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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Contextual Determinants of Induced Abortion: A Panel Analysis

OBJECTIVE

Analyze the contextual and individual characteristics that explain the differences in the induced abortion rate, temporally and territorially.

METHODS

We conducted an econometric analysis with panel data of the influence of public investment in health and per capita income on induced abortion as well as a measurement of the effect of social and economic factors related to the labor market and reproduction: female employment, immigration, adolescent fertility and marriage rate. The empirical exercise was conducted with a sample of 22 countries in Europe for the 2001-2009 period.

RESULTS

The great territorial variability of induced abortion was the result of contextual and individual socioeconomic factors. Higher levels of national income and investments in public health reduce its incidence. The following sociodemographic characteristics were also significant regressors of induced abortion: female employment, civil status, migration, and adolescent fertility.

CONCLUSIONS

Induced abortion responds to sociodemographic patterns, in which the characteristics of each country are essential. The individual and contextual socioeconomic inequalities impact significantly on its incidence. Further research on the relationship between economic growth, labor market, institutions and social norms is required to better understand its transnational variability and to reduce its incidence.

Below: Abortions per thousand live births in Europe during 2009

Full article at:   http://goo.gl/458IUb

By:  Mar Llorente-Marrón, Montserrat Díaz-Fernández, and Paz Méndez-Rodríguez

Departamento de Economía Cuantitativa. Facultad de Economía y Empresa. Universidad de Oviedo. Oviedo, España

Correspondence: Mar Llorente-Marrón. Departamento de Economía Cuantitativa. Facultad de Economía y Empresa. Avda. del Cristo, s/n 33006 

Rev Saude Publica. 2016; 50: 8.

Published online 2016 Mar 10. doi:  10.1590/S1518-8787.2016050005917

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Knowledge of University Students in Szeged, Hungary About Reliable Contraception Methods & Sexually Transmitted Diseases

INTRODUCTION:

Promiscuity and lack of use of reliable contraceptive methods increase the probability of sexually transmitted diseases and the risk of unwanted pregnancies, which are quite common among university students.

AIM:

The aim of the study was to assess the knowledge of university students about reliable contraceptive methods and sexually transmitted diseases, and to assess the effectiveness of the sexual health education in secondary schools, with specific focus on the education held by peers.

METHOD:

An anonymous, self-administered questionnaire survey was carried out in a randomized sample of students at the University of Szeged (n = 472, 298 women and 174 men, average age 21 years) between 2009 and 2011.

RESULTS:

62.1% of the respondents declared that reproductive health education lessons in high schools held by peers were reliable and authentic source of information, 12.3% considered as a less reliable source, and 25.6% defined the school health education as irrelevant source. Among those, who considered the health education held by peers as a reliable source, there were significantly more females (69.3% vs. 46.6%, p = 0.001), significantly fewer lived in cities (83.6% vs. 94.8%, p = 0.025), and significantly more responders knew that Candida infection can be transmitted through sexual intercourse (79.5% versus 63.9%, p = 0.02) as compared to those who did not consider health education held by peers as a reliable source. The majority of respondents obtained knowledge about sexual issues from the mass media.

CONCLUSIONS:

Young people who considered health educating programs reliable were significantly better informed about Candida disease

Purchase full article [Article in Hungarian] at:  http://goo.gl/SPkzcb

By:  Devosa I1,2, Kozinszky Z1,3, Vanya M1,4,5, Szili K1,4,5, Fáyné Dombi A1,2,6, Barabás K7.

• 1Egészségtudományi és Egészségfejlesztő Kutató Csoport, Kecskeméti Főiskola, Tanítóképző Főiskolai Kar Kecskemét.
• 2Szegedi Akadémiai Bizottság Oktatáselméleti Munkabizottság, Magyar Tudományos Akadémia Szeged.
• 3Department of Obstetrics and Gynecology, Blekinge Hospital Karlskrona, Svédország.
• 4Szent-Györgyi Albert Klinikai Központ, Szülészeti és Nőgyógyászai Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged.
• 5Mediteam Zrt. Szeged.
• 6Tanító- és Óvóképző Intézet, Alkalmazott Pedagógia és Pszichológia Tanszék, Szegedi Tudományegyetem, Juhász Gyula Pedagógusképző Kar Szeged.
• 7Magatartástudományi Intézet, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged.
• Orv Hetil. 2016 Apr;157(14):539-46. doi: 10.1556/650.2015.30356.

