Advancing Sexual and Reproductive Health and Rights
 
International Family Planning Perspectives
Volume 33, Number 1, March 2007
UPDATE


WEEKLY DOSE OF MIFEPRISTONE IS AN EFFECTIVE CONTRACEPTIVE

A single dose of mifepristone taken orally once a week may effectively protect a woman against pregnancy.1 As part of a pilot study conducted in three research centers in China between October 2003 and December 2005, 76 healthy women with normal menstrual cycles were randomly assigned to take either 25 mg or 50 mg of mifepristone each week for six cycles; a cycle was defined as 28 days. No women in either group became pregnant during the study's 456 woman-months of use. In addition, there were no significant differences between the two groups in the mean number of days during the first three study cycles in which bleeding or no bleeding occurred. However, in the fourth, fifth and sixth cycles, women in the 50 mg group experienced a significantly greater number of days of no bleeding and a significantly lower number of days of bleeding than did women in the 25 mg group. Only 3–5% of women in the 25 mg group and 8% of women in the 50 mg group experienced mild side effects, such as nausea and swollen breasts, within the first week after each treatment. The authors suggest that a weekly regimen of 25 mg of mifepristone would be the more acceptable choice for women because it has "fewer disturbances of menstrual patterns with the same contraceptive efficacy."

1. Pei K et al., Weekly contraception with mifepristone, Contraception, 2007, 75(1):40–44.

CIRCUMCISION REDUCES HIV RISK AMONG MEN IN KENYA

Circumcision significantly reduces a man's risk of acquiring HIV, according to findings from studies conducted in Kisumu, Kenya,1 and Rakai, Uganda.2 In each study, half of a sample of uncircumcised, HIV-negative men were randomly assigned to receive a circumcision, and half were assigned to the control group; all men made regular follow-up visits to receive HIV testing. Each study was stopped early because it became clear that men in the circumcision groups had a significantly reduced risk of HIV acquisition. In the Kenyan sample, two-year HIV incidence was 2.1% among circumcised men and 4.2% among men in the control group, which corresponds to a 53% reduction in the risk of HIV infection; in the Ugandan sample, HIV incidence over 24 months was 0.66 cases per 100 person-years among circumcised men and 1.33 cases per 100 person-years among men in the control group, which corresponds to a 51% reduction in risk. After the data were adjusted for men's nonadherence to treatment, the reduction in risk increased to 60% for both studies. About 2% of men in the Kenyan treatment group and 8% in the Ugandan treatment group experienced adverse events associated with their circumcision, such as bleeding, infection or swelling. The authors of the Kenyan study suggest that the most effective use of circumcision as a method of HIV risk reduction would be as "one component of a full suite of HIV prevention and reproductive health services, including HIV testing and counselling, diagnosis and treatment of sexually transmitted infections, condom promotion, behavioural change counselling and promotion, and other methods as they are proven effective."

1. Bailey RC et al., Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomized controlled trial, Lancet, 2007, 369(9562):643–656.2. Gray RH et al., Male circumcision for HIV prevention in men in Rakai, Uganda: a randomized trail, Lancet, 2007, 369(9562):657–666.

2. Gray RH et al., Male circumcision for HIV prevention in men in Rakai, Uganda: a randomized trail, Lancet, 2007, 369(9562):657–666.

SOCIAL GROUP LEADERS CAN HELP OTHERS TO AVOID HIV

Training leaders of social networks to counsel other members about HIV risk reduction may be an effective technique for interventions in populations distrustful of outsiders.1 As part of a study conducted between 2003 and 2005 in a Roma (Gypsy) community in Sofia, Bulgaria, researchers recruited 286 men who were part of 52 social networks, and identified the leader of each network. Half of the leaders were randomly selected to take part in small group training sessions on how to counsel and advise others on reducing HIV risk behaviors; the other half received no training. In the three months after the training sessions, conversations about AIDS and safer sex among men in the intervention networks increased significantly. After three months, there was a greater decrease in the level of recent unprotected sex among men in the intervention networks (from 81% at baseline to 65% at three months) than among those in the control networks (from 80% at baseline to 75% at three months); after a year, the level of recent unprotected sex was still below baseline among men in the intervention networks (71%), but not among those in the control networks (86%). Men in the intervention networks showed an even greater decrease in their level of recent unprotected sex with casual partners (from 60% at baseline to 28% at three months and 29% at one year), which was significantly greater than the decrease among men in the control networks (from 54% at baseline to 42% at three months and 47% at one year). Furthermore, compared with men in the control networks, men in the intervention networks had significantly greater increases in their knowledge about AIDS and their positive attitudes toward condoms. In light of their findings, the authors suggest that social network intervention techniques may be effective in other communities "where vulnerable populations may distrust outside authorities but find advice and recommendations coming from personally known network leaders to carry credibility and influence."

1. Kelley JA et al., Prevention of HIV and sexually transmitted diseases in high risk social networks of young Roma (Gypsy) men in Bulgaria: randomized controlled trial, BMJ, 2006, 333(7578):1098–1101.

