Below are citations and abstracts to 10 urban reproductive health studies published from June – August 2009. Entries are listed alphabetically by journal title.
1 – Cult Health Sex. 2009 Jul 10:1.
Guiding change: provider voices in youth pre-abortion counselling in urban Vietnam.
Nguyen HK, Martin P, Chinh NQ, Cong DD. Nossal Institute for Global Health, University of Melbourne, Australia.
Pre-abortion counselling has a role in promoting safe sex practices and in preventing repeated unplanned pregnancies and repeated abortions among abortion-seeking women. Such counselling is essential in Vietnam, especially given the common use of abortion. Arguably, in Ho Chi Minh City, Vietnam, the delivery of pre-abortion counselling is more urgent for young women, who have historically been ignored by State reproductive health initiatives and are increasingly exposed to transmission of sexually transmitted infections (STIs), unplanned pregnancies and abortion. This paper charts urban Vietnamese service providers’ discourses in pre-abortion counselling specific for reducing risks of additional unwanted pregnancies, repeat abortion and STI/HIV transmission among young Vietnamese women. Thirteen providers working in counselling delivery, management and programme-planning at the Reproductive Health Care Centre of Ho Chi Minh City participated in this study. Through qualitative interviews, this paper elicits a range of provider attitudes, considerations and approaches in pre-abortion counselling and presents these discourses using participant anecdotes. Demonstrated among participant responses were five key pre-abortion counselling phases for promoting effective family planning among young women. Topics covered in these counselling phases included abortion complications, post-abortion fertility return, contraception, behaviour change and STI/HIV prevention and sexual and reproductive health basics (SRH). The service provider discourses gleaned from this study are foundational for further research and development of best practice guidelines in pre-abortion counselling.
2: Health Care Women Int. 2009 Jun;30(6):475-83.
Experience with side effects among users of injectables, the IUD, and oral contraceptive pills in four urban areas of Honduras.
Barden-O’Fallon J, Speizer I, Rodriguez F, Calix J. MEASURE Evaluation Project, Chapel Hill, NC 27516, USA. bardenof@email.unc.edu
Contraceptive side effects are often the most commonly reported reason for method discontinuation, particularly of modern methods. We use data from eight focus groups and 800 exit interviews to examine women’s experiences with contraceptive side effects in four urban areas of Honduras. Ease of treatment and differences in motivation to avoid pregnancy are suggested explanations for why side effects cause some women to continue and others to discontinue. Although side effects are a common reason for discontinuation in this population, less than half of the surveyed women were informed about potential side effects by a health worker on the day of the interview.
3: Hum Reprod. 2009 Jul 29.
Psychological distress among men suffering from couple infertility in South Africa: a quantitative assessment.
Dyer S, Lombard C, Van der Spuy Z. Division of Obstetrics and Gynaecology, Faculty of Health Sciences, Groote Schuur 7937, Cape Town, South Africa.
BACKGROUND Recent years have seen a growing interest in the impact of infertility on reproductive health in developing countries. Most of the research which has addressed the psychosocial consequences of infertility in African countries has been qualitative in nature and focused on women. It was the aim of this study to assess psychological distress quantitatively in men suffering from couple infertility living in an urban community in South Africa.
METHODS The Symptom Checklist-90-R, a standardized instrument for the measurement of current psychological symptom status, was administered to 120 men upon first presentation to a public health sector infertility clinic (study group) in a tertiary referral centre. The control group comprised 120 men who attended an antenatal clinic with their partner. All men may have previously fathered a child. Raw test scores were converted into standard area T scores and analyzed further. RESULTS Participants in the study group differed in their psychological symptom status when compared with controls. Male partners of infertile couples had significantly elevated mean T scores for all nine primary symptom dimensions as well as the three global markers of distress (P < 0.0001 versus control), but these did not exceed the upper range of normal.
CONCLUSIONS When compared with controls, male partners of infertile couples experienced elevated levels of psychological distress, but without, on average, suffering from psychopathology. A comparison with qualitative studies from African countries and with quantitative studies from the Western industrialized world revealed both similarities and differences. Understanding and addressing the male perspective of infertility is an important component of infertility management.
