In all regions of the developing world, women are at high risk of sexual and reproductive health problems. Many factors—individual, family and societal—make it difficult for women to obtain the information and services they need to reduce these risks. This issue of International Family Planning Perspectives examines how these factors play out in women's lives.
In the lead article, Fatima Juarez and colleagues examine changes in levels of induced abortion in Mexico between 1990 and 2006 [see article]. Because abortion remains largely illegal and clandestine in Mexico, their calculations are based on numbers of women aged 15–44 treated for abortion complications in the public health system and estimates of the percentage of abortion patients who had complications. Between the two years, the abortion rate increased from 25 to 33 per 1,000 women, and the abortion ratio rose from 21 to 44 per 100 live births. Noting that total fertility declined from 3.4 to 2.2 children per woman during the period studied, the authors conclude that Mexican women who experience unplanned pregnancies are increasingly resorting to clandestine abortion. To protect women's health, they recommend broadening the legal criteria for abortion throughout Mexico, improving contraceptive and postabortion services and expanding training in the provision of safe abortion.
In an exploration of factors that affect the timing of first intercourse among young people in Nyanza, a province whose HIV prevalence is one of the highest in Kenya, Eric Tenkorang and Eleanor Maticka- Tyndale find strong evidence of the role of cultural norms [see article]. Both males and females who rejected myths about HIV transmission and those who experienced less pressure to have sex were more likely to postpone intercourse than other young people. Moreover, cross-gender comparisons revealed an interesting finding: Although males are pressured to initiate sex very early, those who felt confident of their ability to resist the pressure were more likely to abstain than their less-confident peers. In contrast, belief in their ability to abstain was not associated with abstinence for females, who appeared to be influenced to engage in intercourse by social and environmental pressures. The authors recommend that HIV prevention programs focus on dispelling transmission myths and on countering the gendered pressures to have intercourse that young people undergo in early adolescence.
When social norms support early marriage and childbearing, interventions may need to involve community leaders and parents as well as young people, according to a report by Elkan E. Daniel and colleagues on an evaluation of a project in Bihar, India [see article]. The PRACHAR project, which sought to increase contraceptive use by young couples to delay their first birth and space subsequent births, reached out to the community by holding group meetings with young couples' parents and in-laws, disseminating reproductive health messages through street theater and wall paintings, and providing reproductive health information in group and individual counseling sessions with young husbands and wives who had no more than one child. At baseline, about one-quarter of women in both the intervention and the comparison areas wanted to wait at least two years for a child or wanted no more children. By follow-up (21–27 months after the intervention), that percentage had risen to 40% in the intervention areas, but had not changed in the comparison areas. Likewise, contraceptive use increased from 4% to 21% in the intervention communities, compared with 3% to 5% in the comparison areas. Knowledge about key reproductive health information also increased significantly. The authors conclude that culturally appropriate, community-based communication programs that target both young people and those who influence their decisions can lead to both increased demand for and increased use of contraceptives among young couples.
Also in This Issue
•In research examining how interview modes affect the reporting of sensitive behaviors, Barbara Mensch and colleagues found that reporting was more consistent among Brazilian women interviewed by audio computer-assisted self interview (audio-CASI) at both baseline and follow-up than among women interviewed face-to-face at baseline and by audio-CASI at follow-up [see article]. For example, when asked if they had ever had an abortion, 2% of women in the former group said no at baseline and yes at follow-up, compared with 10% of women in the latter group; those proportions were 3% and 9% for coerced sex and 3% and 6% for transactional sex. Moreover, the number of sexual partners reported rose at follow-up for 16% of women initially interviewed using audio-CASI and for 22% of those initially interviewed face-to-face. The authors suggest that use of audio-CASI to gather data on sensitive behavior may produce more reliable information because it appears to reduce social desirability bias.