Sexualité et santé de la reproduction

The sexual behaviour of adolescents has long been associated with reproduction in most African countries. In a country like Niger, early marriage is the main context for initial sexuality among adolescent girls, as shown in the 1992 Demographic and Health Survey. Since that time, girls’ sexual behaviour in sub-Saharan Africa has changed, as have the determining factors for it. In Niger, repeated economic and social crises, youth unemployment and poverty have led to later marriage, which is no longer the sole context for girls’ sexual relations. However, no study has been carried out to explain this change. The paper examines the changes in the determining factors of sexual relations among adolescent girls in Niger on the basis of the 1992, 1998 and 2006 Demographic and Health Surveys.

HIV is a difficult challenge for the penitentiary services. Its prevalence in prison is higher than in the general population. Inadequate prevention programmes, overpopulation and high-risk practices increase the vulnerability of the incarcerated population. Little data exists in Mali on prisoners who are excluded from HIV projects, particularly women, whence the importance of evaluating their behaviour in relation to HIV in order to contribute to setting up a suitable prevention programme in Mali. A cross-sectional study was conducted at Bollé prison on prisoners over the age of 18 who had been incarcerated for more than 3 months. The data were collected by means of an anonymous individual interview and analyses were made of the calculated scores. 59% of the prisoners were under the age of 24 and 52% were not married. 53% and 45% respectively have a fair knowledge of how the disease is transmitted and prevented. There is good tolerance to HIV positives during daily activities. The high-risk practices observed were the sharing of sharp objects (72%), homosexuality (30%) and low use of condoms (22%). A prison is an environment with a high risk of transmission that requires ongoing action.

The Arab world, two-thirds of whose population is today made up of young people under 25, is in full transformation. The Arab revolutions have challenged the value system that reigned for decades or even centuries and that developed under dictatorial and totalitarian regimes. Today, young people in the Arab world, who were the catalysts for the fall of the dictators, now find themselves caught between the difficult quest for their freedom and independence and the weight of reprisals by the former regimes and old conservative opponents. This double constraint that they are under creates a sort of social schizophrenia in them, since freedom also involves the body, initiation to a healthy sex life and a solid knowledge of reproductive health, whereas* conservative governments’ approaches and emerging obscurantist currents regard the body and sexuality as the most impure sins and the most unspoken taboos. This has prompted young people, out of ignorance of their needs and owing to the culture of bodily denial that has been perpetuated for generations, to take risks through experiences that jeopardise their lives and their mental well-being. The situation is alarming, and there is only one solution: sexual education for all young Arabs.

* Translator’s note: the connecting word here did not make sense and has been corrected so that the sentence is logical.

In the North African countries, contraception and sexual health are often analysed solely from the point of view of married women between 15 and 49. Information about knowledge of contraceptive methods, representations and practices have so far only concerned that population group, because these societies do not yet admit that unmarried women may have sexual experience before marriage, and even less that they may use any sort of contraception. In legal terms, fertility and reproduction begin with marriage. Since 2001, a wave of family health surveys have provided new analyses in Algeria, Libya, Morocco and Tunisia concerning the reproductive health of unmarried women and men under thirty (attitudes, representations and, indirectly, sexual practices outside marriage). After presentation of the data, Part 1 of the paper describes the new context for young unmarried North Africans. Part 2 is a comparative study of the representations of sexuality among young women and men, and Part 3 analyses their differential knowledge, representations and practices concerning contraception.

The topic of this paper is justified by the major shortcomings in sexual education and their effect on low contraceptive use, high HIV transmission and high use of abortion among unmarried young people in Africa. Given the current situation in Ouagadougou, the general question is, what is the role of parental education about sex in preventing sexual risks for young people in Ouagadougou? More specifically, in terms of sexual and reproductive health, what education do parents give their children? What factors facilitate parental sex education and what factors hinder it? The general aim of the paper is to examine, for Ouagadougou, the role of parents in young people’s choice of premarital abstinence or protected sexual behaviour. Nvivo QSR software was used for data processing. Analysis involves the definition of typologies and thematic content analysis. The study will reveal the typology of forms of parental sex education for the young. The relationship will also be established between the type of education received and the behaviour adopted.

Understanding the dynamics of sexual risk-taking among the young presupposes understanding their experience of sex, reproduction and relationships. The sexuality of young people in Ouagadougou now is plural and covers a wide range of situations, whether in couple relationships, interactions involved or partners’ resources. The combination of these factors leads to particular problems for prevention. This study examines the emotional, sexual and preventive trajectories of young men and women in Ouagadougou on the basis of in-depth qualitative data. It uses a corpus of 77 semi-directive interviews held in Ouagadougou from 2005 to 2007. Young people’s sexuality, the relationships involved and the implications for prevention are analysed. Their sexual activity occurs in different ways at different times of life. These results confirm the gender dimension of the factors underlying the choice of preventive measures. They show the importance of these factors in the dynamics of risk exposure.

The extension of medicalisation to certain regions of the world, including Mexico, does not mean that women’s expectations and needs for reproductive health have been guaranteed and met. Several authors have described the persistence of coercive medical practices involving the violation of women’s sexual and reproductive rights in institutional facilities. It is possible to observe frequent use of medical interventions such as caesareans, indiscriminate episiotomies and female sterilisation in the public health system. This paper presents the results of a qualitative study carried out in central Mexico on the effect of social inequalities and medicalisation on the sexual and reproductive health of women using public health services. Our results show that these social inequalities are reproduced and legitimised in healthcare departments by the practice of health professionals and doctor-patient interactions in reproductive health departments. This has repercussions on both the satisfaction of users’ needs and their health and the exercise and recognition of their basic reproductive and human rights.

Wherever mothers are at high risk of maternal mortality, their children too are in danger. Infant mortality may be the result of poor maternal health and insufficient care during pregnancy, delivery and the immediate post-partum period. Infections, asphyxia and birth lesions, underweight, delivery complications are the main causes of neonate mortality. Obstetrical complications are now the major cause of death among women of childbearing age in developing countries and are one of the most urgent health problems and most difficult to solve. The Millennium Development Goals see the reduction of maternal mortality as a moral imperative as well as a crucial development priority. Despite efforts made by governments and many appeals from the international community, women who want to give a life lose their own, a reason for our examination of childbirth assistance by qualified staff, still not universally practised. This is particularly true in the countries of sub-Saharan Africa, which are lagging in the attention they pay to health in general and these matters in particular.