Advancing Sexual and Reproductive Health and Rights
 
International Family Planning Perspectives
Volume 33, Number 4, December 2007
UPDATE


CHILD DEATHS DROP BELOW 10 MILLION

For the first time in modern history, the annual number of worldwide deaths of children aged five years or younger has fallen below 10 million.1 According to survey figures based on national data reported by UNICEF, 9.7 million children died at or before the age of five in 2006—down from almost 13 million in 1990. Progress in reducing under-five mortality was made in every region of the world, with the most substantial declines occurring in Latin America and the Caribbean, Central and Eastern Europe, and East Asia and the Pacific. Although progress was made in China, India and several African countries, including Ethiopia and Niger, the large majority of under-five deaths occurred in South Asia (3.1 million) and Sub-Saharan Africa (4.8 million). The decreases in child mortality were attributed to the increased adoption of basic health care interventions, including exclusive breast-feeding, measles immunization, vitamin A supplements and insecticide-treated bed nets that protect against malaria. Although UNICEF's executive director Ann M. Veneman called the new figures "historic," she added, "The loss of 9.7 million young lives each year is unacceptable. Most of these deaths are preventable.…Lives can be saved when children have access to integrated, community-based health services, backed by a strong referral system."

1. UNICEF, Surveys reveal solid progress on child survival. Child deaths fall below 10 million for first time, Sept. 13, 2007, <http://www.unicef.org/colombia/newsletter/ septiembre-07/eng-pop-news-septiembre-07-03.htm>, accessed Nov. 19, 2007.

WORLDWIDE ABORTION RATE FELL BETWEEN 1995 AND 2003

The overall incidence and rate of induced abortion declined worldwide between 1995 and 2003; however, the proportion of all abortions that were unsafe increased.1 An estimated 42 million abortions occurred worldwide in 2003, down from 46 million in 1995; the induced abortion rate decreased from 35 to 29 per 1,000 women aged 15–44 during that period. By 2003, abortion rates in the developed and developing worlds were similar (26 and 29 per 1,000 women, respectively), the result of larger decreases in developed regions (from 39 to 26 per 1,000 women) than in developing regions (from 34 to 29 per 1,000 women). The greatest reduction occurred in Eastern Europe, where the abortion rate went from 90 per 1,000 women in 1995 to 44 per 1,000 women in 2003. Forty-eight percent of the abortions that occurred worldwide in 2003 were unsafe—a three percentage-point increase since 1995; the vast majority of unsafe abortions occurred in developing countries. The authors argue that "meeting the need for contraception and improving the effectiveness of use among women and couples who are already using contraception are crucial steps toward reducing the incidence of unintended pregnancy" and, therefore, induced abortion.

1. Sedgh G et al., Induced abortion: estimated rates and trends worldwide, Lancet, 2007, 370(9595):1338–1345.

BETTER PERINATAL CARE COULD PREVENT STILLBIRTHS

Low rates of physician attendance of births and of hospital delivery in developing countries may contribute to high rates of stillbirth in those countries, according to a study conducted between March 2005 and December 2006 in Argentina, the Democratic Republic of Congo, Guatemala, India, Pakistan and Zambia.1 Over the study period, a total of 60,324 deliveries and 1,472 stillbirths were recorded in the 103 study communities, resulting in a mean rate of 24 stillbirths per 1,000 deliveries. Sixty-four percent of the stillborn infants weighed 2,000g or more, and only 17% showed signs suggesting that death had occurred more than 12 hours before delivery. Overall, 89% of the women had received some prenatal care; however, only 43% of the deliveries were attended by a physician or a nurse, and only 34% of births ocurred in a hospital or clinic. A woman's risk of experiencing a stillbirth was positively associated with lack of prenatal care, lack of a physician attending the birth and not delivering at a clinic or hospital (relative risks, 1.2–2.0). According to the authors, the fact that most of the fetal deaths occurred at or near term "suggests that stillbirth rates could be reduced substantially by higher quality intrapartum care."

1. McClure EM et al., The global network: a prospective study of stillbirths in developing countries, American Journal of Obstetrics & Gynecology, 2007, 197(3): 247. e1–247.e5.

KUWAITI WOMEN OFTEN STOP USING CONTRACEPTIVES

At least two-thirds of Kuwaiti women discontinue using contraceptive methods within three years of initiation, according to an analysis of data from a nationally representative survey conducted in 1999.1 Of the 1,502 married women of reproductive age interviewed, 81% had ever used a contraceptive method. Fifty-two percent were using a method at the time of the survey; about two-thirds were using a modern method, such as the pill and condoms, and one-third were using a traditional method, such as withdrawal. The cumulative probability that a woman would discontinue use of a modern method was 30% after one year, 54% after two years and 68% after three years; for traditional methods, the cumulative probabilities were 40%, 66% and 70%, respectively. Although desire to become pregnant was the main reason given by women when asked why they had discontinued using a modern method, a substantial proportion cited health reasons; method failure was the main reason given by women for discontinuing use of a traditional method. The authors suggest that "better management of those who discontinue for health reasons is likely to increase continuation and reduce unmet need." They also comment that "the high failure rate of traditional methods points to a need for better counselling for those who wish to rely on such methods."

