CONTENTS
Safe
Motherhood
Do Women in Brazil Choose Cesareans Freely?
More than 36 percent of all births in Brazil occur by cesarean section—with many
private hospitals reporting rates in the 80–90 percent range—among the highest
cesarean rates in the world. Articles in the Brazilian popular press typically portray
women as actively choosing to deliver surgically. Doctors often affirm that women’s
demand for cesarean deliveries keeps rates high. While scholarly articles usually include
the motives of both doctors and women, rarely does anyone discuss the power differences
between the two. Doctors clearly have more decisionmaking leverage in the delivery room.
Kristine Hopkins investigated the situation in Brazil. She found that women often do not
seek to deliver surgically and that doctors frequently use their medical authority to
persuade a woman to “choose” a cesarean.
Reproductive
Health
Educating Women Reduces Inappropriate IUD Selection
Population Council researchers tested a strategy aimed at reducing the number of
insertions of intrauterine devices (IUDs) in women with sexually transmitted cervical
infections. Inserting an IUD when a cervical infection is present can increase a
woman’s risk of developing pelvic inflammatory disease, a painful condition that can
lead to infertility and sometimes death. Nurses informed women about various family
planning methods and risk factors for and prevention of sexually transmitted infection.
Physicians then asked the women their preferred contraceptive method. Informed women were
better able to assess their risk for sexually transmitted infections and select a suitable
family planning method than were doctors.
Basic
Research
Key Regulator of Hormone-induced Gene Activation Sought
Four years ago, scientists discovered the first cofactors, cellular molecules that
directly bind to hormone receptors and come in two varieties: coactivators and
corepressors. Coactivators turn genes on when they bind to receptors. Corepressors turn
genes off when they bind to receptors. Population Council molecular geneticist Milan
Bagchi and his colleagues have been investigating a coactivator complex that influences
the action of the hormone progesterone and its receptors in the cell nucleus. This basic
research may one day lead to new, more tissue-specific drugs for contraception or treating
cancer.
Education and
Fertility
Would Girls’ Schools Help Reduce Fertility in
Pakistan?
Researchers have often investigated the influence of women’s educational
levels on their fertility. They have seldom, however, explored the relationship between
children’s education and their mothers’ fertility. Population Council
researchers Zeba Sathar, Cynthia B. Lloyd, and Minhaj ul Haque, along with Cem Mete, a
Population Council postdoctoral fellow in the Yale University economics department,
investigated how the accessibility of public schools in rural Pakistan influences couples
as they envision and build their families. They found that an increase from no girls’
schools to two girls’ schools in each community would increase the probability that a
mother would express a desire to stop childbearing and act on that desire by practicing
family planning by 14 to 15 percentage points.
Fertility
Decline
Language Identity May Outweigh Nationality in Bengal
Why do people in some regions begin using modern contraceptives while people in
nearby locales do not? Population Council demographer Sajeda Amin and her colleagues Alaka
Malwade Basu of Cornell University and Rob Stephenson of the University of Southampton
began wondering just that when they looked at a map of Bangladesh that illustrated the
diversity in rates of contraceptive use in the country. Some of the highest rates of
contraceptive use existed along Bangladesh’s border with the Indian state of West
Bengal. Both populations speak Bengali and share a language-based ethnic identity. The
researchers theorized that the shared culture and history of the two areas might be
playing a role in the diffusion of contraceptive behavior.
Family
Planning
Discussing Sexuality in Egyptian Clinics
Is Feasible
Sexuality lies at the heart of family planning. Discussions between family
planning service providers and clients in Egypt, however, tend to focus primarily on how
contraceptive methods work and how they should be used. Questions concerning the way in
which a method might affect a sexual relationship rarely arise during a consultation. To
address this situation, Population Council researchers examined the feasibility,
acceptability, and consequences of introducing discussions of sexuality during family
planning consultations.
