Researchers have long sought to identify ways of preventing or reducing sexual risk behavior, contraceptive nonuse or discontinuation and unintended pregnancy. Earlier studies tended to focus mainly on individual characteristics, but more recently research has examined family and community factors as well. Although such factors often are not amenable to change, they may give a more complete picture of the context in which risk behaviors arise, and some may provide opportunities for interventions. Several articles in this issue of International Perspectives on Sexual and Reproductive Health find links between these factors and sexual risk behaviors.
The lead article, by Kanako Ishida and colleagues, reports that among 15–19-year-old Jamaicans who neither were in a union nor had a child at the time of a 2008–2009 survey, 32% of females and 54% of males had had sexual intercourse in the previous year; of those, 12% and 52%, respectively, had had more than one sexual partner, and 49% and 46% had used condoms inconsistently or not at all [see article]. The study found that females who had been victims of childhood violence had an elevated risk of being sexually active, while those who lived with a supportive adult had lower risks of being sexually active or of using condoms inconsistently or not at all. Males who had witnessed parental violence were more likely than others to be sexually active and to have multiple partners. In addition, compared with counterparts who endorsed none of three traditional gender role statements, females who endorsed at least one such statement had a higher risk of inconsistent or nonuse of condoms, while males who endorsed three such statements had a higher risk of being sexually active.
Using baseline and follow-up data from a panel study conducted in Honduras, Janine Barden O'Fallon and Ilene Speizer found that 41% of women who adopted the IUD, the pill or the injectable at baseline discontinued their method within 12 months [see article]; of these, 43% switched to a new method (switchers) and 57% stopped use altogether or began to practice contraception again after a month or more of nonuse (stoppers). According to multivariate analyses, the odds of giving method-related problems as the main reason for discontinuation were six times as high among switchers as among stoppers. Switchers were also significantly more likely than stoppers to have discussed discontinuing their method with their partner before doing so and to have sought help from a clinic or health worker. Among women who experienced heavy bleeding as a side effect, switchers were significantly more likely than stoppers to have discussed the bleeding with at least two people, to have talked about it with their partner specifically and to have discussed discontinuing their method with their partner before doing so. On the basis of these findings, the authors recommend that the Honduran family planning program encourage women to talk with their partner, family and others about stopping or switching their method before making—and acting on—a decision.
In Iran, any relationship between males and females outside of marriage (even one not involving sex) is condemned. Nevertheless, evidence suggests that premarital relationships are becoming more common, in part because of delays in the timing of marriage (the proportion of women aged 20–24 who had never been married had risen to 50% by 2006). In a random sample of unmarried female students from four universities in Tehran, Farideh Farahani and colleagues found that slightly more than half reported having had a boyfriend, one in four said they had had some kind of sexual contact and one in 10 said they had had sexual intercourse [see article]. Having had a boyfriend (whether or not the relationship involved sex) and having had sex were negatively associated with parent-daughter closeness. Both very strict and very relaxed parental control during adolescence were associated with having had a boyfriend, but only very strict control was associated with having had premarital sex.
Also in This Issue
•Although Uganda's informal drug shops (which operate mostly in rural areas and rarely employ pharmacists) can legally sell only nonprescription drugs, they often sell a variety of prescription drugs, including those that require injection. In a study by John Stanback and colleagues of drug shop operators who reported selling the injectable contraceptive depot medroxyprogesterone acetate (DMPA), 77% reported having formal family planning training, 62% safe injection training and 59% infection prevention and control training [see article]. Some 96% said they injected DMPA in the shop. Since access to family planning in rural areas is poor, the authors suggest training drug shop operators, many of whom are fully qualified nurses and midwives, as community-based family planning distribution agents. With the appropriate training, supervision and supplies, the authors argue, drug shop operators could play an important role in the safe provision of DMPA.
•Given that 13% of maternal deaths result from unsafe abortion, it is critical that postabortion care be affordable and widely accessible. However, in many countries, postabortion care has not yet been scaled up to the national level or made accessible to all women who need it. Saumya RamaRao and colleagues review what is required for scale-up and the remaining obstacles that need to be overcome [see article].