1. Shah NM et al., Reasons and correlates of contraceptive discontinuation in Kuwait, European Journal of Contraception and Reproductive Health Care, 2007, 12(3): 260–268.

SOME PEOPLE LIVING WITH HIV ENGAGE IN RISKY BEHAVIORS

It is not uncommon for HIV-positive men and women in Botswana to have multiple sexual partners and to engage in other risky sexual behaviors, according to a survey of members of HIV-related support groups and clients of antiretroviral therapy clinics in Gaborone.1 Of 309 people living with HIV who had had sex in the past three months, 80% reported having had only one sexual partner during that time, whereas 20% reported having had two or more. Fifty-three percent of the partners of respondents with multiple recent partners were considered casual or nonsteady, compared with 32% of the partners of those with only one recent partner. Respondents with multiple partners were less likely than those with one partner to be taking antiretroviral therapy (odds ratio, 0.4) or to have disclosed their HIV status to a steady or casual partner (0.2 and 0.4, respectively), and were more likely to not know the HIV status of a casual partner. Regardless of number of partners or partner's HIV status, respondents with multiple partners had reduced odds of consistent condom use (0.3) and of consistent use with a steady partner (0.4). The authors comment that "assistance should be provided to HIV-infected people who continue to practise unprotected sex with uninfected partners or partners of unknown HIV status."

1. Kalichman SC et al., Recent multiple sexual partners and HIV transmission risks among people living with HIV/ AIDS in Botswana, Sexually Transmitted Infections, 2007, 83(5):371–375.

WOMEN AT RISK AFTER BIRTH COMPLICATIONS

Women who experience severe obstetric complications during delivery have an increased risk of death and mental health problems within the subsequent 12 months, according to findings from a prospective cohort study conducted between November 2005 and March 2006 in Burkina Faso.1 Of the 1,014 postpartum women recruited from seven urban and rural public hospitals, 337 had experienced severe obstetric complications, such as uterine rupture and shock. Compared with those with uncomplicated births, women who had experienced a severe obstetric complication were poorer and less educated. Greater proportions of women who had a complicated birth than of those who had an uncomplicated birth had died (2% vs. 0%) or lost their child (5% vs. 3%) by the 12-month follow-up interview. In addition, women who experienced severe obstetric complications had increased odds of experiencing depression at the three-month follow-up interview (odds ratio, 1.8), of having suicidal thoughts during the year following the birth (2.3–2.4) and of reporting that the pregnancy had had a negative effect on their life (1.5–2.6). The authors conclude that "women with severe obstetric complications are a high-risk group and resources need to be devoted to ensure that these women…receive adequate care before and after discharge from the hospital."

1. Filippi V et al., Health of women after severe obstetric complications in Burkina Faso: a longitudinal study, Lancet, 2007, 370(9595):1329–1337.

INTERVENTION REDUCES TRANSMISSION OF SYPHILIS

A prenatal screening and treatment program in Shenzhen, China, greatly reduced the number of infants with congenital syphilis born in the city.1 Between January 2003 and December 2005, 418,871 pregnant women were screened for syphilis in 61 hospitals in all six districts of Shenzhen, of whom 2,019 (0.5%) tested positive; 92% of these women were treated. Of 1,402 infected women who carried their pregnancy to term, 79% experienced a normal childbirth; the remainder had adverse pregnancy outcomes or were lost to follow-up. In all, 92 (8%) of the 1,112 infants born to mothers who tested positive for syphilis had congenital syphilis. Only four of these cases were attributed to treatment failure; in the remainder, the woman refused treatment, came to the hospital for prenatal care late in pregnancy, or came only for delivery or when she noticed abnormal symptoms in her infant after a home delivery. The incidence of congenital syphilis decreased over the study period, from 49 cases per 100,000 pregnant women screened in 2003 to 22 cases per 100,000 pregnant women screened in 2005. Overall, the intervention's success rate in preventing mother-to-child transmission of syphilis was 99%. The authors comment that "hopefully, the success of this project will lead to the scaling up of prenatal syphilis screening throughout China, and will contribute to some of WHO's millennium goals in improving maternal health and reducing child mortality."

1. Cheng JQ et al., Syphilis screening and intervention in 500,000 pregnant women in Shenzhen, the People's Republic of China, Sexually Transmitted Infections, 2007, 83(5):347–350.

IN BRIEF

•The United Nations Population Fund has published a three-hour distance learning course on population issues, covering topics such as reproductive health, HIV/AIDS, adolescents, maternal mortality, and population and development. The course can be obtained on CD-ROM in English, French or Spanish by entering a request at <http://www.zoomerang.com/ survey.zgi?p=WEB2273ABC7JX8>.

•The World Health Organization has published the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY), the first internationally agreed upon classification code for assessing the health of children and youth in the context of their stages of development and the environments in which they live. More information is available at <http://www.who.int/ mediacentre/news/releases/2007/pr59/en/index.html>.