Women's reproductive health remains precarious in many developing countries. Although young women today are marrying later than their mothers did, many still marry and begin childbearing during adolescence. Half of all new HIV infections occur among 15–24-year-olds, 75% of them among females. These risks are exacerbated by poverty, discrimination and lack of information, factors that are the focus of the research articles in this issue of International Family Planning Perspectives. The authors of two of these articles examine data from males as well as females, recognizing that the well-being of each gender affects that of the other.
In the lead article, "Exploring the Socioeconomic Dimension of Adolescent Reproductive Health," Manju Rani and Elizabeth Lule look at differences in the reproductive health outcomes and service use of the wealthiest and poorest adolescent women in 12 countries [see article]. In all but one country, the poorest young women were significantly more likely than the wealthiest to have married and given birth by age 18; in every country, they were significantly less likely to have used a trained birth attendant, to be relying on a modern contraceptive method or to know at least one way of avoiding HIV infection. The analysis also shows that school enrollment and regular exposure to television, radio or newspapers was lower among the poorest young women. Among adolescents who worked for cash, the poorest young women were significantly less likely than the wealthiest to have any control over their earnings. According to the researchers, their findings suggest that current programmatic approaches in these countries—which tend to rely on mass media, clinics or schools to deliver information and services—have not succeeded in reaching the poorest young women, who are often illiterate, unemployed, living in rural areas and cut off from social networks.
Research on condom use has usually focused on respondents' social and demographic characteristics, thus omitting potentially useful information on sexual partners and the respondents' relationships with them. Kofi D. Benefo's article "Are Partner and Relationship Characteristics Associated with Condom Use in Zambian Nonmarital Relationships?" explores that issue using data from a nationally representative sample of women and men [see article]. In his analyses, condom use was not related to partner traits, but was associated with relationship characteristics. In both male- and female-reported relationships, condom use was more common if the man was at least five years older than the woman. The significance of other respondent and relationship factors varied by gender, indicating that different condom promotion interventions are needed for men and women.
China has mandated sex education in middle school curricula since 1988. Many young people, however, view that education as inadequate for their needs. Ying Li and colleagues report the results of a survey at one Chinese college on students' needs and preferences regarding sex education [see article]. Sexual response, HIV/AIDS and sexually transmitted infections were the most frequently requested subjects, with each being named by about nine in 10 students. Both males and females indicated the greatest comfort in discussing male-female communication and social norms, and the least comfort in discussing deviant sexual behaviors. Males favored learning about sexuality through videos and role-playing, while females preferred case studies, classroom lectures and reading, indicating that health educators need to consider gender when deciding on teaching strategies.
Also in This Issue
• With increasing numbers of reproductive-age women and shrinking funding for family planning, should program planners continue to focus their resources on price subsidies? In a Viewpoint, Gaverick Matheny reviews what is known about the effects on contraceptive prevalence of these subsidies, as well as those of expenditures for promotion, quality and distribution [see article]. Noting that the relative effectiveness of these activities is likely to vary across populations, Matheny recommends that program planners conduct research to identify local barriers to contraceptive use and the measures needed to overcome them.
• Despite being hailed initially as a female-controlled method that would allow women to protect themselves from sexually transmitted infections (STIs), the female condom has not proved as popular as expected. Susie Hoffman and colleagues argue that if the method were properly promoted, it could play an important role—and would be well accepted—in preventing unintended pregnancy and STIs [see article].