Iqbal Shah

• World Health Organization WHO

To meet the postpartum family planning (PPFP) needs of women in Nepal, an intervention was launched to integrate PPFP counselling and postpartum IUD (PPIUD) insertion into maternity care. Women delivering in study hospitals over a period of 18 months were interviewed at the time of delivery and at 15 months following the end of the study enrollment...

Objective: To examine the prevalence and predictors of family planning (FP) know-do gaps among married women of reproductive age (MWRA) in low socio-economic urban areas of Karachi, Pakistan. Design: This was a cross-sectional survey of randomly selected 7288 MWRA (16-49 years) to identify predictors of the know-do gap in FP using a logistic reg...

Background Postpartum women have high rates of unmet need for modern contraception in the two years following birth in Nepal. We assessed whether providing contraceptive counseling during pregnancy and/or prior to discharge from the hospital for birth or after discharge from the hospital for birth was associated with reduced postpartum unmet need i...

Background Data collection is the most critical stage in any population health study and correctly implementing fieldwork enhances the quality of collected information. However, even the most carefully planned large-scale household surveys can encounter many context-specific issues. This paper reflected on our research team’s recent experience cond...

Background Health service providers play a key role in addressing women’s need for postpartum pregnancy prevention. Yet, in Nepal, little is known about providers’ knowledge, attitudes, and practice (KAP) on providing postpartum family planning (PPFP), particularly the immediate postpartum intrauterine device (PPIUD). This paper assesses providers...

CONTEXT Abortion is particularly difficult to measure, especially in legally restrictive settings such as Pakistan. The List Experiment—a technique for measuring sensitive health behaviors indirectly—may minimize respondents’ underreporting of abortion due to stigma or legal restrictions, but has not been previously applied to estimate abortion pre...

Background: Integration of maternal care and family planning services has the potential to reduce unintended pregnancies and closely spaced births, leading to reductions in maternal mortality and morbidity. However, few models exist detailing how to implement/integrate such services. This study explored the implementation of the Postpartum Intraute...

Background: Data collection is the most critical stage in any population health study and correctly implementing fieldwork enhances the quality of collected information. However, even the most carefully planned large-scale household surveys can encounter many context-specific issues. This paper reflected on our research team’s recent experiences of...

Introduction: Birth spacing is a critical pathway to improving reproductive health. The World Health Organization recommends a minimum of 33-month interval between two consecutive births to reduce maternal, perinatal, and infant morbidity and mortality. Our study evaluated factors associated with short birth intervals (SBIs) of less than 33 months...

Objectives Abortions are difficult to measure; yet, accurate estimates are critical in developing health programs. We implemented and tested the validity of a list experiment of lifetime abortion prevalence in Istanbul, Turkey. We complemented our findings by understanding community perspectives using in-depth interviews with key informants. Metho...

Background: This qualitative study assessed implementation of the Postpartum Intrauterine Device (PPIUD) Initiative in Tanzania, a country with high rates of unintended pregnancy and low contraceptive prevalence. The PPIUD Initiative was implemented to reduce unmet need for contraception among new mothers through postpartum family planning counseli...

Objective: There is high unmet need for family planning in the postpartum period in Nepal. The current study assessed the effects of a contraceptive counseling and postpartum intrauterine device (PPIUD) insertion intervention on use of contraception in the postpartum period. Study design: We utilized a cluster, stepped-wedge design to randomly a...

Background: The World Health Organization recommends postpartum family planning (PPFP) for healthy birth spacing. This study is an evaluation of an intervention that sought to improve women's access to PPFP in Tanzania. The intervention included counseling on PPFP during antenatal and delivery care and introducing postpartum intrauterine device (P...

Background: Postpartum intrauterine device (PPIUD) use remains very low in Nepal despite high levels of unmet need for postpartum family planning and the national government's efforts to promote its use. This study investigates reasons for continuing or discontinuing PPIUD use among Nepali women. Methods: We conducted in-depth interviews (IDIs)...