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Women’s Awareness and Knowledge of Abortion Laws: A Systematic Review

Background

Incorrect knowledge of laws may affect how women enter the health system or seek services, and it likely contributes to the disconnect between official laws and practical applications of the laws that influence women’s access to safe, legal abortion services.

Objective

To provide a synthesis of evidence of women’s awareness and knowledge of the legal status of abortion in their country, and the accuracy of women’s knowledge on specific legal grounds and restrictions outlined in a country’s abortion law.

Methods

A systematic search was carried for articles published between 1980–2015. Quantitative, mixed-method data collection, and objectives related to women’s awareness or knowledge of the abortion law was included. Full texts were assessed, and data extraction done by a single reviewer. Final inclusion for analysis was assessed by two reviewers. The results were synthesised into tables, using narrative synthesis.

Results

Of the original 3,126 articles, and 16 hand searched citations, 24 studies were included for analysis. Women’s correct general awareness and knowledge of the legal status was less than 50% in nine studies. In six studies, knowledge of legalization/liberalisation ranged between 32.3% - 68.2%. Correct knowledge of abortion on the grounds of rape ranged from 12.8% – 98%, while in the case of incest, ranged from 9.8% - 64.5%. Abortion on the grounds of fetal impairment and gestational limits, varied widely from 7% - 94% and 0% - 89.5% respectively.

Conclusion

This systematic review synthesizes literature on women’s awareness and knowledge of the abortion law in their own context. The findings show that correct general awareness and knowledge of the abortion law and legal grounds and restrictions amongst women was limited, even in countries where the laws were liberal. Thus, interventions to disseminate accurate information on the legal context are necessary.

Full article at:   http://goo.gl/GN3ps1

By:  Anisa R. Assifi,1,* Blair Berger,2 Özge Tunçalp,1 Rajat Khosla,1 and Bela Ganatra1

¹WHO Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland

2

²Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America

1WHO Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland

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Contraceptive Failure Rates in the Developing World

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Contraception Usage and Timing of Pregnancy among Pregnant Teenagers in Cape Town, South Africa

OBJECTIVE:

To evaluate knowledge and use of contraception among pregnant teenagers in the Cape Town metropolitan area.

METHODS:

A cross-sectional study enrolled women aged 16 to 19 years who were pregnant and attending prenatal clinics, and prenatal and labor wards at regional hospitals and midwife-run obstetric clinics in the Cape Town area between March 1, 2011 and September 30, 2011. Data were collected using an administered questionnaire.

RESULTS:

The study enrolled 314 participants. Of the participants, 240 (76.4%) felt their pregnancies had occurred at the "wrong time" but only 38 (12.1%) were using contraception at the time of conception. The form of contraception that participants most commonly had knowledge of was injectable hormonal contraception (274 [87.3%]). Contraception use was low, with 126 (40.1%) participants having never used contraception. The forms of contraception used most commonly were the male condom (106 [33.8%]) and injectable contraception (98 [31.2%]). The majority of participants found it easy to get contraception (192 [61.1%]) and felt that information regarding contraception was readily available (233 [74.2%]).

CONCLUSION:

Contraception use is suboptimal but this may not simply be a reflection of ineffective family-planning services. Further research is needed to fully explain the lack of contraceptive use in this population.

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By:  Vollmer LR1, van der Spuy ZM2.

• 1Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa. Electronic address: lindivollmer@hotmail.com.
• 2Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa. 
• Int J Gynaecol Obstet. 2016 Jan 28. pii: S0020-7292(16)00039-4. doi: 10.1016/j.ijgo.2015.10.011. 

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Trends in Contraceptive Use Worldwide, 2015

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Women's Acceptability of Misoprostol Treatment for Incomplete Abortion by Midwives and Physicians - Secondary Outcome Analysis from a Randomized Controlled Equivalence Trial at District Level in Uganda

Objective

This study aimed to assess women´s acceptability of diagnosis and treatment of incomplete abortion with misoprostol by midwives, compared with physicians.

