Sexuality and reproductive health

This paper describes a study aiming to elicit the needs of adolescents’ fertility behaviour and unmet needs in India and major states. The objective was to understand levels and patterns of adolescent fertility in India and its major states and to see the unmet needs in family planning, also recognizes the information which could guide the development of adolescent-friendly health services by grass root level health workers. This study used the DLHS 2007-08 data and SRS data to meet the objectives. The findings demonstrate that there is clearly an unmet need for information about effective family planning services, also a large unmet need for spacing (28.4) which is often perceived by adolescents to be of primary importance. Integrating these issues into programmes is likely to be an essential element in developing health services and programmes which can reach out to the majority of adolescents in India.

The paper aims to examine the level of birth preparedness and complication readiness among currently married couples and factors affecting it. The study has been conducted among 400 currently married couples in the rural areas of Varanasi district of Uttar Pradesh in India during second trimester of the year (2012). Bi-variate and chi-square analyses have been conducted. Birth-preparedness and complication readiness in the study include many elements: knowledge of danger signs, plan for where to go, where to give birth, saving money, a companion, transportation, a blood donor and a birth attendant. It was found that less than one fifth of women were informed about birth preparedness while they visit health centres during ante-natal care. Around three fifths of husbands were found to be aware of any obstetric danger sign. Education, mass media exposure and economic status are found to be important predictors for the awareness of danger signs among male partners. Government needs to sensitize the birth preparedness among the health personnel delivering maternal care services in rural areas for the timely use of skilled maternal and neonatal care. Couple counselling regarding birth planning during pregnancy must be promoted by government through media too.

This paper is an effort to analyze the prevalence of premarital sex and use of condom among men in India. Using National Family Health Survey, third round (2005-06) data, the study found that premarital sex is higher in rural than urban India. However, it also found that even though unmarried men in rural India are sexually more active than urban men but use of condom is minimal. The result of binary logistic regression shows that unmarried men those who consume alcohol are 1.801 more likely to indulge in sexual activity than their counterpart group without alcohol. Similarly, working men are 1.175 more likely to be sexually active before marriage than unmarried men with no working status. The prevalence of premarital sex is significantly high among teenagers i.e. 15-19 years.

Used the data from sample survey conducted in Anhui JC county, this paper has found that sexual knowledge, attitudes, subjective construction factors, social factors are related with risk sexual behaviors. And subjective construction factors are the most significante. Due to the lack of stable sexual partner in the marriage, rural forced male bachelors are more likely to have muti-sexual partners. The types of their sexual partners are diverse, including girlfriend, females in the marriage, widows/divorced females, sex worker and male. Their sexual behaviors are significant different by age, which means that the proportion of younger who have had different risk sexual behaviors is higher than that of older. However, condom uses in forced male bachelors are lower than in migrants. This is tantamount to put a bridge between high-risk group and general people, and connect them together. Binary logistic regression analysis shows that sexual knowledge, attitudes, subjectve construction, and social factors are associated with risk sexual behaviors, in which subjective constructionion factor is most significant. This means that the risk which forced male bachelors are facing is the interactive result of the chioces of their own.

Background
Dehumanization of childbirth is one major factor deterring pregnant women from seeking facility based delivery contributing to stagnating indicators of MDG 4 and 5 including skilled birth attendance (SBA) rates.
Methods
A qualitative study was conducted in Kenya across 5 districts through 60 case narratives with women who had delivered in the last one year at a health facility or at home. This study sought to explore the determinants of place of delivery and explore the effect of dehumanized child birth experiences on utilization of SBA.
Results
The key determinants of place of delivery was perceptions of respectful care accorded, availability of money to finance health care, fear of HIV testing and socio-cultural beliefs associated with childbirth. Dehumanized childbirth was associated with use of unskilled birth attendance mainly untrained traditional birth attendants. TBAs were often sought as alternatives for provision of delivery services because they have cheaper negotiable prices; they are polite and respectful, did not detain mothers, and offered more friendly services.
Dehumanized treatment during child birth is a deterrent to SBA and service improvements addressing this aspect of care are likely to have a positive impact on health seeking behavior through encouraging utilization of SBA.

Poor maternal health remains a major reproductive health concern in developing countries, despite perceptible strides being made to reduce maternal morbidity and mortality. India has implemented the reproductive and child health (RCH) programmes after the ICPD (1994) at Cairo, which reiterated the need for health care services to enable women to go safely through pregnancy and child birth using Indian National Family and Health Survey-3 (2005-06). Results found that health complications by women vary hugely by region, ranging from 57% in East to 28% in South. Odds ratios indicate health complications is four times higher in the East compared to South (p<0.01). Women in rural areas reported more complications than those in urban areas (p<0.05). Uneducated and poorer women reported more complications compared to educated and richer women, with odds ratios of 20% higher. Women receiving ANC services also indicate lower health complications compared to women not availing ANC services (p<0.01). Analysis clearly signifies the impact of socio-economic, cultural and demographic factors on maternal health, particularly across the regions. Specific regional maternal health programmes that account for the diverse socio-cultural and demographic characteristics are essential to mitigate the regional disparity.

