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ABSTRACT: This study estimated the proportion of abortion patients in the USA reporting perceived and internalized stigma, and assessed associations between those outcomes and women's sociodemographic, reproductive, and situational characteristics by race/ethnicity from a nationally representative dataset. Two-thirds of women reported that some people would look down on them if they knew about the abortion, and more than half of the respondents reported needing to keep their abortion a secret from friends and family. Associations between women's characteristics and abortion stigma varied by race/ethnicity. Results indicate that many abortion patients in the USA perceive and internalize stigma; certain subgroups of women are more likely to perceive or internalize stigma than others.
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 09/2012; 118 Suppl 2:S152-9. · 1.41 Impact Factor
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ABSTRACT: Using a sample of 656 men and 930 women from rural Malawi in 2000, the authors examined the association between various individual and community level factors, as well as participation in social groups, and four reproductive health outcomes: intentions to use any contraceptives in the next six months, current use of modem contraceptives, wanting an HIV test, and having had an HIV test. Women in social groups have higher odds of reporting intentions to use contraceptives, wanting an HIV test, and of having had an HIV test than those not in groups. Among men, social group participation is only slightly associated with having had an HIV test. For all, education is positively associated with all four outcomes, and number of children is associated with intentions to use and actual use of contraceptives. At a community level, proximity to a health center or school is positively associated with three outcomes for women and with use of modern contraceptive methods for men.
African Journal of Reproductive Health 09/2012; 16(3):57-67.
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ABSTRACT: Family planning is one of the four pillars of the Safe Motherhood Initiative to reduce maternal death in developing countries. We aimed to estimate the effect of contraceptive use on maternal mortality and the expected reduction in maternal mortality if the unmet need for contraception were met, at country, regional, and world levels.
We extracted relevant data from the Maternal Mortality Estimation Inter-Agency Group (MMEIG) database, the UN World Contraceptive Use 2010 database, and the UN World Population Prospects 2010 database, and applied a counterfactual modelling approach (model I), replicating the MMEIG (WHO) maternal mortality estimation method, to estimate maternal deaths averted by contraceptive use in 172 countries. We used a second model (model II) to make the same estimate for 167 countries and to estimate the effect of satisfying unmet need for contraception. We did sensitivity analyses and compared agreement between the models.
We estimate, using model I, that 342,203 women died of maternal causes in 2008, but that contraceptive use averted 272,040 (uncertainty interval 127,937-407,134) maternal deaths (44% reduction), so without contraceptive use, the number of maternal deaths would have been 1ยท8 times higher than the 2008 total. Satisfying unmet need for contraception could prevent another 104,000 maternal deaths per year (29% reduction).
Numbers of unwanted pregnancies and unmet contraceptive need are still high in many developing countries. We provide evidence that use of contraception is a substantial and effective primary prevention strategy to reduce maternal mortality in developing countries.
Bill and Melinda Gates Foundation.
The Lancet 07/2012; 380(9837):111-25. · 38.28 Impact Factor
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ABSTRACT: Why is induced abortion common in environments in which modern contraception is readily available? This study analyses qualitative data collected from focus group discussions and in-depth interviews with women and men from low-income areas in five countries--the United States, Nigeria, Pakistan, Peru and Mexico--to better understand how couples manage their pregnancy risk. Across all settings, women and men rarely weigh the advantages and disadvantages of contraception and abortion before beginning a sexual relationship or engaging in sexual intercourse. Contraception is viewed independently of abortion, and the two are linked only when the former is invoked as a preferred means to avoiding repeat abortion. For women, contraceptive methods are viewed as suspect because of perceived side effects, while abortion experience, often at significant personal risk to them, raises the spectre of social stigma and motivates better practice of contraception. In all settings, male partners figure importantly in pregnancy decisions and management. Although there are inherent study limitations of small sample sizes, the narratives reveal psychosocial barriers to effective contraceptive use and identify nodal points in pregnancy decision-making that can structure future investigations.