Methods

This was an analysis of secondary outcomes from a multi-centre randomized controlled equivalence trial at district level in Uganda. Women with first trimester incomplete abortion were randomly allocated to clinical assessment and treatment with misoprostol by a physician or a midwife. The randomisation (1:1) was done in blocks of 12 and stratified for health care facility. Acceptability was measured in expectations and satisfaction at a follow up visit 14–28 days following treatment. Analysis of women’s overall acceptability was done using a generalized linear mixed-effects model with an equivalence range of -4% to 4%. The study was not masked. The trial is registered at ClinicalTrials.org, NCT 01844024.

Results

From April 2013 to June 2014, 1108 women were assessed for eligibility of which 1010 were randomized (506 to midwife and 504 to physician). 953 women were successfully followed up and included in the acceptability analysis. 95% (904) of the participants found the treatment satisfactory and overall acceptability was found to be equivalent between the two study groups. Treatment failure, not feeling calm and safe following treatment, experiencing severe abdominal pain or heavy bleeding following treatment, were significantly associated with non-satisfaction. No serious adverse events were recorded.

Conclusions

Treatment of incomplete abortion with misoprostol by midwives and physician was highly, and equally, acceptable to women.

Full article at: http://goo.gl/7ux4pg

By:  

Amanda Cleeve, Kristina Gemzell-Danielsson, Marie Klingberg-Allvin

Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden

Amanda Cleeve, Kristina Gemzell-Danielsson

WHO Center for Human Reproduction, Karolinska University Hospital, Stockholm, Sweden

Josaphat Byamugisha, Susan Atuhairwe

Department of Obstetrics and Gynaecology, Mulago Hospital, Kampala, Uganda

Josaphat Byamugisha, Susan Atuhairwe

Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda

Nazarius Mbona Tumwesigye

Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda

Elisabeth Faxelid

Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden

Marie Klingberg-Allvin

School of Education, Health and Social Studies, Dalarna University, Falun, Sweden

  

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Surgery for Family Planning, Abortion, and Postabortion Care

This chapter discusses two related but conceptually distinct health concerns in low- and middle-income countries (LMICs): (a) voluntary family planning, and (b) abortion, including postabortion care. In the first section, on family planning, the health condition of interest is unmet need: the percentage of women who would like to either stop or delay childbearing but who are not using any contraceptive method to prevent pregnancy. The unmet need for family planning (to either limit family size or determine the intervals between children) results in unintended and unwanted pregnancies, which in turn lead to a broad range of maternal and child conditions that increase morbidity and mortality. Surgical procedures for family planning can help reduce this unmet need, particularly the need to limit childbirth. 

The second section concerns surgery for induced abortion (as opposed to spontaneous abortion, or miscarriage) and the surgical management of the complications of induced, mostly unsafe, abortion. Unsafe abortion is defined as abortion performed outside of health facilities (or any other place legally recognized for the procedure) or by an unskilled person (WHO 1992). The demand for abortion is high in many LMICs, and the illegality of the procedure in most of these countries increases the likelihood of postabortion complications from clandestine, unsafe procedures (Grimes and others 2006; Shah and Ahman 2009; Singh and others 2006; Singh 2010). Therefore, postabortion care is a significant health issue in LMICs. Timely, safe surgical interventions can reduce the morbidity and mortality associated with unsafe abortions. The same surgical procedures used for abortion are also used to manage incomplete abortion, which is one of the most common postabortion complications and is often accompanied by other complications such as bleeding, sepsis, and genital injury. The surgical procedures used to manage such complications include laparotomy for sepsis and uterine injury and a wide range of minor procedures to repair injuries to the proximal birth canal. Both sections discuss the burden of reproductive health conditions, including morbidity, mortality, and other effects. We discuss surgical procedures (their performance, inputs, and implementation) and the health workforce implications of scaling up those procedures in LMICs. We also explore evidence on the procedures’ effectiveness in reducing morbidity and mortality and improving quality of life as well as evidence on their cost-effectiveness. 

Finally, we outline future directions—including implementation challenges and considerations for increasing access to these surgical interventions—and conclude by summarizing the findings and recommendations.

Sections

• Introduction:  http://goo.gl/iVswFu
• Surgery for Family Planning:  http://goo.gl/iuVhp0
• Surgery for Abortion and Postabortion Care:  http://goo.gl/IOODSg

By:  Babigumira JB, Vlassoff M, Ahimbisibwe A, Stergachis A.