UMBILICAL CORD INFECTION AMONG NEPALESE NEWBORNS

Certain postnatal care practices, such as the application of unclean substances to an infant's umbilical cord, are associated with the risk of umbilical cord infection among newborns, according to a study of infants born in Nepal between September 2002 and March 2005.1 Among the 17,198 infants enrolled in the study, the total incidence of umbilical cord infection (defined as the presence of pus with moderate or severe redness, or the presence of severe redness) was 5.5 cases per 100 neonates. Within two days of delivery, 38% of infants had had mustard oil applied to their umbilical cords, 7% mud, 2% ash and 1% other substances, such as breast milk, saliva or herbs. In multivariate analyses, the application of mustard oil or other substances to an infant's umbilical cord was positively associated with infection (odds ratios, 1.3 and 1.6, respectively); hand washing by the birth assistant or mother was negatively associated with infection (0.7 and 0.8, respectively). In addition, skin-to-skin contact between mother and child was associated with decreased risk of umbilical cord infection (0.6). The authors comment that programs promoting neonatal care should "emphasize hand washing with soap among birth assistants before assisting with delivery, discourage the application of unclean substances to the umbilical cord, and promote the use of skin-to-skin contact for its potential to reduce infection."

1. Mullany LC et al., Risk factors for umbilical cord infection among newborns of Southern Nepal, American Journal of Epidemiology, 2007, 165(2):203–211.

UNSAFE ABORTION IN THE DEVELOPING WORLD

An estimated five million women in the developing world were admitted to hospitals in 2005 because of complications resulting from unsafe abortions.1 According to an analysis of national data from women of reproductive age from 13 developing countries (Bangladesh, Brazil, Chile, Colombia, Dominican Republic, Egypt, Guatemala, Mexico, Nigeria, Pakistan, Peru, Philippines and Uganda), the annual hospitalization rate for women with induced abortion complications ranged from three per 1,000 women in Bangladesh to 16 per 1,000 women in Uganda. National data from the 13 countries and complementary data from five Sub-Saharan countries (Burkino Faso, Ghana, Kenya, Nigeria and South Africa) were used to estimate regional hospitalization rates for women with induced abortion complications in Africa, Asia (excluding China), and Latin America and the Caribbean (nine, four and six per 1,000 women, respectively). Overall, the author estimated that six of every 1,000 women in the developing world are hospitalized each year because of complications resulting from induced abortions; when 2005 population estimates are used, that equals about five million women. The author comments, "The evidence shows that the health burden of unsafe abortion is large. Even so, rates of hospitalization underestimate the true burden because a large proportion of women with abortion complications do not obtain medical care."

1. Singh S, Hospital admissions resulting from unsafe abortion: estimates from 13 developing countries, Lancet, 2006, 368(9550):1887–1892.

SUDANESE WOMEN IN NEED OF REPRODUCTIVE HEALTH SERVICES

Women displaced because of the crisis in Sudan are in dire need of reproductive health services, a situation that may have implications for their wider communities.1 According to a 2005 survey of 1,274 women living in six refugee camps in the Nyala Province of South Darfur, 68% reported not using a contraceptive method, and only 4% reported using a modern method; 63% reported that their husbands would not allow contraceptive use. Not surprisingly, women had high pregnancy rates (mean number of pregnancies, six); 53% of women had had an unattended birth, and just 58% had received prenatal care for all their pregnancies. In addition, fewer than a third of women were breast-feeding at the time of the study, and of those, half reported experiencing problems, such as inconsistent or no milk. The authors comment, "Because women head the majority of households in South Darfur, poor reproductive health…may by extension affect the health of the community."

1. Kim G, Torbay R and Lawry L, Basic health, women's health, and mental health among internally displaced persons in Nyala Province, South Darfur, Sudan, American Journal of Public Health, 2007, 97(2):353–361.

IN BRIEF

•UNICEF has released a report that examines the current status of women worldwide, and the discrimination and disempowerment faced by many women throughout their lives. State of the World's Children 2007 discusses how gender equality would help achieve the Millennium Development Goals, and how investment in women's rights would ultimately advance the rights of both women and children. The full report is available from UNICEF's Web site: <http://www.unicef.org/sowc07/docs/sowc07.pdf>.

•In December 2006, Muslim academics and scholars met at Al-Azhar University in Cairo, Egypt, for a two-day conference entitled The Prohibition of Violation of the Female Body Through Circumcision. According to the New York Times, some male attendees defended the custom of female genital cutting; however, every doctor at the conference agreed that there are no medical grounds for the practice, and religious scholars declared that it is without basis in any Muslim text. <http://www.nytimes.com/2006/12/06/world/europe/06spiegel.html?pagewanted=2&ei=5070&en=8ed0022c58abeab7&ex=1171688400>.

•UNAIDS, in collaboration with the UN Refugee Agency (UNHCR), has released a new policy brief suggesting actions that would help prevent HIV and mitigate the effect of HIV on refugees and their host communities. The brief, entitled HIV and Refugees, is available from the UNAIDS Web site: <http://data.unaids.org/pub/BriefingNote/2007/Policy_Brief_Refugees.pdf>. >