Global Public Health 09/2011; 6 Suppl 1:S1-24. · 0.92 Impact Factor
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ABSTRACT: It is well recognised that unsafe abortions have significant implications for women's physical health; however, women's perceptions and experiences with abortion-related stigma and disclosure about abortion are not well understood. This paper examines the presence and intensity of abortion stigma in five countries, and seeks to understand how stigma is perceived and experienced by women who terminate an unintended pregnancy and influences her subsequent disclosure behaviours. The paper is based upon focus groups and semi-structured in-depth interviews conducted with women and men in Mexico, Nigeria, Pakistan, Peru and the United States (USA) in 2006. The stigma of abortion was perceived similarly in both legally liberal and restrictive settings although it was more evident in countries where abortion is highly restricted. Personal accounts of experienced stigma were limited, although participants cited numerous social consequences of having an abortion. Abortion-related stigma played an important role in disclosure of individual abortion behaviour.
Global Public Health 09/2011; 6 Suppl 1:S111-25. · 0.92 Impact Factor
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ABSTRACT: To assess the theoretical and practical knowledge about emergency contraception (EC) among family-planning (FP) providers in Ghana and to examine the association between FP providers' theoretical and practical knowledge.
Data on 600 FP providers were collected through a census of facilities offering FP services in Kumasi, Ghana, in 2008. Nested linear multivariate regression analysis was used to identify sociodemographic, facility-related, and work-related variables associated with FP providers' theoretical and practical knowledge about EC.
On average, FP providers gave 4.1 correct answers to the 11 questions assessing theoretical knowledge and 5.6 correct answers to the 8 questions assessing their practical ability to provide EC. The FP providers seemed to learn provision-related aspects through practice without having a particularly good theoretical knowledge on EC as a contraceptive method. The health sector in which FP providers worked, their education and having received EC-specific training, the number of services offered, and the number of women seen during a week were all significant correlates of both theoretical and practical knowledge about EC. The 2 knowledge domains were significantly and positively associated.
There is need to improve knowledge about EC among FP providers in Ghana through in-service training.
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 07/2011; 114(1):64-8. · 1.41 Impact Factor
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ABSTRACT: To examine the use of contraception in 13 countries in sub-Saharan Africa; to assess changes in met need for contraception associated with wealth-related inequity; and to describe the relationship between the use of long-term versus short-term contraceptive methods and a woman's fertility intentions and household wealth.
The analysis was conducted with Demographic and Health Survey data from 13 sub-Saharan African countries. Wealth-related inequities in the use of contraception were calculated using household wealth and concentration indices. Logistic regression models were fitted for the likelihood of using a long-term contraceptive method, with adjustments for: wealth index quintile, fertility intentions (to space births versus to stop childbearing), residence (urban/rural), education, number of living children, marital status and survey year.
The use of contraception has increased substantially between surveys in Ethiopia, Madagascar, Mozambique, Namibia and Zambia but has declined slightly in Kenya, Senegal and Uganda. Wealth-related inequalities in the met need for contraception have decreased in most countries and especially so in Mozambique, but they have increased in Kenya, Uganda and Zambia with regard to spacing births, and in Malawi, Senegal, Uganda, the United Republic of Tanzania and Zambia with regard to limiting childbearing. After adjustment for fertility intention, women in the richest wealth quintile were more likely than those in the poorest quintile to practice long-term contraception.
Family planning programmes in sub-Saharan Africa show varying success in reaching all social segments, but inequities persist in all countries.
Bulletin of the World Health Organisation 04/2011; 89(4):258-66. · 4.64 Impact Factor
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ABSTRACT: To assess the fertility and pregnancy experiences of rural Malawian women living with obstetric fistula and following surgical repair of fistula.
Fertility histories were collected via in-depth interviews with women identified in 2007 as having obstetric fistula and with their family members.
Of the 32 affected women interviewed, 17 (53.1%) conceived after developing obstetric fistula: 13 before repair and 6 after repair (with 2 conceiving both pre- and post-repair). Complaints of infertility were more frequent and urgent among women who had undergone repair than among those who had not. Over half (53.8%) of the women who conceived while living with obstetric fistula and all of those who conceived post-repair experienced at least 1 spontaneous abortion or perinatal death. Nineteen (47.5%) of the 40 pregnancies among women living with obstetric fistula and 7 (70.0%) of the 10 pregnancies among women post-repair ended in spontaneous abortion or perinatal death.
Even 2 years after undergoing surgical repair, women can continue to experience the effects of obstetric fistula, which include infertility, spontaneous abortion, and perinatal mortality. The factors responsible for extensive infertility and poor pregnancy outcome in women post-repair warrant further investigation.
