Perceptions and Attitudes regarding Sexually Transmitted Infection (STIs) and Family Planning among Adolescents in Northern Madagascar

The prevalence of sexually transmitted infections (STIs) and early pregnancy are high among adolescents in Madagascar. 

We applied a qualitative descriptive approach to evaluate perceptions, attitudes, and misconceptions regarding STIs and contraception among female and male adolescents ages 15-19 years (n = 43) in Northern Madagascar in 2014 using focus group discussions with open-ended questions. Data were coded and analyzed for major themes. Participants were in the 6th to 12th grade in school; 53% were female. 

Despite high levels of awareness, significant stigma against and misconceptions about STIs, condom use, and sexual practices existed. Many participants did not know how to use condoms and felt uncomfortable suggesting condoms with regular partners, despite acknowledging infidelity as a frequent problem. 

Male participants were more willing to use condoms as contraception for unwanted pregnancy than for prevention of STIs. Most participants held misconceptions about side effects of contraceptives, including infertility, cancer, and preventing bad blood from leaving the woman's body. Systematic and community-wide health education and formal reproductive health curricula in schools may improve attitudes and stigma regarding STIs and family planning. 

These strategies need to be developed and employed via collaboration among faith-based, community and non-governmental organizations, schools, and governmental health and social service agencies.

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By:  Klinger A1, Asgary R2.

• 1 Department of Internal Medicine , Beth Israel Deaconess Medical Center , Boston , Massachusetts , USA.
• 2 Departments of Population Health and Medicine , New York University School of Medicine , New York , New York , USA. 
• Women Health. 2016 Apr 19.

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Contraceptive Failure Rates in the Developing World

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Married Women’s Decision Making Power on Family Planning Use & Associated Factors in Mizan-Aman, South Ethiopia

Background

Women’s use of family planning service is influenced by many factors, especially by their decision making power. A woman’s decision-making power, be it individual or decision made in collaboration with a partner, is the most important factor in the use of family planning in a household. The purpose of this study was to assess the impact of women’s decision making power on family planning use and its associated factors.

Methods

A community-based cross-sectional study was conducted on married women in the child bearing age. The women who were living in Mizan city were selected using the simple random sampling method. Trained nurses collected the data by interview, using a structured and pre-tested questioner. Bivariable and multivariable binary logistic regression analysis was used to identify the associated factors, and the odds ratio with a 95 % CI was computed to assess the strength of the association. Collinearity was also assessed by looking at standard errors in the final fitted model.

Result

Overall, more than two-thirds [67.2 %] of the married women were found to be more autonomous to decide family planning use. Secondary education, government employment, being wives of government employed spouses, having husbands with college or university education, and being in the younger age were significantly associated with women’s decision-making power on family planning.

Conclusions

In this study, women had a high decision making power in family planning use. Age category (34–44-years), formal education, and occupational status had effects on women’s decision making power. Promoting parental adult education and engaging women in out of house employment is essential to improve their decision making power in using family planning.

Knowledge of married women’s decision making power in family planning use and associated factors in Mizan-Aman, South Ethiopia, 2013

Variables	Frequency (%)
Source of information
HEWs	247 (43.6)
Radio	214 (37.7)
Television	377 (66.7)
Health centers	277 (48.9)
Formal Education	68 (12.0)
Places where to get FP services
Hospital	404 (71.3)
Health center	432 (76.2)
Health post	141 (24.9)
Pharmacy	227 (40.0)
Clinics	239 (42.2)
Types of family planning methods
Pills	425 (75.0)
IUCD	344 (60.7)
Inject able	539 (95.1)
Implant/Norplant	361 (63.7)
Female condom	93 (16.4)
Tuba ligation	136 (24.0)
Vasectomy	68 (12.0)
Male condom	294 (51.9)
Emergency contraceptive	169 (29.8)
Calendar method	181 (31.9)

Full article at:  http://goo.gl/RLKbnd

By:  Abeba Daniel Belay, Zelalem Birhanu Mengesha, Manay Kifle Woldegebriel, and Yalemzewod Assefa Gelaw

Woman, Children and Youths Affairs Bureau, Bench Maji Zone, Mizan Aman, Ethiopia

Institute of Public Health, College of Medicine and Health Sciences University of Gondar, Gondar, Ethiopia

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Reproductive Intentions & Family Planning Practices of Pregnant HIV-Infected Malawian Women on Antiretroviral Therapy

The objective of this study was to describe the pregnancy intentions of pregnant HIV-infected Malawian women on antiretroviral therapy (ART) for at least 6 months prior to the current pregnancy, and to assess whether time on ART was associated with pregnancy intention. 

