IN THIS ISSUE
As this journal moves into its 35th year of continuous publication, we are pleased to announce that, as of this issue, its name has changed to International Perspectives on Sexual and Reproductive Health. This change acknowledges the ever-broader range of topics covered in the journal—from HIV to sexual behavior to the reproductive health consequences of intimate partner violence—many of which intersect with our earlier focus on access to and use of contraceptives, pregnancy intentions, and fertility levels and trends. The intersection of such topics under the umbrella of sexual and reproductive health is reflected in the current issue.
Annabel Erulkar and Eunice Muthengi assess a two-year pilot project to delay marriage in Ethiopia's Amhara region, where half of girls are married by age 15, exposing them to the health risks associated with early births [see article]. The program, designed in collaboration with the village where it was to be implemented, included support for girls to remain in school and group conversations in which all community members could discuss issues and engage in collective problem solving. In comparison with girls aged 10–14 in the control village, those in the intervention village were more likely to be enrolled in school and less likely to have been married by the endline survey; among 15–19-year-olds, however, girls in the intervention village were more likely to have been married at endline. Overall, sexually experienced girls in the intervention village were more likely to have used contraceptives than their counterparts in the control village. According to the authors, their findings demonstrate that the incentives and traditions that support the earliest marriages can be changed by altering local opportunity structures and addressing motivations for such marriages.
Prenatal care is associated with positive pregnancy outcomes for both mother and child, yet substantial proportions of women—often those at high risk of negative outcomes—begin care after the first trimester and make fewer than the recommended number of visits. According to research among low-income Brazilian women by Diego Bassani and colleagues, the reason may lie in maternal attitudes as well as in social and demographic factors [see article]. Of the 611 postpartum women interviewed, four in 10 had either begun care after the first trimester or made fewer than the recommended six visits (partially inadequate care), or both (inadequate care). Both inadequate and partially inadequate care were negatively associated with income and positively associated with parity. In addition, women who had received inadequate care were more likely than those who had received adequate care to live separately from the child's father, to have had an unintended pregnancy and to have been dissatisfied with the pregnancy during the prenatal period.
Is sexual violence among the reasons keeping rates of unintended pregnancy high among Jamaican adolescents, despite increased knowledge about contraceptives and use at first sex? According to Joy Baumgartner and colleagues [see article], who interviewed a sample of sexually active 15–17-year-old females, 250 of whom had been pregnant and 500 matched controls who had not, that does not appear to be the case. Compared with controls, young women who had been pregnant were more likely to have had an older partner at first sex and to believe that contraception is a woman's responsibility, but were less likely to have experienced sexual violence or to think that it is important to protect oneself against pregnancy. Although experiences of sexual coercion and violence were not associated with adolescent pregnancy in this sample, the authors point out that half of the young women had had such experiences, and recommend that gender-based violence be addressed at the community level.
Although smaller families are becoming the norm in many South Asian countries, a desire for more sons may encourage couples to have more children than they desire and discourage contraceptive use. In general, according to analyses of recent Demographic and Health Survey data by Anuja Jayaraman and colleagues, the desire for another child decreased and the use of contraceptives rose as the number of sons in the family increased [see article]. These associations were stronger in Nepal and India than in Bangladesh; within India, they were stronger in northern states than in South India or West Bengal. Although most couples want one daughter, the authors conclude that son preference exerts a strong influence on reproductive behavior in this region.
Also in This Issue
•As fertility declines in most regions of the world and dips below replacement level in some developed countries, funding for voluntary family planning programs has declined by 30% since the mid-1990s. One reason, according to John Bongaarts and Steven Sinding, is that the arguments made by opponents of these programs have not been refuted directly and forcefully [see article]. The authors argue that these programs are cost-effective and have had a major impact on fertility in many countries, but that high birthrates and rapid population growth still imperil progress in raising incomes and improving livelihoods in the most impoverished countries (mostly in Sub-Saharan Africa). Noting that women and children continue to suffer and die needlessly as a consequence of unwanted childbearing, they argue that high fertility and rapid population growth remain real problems that merit attention and action.