IN THIS ISSUE
In 2009, this journal changed its name from International Family Planning Perspectives to International Perspectives on Sexual and Reproductive Health to reflect the broadening content of both the field and the studies we were publishing. The articles in this issue revisit our roots in family planning and also highlight the links between contraception and other aspects of reproductive health.
According to analyses of longitudinal data from Bangladesh by Rebecca Callahan and Stan Becker, unmet need may be more effective as a measure of potential unsatisfied demand if used in conjunction with other indicators [see article]. For example, regardless of whether they had been classified as having an unmet need for contraception in 2006, women who had stated at that time that they intended to use family planning were significantly more likely than those who had not to be using a method in 2009. In addition, among women (again regardless of unmet need status) who experienced an unwanted pregnancy between interviews, the vast majority had reported in 2006 that they intended to use a contraceptive method, but had not yet adopted a method when they became pregnant. Further, in this sample, unmet need was not very effective in identifying the contraceptive needs of pregnant and postpartum women because it was defined by the planning status of the women’s previous birth rather than by their future childbearing preferences.
Few studies have used couple-level data to examine associations between relationship-level characteristics and contraceptive use. Using information on nearly 900 couples identified from population-based surveys in three Kenyan cities, Laili Irani and colleagues found that 60% of couples reported contraceptive use [see article]. Couples in which both spouses reported discussing family planning in the previous six months and those in which the spouses disagreed were more likely than those in which neither reported discussion to be using a method. Among couples not currently using a method, those in which the partners disagreed about whether they had discussed their desired number of children in the past six months and those in which both spouses reported discussing family planning use in that period were more likely to intend to practice contraception than couples in which both partners reported no discussion. Given these results, the authors suggest that outreach health workers be trained to teach couples basic skills in communicating about family planning issues, to address their concerns and to encourage them to participate in ongoing programs.
Using data from the 2008 Nigeria Demographic and Health Survey, Latifat Ibisomi examined the relationship between contraceptive use and age differences between spouses in separate multinomial regression models for use of methods that require the cooperation of both partners (condom, withdrawal and abstinence) and use of methods a woman can use without her husband’s knowledge [see article]. Ninety-eight percent of the women were younger than their husband, and two-fifths were 10 or more years younger. In bivariate analyses, women who were no more than nine years younger than their partner were more likely than those who were at least 10 years younger to be using either type of method. However, these associations disappeared when the analysis was adjusted for couple characteristics, suggesting that the age difference itself is less important than such characteristics as education, household wealth and fertility intentions.
Shops run by licensed chemical sellers are the most common source of oral contraceptives and condoms for Ghanaian women, but they are not permitted to sell the injectable, the country’s most widely used method. According to data collected by Elena Lebetkin and colleagues through telephone interviews with shop operators in two districts who had been trained to sell the injectable, 97% reported selling the method, and 94% felt sufficiently trained to do so [see article]. Virtually all shop operators referred clients to a health facility for injection; none provided injection themselves. Of clients who participated in follow-up phone interviews, 79% had made another purchase of the injectable from a shop after their initial purchase, and 97% reporting getting their injection at the facility to which the seller referred them. The clients cited trust, convenience and commodities being in stock (a key problem at health facilities) as key reasons for purchasing the injectable from a shop. The authors note that with little training for operators, sales of the injectable by the licensed chemical sellers could be scaled up to cover all of Ghana.
In an analysis examining the relationship between self-reported HIV status and pregnancy decision making in Nigeria and Zambia,
Akinrinola Bankole and colleagues found that HIV-positive women did not differ from their HIV-negative counterparts in their odds of having had an unintended pregnancy or an abortion in the previous five years [see article]. However, among those who had had an unintended pregnancy, HIV-positive women were more likely than HIV-negative women to have been using a contraceptive at the time they conceived. Women who did not know their HIV status were less likely than HIV-negative women to have had an unintended pregnancy and to have been using a method at the time of conception. The authors recommend that access to effective contraceptive methods and counseling be improved, and that counseling be tailored to the differing needs of HIV-positive and HIV-negative women.