 Carla Makhlouf Obermeyer is Scientist, Department of HIV, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland, and Adjunct Associate Professor of Population and Anthropology, Department of Population and International Health, Harvard University. E-mail: obermeyerc@who.int. This review of recent studies examines the conceptual and methodological tools that are used to understand sexual behavior and HIV. Whereas surveys have provided reliable indicators of behavior, their validity is uncertain, their correlation with biological indicators tenuous, and the explanations they offer limited. Microlevel research has called into question the rationalizing, medically informed, and risk-averse frameworks used in the public health literature on HIV and behavior, but its impact has been limited. Thus, surveys and qualitative research have proceeded along two separate tracks, and this separation has hampered our understanding of sexual behavior. A small but growing number of studies, however, provide examples of less-compartmentalized research that avoids oversimplification. They show that expanding the models that drive research in this area is possible, and that efforts to combine disciplinary perspectives result in deeper understandings of knowledge, risk perceptions, attitudes, and behavioral change. (Studies in Family Planning 2005; 36[1]: 1–12)
Virginia J. Vitzthum is Research Associate, Department of Anthropology, Student Building 130, Indiana University, Bloomington, IN 47405. E-mail: vitzthum@indiana.edu. Karin Ringheim is Director of Research and Analysis, Global Health Council, Washington DC 20006. Side effects influence the acceptability and continuation of hormonal contraceptives. Counseling the client about the management of side effects is a principal approach advocated for increasing continuation. Evidence of a biological basis for variation in women’s tolerance of hormonal contraceptives argues, however, that greater attention should be given to altering the product rather than principally attempting to alter a woman’s ability to deal with the product. Discontinuation rates for hormonal contraceptives, largely attributable to side effects and health concerns, are high in nearly all less-developed countries for which Demographic and Health Survey data are available. Oral contraceptives appear to be particularly problematic for Latin American women, most notably in Bolivia. Clinical trials suggest substantial variation in the physiological response to exogenous hormones, and new evidence confirms the hypothesis that the normal hormonal profiles of Bolivian women are significantly lower than those of women in the United States. These findings suggest a need for more population-specific physiological research linked to analyses of the possible association between endogenous hormone differences and contraceptive continuation. Appropriately adjusting the level of the steroid delivered may benefit women’s health and improve the acceptability and continuation of hormonal contraceptives. (Studies in Family Planning 2005; 36[1]: 13–32)
Monique Hennink is Senior Research Fellow, Opportunities and Choices Reproductive Health Research Program, Division of Social Statistics, and Steve Clements is Research Fellow, Southampton Statistical Sciences Research Institute, School of Social Sciences, University of Southampton, Southampton SO17 1BJ, United Kingdom. E-mail: mon@soton.ac.uk. This study uses a quasi-experimental design to determine the impact of new family planning clinics on knowledge, contraceptive use, and unmet need for family planning among married women in poor urban areas of six secondary cities of Pakistan. Baseline (n = 5,338) and endline (n = 5,502) population surveys were conducted during 1999–2000 and 2001–02 in four study sites and two control sites. Exit interviews with clients identified the sociodemographic and geographic characteristics of clinic users. The results show that the clinics contributed to a 5 percent increase in overall knowledge of family planning methods and an increase in knowledge of female sterilization and the IUD of 15 percent and 7 percent, respectively. Distinct effects were found on contraceptive uptake, including an 8 percent increase in female sterilization and a 7 percent decline in condom use. Unmet need for family planning declined in two sites, whereas impacts on the other sites were variable. Although the new clinics are located within poor urban communities, users of the services were not the urban poor, but rather were select subgroups of the local population. (Studies in Family Planning 2005; 36[1]: 33–44)
Samuel Mills is a physician and recent graduate of the doctoral program in public health and Jane T. Bertrand is Professor, Johns Hopkins School of Public Health, Post Office Box 1165, 615 North Wolfe Street, Baltimore, MD 21205. Email: smills@jhsph.edu. This study explores the role of access versus traditional beliefs in the decision to seek obstetric care from health professionals. Eighteen purposively sampled homogenous groups in Kassena-Nankana District of northern Ghana participated in focus-group discussions about traditional beliefs, barriers to the use of health professionals, and ways to improve obstetric care. All the groups were knowledgeable about the life-threatening signs and symptoms of complications of pregnancy and labor. Decisions about place of delivery generally were made after the onset of labor. Accessibility factors (cost, distance, transport, availability of health facilities, and nurses’ attitudes) were major barriers, whereas traditional beliefs were reported as less significant. Informants made pertinent recommendations on how to improve obstetric services in the district. These findings demonstrate that even in this district, where African traditional religion is practiced by a third of the population, compared with a national average of 4 percent, lack of access was perceived as the main barrier to seeking professional obstetric care. (Studies in Family Planning 2005; 36[1]: 45–56)
Fatima Juarez is Professor-Researcher, El Colegio de México, Centro de Estudios Demograficos y de Desarrollo Ur, Yacatas 351, Col Narvate, México, DF 0320 México. E-mail: fjuarez2@prodigy.net.mx. Thomas LeGrand is Professor, Départment de démographie, Université de Montréal/CIED. Despite the general recognition that the sexual practices of adolescent boys place them at high risk of acquiring sexually transmitted infections (STIs), including HIV, and of causing unwanted pregnancies, advances in mapping their sexual behaviors have been slow. This study uses data recently collected from low-income areas of the city of Recife, Brazil, to study boys’ age at first sexual intercourse and factors that hinder their use of condoms. These boys become sexually active at early ages, and despite their general awareness of HIV, they rarely use condoms, especially at ages younger than 15. Sustained family involvement in guiding boys is associated with later first intercourse and an increased use of condoms. Boys who describe themselves as shy with girls have later first intercourse, although the probability of their using condoms does not differ from that of other boys of their age. Higher socio-economic status leads to earlier sexual activity for boys (in contrast with girls), but also to a greater likelihood of using condoms during first intercourse. (Studies in Family Planning 2005; 36[1]: 57–70)
- Reproductive Health and the Millennium Development Goals: The Missing Link
Barbara Crossette is a writer on international affairs; she was the New York Times bureau chief at the United Nations from 1994 to 2001. Email: bcrossette@aol.com
- Eritrea 2002: Results from the Demographic and Health Survey
- Indonesia 2002–03: Results from the Demographic and Health Survey
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