4: Int J Cancer. 2009 Aug 1;125(3):662-5.
Breastfeeding and breast cancer risk in India: a multicenter case-control study.
Gajalakshmi V, Mathew A, Brennan P, Rajan B, Kanimozhi VC, Mathews A, Mathew BS, Boffetta P. Epidemiological Research Center, Chennai, Tamil Nadu, India.
Breast cancer incidence is low in India compared with high-income countries, but it has increased in recent decades, particularly among urban women. The reasons for this pattern are not known although they are likely related to reproductive and lifestyle factors. Here, we report the results of a large case-control study on the association between breastfeeding and breast cancer risk. The study was conducted in 2 areas in South India during 2002-2005 and included 1,866 cases and 1,873 controls. Detailed information regarding menstruation, reproduction, breastfeeding and physical activity was collected through in-person interview. Odds ratios (OR) and 95% confidence intervals (CI) were estimated by unconditional logistic regression models. Breastfeeding for long duration was common in the study population. Lifetime duration of breastfeeding was inversely associated with breast cancer risk among premenopausal women (p-value of linear trend, 0.02). No such protective effect was observed in postmenopausal women, among whom a protective effect of parity was suggested. A reduction of breast cancer risk with prolonged breastfeeding was shown among premenopausal women. Health campaign focusing on breastfeeding behavior by appropriately educating women would contribute to reduce breast cancer burden. Publication Types: Multicenter Study Research Support, Non-U.S. Gov’t PMID: 19452516 [
5: J Sex Med. 2009 Jul 21.
Prevalence and Potential Risk Factors of Female Sexual Difficulties: An Urban Iranian Population-Based Study.
Goshtasebi A, Vahdaninia M, Rahimi Foroshani A. Iranian Institute for Health Sciences Research (IHSR), ACECR, Tehran, Iran.
Introduction. Female sexual dysfunction is common, a multifactorial phenomenon with a potential to cause marital strain, impaired fertility, and poor quality of life. Epidemiologic data are scarce and little is known about the prevalence of sexual difficulties and the exact role of putative risk factors in Iran. Aim. To determine the prevalence of female sexual difficulties and the potential risk factors in an urban Iranian population.
Methods. A cross-sectional study was performed in the province of Kohgilooyeh-Boyerahmad (KB) in the southwest of Iran and involved sexually active urban women aged 15 years and over, selected via a quota-based cluster sampling method. The study used an ad hoc questionnaire covering the demographic and reproductive variables as well as the data related to sexual difficulties. Data were analyzed using multiple logistic regression models. The main outcome measures were the prevalence rates and the predictors of sexual difficulties.
Main Outcome Measures. The prevalence of female sexual difficulties and the associated risk factors. Results. One thousand four hundred fifty-six sexually active women living in the urban areas of KB province in 2005 were selected. The mean age of the sample was 34.04 +/- 9.2 (16-71) years and the mean number of completed grades was 7.18 (+/-4.8). More than 52% of the participants had experienced at least one type of sexual difficulty. The greatest and smallest frequencies were observed for orgasm difficulty (21.3%, confidence interval[CI](0.95) = 19.2-23.4%) and lubrication difficulty (11.9%, CI(0.95) = 10.2-13.6%). Age, education, contraceptive modality, and obstetric/gynecologic procedures were all associated with at least one type of sexual dysfunction.
Conclusion. Similar to previous studies, we found a relatively high prevalence of sexual difficulties in this urban population of low socioeconomic status. However, our results concerning the role of some demographic and reproductive variables in producing sexual difficulties were different from those reported by other researchers. Goshtasebi A, Vahdaninia M, and Rahimi Foroshani A. Prevalence and potential risk factors of female sexual difficulties: An urban Iranian population-based study.
6: Midwifery. 2009 Jun;25(3):317-26.
Perceived prenatal learning needs of multigravid Ghanaian women.
