Because sexual activity can result in negative consequences, such as unintended pregnancy and sexually transmitted infections (STIs), that affect both individuals and the communities in which they live, most societies attempt to control sexual behavior through pressure to conform to cultural norms. This approach, however, is rarely (if ever) totally successful; thus societies must find other ways of preventing negative consequences or mitigating their effects. The articles in this issue of International Family Planning Perspectives all report on studies that attempt to identify successful interventions or factors around which effective policies or programs might be built.
In the lead article, Nafissatou Diop-Sidibé tests the hypothesis that the age at which young people in Côte d'Ivoire initiate sex is influenced by the sexual and reproductive attitudes and behavior of their siblings [see article]. In life-table analyses, the risk of initiating sex at any given age was generally higher among young men and women who had at least one sibling who had had a premarital birth than among those who did not have such a sibling. However, when the influence of other factors was accounted for, having a sibling with a history of premarital childbearing was associated with early sexual debut only among young men. For young women, early sexual debut was associated with the perception that most or all of their close female friends had had sex rather than with the sexual and reproductive behavior of their siblings.
In China, the incidence of premarital pregnancy and STIs is rising as young people increasingly engage in premarital sexual activity. Bo Wang and colleagues assess the effectiveness of a community-based sex education program for young people in suburban Shanghai [see article]. The program, which covered abstinence, contraception and healthy sexual behavior, used six methods to provide information and services to unmarried 15–24-year-olds over a period of 20 months. Compared with controls, both male and female program participants were more likely to practice contraception and to use condoms, and males were less likely to have coerced a partner into having sex; however, participation in the program was not associated with delayed sexual initiation. The authors note that the program's protective effects increased with level of participation.
Efforts to treat reproductive tract infections (RTIs) and prevent the spread of those that are sexually transmitted are hampered in South Asia because many women do not seek medical care or even know they are infected. Jasmin Helen Prasad and colleagues use findings from a community-based study of RTIs among married women aged 16–22 in rural Tamil Nadu, India, to examine this issue [see article]. Of 240 women who reported gynecologic symptoms, 45% had at least one infection according to laboratory diagnoses; in addition, clinical examinations found that 9% had cervicitis and 7% had pelvic inflammatory disease (PID). Of 211 women who initially reported no symptoms, 30% received positive laboratory tests (though none had multiple infections); 8% had cervicitis and 5% PID. Two-thirds of symptomatic women had not sought treatment; they cited the absence of a female provider in the health center, lack of privacy, distance from home, cost and the perception that their symptoms were normal.
In many countries in Sub-Saharan Africa, women now account for more than half of new HIV infections; often they have contracted the infection from their husbands or long-term partners. Women's risk of being infected within marriage is high in Zambia, where an estimated 16% of adults are infected but fewer than 5% of married women report current condom use. Using data from the most recent Zambia Demographic and Health Survey, Sitawa Kimuna and Yanyi K. Djamba find that 19% of married men reported having had extramarital sex in the year before the survey, and that those men had had an average of 1.3 extramarital partners during that time [see article]. Multivariate analysis revealed large regional differences in the risk of engaging in extramarital sex, indicating, according to the authors, that prevention efforts will need to take into account local norms related to sexual activity.
Also in This Issue
It has been 10 years since delegates to the International Conference on Population and Development (ICPD) issued their groundbreaking agenda prioritizing women's sexual and reproductive health and rights. In a Viewpoint, Adrienne Germain and Jennifer Kidwell assess the progress made since ICPD [see article]. They conclude that much progress has been made overall, but single out four areas that need particular attention: the incorporation of reproductive health in strategies to achieve the Millenium Development Goals, efforts to counter the increasing feminization of the AIDS epidemic, the provision of adequate reproductive health services and education for young people, and the prevention of unsafe abortion.