Advancing Sexual and Reproductive Health and Rights
 
International Perspectives on Sexual and Reproductive Health
Volume 39, Number 2, June 2013
UPDATE


ONE MILLION BABIES EACH YEAR DIE ON THEIR FIRST DAY OF LIFE

The first day in the life of a newborn is also the most dangerous, according to a report published by the international charity Save the Children.1 Worldwide, three million babies die each year within their first month of life, and more than one-third of those deaths occur during the child’s first day. South Asia is the region with the greatest number of first-day deaths—more than 400,000 annually, or 40% of such deaths worldwide. India alone accounts for 29% of all deaths among newborns during their first 24 hours of life. Sub-Saharan Africa, however, is the region in which an infant is most likely to die within a day after birth: It includes the 14 countries with the highest first-day death rates. Most newborn deaths can be prevented, and Save the Children estimates that universal coverage of four low-cost ($0.13–6.00) products could save more than one million newborns a year: steroid injections for women in preterm labor, to reduce deaths caused by premature babies’ breathing problems; resuscitation devices, to save babies who do not breath at birth; chlorhexidine, to prevent umbilical cord infections; and injectable antibiotics, to treat sepsis and pneumonia.

1. Save the Children, State of the World’s Mothers 2013: Surviving the First Day, 2013, <http://www.savethechildrenweb.org/SOWM-2013/files/assets/common/downloads/State%20of%20the%20WorldOWM-2013.pdf>, accessed May 6, 2013.

TRADITIONAL METHOD USE IS COMMON IN IRAN

In Iran, contraceptive prevalence is high and unmet need for contraception is low, according to a study of 2,120 married women aged 15–49 conducted in 2011 in eight cities across the country.1 Overall, contraceptive prevalence was 82% and unmet need for contraception was only 3%. These numbers, however, mask the fact that a substantial proportion of women in Iran still use less-effective, traditional methods. Some 59% of women reported modern method use, and 22% reported traditional method use. The most commonly used method of contraception was withdrawal (22%), followed by the pill, condoms and female sterilization (13–14%). When researchers calculated women’s unmet need for modern methods, they found it to be much higher than the unmet need for any method: 17%. Some 31% percent of women reported having experienced an unwanted pregnancy. The authors conclude that “healthcare policymakers should know that the issue of family planning is not resolved in Iran” and suggest that the country “is likely to face increased prevalence of illegal abortion if women do not shift to modern methods of contraception.”

1. Motlaq ME et al., Contraceptive use and unmet need for family planning in Iran, International Journal of Gynecology and Obstetrics, 2013, 121(2):157–161.

CIRCUMCISION REDUCES ANAEROBIC BACTERIA

Male circumcision appears to reduce genital bacteria, which may at least in part account for the HIV risk reduction associated with the procedure, according to a study among 156 HIV-negative uncircumcised men aged 15–49 in Rakai, Uganda.1 At enrollment, there were no differences between men randomly assigned to receive circumcision immediately and men assigned to delay circumcision for two years in terms of the bacteria from their penile coronal sulcus (i.e., the groove at the base of the glans), or in social and demographic characteristics, sexual practices and STIs. After one year, however, the prevalence and amount of 12 types of anaerobic bacteria were lower among circumcised men than among uncircumcised men. The authors conclude that more research is needed “to determine if a decreased anaerobic bacterial load modifies foreskin inflammation and HIV target cell recruitment/susceptibility, which may play a role in HIV risk reduction conferred by [male circumcision].”

1. Liu CM et al., Male circumcision significantly reduces prevalence and load of genital anaerobic bacteria, mBio, 2013, doi: 10.1128/mBio.00076-13, accessed April 24, 2013.

BREAST-FEEDING CHANGES LEVELS OF HIV IN MILK

The amount of HIV in a mother’s breast milk varies with the frequency with which she breast-feeds, according to a study of 958 pregnant HIV-positive women in Lusaka, Zambia, who were recruited between 2001 and 2004 and were not receiving antiretroviral therapy (ART).1 Half the women were encouraged to breast-feed their newborn exclusively for six months and then to breast-feed nonexclusively for as long as they liked; in this group, the median concentrations of HIV-1 RNA and DNA in milk pumped when their baby was aged 4.5 months was less than 50 copies/ml and less than one copy/ml, respectively. Among the remaining women, who were encouraged to breast-feed their newborn exclusively for four months and then to wean the infant abruptly, the concentrations of viral genetic material in milk pumped at 4.5 months—two weeks after weaning—was significantly higher (RNA, 2,708 copies/ml; DNA, 14 copies/ml). Differences between the groups remained after adjustments were made for possible confounders (e.g., mother’s CD4 count and blood HIV concentration). In addition, the HIV concentration in milk of women who continued to breast-feed at 4.5 months was higher among those who had given their infants other food (RNA, 293 copies/ml) than among women who breast-fed exclusively. At the time the study was conducted, ART was not generally available in Zambia; however, given these results and the fact that ART is now provided routinely to prevent mother-to-child transmission of HIV, the authors suggest that women should continue antiretroviral therapy “over the full duration of time when any breast milk exposures are likely to occur.”

