 Age and Economic Asymmetries in the Sexual Relationships of Adolescent Girls in Sub-Saharan Africa
When this research was undertaken, Nancy Luke was Consultant, International Center for Research on Women, Washington, DC. She is presently Research Fellow, Harvard Center for Population and Development Studies, 9 Bow Street, Cambridge, MA 02138. E-mail: nluke@hsph.harvard.edu. This literature review assesses the extent of age mixing and economic transactions in the sexual relationships of adolescent girls in sub-Saharan Africa and the behavioral dynamics of girls and men involved in these partnerships. The examination of more than 45 quantitative and qualitative studies finds that relationships with older partners and those that involve economic transactions are common and that these asymmetries are associated with unsafe sexual behaviors and increased risk of HIV infection. Although the reasons that adolescent girls engage in sexual relationships with older men are varied, receipt of financial benefits is a major motivation. The literature presents evidence that girls have considerable negotiating power over certain aspects of sexual relationships with older men, including partnership formation and continuation; however, they have little control over sexual practices within partnerships, including condom use and violence. The review discusses directions for further research and the implications of current knowledge for future interventions. (Studies in Family Planning 2003; 34[2]: 67–86)
Estimating Induced Abortion Rates: A Review
Clémentine Rossier is Researcher, Institut National d’Etudes Démographiques, 133 Boulevard Davout, 75980 Paris Cedex 20. E-mail: clementine.rossier@ined.fr. Legal abortions are authorized medical procedures, and as such, they are or can be recorded at the health facility where they are performed. The incidence of illegal, often unsafe, induced abortion has to be estimated, however. In the literature, no fewer than eight methods have been used to estimate the frequency of induced abortion: the “illegal abortion provider survey,” the “complications statistics” approach, the “mortality statistics” approach, self-reporting techniques, prospective studies, the “residual” method, anonymous third party reports, and experts’ estimates. This article describes the methodological requirements of each of these methods and discusses their biases. Empirical records for each method are reviewed, with particular attention paid to the contexts in which the method has been employed successfully. Finally, the choice of an appropriate method of estimation is discussed, depending on the context in which it is to be applied and on the goal of the estimation effort. (Studies in Family Planning 2003; 34[2]: 87–102)
Contraceptive Use in a Changing Service Environment: Evidence from Indonesia During the Economic Crisis
Elizabeth Frankenberg is Assistant Professor, Department of Sociology, 264 Haines Hall, University of California at Los Angeles, Los Angeles, CA 90095. E-mail: efranken@soc.ucla.edu. Bondan Sikoki is Director, SurveyMETER, Yogyakarta, Indonesia. Wayan Suriastini is a graduate student, RAND Graduate School, Santa Monica, CA. In the late 1990s, most Southeast Asian countries experienced substantial economic downturns that reduced social-sector spending and decreased individuals’ spending power. Data from Indonesia were collected in 1997 (just before the crisis) and in 1998 (during the crisis) that are used in this study to examine changes in the contraceptive supply environment and in women’s choices regarding contraceptive use. Despite substantial changes in providers’ characteristics during the first year of the crisis, no statistically significant differences are found between 1997 and 1998 in overall levels of prevalence, in unmet need, or in method mix. Women’s choices regarding source of contraceptive supplies, however, changed considerably over the period. Changes in the contraceptive supply environment are linked here to changes in women’s choice of source of supply, and a number of providers’ characteristics are found to be significantly associated with women’s choices in this regard. (Studies in Family Planning 2003; 34[2]: 103–116)
Reports Cost-effectiveness of USAID’s Regional Program for Family Planning in West Africa
Donald S. Shepard is Professor, Schneider Institute for Health Policy, Heller School G19, MS035, Brandeis University, Waltham, MA 02454–9110. E-mail: shepard@brandeis.edu. Richard N. Bail is Instructor in Medicine, Harvard Medical School, Boston, MA. C. Gary Merritt is a population and public health sociologist, USAID, retired, Arlington, VA. Between 1994 and 1996, the United States Agency for International Development (USAID) closed 23 country missions worldwide, of which eight were in West and Central Africa. To preserve United States support for family planning and reproductive health in four countries in that region, USAID created a subregional program through a consortium of US-based groups that hired mainly African managers and African organizations. This study assesses cost-effectiveness of the program through an interrupted time-series design spanning the 1990s and compares cost-effectiveness in four similar countries in which mission-based programs continued. Key indicators include costs, contraceptive prevalence rates, and imputed “women-years of protection.” The study found that, taking into account all external financing for population and family planning, the USAID West Africa regional approach generated women-years of protection at one-third the cost of the mission-based programs. This regional approach delivered family planning assistance in West Africa cost-effectively, and the findings suggest that regional models may work well for many health and population services in small countries. (Studies in Family Planning 2003; 34[2]: 117–126)
Does Use of the Calendar in Surveys Reduce Heaping?
Stan Becker is Professor, Department of Population and Family Health Sciences and Nafissatou Diop-Sidibé is Research and Evaluation Officer, Bloomberg School of Public Health/Center for Communications Program, Johns Hopkins University, School of Hygiene and Public Health, 615 North Wolfe Street, Room E4148 Baltimore, MD 21205. E-mail: sbecker@jhsph.edu. This study examines heaping of reported durations of three postpartum variables in five countries based on two methods of data collection in retrospective surveys. Two Demographic and Health Surveys were conducted for each of the countries, one that used a five-year month-by-month calendar to record the durations and a subsequent survey in which duration information was collected from simple questions in the body of the questionnaire. Heaping indexes were calculated for breastfeeding, amenorrhea, and abstinence at six, 12, 18, and 24 months postpartum. Use of the calendar was associated with a significant reduction in the proportion of heaped responses for both breastfeeding and amenorrhea, and the effect increased for longer durations. To obtain more accurate information about these variables, the authors recommend the use of the calendar. (Studies in Family Planning 2003; 34[2]: 127–132)
Data
|