Editors

In: Debas HT, Donkor P, Gawande A, Jamison DT, Kruk ME, Mock CN, editors. 

Source

Essential Surgery: Disease Control Priorities, Third Edition (Volume 1). Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2015 Apr. Chapter 7.

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Help-Seeking Behaviors of Abused Women in an Abortion Clinic Population

Women who seek induced abortion procedures experience high rates of intimate partner violence, yet little is known about their help-seeking behaviors. 

Using data collected from patients attending a large Midwestern clinic who screened positive for intimate partner violence, we analyzed how help-seeking women differed from women not seeking help and those not disclosing their help-seeking behavior. 

We measured current and planned resource use and evaluated self-perceived helpfulness of resources. Severe battering, physical and/or sexual abuse, frequent sexual abuse, increased relationship length, and employment were positively associated with help-seeking. 

Nearly half of women who screened positive for abuse in the past year had already sought or planned to seek help, indicating this population is receptive to intervention.

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By:   Megan R. W. TePoel1, Audrey F. Saftlas1, Anne B. Wallis1, Karisa Harland1, Corinne Peek-Asa1⇑

¹University of Iowa, Iowa City, IA, USA

Corinne Peek-Asa, Department of Occupational and Environmental Health, University of Iowa College of Public Health (http://www.public-health.uiowa.edu/), 145 N. Riverside Dr., Room S143 CPHB, Iowa City, IA 52242, USA. Email: corinne-peek-asa@uiowa.edu

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The Relationship Between Pregnancy Prevention and STI/HIV Prevention and Sexual Risk Behavior among American Indian Men

OBJECTIVE:

We examined the relationship between American Indian men's attitudes toward pregnancy prevention, STI/HIV prevention, and sexual risk behavior. Attention was given to: (1) attitudes and intentions to use condoms and sexual risk behavior; (2) STI/HIV prevention characteristics and sexual risk behavior; (3) attitudes toward abstinence and monogamy and sexual risk behavior; and (4) decision-making in relationships and sexual risk behavior.

STUDY DESIGN:

Our sample included 120 heterosexual American Indian men aged 18 to 24 living on a reservation. Data were collected during in-depth interviews. A community-based participatory research framework was used to ensure the relevancy and acceptability of the study given the sensitivity of the topic.

PRINCIPAL FINDINGS:

Results demonstrated that attitudinal factors were associated with sexual risk behavior, particularly inconsistent condom use. Attitudes associated with consistent condom use suggested greater levels of positive dispositions toward prevention and intention to use condoms. Consistent condom use was associated with more cautious attitudes toward sex with multiple sex partners. Study results suggested that American Indian men who reported sex with multiple partners exhibited a set of attitudes and beliefs toward pregnancy prevention and STI/HIV prevention that corresponded with a disposition resulting from their behaviors, in that engaging in sexual risk behavior elevated their levels of risk perception.

CONCLUSIONS:

Our findings suggest that heterosexual American Indian men living in rural environments need sexual and reproductive health programs and clinical services that address differing attitudes toward condom use within the context of multiple sex partners and sexual risk behavior.

  

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By:   Rink E¹, FourStar KT², Anastario MP³.

¹Department of Health and Human Development, Montana State University (http://www.montana.edu/hhd/), Bozeman, Montana.

²School of Public and Community Health Sciences, University of Montana, Missoula, Montana.

³University of Central America, El Salvador.

J Rural Health. 2015 Dec 22. doi: 10.1111/jrh.12166. [Epub ahead of print]

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Women Who Have Sex with Women in Kenya and Their Sexual and Reproductive Health

Purpose: To describe sexual and reproductive health characteristics of women who have sex with women (WSW) in Kenya's three most populous cities: Kisumu, Mombasa, and Nairobi. Although the last decade has shown an upsurge of health-related research studies in African sexual minority populations, these studies have generally concentrated on the health status of men who have sex with men to the exclusion of WSW. This study presents the first findings on Kenyan WSW's sexual and reproductive health.

Methods: A community-based, cross-sectional survey was conducted among 280 women who were at least 18 years old, had at least one female sexual partner in the past three years, and were Kenyan residents.

