 The Prevalence of Reproductive Tract Infections in Hue, Vietnam (PDF)
Phan Thi Lien was previously and Nguyen Thi Loi is currently Director, and Bui Thi Chi is Head, Family Planning Techniques Department, Maternal and Child Health and Family Planning Center of Thua Thien Hue Province, Vietnam. At the time this report was written, Christopher Elias was Country Director, Population Council, Bangkok, and Nguyen Hua Phuc was Head, Microbiology Department, Hue Central Hospital, Thua Thien Hue Province. Michelle Gardner is Program Officer, Population Council, based at the Department of Health in Yangon, Myanmar. Correspondence should be addressed to Michelle Gardner by e-mail at popcouncil@mptmail.net.mm. A study was conducted in central Vietnam to measure the prevalence of reproductive tract infections among clients of a family planning clinic, and to determine the usefulness of simple, clinic-based diagnostic tests. The prevalence of such infections was moderate, with the majority being endogenous. Few cases of cervical infection were identified, and no clinical or sociodemographic variables proved to be good predictors of such infection. Most vaginal infections could be identified through simple, clinic-based diagnostic tests, although further research into the cost-effectiveness of establishing and maintaining these services would be useful. Comparison of the results from laboratory tests and the presumptive diagnosis of the clinician indicate that the current practice of presumptive treatment is leading to significant overtreatment. Use of the World Health Organization flowcharts would reduce the overtreatment of vaginal infection but not of cervical infection. The importance of adapting the flowcharts to local epidemiology is highlighted. (Studies in Family Planning 2002; 33[3]: 217–226)
Maternal Mortality in India: An Update
P. N. Mari Bhat is Professor, Population Research Centre, Institute of Economic Growth, Delhi 110 007, India. E-mail: mari@ieg.ernet.in. This study presents estimates of maternal mortality for India from two indirect procedures, the sisterhood method and a regression method involving sex differentials in adult mortality, and compares them with estimates available from other sources. The sisterhood method is applied to the data collected in a human development survey that covered all rural areas of India in 1994, while the latter method is applied to the data on mortality and fertility rates from India's Sample Registration System. The level of maternal mortality for the early 1980s implied by the sisterhood method is found to be about 15 percent lower than the estimate for the same period derived from the method that uses the data on sex differentials in adult mortality. The estimate for the 1990s from the latter method is consistent, however, with the direct estimates available from the National Family Health Survey and the Sample Registration System. The study also discusses the socioeconomic differentials in maternal mortality implied by the sisterhood data, and spatial and temporal variations in maternal mortality derived from the regression method. (Studies in Family Planning 2002; 33[3]: 227–236)
Is "Abortion Culture" Fading in the Former Soviet Union? Views about Abortion and Contraception in Kazakhstan
Victor Agadjanian is Associate Professor, Department of Sociology, Arizona State University, Tempe, AZ 85287-2101. E-mail: agadjanian@asu.edu. The Soviet legacy of widespread reliance on induced abortion is of critical importance to reproductive trends and policies in post-Soviet nations, especially as they strive to substitute contraception for abortion. Using data from two Demographic and Health Surveys conducted in 1995 and 1999, this study analyzes and compares trends in abortion and contraception, women's attitudes toward abortion, and their perceptions of problems associated with abortion and contraception in Kazakhstan. Despite an overall decline in abortion and an increase in contraceptive use since Kazakhstan's independence in 1991, abortion has remained a prominent part of the country's reproductive culture and practices. This study shows how abortion-related views reflect the long-standing ethnocultural differences between the indigenous Kazakhs and Kazakhstan's residents of European roots, as the latter continue to have significantly higher levels of abortion. The study, however, also reveals the internal diversity among Kazakhs with respect to abortion experiences and views, stemming from decades of the Soviet sociocultural influence in Kazakhstan. In addition, the analysis points to some generational differences in views concerning abortion and contraception. Finally, the study demonstrates parallels in attitudes toward abortion and toward contraception, thereby questioning straightforward assumptions about the replacement of abortion with contraception. (Studies in Family Planning 2002; 33[3]: 237–248)
ReportsAbortion Risk and Decisionmaking among Young People in Urban Cameroon
Anne-Emmanuèle Calvès is Assistant Professor, Sociology Department, University of Montreal, C.P. 6128, succ. Centre-ville, Montréal, Québec, H3C 3J7 Canada. E-mail: anne.calves@umontreal.ca This study examines the use of induced abortion among Cameroonian adolescents and young women, based on biographical data collected in 1997 among young women and men residing in Yaoundé. Results suggest a high prevalence of abortion during adolescence and early adulthood (35 percent of all pregnancies reported). Although most clandestine abortions were performed by a physician or a nurse, the prevalence of abortion performed by nonmedical personnel or using unsafe methods is still high, and postabortion health complications are reported for about one-fourth of all abortions. Logistic regression models are used to examine the effect of women's, partners', and relationships' characteristics at the time of pregnancy on the odds that a pregnancy will be terminated through abortion. The analysis shows a significant effect of school enrollment, parity, and stability and social acknowledgment of the sexual relationship on the risk of having an abortion. Young men's involvement in decisions and their motivations concerning abortion are also examined. (Studies in Family Planning 2002; 33[3]: 249–260)
Menstrual Disorders in Rural Gambia
Gijs Walraven is Head, Gloria Ekpo is Research Gynecologist, and Rosalind Coleman is Research Physician, Farafenni Field Station, Medical Research Council Laboratories, Post Office Box 273, Banjul, The Gambia. At the time this study was conducted, Caroline Scherf was Visiting Gynecologist at Farafenni MRC. Linda Morison is Lecturer, London School of Hygiene and Tropical Medicine. Siobán D. Harlow is Associate Professor, Department of Epidemiology, University of Michigan. Correspondence should be addressed to Gijs Walraven. E-mail: gwalraven@mrc.gm. As part of a community-based reproductive morbidity survey in rural Gambia, the prevalence and association of menstrual disorders with sociodemographic characteristics and other reproductive morbidities, and with knowledge, attitudes, and beliefs concerning menstrual problems were assessed. A questionnaire was administered by a field-worker and by a gynecologist, who also examined the women. Semistructured interviews were conducted to assess knowledge, attitudes, and beliefs in a subsample. Of 607 menstruating women not using hormonal contraceptives, 16 percent complained to the gynecologist of irregular cycles, 14 percent of dysmenorrhea, 8 percent of spotting, and 4 percent of heavy or prolonged bleeding. Each complaint was associated with other reproductive morbidities. A minority of women with menstrual problems had sought health care, and menstruation was revealed to be a highly personal and secretive topic in this population. Menstrual disorders constitute an important unaddressed area of reproductive health service needs in developing countries for which relatively simple and inexpensive therapies are often available. Information, education, and support combined with clinical management of menstrual problems should be core elements of reproductive health programs. (Studies in Family Planning 2002; 33[3]: 261–268) Data
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