Since the 1994 International Conference on Population and Development, postabortion care (PAC) has been recognized as a high priority issue by over 180 nations. PAC is a four-component, integrated service delivery model for treating women experiencing complications from incomplete abortion and treating the unmet need for family planning (FP). This literature review serves to provide the reader a comprehensive summary of PAC, documented in over 400 studies, describing evidence-based “best practices,” while highlighting gaps in the literature. The evidence from this tool can be employed by international professional organizations, country ministries and policymakers to inform policy and guide programs. When emergency treatment is needed, Vacuum Aspiration (VA) or treatment with Misoprostol is effective, coupled with pain management. FP intake increases when provided at the same time and location of treatment. Provision of STI and HIV counseling and services where human and financial resources are available are essential to PAC. Men and community health workers play an important role in supporting women following incomplete abortion. Finally, attention to policy and program issues can eliminate barriers to, and encourage provision of, PAC services, especially to marginalized populations.

Introduction: unsafe sexual behaviour among adolescents has drawn attention from all spheres of life because it makes them susceptible to different sexually transmitted diseases, unwanted pregnancies sometimes leading to abortion and other health related problems.
Objective: To analyze the sexual and reproductive health, particularly sexual activity and contraceptive use among adolescents in rural Ghana, to contribute to the limited data on adolescent sexual and reproductive health and provide recommendations.
Method: A cross sectional survey among adolescents aged 15 to 19 was conducted in Kintampo Ghana from October 2010 to May 2011. It used both qualitative and quantitative methods.
Results: 793 male (43.1%) and female (56.9%) adolescents participated in the study. Of all adolescents interviewed, 42% have been in a relationship. Of those, 95.2% have had sex; 90.4% (males) and (94%) females. Females had 1.3 times the odds of having sex compared to males. Consistent contraceptive use among adolescents was very poor (22.9%) as a result, 30.2% of adolescents have been pregnant with 34% of it ending in abortions and 42.5% live births.
Conclusion: Adolescent’s knowledge on pregnancy and contraception is limited. Unsafe sex is practiced among them.
Recommendation: A participatory intervention study for adolescents is needed

Background:Hospital based studies conducted in most African countries have shown that abortion leads to about 50% of maternal deaths in Africa. Unless concerted effort is made to reduce abortion, many countries in sub-Saharan Africa can not achieve the Millennium Development Goal (MDG) 5 of reducing maternal mortality by half by the year 2015.
Objective:To describe the distribution of abortion (induced or spontaneous) and explore factors associated with abortion in rural Ghana.
Methods:This was a cross-sectional study with a sample of 5,359 females aged between 10-49 years of age. This sample was obtained from a Sexual and Reproductive Health (SRH) survey conducted within 156 communities of Kintampo Health and Demographic Surveillance area from July to November 2011. Socio-demographic and household assets data of the sample were obtained from the Kintampo Health and Demographic Surveillance System (KHDSS) database.
Results: In the multivariate regression analysis, increasing level of education and marital status were associated with abortion.
Conclusion:The findings suggest that abortion among women in the study area is influenced by education and marital status. Based on these findings, appropriate interventions could be designed to reduce the occurrence of abortions in the study setting.

Paper addresses question whether decrease in female fecundity (reproductive senescence) during life cycle might have an influence on realization of fertility. Increasing age at first attempt to conceive might translate into lower than planned number of offspring due to divergence between lifecycle of modern females and changes in fecundity over the life course. We use waiting time to pregnancy (WtP) to account for impact of reproductive ageing on conception probability. This retrospective methodology reflects definition of sub-fertility and infecundity as number of months with regular unprotected intercourse ending (or not) in pregnancy. WtP has been implemented in Polish GGS and contains questions about infertility and number of menstrual cycles needed for conception. Analyses reveal significant increase in WtP among women aged 35+, slight increase among females aged 30-35 and no decrease for younger females. Estimates of infertility yields around 6% for females and around 3% for males (as declared by respondents). Taking into account age patterns of fertility in Poland, reproductive senescence might not have a great impact on realization of fertility intentions. However, due to increase in age at first reproduction we expect that share of couples having problems with conception (prolonged WtP) might increase in the future.