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 03/2011; 113(3):196-8. · 1.41 Impact Factor
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ABSTRACT: To more effectively address individuals' and couples' sexual and reproductive health needs, innovative service delivery strategies are being explored. These strategies are logistically and ethically complicated, considering prevailing gender inequalities in many contexts. We conducted an exploratory study to assess the acceptability of couples' home-based sexual health services in Malawi. We collected qualitative data from six focus group discussions and 10 husband-wife indepth interviews to gain a more thorough understanding of how gender norms influence acceptability of couples' sexual health services. Findings reveal that women are expected to defer to their husbands and may avoid conflict through covert contraceptive use and non-disclosure of HIV status. Many men felt that accessing sexual health services is stigmatizing, causing some to avoid services or to rely on informal information sources. Gender norms and attitudes toward existing services differentially impact men and women in this setting, influencing the perceived benefits of couples' sexual health services.
African Journal of Reproductive Health 12/2010; 14(4 Spec no.):61-71.
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ABSTRACT: While numerous studies have explored young people's sexual behaviour in Peru, to date few have explored how adolescents situate sexuality within the context of their broader lives. This information is needed to inform policies and programmes. Life history interviews were conducted with 20 12-17-year-old young women and men from a low-income settlement near Lima, Peru. Data were analysed using holistic content analysis and grounded theory. Sexuality had a strong presence in respondents' lives. However, interviewees viewed the full expression of their sexuality as a constrained choice. Particular constraints derive from the belief that sexual intercourse always results in pregnancy; the nature of sex education; the provision of proscriptive advice; and the family tensions, economic problems, racism and violence present in young people's lives. The results of this study can inform policies and programmes to support young people as they make sexuality-related decisions.
Culture Health & Sexuality 10/2010; 12(7):771-82. · 1.55 Impact Factor
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ABSTRACT: This study explores the lives of Peruvian adolescents in a low-income human settlement outside of Lima. Twenty 12-17 year olds were asked to narrate their own life stories using the life history narrative research method. Holistic content analysis was coupled with a grounded-theory approach to explore these data. Intergenerational responsibility, family tensions, economic pressures, racism and violence emerged without prompting and dominated the narrators' life stories, underscoring the degree to which these adolescents lack access to the supportive individuals and structures that are key to positive adolescent development. The challenges faced by these and the other 5.8 million 10-19 year olds in Peru require increased attention to the role of families, peers and communities in ensuring that adolescents are able to maintain their well-being and achieve their future expectations.
Journal of Adolescence 03/2010; 33(4):509-20. · 2.05 Impact Factor
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ABSTRACT: The primary objective of this study was to identify and describe individual- and environmental-level factors that Peruvian adolescents perceive to be related to adolescent sexuality. A series of concept mapping sessions were carried out from January-March 2006 with 63 15-17 year olds from a low-income community near Lima in order for adolescents to: (1) brainstorm items that they thought were related to sexuality, (2) sort, group and rate items to score their importance for sexuality-related outcomes, and (3) create pathways from the groups of items to engaging in sex. Brainstorming resulted in 61 items, which participants grouped into 11 clusters. The highest rated clusters were personal values, respect and confidence in partner relationships, future achievements and parent-child communication. The pathway of decision-making about having sex primarily contained items rated as only moderately important. This study identified important understudied factors, new perspectives on previously-recognized factors, and possible pathways to sexual behavior. These interesting and provocative findings underscore the importance of directly integrating adolescent voices into future sexual and reproductive health research, policies and programs that target this population.
Social Science [?] Medicine 03/2010; 70(12):2085-95. · 2.70 Impact Factor
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ABSTRACT: Relative to the attention given to improving the quality of and access to maternal health services, the influence of women's socio-economic situation on maternal health care use has received scant attention. The objective of this paper is to examine the relationship between women's economic, educational and empowerment status, introduced as the 3Es, and maternal health service utilization in developing countries.
The analysis uses data from the most recent Demographic and Health Surveys conducted in 31 countries for which data on all the 3Es are available. Separate logistic regression models are fitted for modern contraceptive use, antenatal care and skilled birth attendance in relation to the three covariates of interest: economic, education and empowerment status, additionally controlling for women's age and residence. We use meta-analysis techniques to combine and summarize results from multiple countries. The 3Es are significantly associated with utilization of maternal health services. The odds of having a skilled attendant at delivery for women in the poorest wealth quintile are 94% lower than that for women in the highest wealth quintile and almost 5 times higher for women with complete primary education relative to those less educated. The likelihood of using modern contraception and attending four or more antenatal care visits are 2.01 and 2.89 times, respectively, higher for women with complete primary education than for those less educated. Women with the highest empowerment score are between 1.31 and 1.82 times more likely than those with a null empowerment score to use modern contraception, attend four or more antenatal care visits and have a skilled attendant at birth.