Bansah M, O’Brien B, Oware-Gyekye F. Nursing & Midwifery Training College, P.O. Box 333, Secondi, Ghana.
OBJECTIVE: to explore the learning needs of multigravid Ghanaian women in an effort to develop more effective prenatal education programmes. DESIGN: a descriptive-exploratory design consisting of in-depth individual semi-structured interviews and a single focus group.
SETTING: prenatal clinic of a large hospital in a city in Ghana, Africa.
PARTICIPANTS: 18 multigravid Ghanaian women between 38 and 40 weeks of gestation who were not experiencing complications with the index pregnancy. FINDINGS: the women reported particular learning needs that were not being addressed during their prenatal care. They identified areas where they wanted more information about specific topics such as birth control, sexual activity during pregnancy and promoting ideal fetal positions. They also wanted information about how to care for themselves and their babies after birth. They received information from staff at the prenatal clinic that sometimes conflicted with what they learned from those in their informal support system (e.g. mothers and friends).
KEY CONCLUSIONS: inconsistency with respect to information received from health professionals and that received from other sources of support created tension that led to increased doubt and anxiety on the part of the women. They reported that they wanted more in-depth information that was relevant to their specific needs and solution centred. They wanted a more interactive educational process including some separate teaching sessions specifically for multigravid women. They also wanted access to information during both private and group encounters with health-care professionals.
IMPLICATIONS FOR PRACTICE: information and strategies deemed to be of interest and importance to these multigravid women, such as private counselling sessions to address individual concerns about safe sexual health and birth control, and interactive groups for multigravid women, could be implemented to increase interest and promote the well-being of these women.
7: Public Health Nutr. 2009 Jun;12(6):789-98.
Determinants of low birth weight in urban Pakistan.
Janjua NZ, Delzell E, Larson RR, Meleth S, Kristensen S, Kabagambe E, Sathiakumar N. Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd, RPHB 430, Birmingham, AL 35294, USA.
OBJECTIVE: To identify determinants of low birth weight (LBW) in Karachi, Pakistan, including environmental exposures and nutritional status of the mother during pregnancy.
DESIGN: Cross-sectional study.ParticipantsFive hundred and forty mother-infant pairs. We interviewed mothers about obstetric history, diet and exposure to Pb. We measured birth weight and blood lead level (BLL). We performed multiple log binomial regression analysis to identify factors related to LBW.
RESULTS: Of 540 infants, 100 (18.5 %) weighed <or=2.5 kg. Umbilical cord BLL was not significantly associated with LBW. Maternal poor self-rated health (adjusted prevalence ratio (adjPR) = 1.83; 95 % CI 1.09, 3.07) and none or one prenatal visit (adjPR = 2.18; 95 % CI 1.39, 3.43) were associated with LBW. A statistically significant interaction between mothers’ mid upper-arm circumference (MUAC) and dietary vitamin C intake was noted. Compared with mothers with MUAC above the median and dietary vitamin C intake above the 3rd quartile (>208.7 mg/d), infants of mothers with MUAC less than or equal to the median and dietary vitamin C intake >208.7 mg/d (adjPR = 10.80; 95 % CI 1.46, 79.76), mothers with MUAC above the median and vitamin C intake <or=208.7 mg/d (adjPR = 10.67; 95 % CI 1.50, 76.02) and mothers with MUAC less than or equal to the median and vitamin C intake <or=208.7 mg/d (adjPR = 13.19; 95 % CI 1.85, 93.79) more likely to give birth to an LBW infant.
CONCLUSIONS: In Pakistan, poor nutritional status and inadequate prenatal care were major determinants of LBW in this setting. Environmental factors including umbilical cord BLL were not significantly associated with LBW.
8: Reprod Health. 2009 Jun 16;6:9.
Maternal health in resource-poor urban settings: how does women’s autonomy influence the utilization of obstetric care services?
