 Articles- Early Marriage and HIV Risks in Sub-Saharan Africa
Shelley Clark is Assistant Professor of Public Policy, University of Chicago, 1155 East 60th Street, Chicago, IL 60637. E-mail: sclark1@uchicago.edu. This article examines the effects of girls’ early marriage on their risk of acquiring HIV/AIDS. By comparing several underlying HIV risk factors, it explores the counterintuitive finding that married adolescent girls in urban centers in Kenya and Zambia have higher rates of HIV infection than do sexually active unmarried girls. In both countries, we find that early marriage increases coital frequency, decreases condom use, and virtually eliminates girls’ ability to abstain from sex. Moreover, husbands of married girls are about three times more likely to be HIV-positive than are boyfriends of single girls. Although married girls are less likely than single girls to have multiple partners, this protective behavior may be outweighed by their greater exposure via unprotected sex with partners who have higher rates of infection. These results challenge commonly held assumptions about sex within marriage. (Studies in Family Planning 2004; 35[3]: 149–160)
- Bridging the Gap Between Evidence-based Innovation and National Health-sector Reform in Ghana (PDF)
John Koku Awoonor-Williams is District Director of Medical Services, Nkwanta District, Nkwanta Health Development Centre, Ghana Health Service, Volta Region. Ellie S. Feinglass is Staff Research Associate and Rachel Tobey is Consultant, Policy Research Division, Population Council. E-mail: efeinglass@popcouncil.org. Maya N. Vaughan-Smith is Mellon Fellow, Nkwanta Health Development Centre, Volta Region, Ghana. Frank K. Nyonator is Director, Policy Planning, Monitoring, and Evaluation Division, Ghana Health Service, Accra. At the time this article was written, Tanya C. Jones was Staff Research Associate, Population Council, Policy Planning, Monitoring, and Evaluation Division, Ghana. Although experimental trials often identify optimal strategies for improving community health, transferring operational innovation from well-funded research programs to resource-constrained settings often languishes. Because research initiatives are based in institutions equipped with unique resources and staff capabilities, results are often dismissed by decisionmakers as irrelevant to large-scale operations and national health policy. This article describes an initiative undertaken in Nkwanta District, Ghana, focusing on this problem. The Nkwanta District initiative is a critical link between the experimental study conducted in Navrongo, Ghana, and a national effort to scale up the innovations developed in that study. A 2002 Nkwanta district-level survey provides the basis for assessing the likelihood that the Navrongo model is replicable elsewhere in Ghana. The effect of community-based health planning and services exposure on family planning and safe-motherhood indicators supports the hypothesis that Navrongo effects are transferable to impoverished rural settings elsewhere, confirming the need for strategies to bridge the gap between Navrongo evidence-based innovation and national health-sector reform. (Studies in Family Planning 2004; 35[3]: 161–177)
Olga Grigorievna Frolova is Professor and Head, Medicosocial Studies and Problem-analysis Department, and Irina Alekseevna Zhirova and Tatiana Mikhailovna Astakhova are Scientific Researchers, Scientific Research Centre for Obstetrics, Gynaecology, and Perinatology of the Russian Academy of Medical Sciences, Moscow. Evert Ketting is Coordinator of Sexual and Reproductive Health, Netherlands School of Public and Occupational Health, Amsterdam, The Netherlands. E-mail: e.ketting@tip.nl. This study examines characteristics and determinants of maternal mortality associated with induced and spontaneous abortion in the Russian Federation. In addition to national statistical data, the study uses the original medical files of 113 women, representing 74 percent of all women known to have died after undergoing an abortion in 1999. The number of abortions and abortion-related maternal deaths fell fairly steadily during the 1991–2000 decade to levels of 56 percent and 52 percent of the 1991 base, respectively. Regional and urban–rural variation is limited. Nine percent of abortion-related maternal mortality is due to spontaneous abortion; 24 percent is related to induced abortions performed inside and 67 percent to those performed outside a medical institution. In the latter group, older women, usually with a history of several pregnancies, are overrepresented. The high rate of abortion-related maternal mortality is due largely to the number of abortions performed at 13–21 weeks’ and 22–27 weeks’ gestation both inside and outside medical institutions. Improving access to safe second-trimester abortion, preventing delays during the abortion procedure, and adequate treatment of complications are key strategies for reducing abortion-related maternal mortality. (Studies in Family Planning 2004; 35[3]: 178–188)
Reports - Long-term Effects of Reproductive History on All-cause Mortality Among Adults in Rural Bangladesh
Lisa S. Hurt is Clinical Research Fellow, and Carine Ronsmans and Oona M.R. Campbell are Senior Lecturers, Infectious Disease Epidemiology Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT. E-mail: lisa.hurt@lshtm.ac.uk. Sajal Saha is Senior Programmer, Health and Demographic Surveillance Programme, ICDDR,B: Center for Health and Population Research, Dhaka. Mike Kenward is GlaxoSmithKline Professor of Biostatistics, Medical Statistics Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine. Maria Quigley is Statistical Epidemiologist, National Perinatal Epidemiology Unit, University of Oxford. A woman’s risk of dying is altered during pregnancy and immediately postpartum. Moreover, physiological and social changes associated with pregnancy may have long-term effects on mortality. Comparing these long-term associations among women and their husbands may provide insights into the nature of such a relationship. In this cohort study, we examine the association between reproductive history and all-cause mortality among ever-married women and men after age 45 in Matlab, Bangladesh, using data collected between 1982 and 1998 for a unique demographic surveillance system. No association was found between parity and mortality among women, but a small decrease in men’s mortality was found to be associated with their wives’ parity. Survival for both sexes was greatly enhanced by an increasing number of surviving children, regardless of parity or other social factors. A “healthy pregnant woman effect” coupled with the social and economic advantages of having surviving children may explain the observed effects. (Studies in Family Planning 2004; 35[3]: 189–196)
Clifford Grammich is Communications Analyst and Julie DaVanzo is Director, Population Matters Program, RAND Corporation, Post Office Box 2138, Santa Monica, CA 90407. E-mail: grammich@rand.org. Kate Stewart is Partner, Belden Russonello & Stewart, Washington, DC. A 1998 public opinion survey conducted in the United States indicated high levels of support for many family planning policies, including US health insurance coverage of family planning services and US sponsorship of family planning programs in developing countries. To gauge changes in opinion on these issues since then, some of the 1998 questions were asked in an omnibus 2003 survey. The results indicate continuing high support for requiring US health insurers to cover family planning services (87 percent in 1998 and 84 percent in 2003), but some loss of support (from 80 to 69 percent) for US sponsorship of family planning programs in developing countries. Opinion remains divided on the policy of prohibiting nongovernmental organizations from receiving federal funding for performing or actively promoting abortion services. The authors explore several possible explanations for these findings, including the role changing presidential policy may have had in shaping opinion regarding family planning aid for developing countries. (Studies in Family Planning 2004; 35[3]: 197–206)
Data - Nicaragua 2001: Results from the Demographic and Health Survey
- Zambia 2001–2002: Results from the Demographic and Health Survey
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