Results: A significant proportion of participants reported that they had at least one male sexual partner in the past three years (38.9%), ever had an abortion (13.2%), been infected with at least one sexually transmitted infection (STI) in the past three years (33.9%), and been tested for HIV at least once (88.9%). Of the women who reported having been tested for HIV, 9.4% (7.5% of the total sample) received a positive test result. Some women noted that they were open with their doctors about their sexual orientation, and that their doctors had not reacted negatively to this information.

Conclusion: WSW in Kenya are at risk for negative sexual and reproductive health outcomes, including HIV, STIs, unplanned pregnancy, and unsafe abortion, positioning these women as a critical population for public health efforts. Some WSW actively exercise their agency in making important health decisions. Therefore, this study indicates a need to incorporate WSW's health concerns within Kenyan national health policy programming.

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By:   Sidra S. Zaidi, MA,^1,2 Akinyi M. Ocholla, MA,³ Rena A. Otieno,⁴ and Theo G.M. Sandfort, PhD^1,2

¹Division of Gender, Sexuality and Health, Department of Psychiatry, Columbia University, New York, New York.

²New York State Psychiatric Institute, New York, New York.

³Minority Women in Action, Nairobi, Kenya.

⁴Women Working with Women, Kisumu, Kenya.

Address correspondence to:

Theo G.M. Sandfort, PhD

Division of Gender, Sexuality and Health

Department of Psychiatry

Columbia University and New York

State Psychiatric Institute

1051 Riverside Drive, Unit 15

New York, NY 10031

E-mail: tgs2001@cumc.columbia.edu

 

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Healthcare Students' Knowledge and Opinions About the Argentinean Abortion Law

Highlights

• In Argentina, around 400,000 abortions are performed every year, resulting in one third of the maternal deaths.
• High quality sexual and reproductive healthcare services are a key strategy to improve adolescents' and women's health.
• We surveyed first year healthcare students in Argentina to determine their knowledge and opinions of Argentina's abortion law.
• Half were unaware of the current regulations and did not recognize allowable circumstances, which could affect their practice.
• It is crucial that medical schools include sexual and reproductive health issues in their curricula.
• Including these issues in the curricula will ensure better quality healthcare services in the future.

Objective

Abortion is legally restricted in Argentina. Although this law is almost 100 years old, most women who meet the criteria for legal abortion are not informed of or offered this possibility within the healthcare system. Healthcare students' knowledge and opinions on abortion may influence their future practice. They may deny a woman with an unwanted pregnancy a practice to which she is legally entitled, resulting in an unsafe abortion. This study assessed knowledge and personal opinions on the abortion law among first year healthcare students in order to design adequate educational strategies.

Study design

In this descriptive, analytical, cross-sectional study, structured self-administered questionnaires were administered to 781 first year medical, nursing, midwifery, and other healthcare students from the Faculty of Medicine, University of Buenos Aires from 2011 to 2013. Data were recorded anonymously in SPSS 20. Student samples were adjusted for gender and fields of study using the University statistics.

Results

Of the students, 48.8% did not know the current regulations. Most of the students thought abortion was legally restricted and failed to recognize the circumstances in which it is allowed. Over 75% of the students were pro-abortion, especially those with sexual experience.

Conclusion

Students lack sound knowledge on the abortion law that may affect their personal lives and influence their future professional practice. It is crucial that medical schools include sexual and reproductive health issues in their curricula in order to ensure better quality healthcare services in the future.

Implications

In Argentina, approximately 400,000 abortions are performed every year, many under unsafe conditions, resulting in one third of the maternal deaths for the past decade. High quality sexual and reproductive healthcare services are a key strategy to improve adolescents' and women's health, thereby lowering maternal mortality.

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By:  Belén Provenzano-Castro, Silvia Oizerovich, Babill Stray-Pedersen

Affiliations

• Department of OB-GYN, Gynaecology Division, Faculty of Medicine, University of Buenos Aires, 2351 Córdoba Av., C1120AAR Ciudad de Buenos Aires, Argentina

• Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Sognsvannsveien 20, 0372 Oslo, Norway

Correspondence

• Corresponding author. 2454 Beruti St., C1117AAD Ciudad de Buenos Aires, Argentina. Tel.: +54 911 5840 8101.

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