Background: Though modern contraceptive use among married women in Nepal has increased from 26% in 1996 to 43% in 2016, it remains low among postpartum women. Integration of counselling on family planning (FP) at the time of antenatal care (ANC) and delivery has the potential to increase post-partum contraceptive use. This study investigates the q...

Despite the numerous benefits of the postpartum copper intrauterine device (PPIUD), which is inserted within 48 hours after giving birth, it is underutilized in many resource‐constrained settings, including Tanzania. We conducted in‐depth interviews with 20 pregnant women who received contraceptive counseling during routine antenatal care in 2016–2...

Background: The International Federation of Gynaecology and Obstetrics (FIGO), in collaboration with the Sri Lankan College of Obstetrics and Gynaecologists (SLCOG), launched an initiative in 2014 to institutionalize immediate postpartum IUD (PPIUD) services as a routine part of antenatal counseling and delivery room services in Sri Lanka. In this...

Background: In Nepal, 54% of women have an unmet need for family planning within the 2 years following a birth. Provision of a long-acting and reversible contraceptive method at the time of birth in health facilities could improve access to postpartum family planning for women who want to space or limit their births. This paper examines the impact...

Background: Non-consensual sex (NCS) among young people, an important subject with public health and human rights implications, was less studied in China. This study is to investigate the NCS awareness and victimization of university students in Shanghai, China and whether they were associated with adolescent gender-role attitudes. Methods: Gend...

Background: Early first-trimester medical abortion (MA) service (≤ 63 days) has been provided by doctors and nurses under doctors' supervision since 2009 in Nepal. This paper assesses whether MA services provided by specifically trained and certified nurses and auxiliary nurse-midwives independently from doctors' supervision, is considered as sati...

This article provides programmatic guidance and identifies future research priorities through a review of interventions to improve postpartum contraception. Thirty-five interventions in low- and middle-income countries were identified and classified according to timing and nature of administration: antenatal, postnatal, both ante- and postnatal, an...

Contraception following delivery or an induced abortion reduces the risk of an early unintended pregnancy and its associated adverse health consequences. Unmet need for contraception during the postpartum period and contraceptive counseling and services following abortion have been the focus of efforts for the last several decades. This article pro...

Unmet need for contraception has been a central indicator for monitoring the progress of family planning programs for 25 years. The purpose of this article is to provide a broad context for the more focused contributions that follow in this special issue. The validity and measurement of the concept of unmet need are discussed. We then present regio...

The objective of the study was to explore parental perspectives and attitudes towards the provision of sexual and reproductive health (SRH) information and services to unmarried youth in Chengdu, China. A representative sample of parents was drawn using multi-stage stratified cluster sampling technique, and information was collected using a structu...

Sexual violence within marriage is a public health and human rights issue; yet it remains a much neglected research area, especially in Nepal. This paper represents one of the first attempts to quantify the extent of sexual violence and its determinants among young married women in Nepal. A cross-sectional survey was conducted among 1,296 married w...

Each year, nearly 22 million women worldwide have an unsafe abortion, almost all of which occur in developing countries. This paper estimates the incidence and rates of unsafe abortion by five-year age groups among women aged 15-44 years in developing country regions in 2008. Forty-one per cent of unsafe abortions in developing regions are among yo...

Women whose abortions performed according to medical guidelines are at very low risk of complications. A significant proportion of women with unsafe abortions, however, are at substantial risk of morbidity and death. Unintended pregnancies occur in all societies, and women determined to avoid an unplanned birth will seek unsafe abortions if they ha...

Despite cultural and religious prohibitions against premarital heterosexual relationships and intimacy, some recent evidence suggests some rise in premarital heterosexual interactions and relationships among young people. On the other hand, although HIV in Iran is a concentrated epidemic and mainly reported among high risk groups such as injecting...

Background: Data of abortion incidence and trends are needed to monitor progress toward improvement of maternal health and access to family planning. To date, estimates of safe and unsafe abortion worldwide have only been made for 1995 and 2003. Methods: We used the standard WHO definition of unsafe abortions. Safe abortion estimates were based...