We conducted a cross-sectional analysis of HIV-infected Malawian women receiving antenatal care at a government hospital with a survey assessing ART history, reproductive history, and family planning use at conception. We used Pearson's chi-square tests and Fisher's exact tests to compare these parameters between women on ART greater than 24 months with those on ART less than 24 months. Modified Poisson regression was performed to assess the association between time on ART and pregnancy intention. 

Most women (75%) reported that their current pregnancy was unintended, defined as either Mistimed (21%) or Unwanted (79%). Women on ART for longer than 2 years were more likely to report an unintended pregnancy (79% versus 65%, p = .03), though there was no significant association between time on ART and pregnancy intention in multivariate analysis. Most women (79%) were using contraception at the time of conception, with condoms being most popular (91%), followed by injectables (9%) and the implant (9%). 

HIV-infected women on ART continue to experience high rates of unintended pregnancy in the Option B+ era. As Option B+ continues to be implemented in Malawi and increasing numbers of HIV-infected women initiate lifelong ART, ensuring that the most effective forms of contraception are accessible is necessary to decrease unintended pregnancy.

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By:  O'Shea MS1, Rosenberg NE1,2,3, Tang JH1,4,5, Mukuzunga C1, Kaliti S6, Mwale M6, Hosseinipour MC1,2,3.

• 1a UNC Project-Malawi , Lilongwe , Malawi.
• 2b UNC Institute of Global Health & Infectious Diseases , Chapel Hill , NC , USA.
• 3c Department of Medicine , University of North Carolina , Chapel Hill , NC , USA.
• 4d Department of Obstetrics & Gynecology , University of North Carolina , Chapel Hill , NC , USA.
• 5e Department of Obstetrics & Gynaecology , Malawi College of Medicine , Blantyre , Malawi.
• 6f Bwaila Hospital, Lilongwe District Health Office , Lilongwe , Malawi. 

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A Family Planning Clinic-Based Intervention to Address Reproductive Coercion

OBJECTIVE:

We assessed the effectiveness of a provider-delivered intervention targeting reproductive coercion, an important factor in unintended pregnancy.

STUDY DESIGN:

We randomized 25 family planning clinics (17 clusters) to deliver an education/counseling intervention or usual care. Reproductive coercion and partner violence victimization at one year follow-up were primary outcomes. Unintended pregnancy, recognition of sexual and reproductive coercion, self-efficacy to use and use of harm reduction behaviors to reduce victimization and contraception nonuse, and knowledge and use of partner violence resources were secondary outcomes. Analyses included all available data using an intention-to-treat approach.

RESULTS:

Among 4009 females ages 16 to 29 seeking care, 3687 completed a baseline survey prior to clinic visit from October 2011 to November 2012; 3017 provided data at 12-20 weeks post-baseline (T2) and 2,926 at 12 months post-baseline (T3) (79% retention). Intervention effects were not significant for reproductive coercion or partner violence. Intervention participants reported improved knowledge of partner violence resources and self-efficacy to enact harm reduction behaviors. In time point specific models which included moderating effects of exposure to reproductive coercion at baseline, a higher reproductive coercion score at baseline was associated with a decrease in reproductive coercion one year later (T3). Use and sharing of the domestic violence hotline number also increased.

CONCLUSION:

This brief clinic intervention did not reduce partner violence victimization. The intervention enhanced two outcomes that may increase safety for women, specifically awareness of partner violence resources and self-efficacy to enact harm reduction behaviors. It also appeared to reduce reproductive coercion among women experiencing multiple forms of such abuse.

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By:  Miller E1, Tancredi DJ2, Decker MR3, McCauley HL4, Jones KA4, Anderson H4, James L5, Silverman JG6.

• 1Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA. Electronic address: elizabeth.miller@chp.edu.
• 2Department of Pediatrics and Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California.
• 3Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
• 4Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA.
• 5Futures Without Violence, San Francisco, CA.
• 6Division of Global Public Health in the Department of Medicine & Center on Gender Equity and Health, University of California, San Diego, La Jolla, CA. 
• Contraception. 2016 Feb 15. pii: S0010-7824(16)00056-1. doi: 10.1016/j.contraception.2016.02.009.

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Determinants of Desire for Children among HIV-Positive Women in the Afar Region, Ethiopia: Case Control Study

Introduction

The desire for a child in Ethiopian society is normal. Among HIV positive women, due to the risk of MTCT, it is imperative to understand factors influencing women’s desire for children. This study aimed at assessing factors associated with desire for children among HIV-positive women in two selected hospitals of Afar Regional State, Ethiopia.

Methods

A facility based case-control study was conducted among 157 cases (with a desire) and 157 controls of HIV positive individuals registered in the selected health facilities. The participants were selected by random sampling technique. Data were collected using face-to-face interview and was analyzed using logistic regression.

