Advancing Sexual and Reproductive Health and Rights
 
International Family Planning Perspectives
Volume 31, Number 2, June 2005
UPDATE


MORE THAN HALF OF CHILD DEATHS COULD BE AVOIDED

Worldwide, more than half of child deaths result from a few preventable and treatable causes, according to new estimates by the World Health Organization.1 Using various methods, including single- and multiple-cause proportionate mortality models, the researchers estimate that 73% of deaths among children younger than five between 2000 and 2003 are attributable to six causes: 19% to pneumonia, 18% diarrhea, 10% neonatal pneumonia or sepsis, 10% preterm delivery, 8% malaria and 8% asphyxia at birth. More than half (54%) of deaths in children are attributable to the four communicable disease categories—diarrhea, pneumonia, malaria and neonatal pneumonia or sepsis—and thus should be preventable. The researchers estimate that undernutrition is the underlying cause of 53% of deaths among children, including 61% of those from diarrhea, 57% of those from malaria and 52% of those from pneumonia. The greatest proportions of child deaths occur in Africa (42%) and Southeast Asia (29%). The major causes of death are the same across regions, except that 94% of malaria-related deaths occur in Africa. The authors comment that their findings “confirm previous work on geographic variations in cause-of-death,” and add that the major causes “can be addressed through existing, available, and affordable interventions.”

1. Bryce J et al., WHO estimates of the causes of death in children, Lancet, 2005, 365(9465):1147–1152.

VACCINE PROTECTS AGAINST HPV INFECTION AND DISEASE

Women vaccinated against the four types of human papillomavirus (HPV) responsible for the majority of genital disease associated with the virus (types 6, 11, 16 and 18) had a significantly lower incidence of persistent infection or genital disease than did women given a placebo, according to a three-year trial conducted in Brazil, Europe and the United States.1 Some 552 healthy nonpregnant women aged 16–23 were enrolled in the study—half of whom were randomly selected to receive the vaccine. Participants were given either vaccine or placebo at the start of the trial and again after two and six months. Over the 30 months following vaccination, the incidence of persistent infection or HPV-associated genital disease was 90% lower among women who received the vaccine than among controls. At the end of the study, 35 women in the control group had HPV infection and six had HPV-associated disease; in the vaccine group, four women had HPV infection and none had HPV-associated disease. Furthermore, vaccine-induced immune response was higher among women who received the vaccine than among controls. In light of their findings, the researchers conclude that a combination vaccine “is efficacious against HPV types that cause cancer and genital warts” and that universal HPV vaccination could substantially reduce disease rates, especially in developing countries that have not implemented cervical cancer screening programs.

1. Villa LL et al., Prophylactic quadrivalent human papillomavirus (types 6, 11, 16, and 18) L1 virus-like particle vaccine in young women: a randomized double-blind placebo-controlled multicentre phase II efficacy trial, Lancet Oncology, 2005, 6(5):271–278.

WOMEN MAKE SOME GAINS, BUT HAVE A LONG WAY TO GO

Women in the developing world have seen improvements in various educational, occupational and reproductive health measures in the past decade, according to a data sheet published by the Population Research Bureau.1 Some 51% of women in developing countries now use modern contraceptives, and the total fertility rate has decreased to three births per woman. In addition, in the developing world, female secondary school enrollment as a proportion of male enrollment increased from 84% in 1995 to 91% in 2000–2003. Furthermore, the proportion of nonfarm wage earners in less developed countries who are women increased from 32% in 1990 to 34% in 2000–2001. However, women remain socially and economically disadvantaged, especially in the world’s poorest areas. For example, in Sub-Saharan Africa, the level of literacy among women is only 85% of that among men, and 58% of HIV-infected adults are women.

1. Ashford L and Clifton D, Women of Our World 2005, 2005, <http://www.prb.org/pdf05/WomenOfOurWorld2005.pdf>, accessed May 18, 2005.

REQUESTS FOR CESAREANS INCREASE WITH WOMEN’S AGE

In Taiwan, older women are more likely than younger women to request a delivery by cesarean section, according to a population-based study of more than 900,000 singleton births between 1997 and 2001.1 In an analysis of data from the National Health Insurance Research Database, the proportion of singleton births delivered by cesarean section due to maternal request increased from 2.0% to 3.5% during that period. In separate analyses by maternal age-group, the proportion of requested cesarean deliveries each year increased with age. In a multivariate analysis controlling for health care facility characteristics, the odds of having requested a cesarean delivery were significantly associated with maternal age: Compared with women aged 25–34, those older than 34 were more likely (odds ratios, 2.0) and those younger than 25 were less likely (0.7–0.9) to have requested delivery by cesarean section. The researchers comment that the trend of preferring cesarean delivery is “likely to increase further unless the reasons for this trend are identified and reversed.”