Each year, nearly 22 million women worldwide have an unsafe abortion, almost all of which occur in developing countries. This paper estimates the incidence and rates of unsafe abortion by five-year age groups among women aged 15–44 years in developing country regions in 2008. Forty-one per cent of unsafe abortions in developing regions are among yo...

The aim of the study is to measure trends in condom use in marital and cohabiting relationships in South Africa and Uganda. The data for the study come from two cross sectional surveys conducted in 1998 and 2008 among adult men and women and their partners in KwaZulu-Natal, South Africa and the Jinja district, Uganda. The findings suggest that cons...

The 1990-2008 estimates for the maternal mortality associated with unsafe abortion require a re-examination. To provide the latest estimates of the mortality associated with unsafe abortion and to examine trends within the framework of new maternal mortality estimates. Extensive search of databases and websites for country- and region-specific data...

Intrauterine device (IUD) use dynamics in 14 developing countries Marie Stopes International delivers quality family planning and reproductive healthcare to millions of the world's poorest and most vulnerable women.

To reduce a large unmet need for family planning in many developing countries, governments are increasingly looking to community health workers (CHWs) as an effective service delivery option for health care and as a feasible option to increase access to family planning services. This article synthesizes evidence on the feasibility, safety and effec...

Medical abortion is under-used in developing countries. We assessed whether early fi rst-trimester medical abortion provided by midlevel providers (government-trained, certified nurses and auxiliary nurse midwives) was as safe and effective as that provided by doctors in Nepal. This multicentre randomised controlled equivalence trial was done in fi...

Despite the grave consequences of sexual violence, and it's persistence both within and outside marriages, this subject has received relatively little attention from researchers, policy makers, and programme managers in Nepal. This paper explores the definition of sexual violence and its various forms and consequences as reported by young married w...

The term “abortion ” covers a variety of conditions arising during early pregnancy, from ectopic pregnancy and hydatidiform mole, through to spontaneous and induced abortion. There are important differences in the dimensions and nature of deaths and disabilities resulting from different kinds of abortion 1.

Despite a substantial rise in contraceptive use around the world, unplanned pregnancies and induced abortion continue to occur. Each year an estimated 19 million abortions are carried out outside the legal system, often by unskilled practitioners or under unhygienic conditions. This paper explores the relationship between contraceptive prevalence a...

Despite the availability of safe and highly effective methods of abortion, unsafe abortions continue to be widespread, nearly all in developing countries. The latest estimates from the World Health Organization put the figure at 21.6 million unsafe abortions worldwide in 2008, up from 19.7 million in 2003, a rise due almost entirely to the increasi...

Objective To understand the situations of childhood sexual abuse (CSA) and to examine associations of CSA with demographic factors and with later risk behaviors among university students in Shanghai, China. Methods A two-stage random sampling method was adopted to conduct the survey anomalously using electronic questionnaire and computer-assisted-...

This commentary discusses conclusions from a technical consultation that examined community-based health workers (CHWs) and their ability to safely and effectively administer injectable contraceptives. It provides the positive outcomes that will result from CHWs administering injectable contraceptives and states that there is sufficient evidence to...

Sexual violence within marriage (SVWM) is a major public health and human right issue and yet remains a much neglected research area, especially in Nepal. An exploratory study using free listing, in-depth case histories and causal flow analysis was conducted among two major ethnic groups in Nepal. Descriptive data collected from free listing indica...

Despite the availability of safe and highly effective methods of abortion, unsafe abortions continue to be widespread, nearly all in developing countries. The latest estimates from the World Health Organization put the figure at 21.6 million unsafe abortions worldwide in 2008, up from 19.7 million in 2003, a rise due almost entirely to the increasi...

This review aims to provide the latest global and regional estimates of the incidence and trends in induced abortion, both safe and unsafe. A related objective is to document maternal mortality due to unsafe abortion. The legal context of abortion and the international discourse on preventing unsafe abortion are reviewed to highlight policy implica...