Result

Factors found to be independently associated with desire for children were age categories of 20–24 years (OR = 6.22, 1.29–10.87) and 25–29 years (OR = 14.6, 3.05–21.60), being married (OR = 5.51, 2.19–13.54), Afar ethnicity (OR 6.93, 1.19–12.14), having HIV-positive children (OR 0.23, 0.09–0.63), duration on ART more than one year (3.51, 1.68–9.05), CD4 count greater than 350 (OR 4.83, 1.51–7.27) and discussion of reproductive health issues with health providers (OR 0.31, 0.12–0.51).

Conclusion

Women who were young, married, Afar, those who received ART more than one year, and had CD4 count >350 were more likely to have a desire for children.

Below:  Factors independently associated with desire for children among cases and controls of HIV positive women on ART Afar region, Ethiopia, 2012

Full article at:   http://goo.gl/5iQNRR

By:  Fatimetu Mohammed, Nega Assefa 

College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia

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Privacy and Confidentiality Practices in Adolescent Family Planning Care at Federally Qualified Health Centers

CONTEXT:

The confidentiality of family planning services remains a high priority to adolescents, but barriers to implementing confidentiality and privacy practices exist in settings designed for teenagers who are medically underserved, including federally qualified health centers (FQHCs).

METHODS:

A sample of 423 FQHCs surveyed in 2011 provided information on their use of five selected privacy and confidentiality practices, which were examined separately and combined into an index. Regression modeling was used to assess whether various state policies and organizational characteristics were associated with FQHCs' scores on the index. In-depth case studies of six FQHCs were conducted to provide additional contextual information.

RESULTS:

Among FQHCs reporting on confidentiality, most reported providing written or verbal information regarding adolescents' rights to confidential care (81%) and limiting access to family planning and medical records to protect adolescents' confidentiality (84%). Far fewer reported maintaining separate medical records for family planning (10%), using a security block on electronic medical records to prevent disclosures (43%) or using separate contact information for communications regarding family planning services (50%). Index scores were higher among FQHCs that received Title X funding than among those that did not (coefficient, 0.70) and among FQHCs with the largest patient volumes than among those with the smallest caseloads (0.43). Case studies highlighted how a lack of guidelines and providers' confusion over relevant laws present a challenge in offering confidential care to adolescents.

CONCLUSIONS:

The organizational practices used to ensure adolescent family planning confidentiality in FQHCs are varied across organizations.

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By:  Beeson T1, Mead KH2, Wood S2, Goldberg DG2, Shin P2, Rosenbaum S2.

• 1Department of Health, Educational Administration and Movement Studies, Central Washington University, Ellensburg, WA. tbeeson@cwu.edu.
• 2Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC. 
• Perspect Sex Reprod Health. 2016 Feb 17. doi: 10.1363/48e7216.

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Are Pregnancy Intentions Associated with Transitions Into and Out of Marriage?

CONTEXT:

In addition to having associations with health outcomes, pregnancy intentions may be associated with social outcomes, including marital transitions.

METHODS:

Linked data from the 2004-2008 Oklahoma Pregnancy Risk Assessment Monitoring System and The Oklahoma Toddler Survey for 2006-2010 on 3,617 women who were married and 2,123 who were unmarried at conception were used to examine the relationship between pregnancy intention status (intended, mistimed by less than two years, mistimed by two or more years, or unwanted) and marital formation or dissolution by the time of the birth and two years later. Logistic regression analyses were conducted, and propensity score methods were used to adjust for confounding characteristics.

RESULTS:

Intention status was associated with marital transition two years after the birth, but not between conception and birth. In adjusted models, among women married at conception, those with a birth resulting from an unwanted pregnancy were more likely than those with a birth resulting from an intended pregnancy to transition out of marriage by the time their child was two years old (odds ratio, 2.2). Among women unmarried at conception, those with a birth following an unwanted pregnancy were less likely than those with a birth following an intended pregnancy to marry by the time their child was two (0.5). Births following mistimed pregnancies were not associated with marital transition.

CONCLUSIONS:

The findings should motivate researchers to broaden the scope of research on the consequences of unintended childbearing. Future research should distinguish between mistimed and unwanted births.

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By:  Maddow-Zimet I1, Lindberg L2, Kost K2, Lincoln A3.

• 1Guttmacher Institute, New York. imaddowzimet@guttmacher.org.
• 2Guttmacher Institute, New York.
• 3Oklahoma Department of Health, Oklahoma City. 
• Perspect Sex Reprod Health. 2016 Feb 29. doi: 10.1363/48e8116.