1. Kuhn L et al., HIV-1 concentrations in human breast milk before and after weaning, Science Translational Medicine, 2013, doi: 10.1126/scitranslmed.3005113, accessed April 17, 2013.

UMBILICAL CORD MILKING FOR ANEMIA PREVENTION

Umbilical cord milking—the process of squeezing blood through the cord toward the baby after delivery—may protect newborns from anemia, which is associated with cognitive impairment and child mortality. To determine whether umbilical cord milking improved newborns’ serum levels of hemoglobin and the iron-storing protein ferritin, researchers conducted a randomized control trial among 200 term and near-term infants born at one North India teaching hospital between April 2010 and September 2011.1 At six weeks of age, infants in the intervention group—whose cord had been milked three times before it was clamped near the umbilicus within 30 seconds of delivery—had a mean hemoglobin level of 11.9g/dL and a mean serum ferritin level of 355.9ug/L. In comparison, infants in the control group—whose cord had been clamped near the umbilicus within 30 seconds of delivery, but was not milked—had significantly lower mean hemoglobin and mean serum ferritin levels (10.8g/dL and 177.5ug/L, respectively). The authors conclude that milking “improves [hemoglobin] and iron status at 6 weeks” and that the procedure “can be used in term and near term babies as a routine” for the prevention of anemia.

1. Upadhyay A et al., Effect of umbilical cord milking in term and near term infants: randomized control trial, American Journal of Obstetrics & Gynecology, 2013, 208(2):120.e1–e6.

IMPROVING CHILD NUTRITION TO DECREASE STUNTING

More than one quarter of the world’s children younger than five are stunted—that is, their growth has been severely and irreversibly impaired by chronic undernutrition during a crucial developmental period. According to a report from the United Nations Children’s Fund, 165 million children around the globe were stunted in 2011; 80% of these children lived in 14 countries, most of them located in Sub-Saharan Africa and South Asia.1 The physical and cognitive deficiencies associated with stunting are permanent and have been linked with lower educational attainment and greater risk of death from infectious disease; however, interventions promoting proper nutrition during the critical 1,000-day window from a woman’s pregnancy through her child’s first two years of life have been successful in reducing stunting. The report highlights programmatic success stories from such countries as Ethiopia, Haiti and Nepal to shed light on factors that lead to sustainable advances in a country’s nutrition status and to decreases in stunting: political commitment and strong government leadership; evidence-based nutrition policy; coordinated and collaborative partnerships across sectors; good technical capacity and program design; sufficient resources to strengthen implementation; and mechanisms to increase stakeholder demand for nutrition programming.

1. United Nations Children’s Fund (UNICEF), Improving Child Nutrition: The Achievable Imperative for Global Progress, New York: UNICEF, 2013, <http://www.unicef.org/media/files/nutrition_report_2013.pdf>, accessed May 20, 2013.

USE OF FEMALE STERILIZATION INCREASES IN MALAWI

Malawi has achieved substantial recent gains in modern contraceptive use—especially use of female sterilization, according to a report from the RESPOND Project.1 Between 2000 and 2010, the prevalence of modern contraceptive use among currently married Malawian women of reproductive age increased from 26% to 42%, and use of female sterilization doubled, from 5% to 10%; in contrast, the prevalence of female sterilization across Africa is less than 2%. The desire to limit childbearing increased over the previous 20 years, so that in 2010, nearly 50% of married Malawian women of reproductive age reported not wanting any more children. In response to this demand, the government of Malawi instituted policies to improve the availability and provision of modern contraceptives, including wide and equitable access to female sterilization. For example, strong public-private partnerships support mobile outreach services that provide a range of modern contraceptive methods free of cost to people in rural and underserved areas. The report concludes that “the Malawi experience holds a number of valuable lessons for other countries seeking to expand access to female sterilization, broaden their contraceptive method mix, and better meet the reproductive needs of the populace they serve.”

1. Jacobstein R, Lessons from the recent rise in use of female sterilization in Malawi, Studies in Family Planning, 2013, 44(1):85–95.

IN BRIEF

•In its World’s Youth 2013 Data Sheet, the Population Reference Bureau provides a comprehensive portrait of the well-being of youth worldwide, including indicators of population, marriage and fertility, and health risks and behaviors. The data sheet—which shows that early marriage and childbearing remain a concern for many young women, especially those in the poorest regions—is available at <http://www.prb.org/pdf13/youth-data-sheet-2013.pdf>.

•The United Nations Population Division has released a wall chart that provides current information about the legal grounds on which abortion is permitted in 196 member and nonmember state countries. World Abortion Policies 2013 also includes such national-level information as abortion and fertility rates, as well as regional unsafe abortion rates. It can be found at <http://www.un.org/en/development/desa/population/publications/pdf/policy/World AbortionPolicies2013/WorldAbortionPolicies2013_WallChart.pdf>.

•The World Health Organization has released its annual compilation of health-related data for its 194 member states. World Health Statistics 2013, which highlights how efforts to meet the Millennium Development Goals have reduced health gaps between the world’s most and least advantaged countries, is available at <http://www.who.int/gho/publications/world_health_statistics/2013/en/>.