IN THIS ISSUE
In many developing countries, parents guard their unmarried daughters carefully from contact with unrelated men, fearing that they may ruin their reputation and bring shame on their family. In India, young women who form premarital relationships—sexual or not—may be beaten or forced into a swiftly arranged marriage with someone other than their chosen partner. Yet, despite these consequences, young people do enter such relationships, as the lead article in this issue of International Family Planning Perspectives shows.
Data gathered by Mallika Alexander and colleagues from youth aged 15–24 in urban slums and rural areas of Pune District, Maharashtra State, indicate that 17–24% of young men and 5–8% of young women had ever had a romantic partner [see article]. Of these, 37–49% of young men and 6–13% of young women had had intercourse. In both urban and rural settings, more than eight in 10 youth said their friends were aware of the relationship; however, fewer than half said their parents knew of it. The authors note that youth who reported that their parents were strict were no less likely than others to have been in a romantic partnership or to have been in a relationship that involved physical intimacy or sexual intercourse.
Also in This Issue
•Nearly all health care providers surveyed in Jamaica and Barbados in 2005–2006 had heard of emergency contraceptive pills, and large majorities had dispensed the method [see article]. Eileen Yam and colleagues found, however, that about half had at some time refused to dispense it, often citing medical contraindications, recent use, safety concerns and feeling uncomfortable about providing the method. Only 57% in Jamaica and 23% in Barbados said emergency contraceptives should be available without a prescription; 44% and 7%, respectively, were willing to provide the pills in advance. A majority in each country believed that the method encourages sexual risk-taking, and about half had age restrictions for use of the pills. Large majorities were willing to provide the method to rape victims, women who had experienced condom failure and those who had used no method of pregnancy prevention, but fewer than half said they would dispense the pills to any woman who asked, regardless of her reason.
•Among female students surveyed in 2005 at the University of Santiago in Chile, almost one-third had experienced some form of sexual victimization since age 14, and 17% reported experiencing such abuse in the past 12 months [see article]. According to the study by Jocelyn Lehrer and colleagues, these incidents most commonly occurred at the home of the victim or the perpetrator (38%) or at a party in someone's home (31%). In 56% of rapes or attempted rapes and 24% of other incidents, both the victim and the perpetrator had used alcohol or drugs. According to a multivariate model that included all variables, sexual abuse during childhood was the only factor associated with victimization since age 14.
•In an examination of the history of Peru's family planning program, James Gribble and colleagues note that policies may actually have effects different from those intended [see article]. During a period of generous donor funding, the government instituted a policy of universal access to family planning. Contraceptive prevalence increased, as both wealthy women and poor women obtained modern methods without charge from Ministry of Health facilities. However, when donors began to withdraw funding in the late 1990s, stockouts of contraceptive methods and changes in service delivery reduced access for poor, rural women, who discontinued modern methods for traditional ones. Between 1996 and 2000, the proportion of Ministry of Health clients accounted for by wealthier women rose from 46% to 53%, while the proportion accounted for by poor women declined from 54% to 47%. By 2004, women in the two lowest socioeconomic quintiles made up fewer than 40% of the ministry's clients. Given the limited resources of developing countries, the authors argue, providing universal coverage through the public sector often ends up serving a considerable proportion of those who can afford to pay for care and restricting access to those who can least afford it.
•Despite a rapid increase in contraceptive prevalence in Guatemala over the past two decades, the proportion of couples practicing contraception who rely on vasectomy has remained at about 1% [see article]. Early efforts at increasing access that focused simply on training providers had failed; training was expensive and providers had too few clients to maintain their interest and skills. However, by using an approach that combined promotion and public education with training of doctors in no-scalpel vasectomy, the Ministry of Health was able to create a sustainable model for vasectomy services.