Induced abortion is legally permitted in Nigeria only to save a woman’s life, but an estimated 1.25 million abortions were performed in the country in 2012, according to the lead article in this issue of International Perspectives on Sexual and Reproductive Health. Authors Akinrinola Bankole and colleagues note that most of these abortions were clandestine, and many were unsafe; some 40% resulted in complications severe enough to warrant treatment in a health facility [see article]. About 212,000 women were treated for complications such as unchecked bleeding and serious infections, and an estimated 285,000 more needed, but did not receive, treatment. The authors call on the government and other stakeholders in the country, where more than 3,000 women are estimated to die of abortion complications each year, to make greater efforts to ensure that women do not continue to suffer or die from unsafe abortion.
Because they often feel stigmatized when they seek sexual and reproductive health services at traditional clinics, many female sex workers in Dhaka, Bangladesh, use alternative services designed specifically for them. However, according to an article by Karen Katz and colleagues, these services generally focus narrowly on prevention and treatment of HIV and other STIs, while the needs of this population for prevention of unintended pregnancy, maternal and child health care, menstrual regulation and treatment for injuries from physical or sexual violence often go unmet [see article]. The authors found that 25% of hotel-based and 36% of street-based sex workers had an unmet need for family planning; 43% and 80%, respectively, had been injured or beaten in the previous year by a client or other partner; and 28% and 54% had been forced to have sex during that period. Of sex workers who had received services in the past six months, 41% of hotel-based and 60% of street-based workers had used a drop-in center, where they felt they were treated well and their privacy was respected. The authors conclude that this population has a pressing need for information and services that are currently not easily accessible.
Beliefs in negative myths about contraceptive methods—such as exaggerated or erroneous reports about side effects, attribution of certain short- or long-term health problems to method use, and negative stereotypes about contraceptive users—are known to be a barrier to family planning adoption and continuation. Using survey data from women and men living in cities in Kenya, Nigeria and Senegal, Abdou Gueye and colleagues examined the link between the prevalence of such beliefs and the level of contraceptive use at the individual and the community level [see article]. Across countries, the most commonly believed myth was that “people who use contraceptives end up with health problems.” On average, urban women in Nigeria and Kenya believed 2.7 and 4.6, respectively, of eight myths, and in Senegal, women believed 2.6 of seven myths. Women’s individual beliefs in myths were negatively associated with their use of modern contraceptives in all three countries. At the community level, women’s beliefs in myths were positively associated with modern method use in Nigeria, but no association was found in either of the other two countries. According to the authors, education programs are needed to dispel common myths and misconceptions about modern contraceptives.
Efforts to promote family planning have been very successful in Sri Lanka, with the percentage of women using any method in 2007 reaching 70%, including 53% who were using a modern method. Moreover, according to the standard Demographic and Health Survey (DHS) definition, only 7% of women had an unmet need for contraception. However, an article by Deborah S. DeGraff and K.A.P. Siddhisena shows that the level of total unmet need in the country varied from less than 2% to more than 19% when alternative definitions of the measure were used [see article]. In addition, levels of unmet need for spacing were uniformly low (2% or less), while unmet need for limiting was generally higher and more variable (as high as 19%). Unmet need for limiting was particularly high under definitions in which women who used traditional methods or practiced prolonged abstinence were classified as having unmet need. The authors suggest that unmet need could be further reduced in Sri Lanka by efforts to meet the family planning needs and concerns of selected subgroups.
Age at sexual debut, at first marriage or union and at first birth are among the most widely used indicators of sexual and reproductive health for female adolescents in developing countries. However, questions have been raised about the accuracy of estimates calculated from survey data, particularly those based on reporting of events occurring before age 15 or 16. Using data from nine countries in Sub-Saharan Africa and Latin America, each of which had two Demographic and Health Surveys conducted five years apart, Sarah Neal and Victoria Hosegood compared the consistency of estimates between surveys and across birth cohorts [see article]. They found that women aged 15–19 were much less likely to report marriages and first births occurring before age 15 than were women from the same birth cohort when asked five years later, at ages 20–24. Early sexual debut was reported more consistently in consecutive surveys than early marriages or births. According to the authors, caution should be used when inferring changes in early adolescent sexual and reproductive health on the basis of estimates of these indicators from the DHS and other household surveys.