Efforts to expand maternal health service utilization can be accelerated by parallel investments in programs aimed at poverty eradication (MDG 1), universal primary education (MDG 2), and women's empowerment (MDG 3).
PLoS ONE 01/2010; 5(6):e11190. · 4.09 Impact Factor
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ABSTRACT: Despite calls to make family planning services more responsive to the values, needs and preferences of clients, few studies have asked clients about their experiences or values, and most have used surveys framed by researchers', rather than clients', perspectives.
Forty in-depth interviews exploring lifetime experiences with and values regarding services were conducted with 18-36-year-old women who visited family planning clinics in the San Francisco Bay Area in 2007. Women were categorized as black, white, English- or Spanish-speaking Latina, or of mixed ethnicity to allow examination of differences by racial, ethnic and language group. Interviews were audiotaped, transcribed and coded thematically; matrices were then used to compare the themes that emerged across the subgroups.
Eight themes emerged as important to women's views of services: service accessibility, information provision, attention to client comfort, providers' personalization of care, service organization, providers' empathy, technical quality of care and providers' respect for women's autonomy. Women reported that it was important to feel comfortable during visits, to feel that their decision-making autonomy was respected, to have providers show empathy and be nonjudgmental, and to see the same provider across visits. The only notable difference among racial, ethnic and language groups was that Spanish-speaking Latinas wanted to receive language-appropriate care and contraceptive information.
Future surveys of family planning service quality should include measures of the factors that women value in such care, and efforts to improve providers' communication and counseling skills should emphasize the personalization of services and respect for clients' autonomy.
Perspectives on Sexual and Reproductive Health 10/2009; 41(3):158-65. · 1.41 Impact Factor
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ABSTRACT: Short birth intervals can have adverse consequences for maternal and infant outcomes. Optimal birth spacing is often presumed to be achieved through the practice of family planning and use of contraceptives, yet most of the available research does not address explicitly the contribution of contraceptive-method use to birth spacing or maternal and infant survival. We conducted a systematic literature review to assess the body of evidence linking contraceptive use to birth-interval length. Fourteen studies published in English between 1980 and 2008 met our eligibility criteria for inclusion. The findings from these studies are mixed but suggest that the use of contraceptives is protective against short birth intervals. Although results are favorable, many of the studies and methodologies employed are dated. More current research is needed to determine the impact of contraceptive-method use on birth-interval length in order to inform the promotion of family planning for reducing maternal and infant morbidity and mortality through birth spacing.
Studies in Family Planning 09/2009; 40(3):205-14. · 1.28 Impact Factor
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ABSTRACT: The reproductive choices made by young women and men have an enormous impact on their health, schooling, employment prospects and overall transition to adulthood. As the largest cohort of young people in history enter their childbearing years, their reproductive behavior will determine the growth and size of the world's population for decades to come.
Demographic and Health Survey data from more than 40 countries were used to examine the proportions of 15-19-year-old women who are currently married or are unmarried but sexually active; their rates of contraceptive adoption, current use, discontinuation, method switching and contraceptive failure; trends in these indicators; and comparisons with older women.
In many countries, the proportion of adolescent women using contraceptives increased substantially over the last two decades; prevalence among adolescents increased faster than among older women. Greater proportions of adolescents than of older women discontinued using a contraceptive method within a year or experienced contraceptive failure.
Adolescent contraceptive use is growing, and compared with adult use, is characterized by shorter periods of consistent use with more contraceptive failure and more stopping for other reasons. Use through the reproductive years is likely to grow, fueled further by growth in the numbers of young people. An expanded demand for contraceptive supplies, services and information can be expected to challenge the preparedness, capacity and resources of existing family planning programs and providers.
International perspectives on sexual and reproductive health 07/2009; 35(2):63-71. · 1.06 Impact Factor
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ABSTRACT: Despite liberal laws, abortions are a major cause of maternal morbidity and mortality in India.
This study uses health provider data (N=2039) collected in Bihar and Jharkhand states, India, in 2004. Logistic regression models are fitted to identify correlates of providers' practice of abortion services and intention to offer medical abortions.