Fotso JC, Ezeh AC, Essendi H. African Population and Health Research Center (APHRC), Nairobi, Kenya. jcfotso@aphrc.org
BACKGROUND: Despite various international efforts initiated to improve maternal health, more than half a million women worldwide die each year as a result of complications arising from pregnancy and childbirth. This research was guided by the following questions: 1) How does women’s autonomy influence the choice of place of delivery in resource-poor urban settings? 2) Does its effect vary by household wealth? and 3) To what extent does women’s autonomy mediate the relationship between women’s education and use of health facility for delivery?
METHODS: The data used is from a maternal health study carried out in the slums of Nairobi, Kenya. A total of 1,927 women (out of 2,482) who had a pregnancy outcome in 2004-2005 were selected and interviewed. Seventeen variable items on autonomy were used to construct women’s decision-making, freedom of movement, and overall autonomy. Further, all health facilities serving the study population were assessed with regard to the number, training and competency of obstetric staff; services offered; physical infrastructure; and availability, adequacy and functional status of supplies and other essential equipment for safe delivery, among others. A total of 25 facilities were surveyed. RESULTS: While household wealth, education and demographic and health covariates had strong relationships with place of delivery, the effects of women’s overall autonomy, decision-making and freedom of movement were rather weak. Among middle to least poor households, all three measures of women’s autonomy were associated with place of delivery, and in the expected direction; whereas among the poorest women, they were strong and counter-intuitive. Finally, the study showed that autonomy may not be a major mediator of the link between education and use of health services for delivery.
CONCLUSION: The paper argues in favor of broad actions to increase women’s autonomy both as an end and as a means to facilitate improved reproductive health outcomes. It also supports the call for more appropriate data that could further support this line of action. It highlights the need for efforts to improve households’ livelihoods and increase girls’ schooling to alter perceptions of the value of skilled maternal health care.
9: Stud Fam Plann. 2009 Jun;40(2):101-12.
Are female orphans at risk for early marriage, early sexual debut, and teen pregnancy? Evidence from sub-Saharan Africa.
Palermo T, Peterman A. Ipas, 300 Market Street, Suite 200, Chapel Hill, NC 27516, USA. palermot@ipas.org
Female orphans are widely cited as being at risk for early marriage, early childbearing, and risky sexual behavior; however, to date no studies have examined these linkages using population-level data across multiple countries. This study draws from recent Demographic and Health Surveys from ten sub-Saharan African countries to examine the relationship between orphanhood status and measures of early marriage, early sexual debut, and teen pregnancy among adolescent girls aged 15 to 17. Results indicate that, overall, little association is found between orphanhood and early marriage or teen pregnancy, whereas evidence from seven countries supports associations between orphanhood and early sexual debut. Findings are sensitive to the use of multivariate models, type of orphan, and country setting. Orphanhood status alone may not be a sufficient targeting mechanism for addressing these outcomes in many countries; a broader, multidimensional targeting scheme including orphan type, schooling, and poverty measures would be more robust in identifying and aiding young women at risk.
10: Vaccine. 2009 Jul 9;27(32):4284-8.
Scaling up interventions to eliminate neonatal tetanus: factors associated with the coverage of tetanus toxoid and clean deliveries among women in Vientiane, Lao PDR.
Masuno K, Xaysomphoo D, Phengsavanh A, Douangmala S, Kuroiwa C. Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. ring8ring8@hotmail.com
The Lao People’s Democratic Republic (PDR) is one of seven countries that have not eliminated maternal and neonatal tetanus in more than 50% of districts. We conducted a community-based household survey to assess the achievements of strategies towards maternal and neonatal tetanus elimination in the capital province. The coverage of tetanus toxoid (TT) was 79.7% by the protection-at-birth (PAB) method. The percentages of deliveries attended by skilled personnel and of deliveries at a health facility were 68.4% and 63.7%, respectively. The progress towards eliminating neonatal tetanus in Lao PDR is not sufficient despite the study sites being placed in the capital province. The lack of continuum of care for mothers and newborns is the major obstacle to scale up the tetanus toxoid coverage and PAB as well as clean deliveries.
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These are superb topics. I wish to submit mine too