1. Lin HC and Xirasagar S, Maternal age and the likelihood of a maternal request for cesarean delivery: a 5-year population-based study, American Journal of Obstetrics and Gynecology, 2005, 192(3):848–855.

EARLY MARRIAGE IS LINKED TO DISADVANTAGE FOR WOMEN

Early marriage continues to be a reality for women in much of the developing world, according to an analysis of Demographic and Health Survey data from countries with surveys conducted between 1995 and 2003.1 For example, among women aged 20–24, 38% of those in Bangladesh and 35% of those in Niger had married by age 15, and 65% and 77%, respectively, had married by age 18. In multivariate logistic regression analyses, lack of education was associated with early marriage in 48 out of 50 countries, with women who had had some education being less likely than those who had had none to have married before age 18. Having a husband who was more than four years older was associated with elevated odds of early marriage in 44 countries. In all 50 countries, women with children were more likely than those with none to have married before age 18. According to the researchers, “There is a need to develop methods to protect girls at risk of child marriage and to address the concerns of girls and women who are already married by ensuring the fulfillment of their right to a full education and providing them with life skills–based training to ensure that they can earn a livelihood.”

1. United Nations Children’s Fund, Early Marriage: A Harmful Traditional Practice, 2005, <http://www.unicef.org/publications/ files/Early_Marriage_12.lo.pdf>, accessed May 19, 2005.

MENSTRUAL IRREGULARITIES LEAD TO IUD DISCONTINUATION

Indian women who experience irregular menstrual bleeding before or after IUD insertion have an elevated likelihood of early discontinuation of the method, according to a study conducted in a rural northern region of the country.1 Of the participants—235 women who had recently accepted an IUD—20% stopped using the method within six months. In multivariate analyses, women who had experienced heavier than usual menstrual bleeding before IUD insertion and those who had experienced intermenstrual bleeding or menstrual disturbances after IUD insertion were more likely than those who had not to have discontinued method use by six months (odds ratios, 2.3–3.0). In addition, women who lived in villages without a health center had elevated odds of early discontinuation (1.9), and those who had knowledge about the IUD and its effectiveness had reduced odds (0.4). In light of their findings, the authors conclude that IUD users who experienced persistent side-effects should be “advised to switch to another method before they discontinue contraceptive use altogether.”

1. Tripathi V, Nandan D and Salhan S, Determinants of early discontinuation of IUCD use in rural northern district of India: a multivariate analysis and its validation, Journal of Biosocial Science, 2005, 37(3):319–332.

IN BRIEF

Beijing Betrayed, a report from the Women’s Environment and Development Organization, finds that even though some progress has been achieved by the world’s governments in regard to the commitments made to women 10 years ago at the United Nations Fourth World Conference on Women, the Beijing Platform of Action is still far from a reality. The report is available at <http://www.wedo.org/files/gmr_pdfs/gmr2005.pdf>.

• Worldwide, substantial progress has been made toward raising girls’ level of education to parity with that of boys, according to a report by the United Nations Children’s Fund (UNICEF). However, three regions—Middle East/North Africa, South Asia and West/Central Africa—have not met the Millennium Development Goal of achieving gender parity in primary education by 2005. [UNICEF, Progress For Children: A Report Card on Gender Parity and Primary Education, No. 2, 2005, <http://www.unicef.org/publications/files/PFC_rev_11_April_Eng.pdf>, accessed May 23, 2005.]

• In its report, HIV-Related Stigma, Discrimination and Human Rights Violations, the Joint United Nations Programme on HIV/AIDS (UNAIDS) examines the barriers that stigmatization, discrimination and human rights violations pose to the prevention and treatment of HIV/AIDS. The report, which documents case studies of programs that have been successful in addressing HIV-related human rights violations, stigma and discrimination, is available at <http://www.unaids.org/html/pub/una-docs/jc999-hrviolations_en_pdf.pdf>.

Global Monitoring Report 2005: Millennium Development Goals: From Consensus to Momentum, the World Bank’s second annual report assessing progress on the Millennium Development Goals (MDGs), finds that rapid action to accelerate progress is needed—especially in Sub-Saharan Africa—if the MDGs are to be achieved. The report is available from the World Bank’s Web site at <http://www.worldbank.org>.