Advancing Sexual and Reproductive Health and Rights
International Perspectives on Sexual and Reproductive Health
Volume 39, Number 4, December 2013


In Uganda, where abortion is severely restricted, unsafe abortion takes a considerable financial toll on women and their families, often resulting in a decline in economic stability and household well-being. Using prospective data from a 2011–2012 survey of women who received postabortion care at Ugandan health facilities, Aparna Sundaram and colleagues found that on average, Ugandan women paid US$23 for their abortion procedure [see article]. Those who received treatment for complications at a health facility spent an average of US$49 for both the procedure and the treatment of complications. For many women, these expenditures are significant, given that Uganda has one of the lowest per capita incomes in the world and that a substantial proportion of the population lives in poverty. In follow-up interviews 2–3 months later, 73% of women surveyed reported that they had lost wages, 60% that their children had had less to eat, were unable to attend school or both, and 34% that they had experienced a decline in the economic stability of their household. Women who had received inpatient treatment were more likely than those who had not to have experienced each of these three consequences. According to the authors, their findings suggest that strategies to reduce the number of unsafe procedures, such as expansion of access to contraceptives to prevent unintended pregnancies, are urgently needed.

Analyses of 2010 survey data from 698 married or cohabiting couples show that the quality of a couple’s relationship is linked both to their use of contraceptives and to the type of method they use. Carie Muntifering Cox and colleagues found that the more satisfied women were with their relationship, the more likely they were to use a contraceptive method that both partners would typically be aware of (such as withdrawal, condoms, spermicide) than to use no method [see article]. In addition, the more strongly men felt that the communication in their relationship was respectful, the more likely their partners were to use either a method that both partners would typically be aware of or a method that a woman could use without her partner’s knowledge than they were to use no method. The researchers recommend that relationship quality be taken into consideration in the design of family planning programs and policy.

According to qualitative research by Jane K. Cover and colleagues, a contraceptive pill that could be taken on demand could appeal to a wide range of women in different settings, particularly those who have sex infrequently [see article]. The researchers conducted 39 focus groups and 23 in-depth interviews in Kampala, Uganda, and Lucknow, Uttar Pradesh, India, to understand the potential market for an ondemand pill. In both countries, participants viewed the product favorably largely because it would be easier than taking a daily pill and could be taken without a partner’s knowledge. In Uganda, where partner opposition to contraception is high, the ability to use a contraceptive without their partner’s knowledge emerged as a prominent advantage. By contrast, effectiveness was a greater concern for women in Lucknow, where unintended pregnancy among unmarried women often has serious social consequences.

According to research by Blair Darney and colleagues, Oportunidades— a government program that gives cash stipends to female household heads and wives of household heads on the condition that they use health services and attend school—was not directly linked to reductions in pregnancy among rural adolescents [see article]. In multivariable analyses using matched 2006 samples of women with or without exposure to Oportunidades, exposure to the program was not associated with pregnancy experience among adolescents. Educational attainment, marital status, pregnancy experience and access to health insurance—but not exposure to Oportunidades—were positively associated with current modern contraceptive use among adolescent and young adult women. However, a structural equation model showed that the program had a small, indirect, negative association with adolescent pregnancy through current school attendance. The authors recommend that Mexico’s family planning program focus on strategies to increase contraceptive use—which remains very low among young rural women, whether or not they are enrolled in Oportunidades.

In analyses of longitudinal data from married women in four rural areas of India, changes in women’s reproductive experiences and functional autonomy were associated with changes in intimate partner violence in the 12 months before the follow-up interview [see article]. Using survey data from 1998–1999 and 2002–2003, Christine Bourey and colleagues found that women who had greater or continuing freedom of movement and continuing financial autonomy at follow-up had a lower risk of experiencing initiation of violence than of experiencing no violence. Women who reported that their economic contribution to the household decreased or increased and women who had an unwanted pregnancy had a higher risk of experiencing continued violence than of experiencing no violence. The death of a child was associated with a higher risk of initiation of violence. The researchers suggest that, in a setting where the prevalence of intimate partner violence increased by 77% over the study period, programs aimed at reducing violence or increasing women’s autonomy be designed with these associations in mind.
—The Editors