Sexuality and reproductive health

Menstrual Hygiene and Use of Sanitary Napkins in Nepal

USAID’s Healthy Homes or Ghar Ghar Ma Swasthya (GGMS) Project in Nepal conducted a household survey to assess the knowledge, attitudes, and practices (KAP) among women of reproductive age in Nepal related to Family Planning and Reproductive Health. One objective was to assess menstrual hygiene practices.
The sample size was 1800 women - 1400 married and 400 unmarried - aged 15-49 years old, selected using a three-stage stratified cluster sampling and drawn from both mountain and hills strata in all five development regions. Sixty clusters were selected randomly from the 49 hard to reach districts.
Selected findings
The median and mode age for first menstruation were 14 years. For length of period, the median and mode were 4 days. Over three-fifths (62%) of those currently menstruating reported using cloth only, 5% disposable napkins only and approximately one-fifth said both.

More than half (56%) said they learned about menstruation from their mother, who was also the person the majority (58%) of respondents told when they started menstruating.

Additional information about attitudes and practices related to menstruation and sanitary napkins will also be presented.

Issues of abortion are critical in Ghana largely due to its consequences on sexual and reproductive health. While the practice is generally regarded illegal, the negative perception society attaches to it makes it difficult for young people to access the service and share their experiences. This paper explores the pre and post abortion experiences of young people; a subject scarcely researched in the country. Clients of Planned Parenthood Association of Ghana (PPAG) Clinic at Cape Coast constituted the study population. The interview guide was used to collect data from twenty-one respondents between the ages of thirteen and twenty-four. Guided by the bio-psychosocial model, the study revealed that thoughts of causing ‘murder’, guilt, fear of societal stigma, shame, and loss of partners, leaving with the guilt of ‘murder’ as well as self-imposed stigma were the pre and post abortion experiences the respondents encountered. Bleeding, severe abdominal pains and psychological pain were also reported. Research must focus more in this area. PPAG Clinic must integrate psychosocial treatment in its abortion services while intensifying behaviour change communication and community-based stigma-reduction education in the Metropolis.

Since 2006, in Colombia abortion is permitted under three limited circumstances. Nonetheless, many women still have limited access to legal abortion. Recent evidence shows that less than 1% of the 400,000 induced abortions in 2008 were legal. Moreover, evacuation by D&C is still the standard of care for abortion services and for treating abortion complications, rather than the WHO-recommended method of MVA. In addition, administrators of health care enterprises are claiming that legal abortion services are a cost burden to the health care system, with no evidence to support their claims. The aim of this study, the first of its kind in Colombia, is to document the comparative costs of a) legal abortion vs. the cost of treating complications due to unsafe abortion, and b) document the costs of using modern (MVA) vs. older (D&C) techniques. Findings will allow us to provide evidence to dispel erroneous allegations associated with the provision of legal abortions, to help remove barriers for accessing safe abortion services, to investigate the extent to which using a modern (MVA) vs. older (D&C) technique represents lower costs to the health system and to fill out the knowledge gaps to deal more directly with barriers to legal abortion services.

Due to the growing shortage of women on the marriage market in China, male bachelorhood is becoming a new demographic concern. Although marriage remains in most cases the only socially acceptable setting for sexuality, the female shortage implies that marriage-squeezed male bachelors can only meet their sexual needs through means other than heterosexual marriage. Little information is currently available on the situation of these marriage-squeezed males in China, but some recent studies indicate, for instance, that there is a higher occurrence of masturbation and use of prostitution among them. In parallel, it has been stated that unsafe sexual behaviours, including commercial sex and unprotected sex, increase the risk of transmission of HIV and STIs. Therefore, such unsafe behaviours may have substantial implications for prevention of HIV and STIs in this population. This paper investigates the sexual behaviours of male migrant bachelors in Xi’an and focuses on the risk they face in their sexual intercourses during their migration experience. Their general situation and specific characteristics are described, as well as the influence factors behind these risky sexual behaviours.

Background: Youths residents in Anambra are mainly involved in trading that entail lots of travelling making it difficult get them access health services. However, majority are very religious and are found in a larger group in churches on Sundays and weekday evenings.

Methods: A one-week evening retreat "The Sexual health and wellbeing of Youth” was organised for Youth Organisation comprising over 5000 members. It was fixed into an existing youth program that addressed HIV/STI effective prevention strategies and other SH issues that affect youths. It was innovative, creative, and comprehensive including free HCT. The outreach provided ongoing SH information, counselling via phone and referred where to access full service.

Results: Participants became concerned about their SH. 9weeks afterwards, over 3000 youths sought for on-going counselling, enquiries, referrals and took charge of their SH. Lots of phone helpline calls/SMS answered.
Number of youths who access STDs/HIV clinics in the referred hospitals increased from 24%to65%. They took up the campaign, 'STDs/HIV is our business' to reduce the high rate among them.