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Comprehensive Assessment of Health Needs of Young Minority Males Attending a Family Planning Clinic

The objective of this study was to assess the overall health, including sexual and reproductive health (SRH) knowledge and needs, sexual behaviors, and testicular health practices among young minority males. 

Anonymous questionnaires were administered to 18- to 25-year-old males receiving services at health clinics in a large southwestern U.S. city. The survey was completed by 258 males with a mean age of 20.8 years. Most young males (67.1%) identified as African American, and 32.9% as Hispanic. 

Results suggest study participants lack SRH knowledge related to pregnancy and condom effectiveness, and engage in risky sexual behavior including not using birth control at their last sexual encounter. 

Although 21.6% of participants had a sexually transmitted infection (STI) in the past year, approximately 80% perceived their STI/HIV risk as very low or low. Respondents had low engagement and lack of knowledge of testicular health practices. The majority of respondents (71.1%) reported having been in a physical fight one or more times and 18.1% reported being victims of intimate partner violence. 

These data support a need for comprehensive health services for minority young males.

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By:  Pastuszak AW1, Wenker EP2, Smith PB2, Abacan A2, Lamb DJ2, Lipshultz LI2, Buzi R2.

• 1Baylor College of Medicine, Houston, TX, USA pastusza@bcm.edu.
• 2Baylor College of Medicine, Houston, TX, USA. 
• Am J Mens Health. 2016 Feb 4. pii: 1557988316629627.

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Eliminating the Phrase "Elective Abortion": Why Language Matters

The phrase "elective abortion" is often used to describe induced abortions performed for reasons other than a direct, immediate threat to maternal physical health. 

We argue that the term "elective abortion" is variably defined, misrepresents the complexity and multiplicity of indications for abortion and perpetuates stigma. In practice, restricting access to abortion at the legal, regulatory or institutional level based on subjective perceptions of patient need constrains health care providers' ability to act according to their best clinical judgments and limits patient access to care. 

The phrase "elective abortion" should be eliminated from scientific and medical discourse to prevent further damage to the public understanding of the variety of indications for which women require expeditious and equitable access to induced abortion.

Full article at:   http://goo.gl/dDSttK

By:  Janiak E1, Goldberg AB2.

• 1Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA 02115, USA; Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA. Electronic address: ejaniak@partners.org.
• 2Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA; Planned Parenthood League of Massachusetts, Boston, MA 02215, USA. 

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Constructing a Validated Scale to Measure Community-Level Abortion Stigma in Mexico

OBJECTIVE:

In Mexico, abortion stigma in the general population is largely unexplored. We developed a scale to measure abortion stigma at the community-level, examine its prevalence, and explore factors associated with abortion stigma in a nationally representative sample.

STUDY DESIGN:

Following intensive qualitative work to identify dimensions of the stigma construct, we developed a comprehensive list of statements that were cognitively tested and reduced to 33 to form a scale. We piloted the scale in a nationally and sub-regionally representative household public opinion survey administered to 5,600 Mexican residents.

RESULTS:

Factor analysis tested the internal consistency and reliability of five previously hypothesized dimensions of abortion stigma: secrecy, religion, autonomy, discrimination, and guilt/shame. Under the assumption that these dimensions were independent, confirmatory factor analysis indicated that each of these dimensions functioned as independent sub-scales. However, to test this assumption, we conducted exploratory factor analysis which revealed a strong co-dependence between discrimination, guilt/shame and religion statements, resulting in a 23-item four factor model of abortion stigma and the elimination of the guilt/shame dimension. Both methods revealed a full scale and sub-scales with Cronbach's alphas between 0.80-0.90. Regression analyses suggested that older, less educated individuals living in the north of Mexico report higher levels of stigma, especially related to discrimination and religion.

CONCLUSIONS:

This community-level abortion stigma scale is the first to be developed and tested in Mexico. This tool may be used in Mexico and other similar country settings to document the prevalence of community-level abortion stigma, identify associated factors, and test interventions aimed at reducing abortion stigma.

IMPLICATIONS:

Abortion stigma prevents women from accessing safe abortion services. Measuring community-level abortion stigma is key to documenting its pervasiveness, testing interventions aimed at reducing it, and understanding associated factors. This scale may be useful in countries similar to Mexico to support policymakers, practitioners and advocates in upholding women's reproductive rights.

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By:  Sorhaindo AM1, Karver TS2, Karver JG2, Garcia SG2.

• 1Population Council, Mexico City, Mexico. Electronic address: sorhaindoannik@gmail.com.
• 2Population Council, Mexico City, Mexico. 
• Contraception. 2016 Jan 26. pii: S0010-7824(16)00033-0. doi: 10.1016/j.contraception.2016.01.013. 

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