Tailoring sexual and reproductive health services to meet the needs of people living with the human immuno-deficiency virus (HIV) is a growing concern but there are few insights into these issues where HIV is most prevalent. This cross-sectional study investigated the fertility intentions and associated health care needs of 459 women and men, not s...

To evaluate the long-term (48-month) sustainable effect of a set of community-based interventions to promote contraceptive use among sexually active unmarried youth in suburban Shanghai, China. A nonrandomized community trial with one intervention and one control group was conducted in two comparable towns of a suburban area of Shanghai. The interv...

Maternal mortality continues to be the major cause of death among women of reproductive age in many countries. Data from published studies and Demographic and Health Surveys show that gains in reducing maternal mortality between 1990 and 2005 have been modest overall. In 2005, there were about 536,000 maternal deaths, and the maternal mortality rat...

Reliable information on abortion levels and trends worldwide, and on regional variations in incidence, are important in light of the implications for family planning programs and policies and because it can influence the discourse around abortion laws and policies. Moreover, these findings can inform estimates of the economic and health burdens of...

Background: Information on incidence of induced abortion is crucial for identifying policy and programmatic needs aimed at reducing unintended pregnancy. Because unsafe abortion is a cause of maternal morbidity and mortality, measures of its incidence are also important for monitoring progress towards Millennium Development Goal 5. We present new...

Communication concerning sexual matters between parents and their adolescent children serve as a protective factor and exerts a favourable influence on adolescents' sexual behaviours. As limited data regarding parent-adolescent sex communication are available in China, this study was undertaken with the aim of exploring the patterns and related fac...

Purpose Sex education in China has been promoted for many years, but limited data are available regarding the sources from which adolescents receive sex‐related knowledge. The present study was designed to examine the sources from which Chinese adolescents obtain their information on puberty, sexuality and STI/HIV/AIDS, and whether there are any di...

In recent years, more adolescents are engaging in premarital sex in China. However, only a limited number of studies have explored out-of-school youth's sexual attitudes and behaviors, critical for prevention intervention development. Using data from the baseline survey of a comprehensive sex education program that was conducted in a suburb of Shan...

Ending the silent pandemic of unsafe abortion is an urgent public-health and human-rights imperative. As with other more visible global-health issues, this scourge threatens women throughout the developing world. Every year, about 19-20 million abortions are done by individuals without the requisite skills, or in environments below minimum medical...

The trends in contraceptive uptake and condom use among single and married young women show distinct patterns in sub-Saharan Africa. A large median increase of 1.4 percentage points per year in condom use by single young women for pregnancy prevention was witnessed in 18 countries based on Demographic and Health Survey data from 1993 to 2001. In co...

To assess the feasibility and effectiveness of sex education conducted through the Internet. Two high schools and four colleges of a university in Shanghai were selected as the research sites. Half of these were assigned to the intervention group and the other half to the control group. The interventions consisted of offering sexual and reproductiv...

An acceptability study of an injectable preparation of the synthetic steroid testosterone undecanoate as a once-a-month male contraceptive method was carried out concurrently with, but independently from, a clinical safety and efficacy trial of this preparation in China, from 1997 to 1999. Three hundred eight men, the entire group of volunteers enr...

The purpose of this study was to evaluate a community-based comprehensive sex education program among unmarried youth in China. The impact of the intervention on sexual knowledge, attitudes, and sexual initiation were assessed, using a pre-test post-test quasi-experimental research design. The program used six methods for providing sex-related know...

The trends in contraceptive uptake and condom use among single and married young women show distinct patterns in sub-Saharan Africa. A large median increase of 1.4 percentage points per year in condom use by single young women for pregnancy prevention was witnessed in 18 countries based on Demographic and Health Survey data from 1993 to 2001. In co...

Globally, 19 million women are estimated to undergo unsafe abortions each year. Age patterns of unsafe abortion are critical for tailoring effective interventions to prevent unsafe abortion and for providing post-abortion care. This paper estimates the incidence and the rate of unsafe abortion among women aged 15-44 in the Africa, Asia (excluding E...