Conclusion: This showed that business-addicted youths can leave their businesses to access STI/HIV services if the knowledge and the effects are known and the need to do so.

About 80 percent of maternal deaths result from obstetric complications and a majority of these deaths can be prevented with timely medical treatment. The objective of this paper is to explore the barriers in receiving timely appropriate care for obstetric complications in rural Uttar Pradesh. World-wide one of the highest number of maternal deaths occurs in rural Uttar Pradesh. For this study the data from the latest RCH-DLHS-3 (2007-2008) and primary survey conducted during 2007-2009 has been used. Univariate, bivariate and multivariate logistic regression analysis has been conducted to examine the effect of demographic, socio-economic, health status, health-seeking behaviour and community variables on the obstacles in receiving health treatment for obstetric complications. This study answers several questions which are vital for improving maternal health such as, is economic development essential for reducing number of maternal deaths?; distance vs. road connectivity to health facilities; quality of care (QOC) vs. location of health facility; Does ANC improve treatment seeking behavior for obstetric complications? Based on the findings of the study potential areas for policy and research aimed at improving maternal health have also been discussed.

India accounts for about one-quarter of maternal deaths worldwide with the highest number of deaths occurring in the state of Uttar Pradesh. Utilization of antenatal, natal and postnatal care is important for reducing maternal morbidity and mortality. Uttar Pradesh, however, is characterized by low uptakes of maternal health services. Using RCH-DLHS-2 (2002-2004) dataset, present study attempts to investigate the importance of community and individual level variables in explaining factors affecting the utilization of antenatal, delivery and postnatal services in Uttar Pradesh by using techniques of simple logistic regression analysis and multilevel logistic regression analysis. Multilevel analysis has number of advantages over logistic regression analysis. From the analysis it is evident that the standard error of the coefficients under both the techniques present different picture. When data has hierarchical structure more and more community level variables emerge as significant associates of antenatal, natal and postnatal services.

Every year 358,000 maternal deaths take place. About 80 percent of maternal deaths result from obstetric complications and a majority of these deaths can be prevented with timely treatment. Women experiencing obstetric complication do not obtain adequate care in time due to three delays: delay in making the decision to seek care, delay in reaching an obstetric facility and delay in receiving care once the facility has been reached. According to UNFPA ‘three delay model’ is most appropriate for analysis of determinants of maternal mortality. Therefore, the objective of this paper is to examine the ‘three delays’ in receiving adequate care by women experiencing obstetric complications. Findings show that a high proportion of women experience ‘three delays’. Further study reveals that major obstacles in the decision to seek care (delay I) are low status of women, underestimation of illness severity, household responsibilities, perceived physical accessibility and QOC. Women experience delay in reaching facility (delay II) due to distance, road connectivity, unavailability of transport and cost. Availability of poor QOC in health facilities leads to further delays (delay III). Multivariate logistic regression shows that demographic, socio economic, health status, health seeking behaviour and community variables affect ‘three delays’

The main objective of the study is to examine the effect of maternal age on adverse birth outcomes specifically preterm birth, termination or abortion, small for gestational age and low weight at birth. Third round of National Family and Health Survey data (2005-06) has been used for analysis. Bivariate and multivariate analyses were performed and age of the women were divided into three categories like 1) less than equal to 19 years, 2) 20-34 years and 3) more than equal to 35 years. Finding shows young maternal age has a higher risk of adverse birth outcomes such as low weight at birth and preterm delivery. They also reported seven times more of delivered premature birth than adult mothers of the study sample. It also comes from the analysis that women with less education and belongs to lower socio-economic strata have a high probability of adverse birth outcome. Complications during pregnancy are also found higher among young women as compare to adult women. From the study it is found that there is an association between education and wealth with adverse birth outcome along with younger maternal age.

Using nationally representative cross sectional information drawn from Nepal Adolescent and Youth Survey 2011, this paper attempts to explore the determinants associated with premarital sex among unmarried adolescents and youths in Nepal. Two stages stratified sampling techniques was used to collect the information. Altogether 14853 adolescents and youths (7109 boys and 7644 girls) aged 10-24 from 300 cluster comprising 9000 households were selected for the interview. Both bivariate and multivariate analyses have been used to analyze the data.
Bivariate analysis reveals that age, education, mass media exposure, exposure to internet, household economic condition and other spatial factors are significantly associated with premarital sex among youths. As expected, a higher proportion of adolescents and youths having higher education, exposed to FM, Radio, TV and Internet have premarital sexual experience. However, age, education, mass media exposure are strong predictors of premarital sex among adolescents and youths after controlling the influence of other variables in multivariate analysis.
This study is conclusive that education, mass media exposure (FM, TV, Radio, Internet exposure) are the significant predictors associated with premarital sex among youths.