America: cross-sectional study, American Journal of Obstetrics and Gynecology, 2005, 192(2):342–349.

Contraceptive Acceptance Low After Abortion in India

Fewer than half of Indian women who have induced abortions are willing to accept a contraceptive method following the procedure, according to a study conducted in 13 Indian states between January 1996 and February 1997.1 Of the 1,851 women who had had an induced abortion in the three years prior to their interview, 49% accepted a contraceptive method; almost half of them chose tubal sterilization, and the majority of the remaining women chose either the IUD or oral contraceptives. Acceptance of a method was significantly associated with older age and higher parity. The most common reason given by women for not accepting a method was that their "husband objected." The authors comment that women's low contraceptive acceptance rate may in part be because "abortion providers did not view contraceptive provision as their responsibility" and "services for abortion and family planning often were not available on the same day or in the same location."

1. Dhillon BS et al., Induced abortion and concurrent adoption of contraception in the rural areas of India (an ICMR Task Force study), Indian Journal of Medical Sciences, 2004, 58(11):478–484.

Malaria May Increase Risk of HIV Transmission

HIV-infected individuals experience a significant increase in the concentration of the virus in their blood during episodes of malaria, according to a study conducted in rural Malawi between February 2000 and November 2001.1 Of the initial sample of 334 men and women who, at baseline, tested positive for HIV and negative for the parasite that causes malaria, 77 had their HIV viral loads measured at baseline, and then again during and after episodes of malaria. The median concentration of viral genetic material in these participants' blood was almost twice as high during episodes of malaria as it was at baseline (168,901 vs. 96,215 copies/mL), and then fell to a concentration close to the baseline level (82,058 copies/mL) by 8–9 weeks after malaria treatment. Those who had a fever, high parasite density or both during malaria had even higher viral loads (179,072–196,098 copies/mL). In light of their findings, the researchers comment that "malaria, especially if frequent, unrecognized, inadequately treated, or untreated, might lead to sufficient elevation of viral loads in HIV-infected adults to result in increased rates of HIV transmission and disease progression."

1. Kublin JG et al., Effect of Plasmodium falciparum malaria on concentration of HIV-1 RNA in the blood of adults in ruralMalawi: a prospective cohort study, Lancet, 2005, 365(9455):233–240.

Antiherpes Therapy Needed in Syndromic Management

High rates of failure for symptom-based antibiotic treatment of genital ulcer disease may indicate a need for antiherpes therapy, according to data from a study conducted among women attending a health center in Addis Ababa, Ethiopia, between June and September 2001.1 Of the women screened for the study, 106 had clinical symptoms of STIs (87 with vaginal discharge and 19 with genital ulcer disease) and 67% were HIV-positive. The women were treated with different antibiotic regimens depending on their symptoms and risk factors. At follow-up, 30% had no improvement in their condition. In a logistic regression analysis that adjusted for HIV infection and other potentially confounding factors, having genital ulcer disease (with or without discharge) was the only factor significantly associated with increased odds of treatment failure (odds ratios, 5.1 and 4.1, respectively). The researchers note that herpes infection—which is not treatable with antibiotics—is an important cause of genital ulcer disease, which in turn increases the risk of HIV transmission. They recommend, therefore, that "antiherpes therapy should be included in syndromic management algorithms."

1. Wolday D et al., Risk factors associated with failure of syndromic treatment of sexually transmitted diseases among women seeking primary care in Addis Ababa, Sexually Transmitted Infections, 2004, 80(5):392–394.

Five Million New HIV Infections in 2004

In 2004, the number of people living with HIV rose to 39.4 million, according to estimates from UNAIDS.1 Nearly five million people acquired the virus, and the number of people living with the infection rose in every region of the world. An estimated three million AIDS-related deaths occurred in 2004, more than half a million among people younger the 15. Sub-Saharan Africa, which is home to two-thirds of all people living with HIV, continued to be the region worst affected. However, parts of Europe and Asia saw the largest percentage increases: Between 2002 and 2004, the number of people living with HIV increased by 40% in Eastern Europe/Central Asia (from 1.0 million to 1.4 million) and 50% in East Asia (from 760,000 to 1.1 million).

1. UNAIDS, AIDS Epidemic Update: December 2004, <http://www.unaids.org/ wad2004/EPI_1204_pdf_en/EpiUpdate04_en.pdf>, accessed Mar. 23, 2005.

Unmet Need Remains High in the Developing World

Use of modern contraceptive methods remains low and unmet need for family planning remains high in some of the world's poorest and most populous areas.1 According to an analysis by the Population Reference Bureau, 19% of married women aged 15–49 in the world's 49 least developed countries use a modern method. Up to one-third of married women in such countries as the Democratic Republic of Congo, Ethiopia, Pakistan and Nigeria say that they would prefer not to become pregnant but are not currently using a modern method. These high levels of unmet need are a major reason why an estimated 20% of pregnancies in developing countries end in abortion and 30–40% of births in Asia, the Middle East, Sub-Saharan Africa and Latin America are unwanted or mistimed. The authors cite "population growth, a shortage of supplies and inadequate funds" as some of the important challenges to meeting the need for family planning.

1. Population Reference Bureau, The Unfinished Agenda: Meeting the Need for Family Planning in Less Developed Countries, Washington, DC: Population Reference Bureau, 2004.

Indonesian Midwives Improve Child Nutrition

Indonesian children whose early years are spent in communities with midwives tend to be taller than other children, most likely because of improved nutrition.1 In an analysis of data from the 1993 and 1997 waves of the Indonesia Family Life Survey, children whose communities had a midwife during their first four years of life were significantly taller for their age than children whose communities had no midwife; they were also taller than children living in the same communities who were born before there was a midwife present. The benefits of exposure to midwife services were greatest for children whose mothers had no more than an elementary school education. In further analyses, children born and raised in communities with midwives were exclusively breast fed for significantly longer than children in other communities, although the overall duration of breast-feeding did not change. Children in communities with midwives were also more likely than other children to have visited a midwife for outpatient care. The researchers conclude that the presence of a midwife during children's early years has a positive effect on children's height, probably because of improvements in nutrition and greater use of outpatient care.

1. Frankenberg E, Suriastini W and Thomas D, Can expanding access to basic healthcare improve children's health status? Lessons from Indonesia's 'midwife in the village' programme, Population Studies, 2005, 59(1):5–19.

In Brief

•In their joint report Preventing Cervical Cancer Worldwide, the Population Reference Bureau and the Alliance for Cervical Cancer Prevention focus on low-cost prevention and treatment of cervical cancer in the developing world. The report is available at <http://www.prb.org/Template.cfm?Section=PRB&template=/ContentManagement/ContentDisplay.cfm&ContentID=12133>.

•In Growing Up Global: The Changing Transitions to Adulthood in Developing Countries, the National Research Council and Institute of Medicine report that young people in developing countires are spending more of their youth in school and are delaying entering the workforce, marriage and childbearing. [Lloyd CB, ed., Growing Up Global: The Changing Transitions to Adulthood in Developing Countries, Washington, DC: National Academies Press, 2005.]

•Reproductive Health and the Millenium Development Goals: The Missing Link, by Barbara Crossette, examines why no explicit commitment to the reproductive health and rights of women is included in the Millenium Development Goals—a roadmap for development by 2015. The report, commissioned by the William and Flora Hewlett Foundation, is available at <http://www.hewlett.org/Programs/Population/Publications/crossettereport.htm>.