The concerns about the potential threats of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) have increased, since, in China, there is a lack of sexual education and condom use is rare. A community-based survey was conducted in September 2001 in Changchun city among 1227 unmarried young people aged 15-24 ye...

To assess the contraceptive effectiveness of condoms versus oral contraceptive pills and estimate the reproductive consequences of a major shift from pill to condom use. Secondary analysis was performed on nationally representative cross-sectional surveys of women in 16 developing countries. In the 16 countries, the median per cent of married coupl...

Globally, 19 million women are estimated to undergo unsafe abortions each year. Age patterns of unsafe abortion are critical for tailoring effective interventions to prevent unsafe abortion and for providing post-abortion care. This paper estimates the incidence and the rate of unsafe abortion among women aged 15—44 in the Africa, Asia (excluding E...

Using "calendar" data for single women aged 15-24 from successive Demographic and Health Surveys (DHS) conducted in Colombia and Peru during the 1990s, we document trends, year by year, in sexual activity, the use of contraceptives, and subsequent reproductive outcomes. We provide evidence of the important and hitherto largely untapped potential of...

This paper reports a hospital-based longitudinal study that was conducted in Zibo, China, in June 1996. The objective was to investigate the existing patterns of breastfeeding, amenorrhea and contraceptive use among postpartum women in urban areas of China. Information was obtained from 492 newly parturient women. Follow-up interviews were done at...

Unsafe abortion is preventable and yet remains a significant cause of maternal morbidity and mortality in much of the developing world. Over the last decade, the World Health Organization has developed a systematic approach to estimate the regional and global incidence of unsafe abortion. Estimates based on figures around the year 2000 indicate tha...

In 1999 UNICEF, in cooperation with the government of Iraq and the local authorities in the "autonomous" (northern Kurdish) region, conducted two similar surveys to provide regionally representative and reliable estimates of child mortality (the subject of this paper) and maternal mortality. In a cross-sectional household survey in the south/centre...

These three papers, with Nahid Toubia and Iqbal Shah responding to Marcel Vekemans, contain three different points of view on the priority that infertility treatment should be given when there are limited resources for public health services. The authors address the question of whether infertility treatment is a luxury in a world of population expa...

With over 50% of couples using a contraceptive method in 1990, contraception - a novelty two decades ago - has become the norm in much of the world. Only in sub-Saharan Africa does the prevalence remain below 18% for most countries. However, it is expected to rise to 26% by the year 2000, corresponding to a projected TFR of 5.33 births per woman. T...

Fertility exposure analysis was developed recently by Hobcraft and Little in order to evaluate the relative importance of the various proximate determinants upon levels of current fertility. In the present paper we extend the analysis to the study of changes in fertility between two cross-sectional surveys. We show how to express fertility change a...

PIP Evidence of trends in fertility and related variables in Pakistan during the 1970s is analyzed using data from 2 comparable surveys: the 1975 Pakistan Fertility Survey (PFS) and the 1979-80 Population, Labor Force and Migration Survey (PLM). Both suggest that fertility was fairly constant, with a total fertility rate around 7.0 until the 5-year...

The trends in contraceptive uptake and condom use among single and married young women show distinct patterns in sub-Saharan Africa. A large median increase of 1.4 percentage points per year in condom use by single young women for pregnancy prevention was witnessed in 18 countries based on Demographic and Health Survey data from 1993 to 2001. In co...

This paper uses data on family planning and condom use by married or cohabiting couples in Kenya, South Africa, Tanzania, Uganda, Zambia and (to a lesser extent) Zimbabwe collected by the World Health Organization (WHO) in 1999-2000 as part of a major research initiative. We find that the use of family planning has strong and approximately equal in...

Nearly one in five adolescents (10~19 years) in the world live in China. Therefore, the status of and progress in adolescent sexual and reproductive health in China will have an important bearing on the global situation. Yet, it was not a long time ago, when there was a complete lack of information and absence of a discussion on the critical issues...