While a majority of respondents (63.2%) provide abortion services, only 2.9% currently provide medical abortions and 23.8% intend to provide medical abortions. Private rather than public clinic providers and female rather than male providers are more likely to offer abortion services and intend to provide medical abortions. Aspects related to medical abortion's market demand, its safety, efficacy and perceived ease of delivery weigh more than patients' rights and personal interests on providers' decision to provide medical abortions.
This study enlarges the knowledge base on abortion service providers and offers recommendations for improving access to safe abortion services in India.
Contraception 01/2009; 78(6):500-6. · 2.72 Impact Factor
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ABSTRACT: Eliminating racial and ethnic disparities in health care is an important national priority. Despite substantial research documenting such disparities, this topic has received limited attention in the reproductive health field.
Logistic regression was used to test for group differences in three service delivery preferences and five service quality perceptions among a nationally representative sample of 1,741 low-income black, Latina and white women aged 18-34; the data were collected in 1995 and represent the most recent data available for looking at these issues.
English-speaking Latinas and Spanish-speaking Latinas were more likely than whites to prefer a female clinician at their visits (odds ratios, 1.8 and 3.6, respectively) and to highly value clinician continuity (1.7 and 2.2). English-speaking Latinas and blacks were more likely than whites to prefer receiving reproductive health care at a site delivering general health care (1.5 and 1.6). Both groups of Latinas were less likely than whites to give the facility environment or the patient-centeredness at their most recent reproductive health visit the highest rating (0.3-0.5). Blacks were more likely than whites to report ever having been pressured by a clinician to use contraceptives (2.3).
Efforts to reduce racial, ethnic and language group differences in clients' perceptions of reproductive health service quality should focus on improving client-clinician communication, the service environment and contraceptive counseling. Future research should continue to assess group differences and try to determine their underlying causes.
Perspectives on Sexual and Reproductive Health 01/2009; 40(4):202-11. · 1.41 Impact Factor
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Irving F Hoffman,
Francis E A Martinson,
Kimberly A Powers,
David A Chilongozi,
Emmie D Msiska,
Emma I Kachipapa,
Chimwemwe D Mphande,
Mina C Hosseinipour,
Harriet C Chanza,
Rob Stephenson, Amy O Tsui
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ABSTRACT: To estimate the effect of receiving HIV-positive test results on intentions to have future children and on contraceptive use and to assess the association between pregnancy intentions and pregnancy incidence among HIV-positive women in Malawi.
Women of unknown HIV status completed a questionnaire about pregnancy intentions and contraceptive use and then received HIV voluntary counseling and testing (VCT). Women who were HIV-positive and not pregnant were enrolled and followed for 1 year while receiving HIV care and access to family planning (FP) services.
Before receiving their HIV test results, 33% of women reported a desire to have future children; this declined to 15% 1 week later (P < 0.0001) and remained constant throughout follow-up. Contraceptive use increased from 38% before HIV testing to 52% 1 week later (P < 0.0001) and then decreased to 46% by 12 months. The pregnancy incidence among women not reporting a desire to have future children after VCT was less than half of the incidence among women reporting this desire.
With knowledge of their HIV-positive status, women were less likely to desire future pregnancies. Pregnancy incidence was lower among women not desiring future children. Integration of VCT, FP, and HIV care could prevent mother-to-child HIV transmission.
JAIDS Journal of Acquired Immune Deficiency Syndromes 05/2008; 47(4):477-83. · 4.43 Impact Factor
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ABSTRACT: Community-based reproductive health agents (CBRHAs) can increase community knowledge of and offer immediate access to reproductive health services, including HIV/AIDS. Due to growing interest in integration of family planning and HIV services in Ethiopia, it is important to examine whether CBRHAs are efficiently offering both service types. The present analysis uses survey data collected from Ethiopian CBRHAs and examines associations between agents' demographic, personality and work-related characteristics and their capacity to provide integrated services and have high client volumes. Multivariate probit and bivariate probit regression models are fitted for the two outcomes of interest. Nearly half of CBRHAs in our sample offer integrated services, but this is not jointly associated with increased productivity. Personality traits and work experience are more strongly associated with agents' capacity to provide integrated services than demographic characteristics, while agents' gender and work-related characteristics are significantly associated with increased likelihood of serving more clients.
Health Policy and Planning 12/2007; 22(6):404-14. · 2.65 Impact Factor
