Small proportions of Indian youth report having had premarital sex, but among those who do, few say they used condoms. According to a study conducted by K.G. Santhya and colleagues among 2,408 married or unmarried youth aged 15–24 who had had premarital sex, just 7% of young women and 27% of young men said they had ever used a condom [see article]. In analyses that examined multiple measures of condom use—ever-use, use at first sex, use at last sex and consistent use—discomfort with approaching a provider or pharmacist for condoms was negatively associated with all four measures among young men and with use at last sex among young women; having peers who had had premarital sex was positively associated with all measures of use among young men and with ever-use among young women. Women who had had sex only with nonromantic partners were less likely than those who had done so only with romantic partners to have used a condom at last sex; in contrast, young men were generally more likely to have used condoms with nonromantic partners. The authors recommend that service delivery structures be modified to enable youth to obtain condoms easily and privately.
Studies of sexual behavior have generally concluded that men tend to overreport their sexual behavior and women to underreport theirs. To examine this assumption, Shelley Clark and colleagues looked at data on 1,299 partnerships in the last year reported by 1,275 men and women who were aged 18–24 and living in Kisumu, Kenya [see article]. Even after adjustment for sample selection bias, men reported twice as many partnerships as women, as well as more casual partnerships. When selective reporting of partnerships was accounted for, however, aggregate gender differences in sexual behavior almost entirely disappeared. In a matched-couples sample—created to compare the reports of partners within a couple—agreement between partners was moderate to substantial on most relationship characteristics and behaviors, including type of relationship, frequency of sex and condom use. Partners' reports tended to agree on whether the man had other partners, but not on whether the woman did. The authors conclude that although accounts of behavior within relationships are generally reliable, both sample selection and selective reporting of partnerships can influence the aggregate level of agreement.
First-trimester abortion was legalized in Mexico City in 2007, but little is known about clients' views of the quality of care in public-sector facilities. Davida Becker and colleagues interviewed more than 400 abortion patients before they left the service facility about their perceptions of the care they had received [see article]. The women gave the overall services a high rating, with a mean of 8.8 on a scale of 10. Overall service ratings were higher among women who reported that the doctor made them feel comfortable, that the staff treated them with dignity and respect and were very careful to protect their privacy, that they were given sufficient information on self-care at home following the abortion and that they felt confident in the doctor's technical skill. Rating site hours as very convenient, waiting time as acceptable and the facility as very clean were also associated with higher overall scores. According to the authors, efforts to improve patient experiences should focus on client-staff interaction, information provision, service accessibility, technical competence and the facility environment.
Although the introduction of a new method into a family planning program may increase use, it may also have unforeseen effects on the use of other methods, according to a study by Elizabeth Sutherland and colleagues [see article]. Using data from 13 countries that had had two or more Demographic and Health Surveys since the early 1990s—when the injectable was introduced by many programs—the authors found that both use of any modern method and use of the injectable rose in all countries, and that the increase in overall modern method use exceeded the increase in injectable use in all but three countries. Nevertheless, the increases in injectable use were partially offset by declines in use of long-acting or permanent methods, particularly among women who said they wanted no more children. Noting that ideally, women would progress from shorter- to longer-acting methods as their families grew, and would switch to a permanent method when they were sure that they wanted no more children, the authors recommend interventions to promote demand for long-acting and permanent methods among women for whom they are appropriate, while maintaining a broad range of methods for women with varying contraceptive needs.
Also in This Issue
Although some fertility declines have occurred in Sub-Saharan Africa, the average total fertility rate in 2005–2010 exceeded 5.1 births per woman, a level that appears to be driven by a desire for large families. In a Comment, John Bongaarts uses a combination of cross-national analyses and case studies to tackle the long-debated question of whether family planning programs can lower ideal family size—and therefore fertility—in Africa [see article]. The results, he concludes, suggest that they can, even in the world's poorest and least-developed countries.